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Professional Development for Healthcare Cultural Competency Coordinators from around the country – Summary of Day One

We’ve taken yet another step in becoming one of the national leaders and reference points of Cultural Competency in the health care system in Israel. On Monday, 23 April we held the first meeting of a professional development seminar cultural competency coordinators from around the country. This is the first such seminar ever to take place in Israel! Our 16 participants included representatives from the major hospitals in the country: Hadassah Medical Center and Sha’are Zedek in Jerusalem; Shiba-Tel Hashomer and Sourasky Medical Center in the Tel Aviv area, Rambam in Haifa, and more.

We have been working to advance cultural competency in the health care system in Israel since 2007, and we are in constant contact with most of the cultural competency coordinators around the country. Most of these coordinators have been appointed since the publication of the Ministry of Health’s Cultural Competency Directive, published in February 2011, that will require medical interpretation services, education and training of medical staffs, environmental adaptations of all health care institutions by 2013. As a first step, the Directive requires health care organizations to appoint a cultural competency coordinator to be responsible for all the processes that work toward equal cultural and linguistic accessibility for all.

Our unique seminar is taking place in cooperation with the Ministry of Health and is a natural continuation of the Directive. The training will provide knowledge and tools to enable cultural competency coordinators to assimilate the Directive in their institutions. It is important to note that most cultural competency coordinators are already in senior management positions in their organizations.

The 5-day training seminar, which will meet weekly until the end of May, will include 50 hours of frontal lectures as well as a webinar with cultural competency coordinators from Canada and the USA. Our funders for this course are the Jerusalem Foundation and the New Israel Fund. The course is being held at the Nursing School at the Tel Aviv Sourasky Medical Center.

The training course will cover:

Introduction to Cultural Competency: Medical interpreting and translation and mediation in health services, models of intercultural communication between patient and caregiver, cultural dimensions in interpersonal communication, dealing with political and social tensions, different cultures’ approaches to health and sickness, and more.
Practical guidance for cultural competency processes in health care organizations – from the cultural competency coordinator’s first steps to full organizational adaptation.

It will also include guest lectures on the following subjects:

• Inequality in the health care system and the role of the cultural competency coordinator in reducing gaps.
• Acquaintance with the main theories of cultural competency in Israel and around the world.
• Tools for implementing principles of cultural competency in a health care organization.
• Tours of hospitals and clinics that are undergoing cultural competency processes.
• Clinical aspects of different cultural approaches to sickness and health.
• Culturally-dictated social norms.
• Cultural competency from the viewpoint of health organization administration.
• Cultural competency from the viewpoint of social organizations dealing with community health.

The opening lecture was given by Dr. Emma Averbuch from the Unit of Decreasing Health Inequality at the Division of Health Economics and Insurance Division of the Israeli Ministry of Health. Dr. Averbuch emphasized the importance of the cultural competency coordinator and how he or she can contribute to decreasing inequality in health care. She also surveyed the Ministry’s activities thus far in advancing cultural competency and decreasing inequality in the system.

Prof. Leon Epstein speaks on Inequality in Health at the Cultural Competence Coordinators training

Prof. Leon Epstein speaks on Inequality in Health at the Cultural Competence Coordinators training

The participants also had the first session covering the “Guide for Cultural Competency Processes in Health Care Organizations”, which is a practical guide we developed over the past 2 years. It details the steps that must be taken to assimilate cultural competency principles in an organization. This meeting concentrated on defining the role of the cultural competency coordinator, as well as first steps in creating a suitable buzz within an organization for cultural competency. In addition, the participants related their experiences with the community, and the discussion that followed focused on the need to establish and expand these relationships to be helpful in times of crisis.

Part of the training included a practical exercise in creating change. Each participant was asked to choose a small initiative that is related to at least one component of cultural competency that he or she wanted to change by the end of the training course at the end of May. This initiative needed to be something easily implementable and with high visibility in the organization. Participants chose projects such as mapping needs and resources, linguistic accessibility of restrooms, and more.

Simulation of a case of cultural competence at the training

Simulation of a case of cultural competence at the training

Two guest lectures dealt with the relationship between risk management and cultural competency, from Ronen Regev-Kabir, Deputy Director, Public Trust organization, and Netalie Goldfarb, the Care Competency Unit of the Ministry of Health. Our own Dr. Hagai Agmon-Snir closed the day with a workshop on cultural dimensions and the main values of interpersonal communication, to give a taste of the cultural competency workshop that will be the focus of the second workshop on 30 April.

In parallel to this meeting, an Internet discussion group was established that will deal with cultural competency in the health care system in Israel. There will be participants from within and without the health care system and it will enable participants to share knowledge in this area. You can view the discussion group and the course’s accompanying materials here.

Assisting Paramedical Professionals in Receiving Certification from the Israeli Ministry of Health

Here’s an example of how our work in one area uncovers more and more needs in East Jerusalem, and opens up more opportunities to begin to close the gap in services to Palestinian residents of East Jerusalem.

We spent a long time working toward the opening of a Well-Baby Clinic in Silwan in August 2011. While working on the issue of opening more clinics, we discovered that there was a severe lack of Arabic-speaking nurses who were certified by the Israeli Ministry of Health. It meant that these Well-Baby Clinics in East Jerusalem and other healthcare institutions find it hard to find good certified nurses. The employment authority of the Municipality looked into the matter, and discovered that the problem was much larger – in general there is a dearth of Arabic-speaking medical and paramedical personnel, certified by the Israeli Ministry of Health, in East Jerusalem.

