Caring for Sikh patients wearing a kirpan (traditional small sword): cultural sensitivity and safety issues

Devout Sikh men wear the kirpan (a traditional small sword) as part of their religious faith. The kirpan is one of five symbols of Sikhism (the five Ks described below). Many traditional Sikhs undergo the amrit ceremony, akin to baptism, following which they are meant to wear the five Ks at all times. Several legal controversies have emerged in the West, especially in the USA (Lal, 1999) and Canada (Wayland, 1997), over safety issues related to the kirpan, such as students wearing it to school or passengers wearing it during flights (for an overview of the recent cases, see www.sikhs.ca/kirpan).

Some educational institutions in the UK have been provided guidelines to ensure that Sikh students are allowed to wear the kirpan without compromising health and safety standards (http://www.dfes.gov.uk/schoolsecurity/dwtannexf.shtml). In-patient psychiatric services looking after Sikh patients may face similar dilemmas between respecting the Sikh religious traditions and ensuring safety of the patient and others. This paper briefly outlines the history of Sikhism, summarises the importance of the kirpan in the Sikh tradition and recommends policies that health authorities and mental health trusts can adopt to ensure that when caring for Sikh patients, neither cultural sensitivity nor individual safety are compromised.

Overview of Sikhism

This is a brief outline and interested readers can find more details in Singh (2001), McLeod (1989) or at several websites (www.sikhnet.com; www.allaboutsikhs.com; www.sikhs.org; www.srigurugranthsahib.org; www.sikhnation.com). There are 22 million Sikhs worldwide, 20 million of whom live in India. The religion emerged in the state of Punjab, North India, in the 16th century. The founder of the faith, Guru Nanak, was born in 1469 ad into a Hindu family during a turbulent period of serious conflict between the ruling Mughals (Muslim invaders from Persia) and the majority Hindu population, and also between upper and lower caste Hindus. Nanak preached the essential unity of mankind and argued against the caste system and polytheism. Combining the Hindu concept of karma (righteous deeds) with the Muslim concept of monotheism, Nanak rejected rituals, asceticism, monasticism and formalism in favour of egalitarianism (including complete equality of sexes), social order, communal harmony and charity. His followers became known as Sikhs (from the original Sanskrit shishya, or disciple/pupil, with Nanak as a Guru, or teacher). The basic tenets of Sikhism are that there is only one God (Akaal Purakh), who is timeless and formless and whose essence is power and love. Everything in the universe occurs within the will of God (Hukam). Humanity is the highest creation of God and human beings have been bestowed with free will. Humans should restrain the five passions of kaam (lust), krodh (anger), lobh (greed), moh (undue attachment to possessions or people) and ahankar (false pride), with the eight virtues of gyaan (wisdom), sat (truthful living), niaon (justice for all), santokh (temperance, self-restraint), djhiraj (patience, tolerance), himmat (courage), namrata (humility) and sabar (contentment, freedom from fear). The writings of Nanak and other Gurus are compiled in the Sikh holy book, Guru Granth Sahib, which for Sikhs, embodies the living spirit of the Gurus.

Sikhism spread under the leadership of the ten Gurus at a time of increasing Mughal oppression, especially under the rule of the Mughal emperor Aurangzeb, who levied higher taxes on non-Muslims, destroyed Hindu temples and suppressed popular revolts with large scale massacres. Guru Tegh Bahadur, the ninth Sikh Guru, asked Aurangzeb to stop the persecution of non-Muslims. In November 1675, Guru Tegh Bahadur was publicly beheaded at the orders of Aurangzeb at what is now a famous Sikh temple, Sis Ganj in Delhi. His son, the tenth Guru Gobind Singh, created an army of soldiers known as the Khalsa (from Khalis: pure) in a ceremony on 30 March 1699. Khalsa were an army of ‘saint-soldiers’, created in a ceremony of amrit chhakna (the ritual taking of nectar) and were required to wear five Kakkars (kakkar is the letter k in Punjabi). All Sikh men, who underwent the amrit ceremony, were thereafter to be called Singh (lion) and women as Kaur (Princess), repudiating and replacing the caste-based surnames. The five k’s are kes (unshorn hair, as a sign of a saint), kangha (a small comb to keep the hair tidy), kachhehara (riding breeches, a symbol of continence), kara (literally a link, a steel bangle worn on the right wrist, as a reminder of the bond between a Sikh and the Guru, and for the need for restraint) and the kirpan (Fig. 1). Kirpan (from kirpa: mercy and aan: honour) symbolises power and freedom of spirit, and is a reminder to Sikhs to fight injustice and oppression, but is not to be used as an instrument of violence.

