Courses

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.

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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.

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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.

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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!

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

The Arabic-Hebrew Studies Center in Jerusalem – the 2010-11 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). Last year we had “just” 5 courses, and in the last years, because of the demand, we find ourselves expanding the number of courses every year.

The groups meet on Mondays, Tuesdays and Wednesdays at the newly renovated JICC building. This year, the participants enjoy the new heating and air-conditioning systems, audio-visual capacities for learning, new furniture and more. Following the renovations, we have now a much more adequate second floor for the courses – more space options for the classes, less noise and interruptions between the groups, and even more restroom stalls…

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.

This year we have more than 70 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.”

More on the JICC courses can be found in the blog post from last year.

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2014-04-09T17:42:30+00:00February 7th, 2011|Blog, Courses, Language Center|

Promoting Healthcare Cooperation through Cross-Cultural Dialogue of Jewish and Arab doctors in Jerusalem

On Thursday, January 13, after long and intensive preparation, we had the first of 10 meetings of the cross-cultural dialogue group of health professionals in Jerusalem. Thirty participants, 19 Jews and 11 Arabs, met for the first time at Hadassah Mount Scopus hospital. The participants included doctors from Jerusalem hospitals (Hadassah Mount Scopus, Hadassah Ein Kerem, Shaare Tsedek, Bikur Holim, Al-Mukassed and more), HMOs (Clalit and Maccabi) and also from the Red Crescent.

Doctors East and West Jerusalem Seminar - meeting 1

Doctors East and West Jerusalem Seminar – meeting 1

The group heard an introduction to medicine in East Jerusalem from Dr. Nafiz Nubani, Deputy Director of the Jerusalem District of the Ministry of Health. We then had a presentation by Dr. Maurit Be’eri, Deputy CEO of Alyn Pediatric Hospital, on the process of increasing cultural competency that the institution has been undergoing with the assistance of the JICC. Thanks to the simultaneous translation, we could have the talks in Arabic and Hebrew, respecting the mother tongues and identities of all the participants. The next meetings will deal with the treatment process from the primary clinic in east Jerusalem to the hospital and back, cultural competency in the context of Islam and East Jerusalem, becoming acquainted with healthcare models that were used in other places, and more. One of the meetings will be dedicated to touring clinics in East Jerusalem.

Dr. Morit Beeri, Deputy CEO of Alyn Pediatric Hospital, speaking to the Doctors Group

Dr. Maurit Beeri, Deputy CEO of Alyn Pediatric Hospital, speaking to the Doctors Group

We put intensive effort into creating this group; indeed, it was a challenge we wanted to invest in. At the beginning of the process, we intended to hold a group for a variety of medical professionals – doctors, nurses, administrators, pharmacists, etc. People with whom we consulted had two assumptions. One was that doctors would not be interested in a group like this and would not register for it because they are too busy. The second was that doctors would not come to a group that includes people from other professions… We took the risk – we decided to limit the group to doctors and to try anyway – we knew that if we succeed, these doctors will be the best agents of change in the health system. The 30 doctors who came to the meeting, most of whom senior physicians in the health system in East and West Jerusalem, showed us that we were correct in our strategy.

Intensive staff efforts were required for this group to materialize and then to crystallize. Hadassah agreed to notify its entire doctors’ mailing list about it. HARI (Israeli Doctors Histadrut/Union) distributed notices about the group to all the doctors in Israel (16,000 doctors). The surprising result was that there were many who called and asked for details. Tal Kligman, the project manager, worked with the entire project team to create engaging content for the meetings, including cultural competence issues and strategies, best practices for interaction between diverse staff members, and more. Much work was invested in creating contents and structure that would be effective and relevant for all participants, Arabs and Jews, and be appealing to them. Tal spoke with each of the participants a few times. An evaluator was selected for the process and began his work.

At this point, after one meeting, our feeling about the implementation is that it is very successful. It is very important to note that without the funding of the Beracha Foundation, this group could not take place. The investment of staff time and effort, the intense facilitation, the simultaneous translation etc. – all these made the recruitment of the doctors possible and optimized the impact of the process. As a result, senior doctors on both sides (including the director of Hadassah Mount Scopus hospital, heads of departments, heads of HMO teams, deputy general of the Ministry of Health Jerusalem District and others) have enrolled. We believe that this high-profile group will create a network of Arab and Jewish doctors in Jerusalem that will be helpful (together with the JICC’s efforts in the field) to improve equality in medicine in Jerusalem. The JICC has a mission to make Jerusalem a culturally competent city, and this group of doctors will definitely help us in this mission, thanks to the process they will get through in these meetings.