We also discovered that there are hundreds of graduates of Palestinian universities and colleges in the West Bank (for example, Bethlehem University, the American University of Jenin), who cannot work in their fields in the Israeli healthcare system. These institutions are considered ‘overseas’ institutions, and graduates must pass Israeli Ministry of Health certification and competency exams. (Israeli graduates must pass these examinations as well.) Very few Palestinian graduates from East Jerusalem pass these examinations. Paradoxically, the Israeli Ministry of Health is eager for these graduates to find work in the Israeli healthcare system in East Jerusalem, to reduce the above-mentioned lack of Arabic-speaking medical and paramedical professionals.

A preparatory meeting of nursing school graduates in East Jerusalem

A preparatory meeting for nursing school graduates in East Jerusalem

The Jerusalem Foundation, our long-time partner in creating cultural competence in the city and in creating better opportunities to all in the city, asked us to enter into the picture. Much of the initial work was investigative: we first sought to figure out the real obstacles that prevented Palestinian graduates from passing the examinations, and then proposed responses. At the outset we chose to concentrate first on occupational therapy and nursing. As part of this extended learning process, in November 2011 we held public meetings for each of the professions, which included relevant information about the certification process. Most of the participants had previously failed the exams, and they became integral partners in our learning process of constructing a full picture of the current situation.

The results were fascinating – and yet, typical – of many of the difficult problems that we have encountered, whose sometimes solutions were relatively simple. Indeed, we find many times that what looks as huge barriers can be overcome by simple solutions. Let us share these results and the response we suggested with you:

In occupational therapy, it turns out that until very recently, the exam was available only in Hebrew and in Arabic. Yet, the problem was that the Arabic translation was very poor, which hurt candidates’ chances of passing. More importantly, at Bethlehem University and at the American University in Jenin, the students learn in English! Thus, they would be much more comfortable taking the exam in English. Fortunately (unrelated to our work), in the past year students have been able to take the certification exam in English as well.

But this was only the beginning of the story. We discovered that part of the required material for the exam included position papers in occupational therapy that exist only in Hebrew; knowledge of Israeli laws, which is also available only in Hebrew; and the guidelines for occupational therapy in Israel, which exists in Hebrew, Arabic and English, but that the students knew nothing about! In other words, the Palestinian graduates were sitting for exams, for which they did not have access to or did not even know about significant parts of the material. Many graduates received scores between 50 – 60 (passing is 60), and this is without knowing about a good deal of the required materials.

This information enabled us to respond quickly. We translated the position papers into English (the language preferred by the graduates for the exam); we obtained guidelines for occupational therapy in Israel in English; with assistance from the Hebrew University Hadassah School of Occupational Therapy, we developed a program to prepare graduates for the exam that will take place in June 2012. This program began a week ago with 17 dedicated participants. The course will include 11, 3-hour meetings as well as 2 concentrated days as the exam nears.

Our follow-up is both group and individual – we purchased occupational therapy textbooks that are important for the exam, and participants will be able to use these materials. We helped each and every one of the participants register for the exam with the Israeli Ministry of Health, and more. We are very optimistic, but we will of course be calmer after the results of the June 2012 exams are released…

The situation in the field of nursing was more complicated. Here, too, graduates from East Jerusalem could take the exam in only Hebrew or Arabic, with very poor achievements (1-2 graduates passed the exams each year). The exams themselves are considered difficult – many graduates of Israeli universities also fail the exams each year. After a meeting with the Ministry of Health, it was clarified that from now on it wouldn’t be a problem for East Jerusalem residents to take the exam in English. Thus far we’ve given some 50 nursing school graduates a pre-test, similar to the real examination, to find out what we need to concentrate on in the course. We identified that 20 received between 50 – 60 on the pre-test (60 is the passing grade). This result encouraged us, since the graduates didn’t have much time to study, and if such a large group is so close to passing, the chances of at least 15 passing the certification exams in September after a program of intensive preparation and study, are good. In addition, we learned from the exams on what areas we need to focus more in the preparations.

Based on this information, a preparatory program for Palestinian nursing school graduates is being developed to prepare them for the government exams in September 2012. It is important to note that those who pass the nursing examination in a language other than Hebrew must also pass an additional exam in Hebrew language in order to receive a license to be a nurse in Israel. Yet, the Ministry of Health allows East Jerusalem residents who passed the exam not in Hebrew to work in Palestinian institutions in East Jerusalem. This means that those who pass the exam would only be able to work there. Although there is also a severe lack of personnel in East Jerusalem, we hope to provide participants in this course with Hebrew instruction, so that they will be fully qualified to work in nursing, anywhere in the healthcare system in Jerusalem.

We will be following these women and men through the examination and (hopefully) placement process. We hope that at the end of this process we will not only helped dozens more people receive employment in their chosen professions, we will help more of the 280,000 Palestinian residents of East Jerusalem receive better health care.

The JICC in Sefad at the Ziv Medical Center

Even though the JICC is focusing on the Jerusalem area, we find more and more cases in which the expertise we gained in the city is important in capacity building in other places. One example was today, when some 20 members of the senior administration staff of the Ziv Medical Center in Sefad gathered for a unique workshop on cultural competency, facilitated by the Jerusalem Intercultural Center (JICC). The workshop was organized by Dr. Sarah Nissim, Deputy Director of the Nursing School and Cultural Competency coordinator for the hospital. Dr. Nissim had asked the JICC to present cultural competency to the senior managers, before they began to assimilate the principles in the hospital. Sarah, who is a veteran colleague of the JICC in cultural competency, sought to engage the JICC to facilitate the assimilation of cultural competency principles in the hospital, as per the Ministry of Health directive, in the 2012 work year.

