Archive for May, 2009

A Call for Cultural Competency in Jerusalem’s Medical Services – an Article

May 28th, 2009

We just published an article at the Jerusalem Post and Search for Common Ground (SFCG) News service on our cultural competency program in Jerusalem. Here are the links and the text:

SFCG: English, Arabic, Hebrew.

The Jerusalem Post (English).

PDF (English).

Text:

A call for cultural competency in Jerusalem’s medical services

May. 20, 2009
HAGAI AGMON-SNIR , THE JERUSALEM POST

A few years ago, my mother underwent hip replacement surgery. Before she was discharged, the surgeon gave her quite a few instructions for the period following surgery. There were some necessary accessories and equipment: a wheelchair, special pillows and devices to help lift objects. These were available for almost nothing from Yad Sarah, an organization founded by haredim that lends medical equipment to those who need it.

“If you don’t follow the directions I gave you and you don’t use the equipment,” said the surgeon, “your leg won’t function the way it’s supposed to and the effects of the excellent and expensive surgery will be wasted.” Today my mother traverses the country with her new hip and any memory of the fracture has been erased.

Lying next to my Jewish mother in the hospital were Palestinian mothers from east Jerusalem who had also fractured their hips and received hip replacement surgeries. Most of them, like my mother, were covered by national health insurance, which made them luckier than their sisters from the West Bank and Gaza who are not entitled to these benefits. The women from east Jerusalem were given the same instructions my mother received and were also sent to Yad Sarah, which has branches serving east Jerusalem for the Palestinian population.

Yet there is good reason to suspect that, unlike my mother, many of them are limping today. Research carried out in hospitals in Jerusalem shows that about half of the Arabic-speaking patients do not understand the instructions they are given for post-treatment care because they are given in Hebrew.

One third of Jerusalem’s residents are Arabic-speaking Palestinians, both Muslim and Christian. In times of need, these residents will almost always choose to go to hospitals in west Jerusalem. At some of these medical institutions, more than half of the patients are Palestinian, yet none of them are provided translation services into Arabic or any other language. Occasionally, medical staff improvise and ask an Arab hospital worker or a visitor who speaks both Hebrew and Arabic to translate, making them privy to the patient’s personal medical details. It’s not unheard of for the patient’s child to act as a translator, telling his or her mother that the doctor recommends an abortion or that a suspicious lump was found in her breast.

In addition to the lack of language services, none of these establishments provide religious services to Muslims or Christians. Nurses complain about Muslim men washing their feet in sinks designated for hand washing. The simple solution – low sinks for feet-washing before prayers – cannot be found at any of these places. On the other hand, Jews may receive visits from a rabbi, have meals provided by various religious organizations according to their specific kashrut needs, or pray in an in-hospital synagogue.

RECENTLY, THE Jerusalem Intercultural Center hosted senior directors from the Coney Island Hospital in New York City, introduced to us through our collaborative work with Rabbi Bob Kaplan of CAUSE-NY, an organization committed to the availability of health services in New York. In compliance with the law, signs at the hospital appear in five languages, and anyone entering the hospital is entitled to receive hospital services in his or her own language. Sometimes a translator is present in the room and other times (with more obscure languages) translation is provided through a phone service, called tele-interpretation.

The hospital has a synagogue, a Christian church, a mosque and a Hindu temple – in accordance with the needs of the communities that it serves. Kosher food is provided for Jews and halal food for Muslims. In the case of Indians and Pakistanis, the food is prepared and spiced in a way that is suitable for their palate.

Is this hospital anomalous? Not at all. In the past 15 years the “cultural competency” approach has become widely practiced in health systems in North America, Australia and Europe. It has simply skipped over Israel, despite much evidence showing that medical services adjusted to culture, religion and language improve the quality of care and the outcome of treatment. And, of course, such an approach is far more just and ethical.

Shocked by this state of affairs, the Jerusalem Intercultural Center and the Jerusalem Foundation have launched an initiative to encourage cultural competency. The need, by the way, exists not only for the Palestinian population in the city, but also for the Yiddish-speaking haredi community (which comprises about one quarter of the city’s residents), as well as people from a variety of other backgrounds who speak languages like Amharic, Russian, French and Spanish. We are only at the beginning of the road, but already there are medical institutions, such as Alyn hospital (for pediatric rehabilitation) and Clalit Health Services, that are now building up cultural competency in their facilities.

We hope that by introducing cultural competency into the medical services in Jerusalem we will help reduce the current inequality that exists in this field. Moreover, we believe that this is a way to teach the people of this city the value of accepting the other, being considerate of those who are different from us and to encourage people to think in terms of human rights even in a city as fraught with tensions as Jerusalem.

The writer is the director of the Jerusalem Intercultural Center and can be reached at hagai@jicc.org.il. The project Cultural Competency in Jerusalem is sponsored by the Jerusalem Foundation. This article was written for the Common Ground News Service in collaboration with The Jerusalem Post.

