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Tailor-made: care for elderly Muslims

A haven in foreign lands

Sultan Baylar offers her guests lokum, a sticky Turkish sweet, also known as Turkish Delight, then eau de cologne for their hands. For this is how it is done where she comes from. Nevertheless the former housewife cannot offer her guests the traditional gifts herself. The 67-year old can barely stand anymore and, on account of her weak heart, sits for the majority of the time on the sofa. Every day, one of her carers comes and carries out her hostess duties for her. Today it is 43-year old Zeynep Yalcin. She wears a colourful dress, a red headscarf and affectionately calls Baylar "Sultan anne", meaning Mother Sultan. Mother Sultan says she would actually prefer to live in Turkey, and sighs. "I didn’t plan on getting old here." But unfortunately with her sick, bedridden husband and her own complaints, she cannot return home. The couple has health insurance only valid in Germany. "No doubt we will stay in Berlin."

Culturally sensitive care

Two elderly men playing memory with nursein day care

The Baylars' experience is common to hundreds of thousands of former so-called "guest workers" in Germany. They have stayed "abroad" following their retirement, although this was not originally their plan. Some want to stay near their children who have had their own families here. Others value the German health system in their old age. Forecasters predict that by 2030 a quarter of all elderly people living in Germany will be immigrants.

Time and time again some of them will, however, learn that German hospitals and care facilities are not equipped for the special needs of devout or even less devout Muslims. Often, they terminate their treatment prematurely because there are no staff who speak their language or because their dietary regulations, such as not eating pork, are not taken into consideration. At the same time, "culturally sensitive" care of the elderly and the sick has been identified as a gap in the market. For some years now the number of institutions with employees of Turkish or Arab extraction has been growing.

It is not sufficient to speak Turkish or Arabic

"Praise God, I am very satisfied with my carers," says Sultan Baylar. How did she find them? Her Turkish doctor gave her a brochure after her diagnosis seven years ago. "Deta-Med Home Care" was written on the front. After making the initial telephone call, this illiterate lady did not have to worry about anything else. All the paperwork with the health authorities was dealt with by a social worker from the Turkish care service.

"It is not enough just to be able to speak Turkish or Arabic," says Nare Yesilyurt, Director of Deta-Med. "There are particular Muslim cultural customs that you need to know about." This 41-year-old founded the Berlin company 10 years ago and now employs over 200 staff. They are trained in "culturally specific care for the elderly" by the director herself. The carers learn which suras they should recite from the Koran in the case of outpatient terminal care, or to pronounce the shahada, the profession of faith. They also learn that Muslims wish to be washed only with running water before praying, as this is how it is prescribed in Islam.  The training course also includes learning about hair removal from various parts of the body that is customary in the Middle East.

Güllü Albayrak Kuzu, the Director of Kamil Day Care, knows these rules. Every day she receives around 15 patients in her brightly decorated premises in Berlin. Most of them are Turks and Arabs suffering from dementia. From 8 a.m. to 4 p.m. they are cared for and washed. They can make things, drink Turkish tea or relax with a massage in a leather chair. "The chairs are a real winner," says Albayrak Kuzu, who has put a couple of these in the prayer and quiet room.

Service for illiterate clients is standard

As far as the headscarf-wearing care director is concerned, language is the key to culturally sensitive care for the elderly. "Many problems cannot be detected by x-rays," she says. If the medical staff can speak the patient's native language, trust is built up more quickly. And so the clinical picture and causes can often be more precisely diagnosed.

Albayrak Kuzu previously worked for many years in German care institutions. She knows the differences in culturally sensitive work: often pensioners from less educated immigrant families have to have the meaning of care for the elderly or day care explained to them. Many do not know that former guest workers do not have to pay for costs of care provision themselves. Also, a large number of older Muslims in Germany cannot read or write. Dealing with documents and co-ordinating appointments is therefore usually part of the standard programme in the culturally sensitive care industry. Albayrak Kuzu and her six colleagues also deal with letters, applications, doctor's appointments and new medication prescriptions for their patients.

Considerable misgivings still exist in relation to care homes

In addition, it is by no means customary in Turkish and Arab families to pass on to strangers the responsibility for parents in need of care. Many are very reluctant to do so and feel bad as a result. The Berlin "Türk Bakim Evi", the first Turkish old people's home in Germany, recognises the problem. Since opening at the end of 2006, despite offering Friday prayers, dishes without pork and Turkish satellite television, only a proportion of its 155 beds are occupied. Even the director of the Kamil Daycare facility often has to speak to relatives several times "before they entrust their parents to us on a trial basis."

However, the majority of places here are now taken. Around nine o'clock in the morning grey-haired gentlemen and elderly ladies wearing headscarves shuffle through the hall. The driver has just dropped them off and waves goodbye to them. "Hello" the women sing cheerily to the director. They make their way unhurriedly to the dining room where breakfast is already waiting for them. A few of them are already looking forward to the electronic massage afterwards.

Ferda Ataman, 01.09.2009

Ferda Ataman is a journalist for the Tagesspiegel and a former participant of the German Islam Conference.

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