Dr. Shapiro Klein, Deputy Director of the hospital and Dr. Sarah Nissim (Cultural Competency coordinator) began the workshop with opening remarks.

The JICC in Sefad at the Ziv Medical Center

At the beginning of the day the participants shared their experiences of intercultural encounters in the different departments. Thus, for example, one person detailed the difficulties dealing with a Druze girl with an eating disorder. Another doctor spoke about the difficulty working with the Haredi community and its rabbis, despite the dialogue that takes place from time to time between local rabbis and medical staff. We saw the huge difference between the Jerusalem hospitals that deal with diverse communities within the Jerusalem region, as opposed to Ziv, which deals with diverse communities over a vast area (mostly the upper and eastern Galilee and the Golan Heights), which requires a different type of communication with the different community heads.

As such, the first ‘theoretical’ part of the workshop dealt with tools and ways to bridge the gaps between cultures. These tools followed a clarification of the concept of ‘cultural dimensions’, and an analysis of dialogues between patient and caregiver in which different cultural values are presented.

The second part provided practical tools for professional medical interpretation, as well as practical suggestions on how to relate to non-professional interpreters, through movies and analysis of case studies, from Israel and around the world. Immediately after lunch the participants practiced their knowledge of intercultural issues – a specially-trained actress played a Haredi and Palestinian patient in two separate scenarios.

Role play

This workshop was used as a kickoff to the process of assimilating cultural competency principles into the hospital, which will be led by Dr. Sarah Nissim. Part of the plans discussed with her include a workshop for bilingual staff members to overcome the communication problems with the Ethiopian community and training of facilitators from among the hospital staff to establish a set mechanism of training medical staff at the Ziv Medical Center in Sefad.

Cultural Competence and Mental Health – Beginning to work with the Jerusalem Center for Mental Health

We are on the verge of yet another transformative process in the field of cultural competency. On March 14 – 15, the JICC was invited to present its introductory cultural competency workshops to 70 senior managers from the Jerusalem Mental Health Center, at its annual management conference at the Dead Sea. This Mental Health Center includes hundreds of staff who are responsible for 300 hospital beds (active and extended stay departments) over 2 campuses (Kfar Shaul and Eitanim), Mental Health Centers in west and south Jerusalem, in Ma’ale Adumim, Mevasseret Zion and in Beit Shemesh. The Center also serves the Arabic-speaking population from East Jerusalem. The focus on cultural competency at the annual conference is a kickoff to the process of making the Jerusalem Center for Mental Health culturally competent. The Jerusalem Center was the first mental health center in Israel to commit, through the JICC help, to assimilate principles of cultural competency throughout its system of care.

Mental health services are a special challenge for cultural competency, since most care is based on verbal communication. At the same time, it is important to note that public mental health services are required comply with the Ministry of Health directive (February 2011) on cultural competency, as other health care organizations. In this conference the issue was introduced to the senior management, including department directors, as well as those in key roles, before cultural competence is being assimilated in all departments. The spotlight given at the conference is the result of many meetings between the JICC and the Jerusalem Center administration, as well as with the Jerusalem Foundation, to explain its importance in psychological care.

Practicing Dialogue

Throughout the first day the participants told stories about intercultural challenges and events they had encountered. In addition, Dr. Hagai Agmon-Snir, JICC Director, presented a workshop on intercultural communication and cultural dimensions and how awareness of this subject influences mental healthcare.

During the second day the participants were exposed to the importance of professional interpreting in therapy sessions, and shared examples, from Israel and around the world, of therapy being compromised because of language barriers. Senior staff understood the need and seemed willing to change the existing situation (which today uses non-professional and unskilled interpreters) to make the services more accessible. The day included a fascinating discussion about the boundaries of multiculturalism (“How much should I give up my professional and personal values in order to adapt the therapy session to the patient that comes from a culture that is entirely different than mine?”).

Workshop of the Jerusalem Center for Mental Health March 15, 2012

It was obvious that the 2 days of the conference were a first taste, and that this will be a long process that will require close cooperation between the JICC and the Jerusalem Center for Mental Health. The process will include training the medical and administrative staff in CC skills, and training bilingual staff in a medical interpretation, as has been done in other Jerusalem hospitals (Bikur Holim, Alyn, Hadassah) and HMOs. We believe that the products of this lengthy process can be a prototype for similar accessibility processes in other mental health centers around Israel.

8th Annual Speaking Art 2011

Each year, our Speaking Art Conference for Jewish and Arab professionals in the performing arts gets better and better. This year, the 8th annual conference opened on November 16, which was also International Tolerance Day, and was held for two days at the Jerusalem International YMCA, the Beit Masia Theater and the Vertigo Studios at the Blaustein Civic Center. About 70 Jewish and Arab artists came together from all over Israel. This year, for the first time, 70% of the participants came from the Jerusalem area, the highest it’s ever been.

We’d like to thank the Dear Foundation and the Jerusalem Foundation for their ongoing support of the conference. The conference started with a workshop led by social activist Elad Vazana and renowned American choreographer Donald Byrd, followed by a guest workshop with famous singer Achinoam Nini (aka Noa) and guitarist Gili Dor. As part of the workshop, the participants engaged in a discussion with Nini and Dor about using music as a tool for dialogue between the Arabs and Jews.