A strategic group on Ultra-Orthodox – non-Ultra-Orthodox relations in Jerusalem – May 24, 2009

May 24th, 2009

Today we convened once again for the meeting of Jewish Jerusalemite leaders that discuss and negotiate a strategic approach to relations between Ultra-Orthodox and non-Ultra-Orthodox Jews in Jerusalem. The meeting took place at the office of the Municipality Engineer, with 15 participants – municipality council members, high-level Rabbis, and non-Ultra-Orthodox leaders and professionals.

The meeting focused mainly on housing issues in Jerusalem, and the feeling was that the group had an important breakthrough. In previous meetings we understood that demographic changes in different neighborhoods create most of the tensions. The main way out is to find proper solutions for expansion for both Ultra-Orthodox and non-Ultra-Orthodox populations, while minimizing co-living in the same neighborhoods. The religious autonomy required in Ultra-Orthodox neighborhoods, and the extremely different perspectives that the two groups hold on the character of the public sphere, require separation between the communities as much as possible. The main solution for the short term is the creation of 15,000 new apartments for each of the two populations, in different parts of the city. Obstacles for moving forward with this solution exist and important questions and issues were raised.

Yet, additional housing is only part of the solution. While the Ultra-Orthodox neighborhoods are very appealing to the Ultra-Orthodox Jews, many non-Ultra-Orthodox residents do not find their neighborhoods attractive, leading them to decide to leave the city. Frequently they sell their apartments to Ultra-Orthodox Jews and then again mixed neighborhoods – with their many tensions – are created. An integral part of the solution must be the effort to make these neighborhoods more attractive in terms of culture, improved services etc. The Ultra-Orthodox members of the group said, to the surprise of some other members, that they are willing to support such processes, in order to keep the non-Ultra-Orthodox residents in the city.

At the conclusion of the meeting the participants felt that we made an important step forward and they are now looking forward to our next steps.

Cultural Competence Training – Alyn – May 18, 2009

May 18th, 2009

Today we held the third Cultural Competence training to a group of staff members in the Alyn hospital in Jerusalem. This training is part of our efforts, together with the Alyn Hospital’s management, to transform Alyn into a cultural competent hospital, the first of its kind in Israel. The work with Alyn is a component of the Jerusalem Cultural Competence in Health Project initiated by the Jerusalem Inter-Cultural Center and the Jerusalem Foundation.

Alyn training May 2009

Alyn training May 2009

Towards each training in Alyn we interview several intended participants and based on their input we adapt the case studies that will be used in the training to the needs of the specific clinic. Today for example we added an extra focus on Ultra Orthodox patients and invited experts in the field to share their knowledge. We also improved two of the learning modules by using more dialogues for analysis and real-life stories. Thus the modules became more interesting and interactive.

Alyn training may 2009

Alyn training may 2009

Diversity SWAT Team Webinar 1 – London!

May 13th, 2009

Our new series of webinars is dedicated to what we call “Diversity SWAT Teams”. We brought together Rabbi Bob Kaplan from the JCRC-NY, Alex Goldberg from the London Jewish Forum and Hagai Agmon-Snir from the Jerusalem Inter-Cultural Center, to detail the ways by which they effectively manage cross-cultural community conflicts in their respective locations. These three organizations perceive such interventions to be part of their role.

Alex Goldberg at the Diversity SWAT Team Webinar

Alex Goldberg at the Diversity SWAT Team Webinar

Today we had the first webinar in the series. Alex Goldberg presented the approach the London Jewish Forum is implementing in London and other British cities. Mainly he focused on how they engage the government, police, businesses, civil society and NGOs in their processes. Following the presentation, the two other panelists, Rabbi Bob Kaplan and Dr. Hagai Agmon-Snir, added their perspectives on the issues and raised questions that may help in this inter-city learning.

For us at the JICC, this series is very important. Increasingly we find ourselves involved in creating and training Diversity SWAT Teams in mixed cities in Israel, together with local municipal agencies.

You can find the presentation and additional information (also about the next webinars in this series) online at the NYJEE site.

Ethiopian Community, Talpiot, May 13, 2009

May 13th, 2009

A month ago, we updated on our efforts, together with Mosaica, to train establishment agencies, such as the Community Council, the Welfare Department, the Absorption Authority etc., to work with the Ethiopian community in the Talpiot neighborhood. Since then, we met again with representatives from the community, from organizations that advocate for them and from establishment agencies.

Some of the Training Participants

Some of the Training Participants

Today we held the first cultural competency training for representatives of agencies that work with the Ethiopian community, focusing on cross-cultural communication. We learnt about the communication style of Israelis and compared it with the communciation style of Israeli-Ethiopians. In fact, Israeli-Ethiopians tend, as all multi-identity individuals (or, in other words, every individual…), to use both systems of communication, even though they seem to contrast with each other.

Dr. Hagai Agmon-Snir at the training

Dr. Hagai Agmon-Snir at the training

We invented a case study specifically for this training about an Ethiopian community leader who gets in conflict with the establishment over community issues. It was striking, but not surprising, to see how much the participants identified with the case study, feeling that the story resembles many of the incidents they encounter daily. We began analyzing the case and many issues were raised. On our next meeting we will have to think about solutions – how does one crete a bridge between these two cultures.