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The Jerusalem Arabic-Hebrew Study Center – End of the 2009-10 classes

This week marked the conclusion of most of the JICC’s Hebrew and Arabic language courses for 2009-2010. The Hebrew-Arabic Study Center provides languages courses in Hebrew and Arabic to promote efficacious and positive communication between Arabs and Jews in Jerusalem.

The Hebrew-Arabic Study Center programming is made possible through the partnership of the Jerusalem Foundation, and thanks to their support our courses are offered to the public at a heavily subsidized rate.

This year we held five Arabic courses (Palestinian dialect) for Hebrew speakers: two for beginners, two intermediate level groups, and one for advanced learners. Demand for Arabic language courses is high in Jerusalem; all of our courses operated at capacity this year, with 13-15 students in each course.

This demand is sparked in part by the unique approach of our programming – intensive language acquisition with an emphasis on the needs of professionals working with Arabic speakers in the city – answering an increasing demand for Arabic skills. The high quality of our two devoted teachers, Suha Kadri and Saida Rubhi, is another primary reason for courses’ success. Registration for 2010-2011 is already almost full …

Final Field Trip of the Advanced Arabic Course

Final Field Trip of the Advanced Arabic Course

At the same time, the JICC, together with the Kesher organization, provided Hebrew instruction for Arabic speakers. Our Hebrew language course was the first of its kind specially tailored to meet the unique requirements of parents of special needs children. Today, Jerusalem-based institutions providing medical and support services to special needs children are very Hebrew-centric. These parents joined this adapted course to help ensure that they could properly communicate with their children’s Hebrew-speaking medical professionals and caregivers and access the best possible services for their families.

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2014-04-09T17:21:30+00:00June 24th, 2010|Blog, Courses, Language Center|

Our Second Medical Interpretation Training – Covered by the Jerusalem Post – February 2010

We have just completed the second medical interpretation training in Jerusalem (read here about the first one we conducted in October 2008). This time, 10 of the participants came from the Clalit HMO clinics from all over Jerusalem, while another 4 came from the Alyn hospital. This training is one of the components of the Jerusalem Cultural Competence in Health Project initiated by the Jerusalem Inter-Cultural Center and the Jerusalem Foundation. The medical interpretation training includes three elements: theoretical lectures on translation and interpretation, presented by Prof. Miriam Schlesinger and Dr. Michal Schuster from the Bar-Ilan University, simulations and case studies, and language-specific training on medical terms and their usage, in this case in Arabic, Russian and Amharic.

The Medical Interpretation Training at Clalit Medical Services

The Medical Interpretation Training at Clalit Medical Services

On February 13, 2010, after visiting our training, Judy Siegel-Itzkovich from the Jerusalem Post published an article titled “Risky misunderstandings”, asserting that “the state’s failure to require trained medical interpreters may pose a danger.” While most health systems and the state are not taking responsibility to do whatever is required in this life-risking situations, Siegel-Itzkovich describes our training as an important step towards resolving language barriers in medical treatment. The article can be found here, or downloaded as a PDF file (see below for full text).

It is important to note that in the near future the Hadassah Mount Scopus hospital, in partnership with the Jerusalem Foundation and ourselves, is planning to initiate a volunteer-based interpretation service in Arabic and Russian. The JICC will train the interpreters as well as provide additional cultural competency trainings to medical staff in the hospital. This can be seen as a first and important response of the Hadassah organization to the urgent need at the Hadassah Mount Scopus hospital, where 55% of the patients are Arabic-speaking (see our previous article about this issue here).

Appendix: full text of the Jerusalem Post Article:

Risky misunderstandings
By JUDY SIEGEL-ITZKOVICH
13/02/2010
The state’s failure to require trained medical interpreters may pose a danger.

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.

There have been some reported cases of non-Hebrew speakers dying because of their failure to understand or be understood in hospitals; surely other tragedies have not been reported.