After the opening, the conference participants engaged in either music, theater or dance workshops led by professional artists in their respective fields. In the workshops, the participants not only had the opportunity to take part in professional enrichment, but were also able to unite with their Jewish and Arab colleagues to learn from them and to create dialogue through art and creativity.

The Jerusalem YMCA hosted the music workshop led by composer, musician and singer Sameer Makhoul. The group played a variety of songs together and explored other cultures through the songs.

The theater workshop was held at Beit Masia in conjunction with Jerusalem’s Psik Theater. Led by Hisham Suleiman, a director, actor, playwright and founder of the Nazareth Fringe Theater, and Shmuel Hadjes, actor and founder of Psik, the participants developed short pieces based on personal stories of conflict, discussing everyday encounters between Jews and Arabs.

The movement and dance workshop was hosted by the Vertigo dance group at the Gerard Behar Blaustein Civic Center, and was led by Ilanit Tadmor, a professional dancer and teacher of improvisation and composition. Donald Byrd, Tony Award nominee and Bessie Award winner, participated in the conference as part of his research project at the Foundation for Jewish Culture, in which he is studying the role of the performing arts in the Palestinian-Israeli conflict.

As part of the Conference, two concerts were open to the public. The first took place at Beit Masia and featured the Jewish performers Achinoam Nini and Gili Dor together with Arab dancer Mona Mashi’l. The conference closed with a performance by well-known Arab singer Amal Murkus to an audience of 500 a new record for closing concert attendance.

Here is a link to a short film taken at the rehearsal for the concert.

We are especially proud of the ongoing activities that have sprouted as a result of Speaking Art. The first is the Jewish – Arab theater group that meets at the Jerusalem International YMCA, Freeze, which was started by Speaking Art ‘graduates’ in 2009. Also of special mention is a core of some 6 musicians who continued to meet in both Tel Aviv and Jerusalem after the 2010 conference. Instances of additional cooperative work that have resulted from this past Speaking Art conference include:

  1. Achinoam Nini and Mona Mashi’l are exploring possibilities of working together further.
  2. The director of the Jewish – Arab Center in Jaffa is seeking to work with the music group that formed at Speaking Art.
  3. The Jewish-Arab music ensemble, Na’am, is seeking to add musicians from the music group to its ranks.
  4. The Jewish and Arab facilitators of the theater group, Shmulik Hadjes and Hisham Suleiman, have met to discuss further work together as well.

Some of our participants’ feedbacks:

“It was the best Speaking Art conference yet”

“Thank you for creating this conference, which provides an excellent platform for acquaintance and mutual activity! May we continue having dialogue and making art in the coming years!!!”

“Many thanks to you at the Jerusalem Intercultural Center and your partners: Dear Foundation, the Jerusalem Foundation and the Jerusalem International YMCA for holding this conference. For Jews and Arabs who wish to listen and cooperate it was a blissful event”.

“This time the event was so much emotional for me that I found myself crying while watching some of the acts. The workshop with Samir was fantastic and the live performances were phenomenal! The standard of the conference this year was highest than ever. Bless you!”

“I want to express my appreciation to the center’s staff. The big effort put into the conference is very evident. Well done!”

2014-07-11T09:13:24+00:00November 20th, 2011|Arts, Blog, Jewish-Palestinian/Arab, Speaking Arts Conference|

The Arabic-Hebrew Studies Center in Jerusalem – the 2011-2012 classes

Well, if you want to know more about the JICC Arabic courses, you need to click here and read the post from last year (let’s not repeat ourselves too much…). So we can focus on the updates for the 2011-2012 classes. This fall we have opened up 6 courses in Arabic: 2 in Level 1 (beginners), 2 in Level 2 (advanced beginners), 1 in Level 3 (intermediate) and 1 in Level 4 (advanced).

The groups meet on Mondays, Tuesdays and Wednesdays at the JICC building.

The goal of the courses is to train professionals who need to use Arabic in their professional capacities to communicate on a reasonable level, and the curriculum is designed for this purpose. Classes include a large component of discussions and listening to songs and other verbal material to practice. “After only 4-5 lessons, the teacher gave us a 30-minute lecture in Arabic – on the teacher’s family, on their pilgrimage to Mecca, etc. and we understood everything!” exclaimed one participant.

Teaching in progress

Teaching in progress

This year we have some 80 participants – students, professionals and activists who come into regular contact with Arabic-speaking residents and who need it to communicate with them.

“I enjoy the course immensely,” said another participant. “I don’t believe I’ll ever be fully fluent, but it does definitely help me to understand Arab culture and history. I am now more aware of the presence and (or absence) of Arabic all around me – on signs, in stores. It is also very interesting for me to see the similarities between Arabic and the language found in Jewish sources.”

The format is hence similar to previous years, but we (and more important, the participants) feel that the classes improve from year to year!

2014-04-11T15:20:52+00:00September 14th, 2011|Blog, Courses, Language Center|

“Haaretz” article on our interpreters course in Bikur Holim: medical staffers are learning Arabic, Yiddish and more and learning cultural sensitivity to bridge gaps with communities in need of care

Following our interpreters course at Bikur Holim(see our blog entry about it!), Haaretz published an article that covers the story.

You can find the Article in English here, and the Hebrew version here.

