Six months ago, few outside of the professionals required to wear them could probably tell an N95 respirator from a molded surgical mask. Now, with masks serving as the face of the coronavirus crisis, the majority of the public could probably pick an N95 out of a lineup. Or, as hospital shortages have suggested, an Amazon search results page.
To be effective, N95 masks must be secured tightly to the face. A metal strip bridging the nose creates an adjustable seal at the top. Elastic straps fasten masks to the face, sitting above and below the ears on the crown of the head and back of the neck. The bottom edge is fitted snugly against the jaw, covering the mouth completely.
For many hospital staff, lack of access to the personal protective equipment (PPE) designed to safeguard wearers against high-risk health threats like the coronavirus, which is transmitted through respiratory droplets, has created controversy around face masks.
For others, however, the tension surrounding N95s is not a matter of availability. It’s a conflict between professional responsibilities and a deeply personal commitment to faith.
What are Sikhism and the practice of kesh?
Sikhism is a monotheistic religion that originated in the Punjab region of India in the 15th century. Its core tenets center on daily prayer in the form of five nitnem banis, a fundamental belief in equality, the pursuit of an honest livelihood, and a commitment to service, or seva. As of 2019, an estimated 27 million people around the world identify as Sikhs.
Since the 17th century, initiated Sikhs, or Khalsa, have also adopted physical symbols of their faith. Put forth by Guru Gobind Singh as a way to identify and unite Khalsa, these articles are known as the Five Ks: kangha, a wooden comb; kara, an iron bracelet; kachera, tied shalwar underwear; kirpan, an iron dagger; and kesh, or uncut hair.
Kesh is an influential practice even outside of the Khalsa order. Many Sikh men sport unshaved facial hair and keep their long hair wrapped in turbans. Women grow their hair out, as well, covering their heads in scarves known as chunni or dupatta. Though non-initiated Sikhs may remove body hair to varying degrees, traditionalists abstain to honor the bodies God created.
When a religious commitment challenges the Hippocratic Oath
Hair can be integral to identity and, as such, controversial. Religion, race, and personal expression have all spawned conversations about the cultural significance of hair and even shaped laws regarding civil rights. Now, in the throes of the coronavirus pandemic, the Sikh principle of kesh has highlighted yet another hairy subject, in both senses of the word.
Doctors wearing PPE while treating COVID-19 patients are required to pass “fit tests” to ensure that their face masks are tightly secured. Facial hair inhibits the proper use of masks and respirators by creating gaps where they’re meant to be sealed. Long beards are understandably problematic, but even stubble can interfere with the efficacy of facial PPE.
This issue came to light recently when five Sikh doctors in the UK’s National Health Service (NHS) began protesting after failure to pass a fit test resulted in their medical duties being shifted, according to the Sikh Doctors Association. Following complaints that NHS higher-ups requested they remove their facial hair, a direct violation of kesh, the doctors involved were reportedly given powered air purifying respirators, or PAPRs, instead.
PAPRs shield the entire face, similar to a welding helmet, allowing healthcare workers whose religions preclude them from removing body hair to fulfill their duties safely. This could benefit Muslim, Orthodox Jewish, and other medical professionals outside the Sikh faith, as well. PAPRs are also more expensive, however, and their supply is even more limited than that of N95 masks, meaning they may not be a sustainable PPE alternative.
To shave or not to shave
Faced with a similar predicament, two Canadian doctors recently made the difficult decision to shave their facial hair, for the first time, in order to carry out their professional duties.
After consulting friends, family, and religious leaders, Dr. Sanjeet Singh Saluja, an associate director of the department of emergency medicine at the McGill University Health Centre (MUHC), and his brother Ranjeet, an MUHC neurosurgeon, deemed the global health crisis an “exception to the rule” and one of few situations that could convince them to defy kesh.
The dilemma was something of a catch-22: While removing their facial hair would violate one pillar of Sikhism, opting to not serve their community in a time of peril would contradict not only the oath they took as doctors but also their commitments to another Sikh pillar: seva.
An ultimate act of service for a Sikh
Though both brothers ultimately came down on the side of service, the act was not without personal consequence. “It is an essential part of my identity,” Dr. Sanjeet Singh Saluja told the McGill Reporter of his facial hair, noting that shaving it was “the saddest thing I’ve ever done. More than a month later, I still have trouble looking at myself in the mirror.”
Of everyone impacted by COVID-19, which by now is just about everyone on Earth, healthcare workers have shouldered some of the greatest trials, tragedies, and tribulations. And some, like the Saluja brothers, have had to deal with issues many of us may not have considered.
Amid recent protests to reopen cities and states at the cost of others, both those at high risk of contracting the coronavirus and those on the front lines fighting it, stories like these are a reminder that we all have a part to play in overcoming the pandemic. As much as clapping for doctors and nurses from the admittedly stir-crazy comfort of our balconies acknowledges the sacrifices they make for all of our health and safety, taking action to flatten the curve speaks far louder than any words of encouragement on social media ever could.
So stay home, social distance, and do whatever else you can to help get the coronavirus crisis under control. Because no hospital worker should feel the need to sacrifice one oath for another.