Fig. 1. The Sikh kirpan

Safety issues related to the kirpan

In the now famous ‘Quebec kirpan case’ (www.sikhs.ca/kirpan), the public perception of the kirpan was that it was a potentially dangerous ‘weapon’. Sikhs do not perceive the kirpan as a weapon, and the translation into ‘dagger’ is inappropriate, given the pejorative association between a dagger and violence. However, no English term captures the true cultural meaning of the kirpan.

The kirpan is symbolic rather than functional, and is a reminder to Sikhs of their duty to fight injustice and maintain independence of spirit. It is usually about 8 inches long, is blunt and is worn sheathed and attached to a cloth belt, called the gatra (Fig 1). Such a kirpan is no more dangerous than a dinner knife and its use in an act of violence is practically unknown. However, there may be the rare instance of a patient wearing a potentially unsafe kirpan, such as one with sharp edges or a pointed tip. In even rarer instances, a patient may insist on wearing a much longer kirpan, such as the 3-foot long ones that are worn on ceremonial occasions. In such cases staff may have reasonable concerns about safety but feel unable to discuss the issues, lest cultural sensitivities are compromised. Even if the Sikh patient himself is not deemed at risk, a kirpan may be considered a ‘health hazard’ if another violent patient may somehow gain access to it.

Recommendations

A greater awareness of the cultural and religious meaning and significance of the kirpan, and knowledge of Sikhism in general, is a prerequisite for appropriate management of such issues within mental health. Areas such as Southall or Birmingham, which have large Sikh populations, are likely to have some staff from Sikh backgrounds, or with a greater awareness of Sikh religion and customs. However, while Sikhs have spread throughout the UK, knowledge about Sikhism is unlikely to be widespread, especially in areas with small ethnic minority populations. Mental health trusts should endeavour to produce leaflets on the religious and cultural aspects of different religious groups in both English and the minority language to facilitate understanding, improve cross-cultural communication and importantly, to allow the ethnic minority patients to feel that their belief systems are understood and respected. Specifically in relation to caring for Sikh patients wearing the kirpan, the following strategy might be useful.

1. 1. Mental health trusts should develop leaflets in English and Punjabi, specifically addressing the issues related to the kirpan, emphasising both the staff’s understanding of the importance of the kirpan to Sikhs and also concerns about potential risks. These should be available on all in-patient and day-care units.

2. 2. It is important to remember that not all Sikhs wear the kirpan and the issue will arise in only a small number of Sikh patients.

3. 3. If a patient is wearing the kirpan, the staff should not automatically assume that it is dangerous. However, it may be necessary to examine the kirpan to ensure safety.

4. 4. If there are concerns about safety, these should be discussed openly but sensitively with the patient and carers, explaining that the concerns are about safety and in no way challenging or judgmental of the religious traditions of Sikhs.

5. 5. Patients and carers should be allowed to express their views including ventilation of any distress, since for devout Sikhs, the five Ks are the paramount and highly emotive articles of faith. Brusque, confrontational or insensitive handling of the discussion is only likely to appear insulting, and may polarise and entrench opinions.

6. 6. Solutions should be allowed to emerge from within these discussions, rather than imposed. A simple solution might be to replace a potentially ‘ risky’ kirpan with a smaller, safer one.

7. 7. Mental health services may like to have a few sheathed kirpans, which meet health and safety standards, along with gatras (the cloth ‘ holster’) on the wards. The patient should be allowed to choose one from these instead, and the family should be asked to keep the patient’s kirpan at home during the in-patient stay. The ward kirpan and the personal kirpan can be swapped at discharge. Kirpans of various sizes and shapes can be bought at most Sikh temples and are often on sale in stalls outside the temple following the Sunday service.

Nothing defeats cross-cultural ignorance, anxieties and prejudices better than simple, straightforward and accurate information. Sometimes an excessive and inappropriate concern about cultural sensitivity masks a patronisingly dismissive attitude to the cultural needs of minority groups. Alternatively, genuine cultural sensitivity and concern about transgressing cultural boundaries may lead to important issues being ignored. For staff looking after patients from ethnic minority groups, this can be a delicate balancing act. It is hoped that at least in the area of Sikh patients wearing a kirpan and safety concerns, the above recommendations will help staff to look after patients in a clinically and culturally appropriate manner.