We loved this excellent article very much. But we have two minor comments:

  1. The English headline is misleading – it says “To give better care, Israeli doctors learning Yiddish and Arabic”. Well, this course was for bilingual staff who already speak two languages, but need to learn the professional tools for medical interpretation. We are very happy to see that medical staff is learning the languages of their patients, but frankly, we prefer that they use expert medical interpreters rather than relying on the basic language course they had.
  2. We do not recommend saying “Abi gezunt” to a sick person…. it means “health is the most important thing”. You use this phrase when someone lost money or when his/her car was damaged in a car accident. The idea is that never mind the money – health is much more important. It is a bit cynical to say it to a sick person. Better use “Sei gesund” (be healthy). 🙂

Yet, great article! Here is the full text:

To give better care, Israeli doctors learning Yiddish and Arabic
Medical staffers are learning Arabic, Yiddish and more and learning cultural sensitivity to bridge gaps with communities in need of care.
By Dan Even, “Haaretz”

“Abi gezunt” (be healthy ) is a common refrain used by members of the ultra-Orthodox community in Jerusalem when fulfilling the religious commandment of visiting the sick.

But patients from the mostly Yiddish-speaking community who need medical treatment sometimes find it difficult to communicate with the doctors in Hebrew, which they use for prayers only.
Doctor with translators

A doctor and two translators simulating a Russian-Hebrew conversation.
Photo by: Olivier Fitoussi

In the past decade there has been an increasing awareness in Western countries of the importance of training teams in medical interpretation, in order to improve communication between doctors and patients from different cultures.

The medical system in Israel, an immigrant-absorbing country, has also recently instituted a special training program. After the opening of interpretation courses in Arabic, Russian and Amharic, last month a first course opened in Jerusalem to train interpreters in Yiddish.

“The Israel health system is good, but the issue of cultural competence has skipped us as though it never existed, maybe because it sounds too political or too leftist,” said the director general of the Jerusalem Inter-Cultural Center, Dr. Hagai Agmon-Snir, who initiated the program.

“Maybe it’s because of the melting pot concept, which led to a belief that if a patient speaking a foreign language arrives at the hospital, it’s preferable that he make an effort to speak Hebrew,” said Dr. Michal Schuster, a graduate of Bar-Ilan University’s translation studies program, who is participating in the project.

The interpreters’ course that began in May for the staffs of the Bikur Holim Hospital in Jerusalem was designed to train medical interpreters in Yiddish, the mother tongue of the ultra-Orthodox patients who use the medical institution. On the obstetrics wards, for example, 80 percent of the women are Haredi.

“It’s no secret that as opposed to the ‘State of Tel Aviv,’ here we have patients from specific populations, and there are patients from the Haredi and Arab populations who are in need of a sensitive attitude in various medical situations,” said the medical director of Bikur Holim, Dr. Raphael Pollack. Agmon-Snir says while the patients know a little Hebrew, they shouldn’t have to stumble for words when in a hospital setting.

“Theoretically there’s no need for interpreters into Yiddish, but there are members of the Haredi community who are capable of expressing their distress more easily in Yiddish, and we should make communication easier for them,” the doctor said.

The language training consists of 40 academic hours over a period of six weeks, and is being taught to 36 Bikur Holim nurses and administrators. The course includes introductions to anatomy, in order to become familiar with common medical terms such as EKG or blood count, the study of precision in translating and of medical ethics. The cultural competence course, which is designed for a larger number of staff members, also includes content related to the cultural differences among patients of different origins.

Schuster says that they make sure not to perpetuate stereotypes about minority groups, “instead, we provide tools for dealing with a patient from a different culture, principles of listening and understanding the cultural nuances,” she said.

Shake hands

“In the Ethiopian community, at the beginning of treatment the doctor is supposed to stand up and shake the patient’s hand,” says Dr. Idit Dayan, the coordinator of welfare at the Jerusalem Foundation, which is a partner in planning the project and promoting cultural competence in the Jerusalem health services, and supports it to the tune of hundreds of thousands of shekels annually. “There are Russian doctors who confessed to us that they don’t understand the custom, but it constitutes a code of honor in the Ethiopian community, and it helps to improve communications and breaks the ice between the doctor and the patient.”

Cultural misunderstandings are liable nowadays to lead to medical negligence claims, and Israeli courts have already dealt with scenarios originating in an absence of cultural competence on the part of medical staffs.

In January 2007, the Jerusalem Magistrate’s Court granted compensation of NIS 250,000 to a couple from Bueina-Nujidat in the north, after the woman miscarried and claimed that at Poriya Hospital, where she was under supervision, they were negligent in treating her.

It turned out that during the period of supervision the woman, who is an Arabic-speaker, was given medical explanations in Hebrew. One of the doctors testified at the trial that she had given the expectant mother explanations in Arabic, but it turned out that she had explained the nature of the treatment the woman required at home using only isolated words rather than sentences.

In the ruling, Judge Arnon Darel said “the hospital did not meet its minimal obligation of providing the explanation in a manner understandable to the patient.”

The present project began in 2008 with the support of the Jerusalem Foundation, and continued with a pilot in the Alyn Pediatric and Adolescent Rehabilitation Center, when staffs were trained in medical interpretation and directional signs in various languages were posted.

The project has since expanded to the Clalit health maintenance organizations in Jerusalem, especially in the clinics that serve the Ethiopian community, and the Arab community in East Jerusalem.

In the past year the program was also expanded to Hadassah University Hospital at Mount Scopus and at Ein Kerem, and is slated to also be used at the Kfar Shaul Mental Health Center.

The profession of medical interpretation is still in its infancy in Israel, but the vision for the future includes the development of a new career path. At Alyn there is already a salaried Arabic interpreter. The increasing awareness of cultural differences and the fear of lawsuits have led the Health Ministry to publish a director general’s circular on the subject of cultural and linguistic accessibility in the health system.

