Khokar M M, Gibso B, Winslow M, Owens J. 'Oral cancer is a punishment for my sins': oral histories of oral cancer, fatalism and Islamic religious beliefs in Pakistan. J Relig Health 2022; DOI: 10.1007/s10943-022-01585-7.

Doctors and spiritual healers working together could be of benefit.

There is little research concerning the experience of patients with oral cancer in low to middle income countries such as Pakistan. The social aspects of the disease - gender and socio-economic status - interplay with religious practices. Those with fewer resources, who also experience the highest rates of cancer, place a higher premium on religious beliefs and fatalism. Those with fatalistic beliefs believe that a divine being is in charge of the illness and this has been linked to non-participation in health promotion projects. Taking an oral history approach, this study carried out open ended interviews with a purposive sample of 15 female oral cancer patients with ages ranging from 29 to 80 years, from Rawalpindi/Islamabad.

The fatalism was common to all participants, and this led to the belief that Allah had both given them the disease but also that he had the ability to cure it. Even undergoing successful surgery did not weaken this belief. She chose not to complain because this might anger Allah. Another participant believed that because she had the disease, she was being punished for previous wrongdoings and frequently asked for forgiveness.

Some received comfort for their fears about the disease from their faith - 'when I am scared I tell myself that it is by God's will' but the contrasting advice from spiritual healers (piirs) and from the medical profession caused confusion.

For some, only after several unsuccessful visits to different piirs did they take the opportunity to seek medical advice. No conflict was felt about consulting both. The suggestion to visit the piir first was frequently a part of the support mechanisms from their social networks. The spiritual healing took the form of prayers being blown over the lesion. When both medical treatment and spiritual healing were combined, interviewees felt that both were equally responsible for successful treatment.

Women of comparatively higher social class or who were better educated believed in Allah 'that he is the one to give hardships and he is the one to cure' but dismissed the work of the piirs, having faith that Allah worked through the medical profession to heal them.

The responses to cancer from these women are complex. However, delays in seeking medical advice, due to consulting the healer first, may result in late diagnosis and poorer outcomes. The engagement of medical professionals with piirs to promote oral health may lead to the development of an improved referral pathway for oral cancer.