According to the circular, by February 2013 all the institutions in the health system will be required to provide medical translation services to patients by means of a professional hotline, by employing cultural experts or by employing staff members who speak foreign languages, after they undergo training, and to refrain insofar as possible from using a family member as a translator.

Speaking Art Conference: Triggering Activity year-round – Follow-up Meeting on June 2011

By Naomi Roff Kohn, The Jerusalem Foundation:

Published at the Jerusalem Foundation site.

Understanding Each Other Through Music
June 2011

The Speaking Art Conference, held every December for the past seven years, is an opportunity for Jewish and Arab artists in the field of music, theater and dance to work together, thus getting to know other performing arts projects from different cultures and groups throughout Israel.

In order to strengthen the impact of the conference and to increase continuity from year to year, the Jerusalem Foundation and the Jerusalem Intercultural Center (JICC), have begun to hold mid-year meetings, bringing the artists together for shared activities, to strengthen their bonds and friendships, and to discuss suggestions for the next festival.

On June 16, 2011 some 20 Jewish and Arab artists participated in the mid-year meeting with a jam-packed day. It started with a workshop by Shmuel Hadjes, founder and director of the Jerusalem-based Psik Theater, and Hisham Suleiman, founder and director of the Nazereth Fringe Theater, entitled “The Internal Conflict.”

Speaking Arts workshop at the JICC house - June 2011

Speaking Arts workshop at the JICC house – June 2011

Musicians continued their work on a text they prepared during the last conference while other participants discussed how their religious and national identity influenced their work as artists.

After lunch the group visited the Al-Ma’mal Foundation for Contemporary Art in the Christian Quarter of the Old City, to broaden participants’ familiarity with the art scene in east Jerusalem. Since many of the participants were not from Jerusalem, the group also toured the Christian and Jewish Quarters of the Old City and visited holy sites such as the Church of the Holy Sepulchre.

Discussions were held on how the November annual event can be improved, expanded, and strengthened.

The day ended with an one-hour concert of the Jewish-Arab band Na’am in the JICC’s garden. The participants gathered around the band, listened to the music and it was a wonderful end to an enriching day.

Evening Concert at the JICC garden - June 2011

Evening Concert at the JICC garden – June 2011

A clip of the afternoon concert at the JICC beautiful garden (thanks to the Jerusalem Foundation):

Original at: http://youtu.be/wdt3eUPn9xY

First time in Yiddish!! – opening of medical interpreters course in Bikur Holim Hospital

Today we began implementing our cultural competence program at the Bikur Holim hospital in Jerusalem. Bikur Holim is one of the oldest hospitals in the city (founded in 1826). From the article in Wikipedia about the hospital, we have chosen to cite the following:

Situated near the religious neighborhoods of Geula and Mea Shearim, Bikur Holim admits a very high percentage of Haredi Jews, and tries to cater to their needs. Shabbat is strictly observed. Non-Jewish employees record medical information and answer telephones on the Sabbath. Food is warmed in ovens operated by a timer, in keeping with Orthodox religious rulings.

The Haredi (Ultra-Orthodox) orientation of the hospital is very much known in Jerusalem. Yet, it is not surprising to find out that since most of the medical and non-medical staff are non-Haredi, there is still a need for improving cultural competence for Haredi patients and families. When we approached the hospital management, half a year ago, as a part of the program of cultural competence in Jerusalem (a program we share with the Jerusalem Foundation), we were warmly invited in. The staff also emphasized that the hospital accepts patients from all around the city, including high percentage of Palestinians (Muslims and Christians), new immigrants from all around the world and migrant (foreign) workers. Together, We planned a cultural competency program for the hospital.

Bikur Holim Medical Interpretation Course

Bikur Holim Medical Interpretation Course

The first step of the implementation was today – a medical interpretation course for more than 30 bilingual staff members. Well, we did such 30-40 hour training courses before, in Alyn hospital, in Clalit HMO and in Hadassah. But this time, in addition to Arabic, Russian and Amharic interpreters, we have a large group of Yiddish interpreters! Indeed, although most of the Haredi community can speak in Hebrew, many of them are much more used to Yiddish, and Hebrew for them is a kind of a second language. Also, medical terminology and explanations in English or in Hebrew are hard for many of them to understand. We believe that using Yiddish can help many of them and would make them feel more “at home” in a Western hospital.

Bikur Holim Interpretation Course - on the left Rabbi Shlomo Pappenheim, main Eda Haredit Leader and a Board Member of the hospital

Bikur Holim Interpretation Course – on the left Rabbi Shlomo Pappenheim, main Eda Haredit Leader and a Board Member of the hospital

Definitely, if this works well, we will advise other medical institutes in Jerusalem, that also serve large Haredi populations, incorporate Yiddish into their list of interpretation languages.

The next step will be providing our staff training workshops of cultural competency. One of the urgent needs is to make Arab patients feel “at home” in a hospital that is seen as oriented towards religious Jews. With the help of the wonderful staff of the hospital, we are sure that this challenge can be met.

Jerusalem is leading the way in cultural competence

The cover of the In Jerusalem Magazine of the Jerusalem Post says it all:

“Jerusalem is leading the way in implementing the Health Ministry’s directive to make health care more friendly to patients of different background”

The cover of "the Jerusalem Post"'s "In Jerusalem" Magazine April 29 2011

The cover of “the Jerusalem Post”‘s “In Jerusalem” Magazine April 29 2011

The cover relates to the main article in the magazine that depicts the work of the JICC in the area of cultural competence in Jerusalem health system and beyond. It shows how our pioneer work creates a ripple effect – impacting the national health system and other systems as well.


The original article (high quality PDF, large file – 7MB)

The Internet version of the article

Full text:

Diagnosis: A cultural awareness deficiency
April 28, 2011

Efforts are being made to enable patients of all backgrounds to communicate with their doctors, but a culture gap remains.
Suppose you felt very sick, but when you reached an Israeli hospital, the doctors and nurses spoke only Swahili. You couldn’t describe your problem, ask or answer questions, understand the forms you had to sign or even identify the WC. Like the Bantu language of eastern Africa, Hebrew is spoken by only five to 10 million natives.
But even though no US hospital or clinic is eligible for federal funds unless it has a team of professional medical translators and experts in cultural competency, the Health Ministry has not set any requirements that will help masses of immigrants and Israeli Arabs communicate in health facilities. And Israel has an even higher proportion of immigrants speaking languages other than the native tongue than the US.
Imagine visiting a foreign country, where you do not speak the language, and needing medical attention. Unable to understand the doctor’s instructions, warning labels on medication or paperwork needed to be filled out, it would be a grave situation. But as bad as that is, imagine if this was in your own country, where you lived.

What seems like a nightmare is, for many of the country’s residents, a reality. In Jerusalem alone, with its diverse population, you can ride a bus and easily hear five different languages being spoken. Despite this, the healthcare system speaks only one.

So what are the non-Hebrew speakers to do? Until now, basically nothing. While the idea of cultural competence is gaining popularity throughout Western countries, Israel is somewhat behind. In some countries, there are laws regulating the languages in which certain services must be provided in an effort to be more competent in dealing with different cultures. With the most pressing area arguably the healthcare system, little has been done in Israel to accommodate the needs of patients from different backgrounds who speak a number of different languages.
But not everyone has been standing idly by. Recognizing the diverse nature of the city , the Jerusalem Inter-Cultural Center (JICC) has been active for more than 10 years, trying to make the capital a more residentfriendly city, no matter what the resident’s religious beliefs, ethnicity or language. Among its efforts, the JICC has been instrumental in bridging haredi and non-haredi elements in the city, has acted to improve the municipality’s service to east Jerusalem and has tried to increase cooperation between Arab and Jewish groups by involving them in joint projects. Four years ago, the JICC began promoting the idea of cultural competence in the healthcare system in Jerusalem in an effort to enable patients of all backgrounds to have the ability to communicate with their healthcare providers and understand their medical treatment.

“A health system cannot provide a good response to different cultures if it doesn’t know how to adjust to language and culture,” says Hagai Agmon-Snir, director of the JICC. “When doctors have to treat people who don’t understand their language, it resembles veterinary care. Maybe it will work [at the doctor’s office], but the treatment won’t continue at home. And it’s also difficult to treat someone if you don’t fully understand their problem.”

But there is a solution – medical interpreters. “There can be an interpreter in the room with the patient or telephonic interpretation. [The doctor has] a phone with two receivers, and he calls someone somewhere in the world [who can speak that language],” explains Agmon-Snir. Each option has its advantages and disadvantages. The live, present interpreter may be better qualified, but his presence may make some patients uncomfortable and less willing to disclose information. The telephonic option is more discreet and offers translations in 180 languages, though it’s not medical-specific.

But according to Agmon-Snir, there are almost no hospitals in the country that employ interpreters or offer the telephone service. Instead, most hospitals, when faced with a non-Hebrew speaking patient, rely on makeshift sign language, a non-native common language like English or a fellow patient or family member to interpret. “But these solutions are very problematic, ethically as well,” says Agmon-Snir. “To get a patient and have him translate someone else’s personal problems or having children translate problems relating to their mother’s pregnancy or menstruation is a very problematic thing,” he says.

In February, however, the Health Ministry made what has been hailed by many as a breakthrough. It issued a directive calling for an increase of cultural competence throughout the country’s healthcare providers. Among the directive’s requirements are the following: all forms requiring a patient’s signature must appear in Hebrew, Arabic, English and Russian; signs must be posted in Hebrew, English and Arabic; call centers must offer service in Hebrew, English, Arabic, Russian and Amharic; and some form of interpretation service must be offered to any patient who requests it, be it by an employed interpreter, a staff member who is bilingual or a telephone service.

The directive applies to hospitals, as well as health fund clinics and public health facilities. Every healthcare provider has two years to implement the directive.

Though groups such as the inter-cultural center praised the directive as an advancement in cultural competence awareness, many people were up in arms because while the directive calls for the implementation of costly translation services, it does not provide any financial support. Moreover, there are those who feel that Arabs and other minorities should learn Hebrew and that new immigrants should learn to speak the language just like everyone else.

But according to Agmon-Snir, that ideology has no place in the healthcare system. “If I’m a new immigrant, who says I can learn a new language well enough to understand everything that they tell me? And in healthcare, that’s critical,” he says. “Every person has a mother tongue in which he understands the best. If you’re a nurse or a doctor or a pharmacist, you have to provide the best possible service; this isn’t the education system,” he charges.

He adds that many aspects of the directive are already anchored in the National Health Insurance Law of 1994, making the directive legally binding, whether critics approve of it or not.

But cultural competence goes far beyond translation. “The more a patient feels his needs are being met, spiritually as well, the more able he is to be healed,” says Agmon-Snir. He says that many people connect to God while in the hospital. “The moment you see that there is a place for you to pray or for your family to pray, and you see that the hospital takes you and your needs seriously, then your attitude towards the medical staff and to treatment is different… it helps you heal,” he says. Understanding a patient’s religious needs is also an important part of healthcare.

To that end, the Alyn Pediatric and Adolescent Rehabilitation Center, which caters to a large non-Hebrew-speaking clientele and underwent a number of JICC cultural competence seminars two years ago, opened a Muslim prayer room. “Abroad, it’s very acceptable – Coney Island hospital in New York has a mosque, a synagogue, a church and a Hindu temple. But here in Israel, to build a Muslim prayer room is seen as a political statement,” says Agmon-Snir, who stresses that it’s really a professional statement, not a political one.

According to Naomi Geffen, cultural competence coordinator at Alyn, the hospital had a synagogue at the current location since 1971 but only recently installed a Muslim place of worship. “In 2010 we opened a prayer room for Muslims, along with the JICC and an imam to help us set it up. His congregation donated a special clock and rugs,” says Geffen. She says the hospital has received a lot of positive feedback about it.

To date, Alyn has undergone the most extensive process and, according to Agmon-Snir, it’s the most culturally competent hospital in Israel. The JICC training, which Alyn underwent, is mainly funded by the Jerusalem Foundation. It provides seminars on how to treat patients from different cultures, offers special medical interpretation courses and helps institutions become more culturally friendly to their patients. But the participating institutions also invest their own money to send the staff to the seminars, hire interpreters, and build facilities such as the Muslim prayer room.

“We wanted to expose workers to different scenarios and give them the ability to be more sensitive to people from all different backgrounds,” says Geffen. “We brought in actors to perform scenarios and see how we should relate to different cultures.” The hospital sent 14 employees to become trained medical interpreters, and all signs were changed to read in Hebrew, Arabic and English, with some departments bearing signs in Russian as well.

“There’s always space to learn, and we wanted to become more aware and sensitive at foreseeing problems that could happen and set up therapeutic settings that would prevent them,” says Geffen.

After undergoing a two-year in-depth process, the hospital now conducts regular follow-ups every three months, which involve films, discussions and lectures. According to Geffen, 99 percent of the Health Ministry’s directive has already been implemented at Alyn.

Hadassah Medical Center on Mount Scopus is following suit. In September it began training Arab and Russian-speaking volunteers to become medical interpreters. At the same time, the hospital worked to educate the rest of the staff about the uses and capabilities of these interpreters. To date, there are 34 volunteer interpreters who are available for daytime rotations. The interpreters serve in the gynecology, emergency and internal medicine departments, where they are most needed, but can be requested by telephone to help out in any area of the hospital. In November, the first month the interpreters were made available at Hadassah, there were 83 requests for their services. By January the number had risen to 121.

Adit Dayan of The Jerusalem Foundation, a major partner in funding the JICC project, says the training provided for Hadassah cost NIS 180,000, aside from the hospital’s own costs of sending employees to the seminars. Dayan says that with the release of the new directive, many more hospitals and clinics have been approaching the foundation requesting their assistance, and she hopes the foundation can work out an arrangement to aid them.

But beyond interpreters and religious needs, there are additional aspects of cultural competence. One example is understanding the patient’s expectations of proper treatment. “The average Ethiopian, for instance, expects the doctor to touch him when treating him; but the average Israeli doctor just takes his card, looks at the lab results and barely even looks at the patient,” says Agmon-Snir. “From the Ethiopian’s perspective, that’s a bad doctor. They feel that blood should be drawn, or at least blood pressure should be taken,” he says. According to him, doctors should go out of their way to perform minor procedures like taking blood pressure, even if it’s unnecessary, if it gives a patient the sense that he’s receiving proper care.

Agmon-Snir recounts the story of a doctor who worked in a predominantly Ethiopian-populated area and took one of the seminars. “He said he didn’t understand what we were talking about and why these things were important. But then he came back and said he tried out the suggestions anyway,” recalls Agmon-Snir with a smile. “He said when an Ethiopian patient walked in, he stood up, shook his hand and asked him how he was. The doctor didn’t understand why or how, but he said it worked beautifully and made a difference.”

Another dimension of cultural competence dealt with in the JICC seminars is manner of speech. “Israelis speak the most direct language. In addition, medical jargon in Israel is very direct,” says Agmon-Snir. “So when a patient [from a different culture] walks in and speaks with the doctor, there are two problems: the directness of the doctor’s speech may be insulting, and the Israeli ear is not sensitive to what it hears,” he says. “Instead of asking a patient if he understood, the doctor should ask him what he understood.” Only in this way can the doctor verify that the patient fully comprehends what he is being told.

Cultural competence, however, is not just for minorities. According to Agmon-Snir, we all potentially have what to gain from a more culture-conscious environment. “In today’s Israeli reality, everyone is a minority. Many times, even the hegemony feels like a minority,” he says. “When you go to the hospital and you’re sick and the doctors come and speak Russian around you, the fact that you’re a native Israeli doesn’t help,” he says. He adds that many doctors and nurses today are Arabs.

With the new Health Ministry directive, the JICC is receiving an increasing number of requests to help make facilities, in Jerusalem and beyond, more culturally competent. Agmon-Snir’s hope, however, is that this is just the beginning and that awareness of the need for cultural competence will grow and extend to other realms as well, such as legal and social services.

2014-04-09T17:53:10+00:00April 29th, 2011|Blog, Cultural Competence, Cultural Competence in Health Services|