But when asked by The Jerusalem Post to comment on this problem, Health Ministry associate director-general Dr. Boaz Lev shrugged and said: “I’m afraid I don’t have a good answer. I think it is a very important matter, but it isn’t on our list of top priorities. I wish we could ensure that there are professional medical translators everywhere.” He added that the matter of cultural competency in medical institutions was raised in the ministry’s executive and there were even seminar days to discuss it. “It is not foreign to us. But we don’t have the financial resources to deal with it seriously.”

WITH A vacuum left by the ministry, at least a number of voluntary and public organizations are trying to provide some training and services on a relatively small basis. The Jerusalem Inter-Cultural Center (directed by Dr. Hagai Agmon-Snir and with support from the Jerusalem Foundation) has begun to offer three-day medical interpretation courses for people – mostly women – employed in different capacities in hospitals and clinics. Established a decade ago, the Inter-Cultural Center on Mount Zion aims to promote dialogues among different cultures, so cultural competency and medical translation in medical facilities made it a natural for initiating the project.

Although they were never trained as medical translators or cultural “bridgers,” the class participants have been doing it without additional salary or benefits and not even after volunteering to do so. They are nurses, secretaries and even maintenance workers who speak other languages such as Arabic, Amharic, Russian and Spanish and were asked by their bosses to help out when patients could not understand or be understood. English is usually not a problem, as most doctors and nurses speak it adequately. Several of the particiipants, including a man from Beit Shemesh, were former Ethiopian immigrants, while many of the Arab women work in the Sheikh Jarrah outpatient medical center in east Jerusalem.

The Inter-Cultural Center found a teacher, and Clalit Health Services – the largest health fund – and Alyn Hospital (the National Pediatric and Adolescence Rehabilitation Center) sent 15 staffers (only one of them male) to take the first-ever course in Clalit’s community clinic in the capital’s largely low-income Katamonim quarter. Pazit Kalian of Clalit’s Jerusalem district was instrumental in getting her staffers to participate in the eight-hour-a-day course.

Almost two years ago, Alyn held a one-day symposium on cultural competency in medical institutions that featured experts from New York City’s Coney Island Hospital and described advanced work done there.

In front of the class in the Katamonim was Dr. Michal Schuster, who studied translation and interpreting at Bar-Ilan University, while Prof. Miriam Shlesinger – the veteran chairman of that BIU department – sat in to observe and comment.

THEY TOLD the Post that some medical institutions have specifically hired Ethiopian immigrant women to fill cleaning worker jobs so they could “double” as medical translators. Yet these maintenance staffers are not familiar with medical terms, psychology or the ethical boundaries of professional interpreting, they said.

Some of the class participants, said Schuster, are “very bitter” about doing medical interpreting in addition to their regular job without getting any compensation. She also said one government medical center even turned down the free medical interpreting service provided by Rabbi Yechiel Eckstein’s International Fellowship of Christians and Jews. The hospital claimed some its own personnel were able to translate when necessary, and that a phone service “doesn’t fit the structure of the hospital.” Now the service will work specifically in Amharic and Hebrew with help from the Tene Briut organization and Magen David Adom. One need only call MDA’s 101 number to access it.

Shlesinger, who said she is “obsessed with translation and interpreting to help people overcome the language gap,” has set up many programs for the Jewish Agency and other organizations, but not until now not in the field of medical care. If immigration tapers off, “there will always be Arabs, deaf people and foreign tourists who need help, as well as older immigrants who don’t adequately comprehend Hebrew. Even my 90-year-old mother who came here from Florida 30 years ago wants to speak English when talking to her physician,” she noted.

“It has become our ideology that interpretion be available for healthcare. We really believe in it. It raises the participants’ self esteem. Big hospitals really should have in-house professional medical interpreters. But for this sea change to happen, there needs to be more lawsuits against hospitals and medical organizations by people who suffered a tragedy due to being unable to understand Hebrew. The Health Ministry needs a push,” said Shlesinger, who in the past has raised the issue with the ministry’s Dr. Lev.

SCHUSTER ADVISED the course participants not to be afraid when the doctors and nurses speak too fast. “You must not add any words of your own, or leave any out. Never give any advice not connected to treatment. It is forbidden for you to sell anything for your own benefit, or to arrange an earlier place in the queue if they want to give you something. You have to listen and know the medical terms and how the health system and procedures work.”

She added more advice: “Make sure you understand both the medical professional and the patient. Correct yourself if you are mistaken. Run a conversation that flows. Sometimes doctors use high-faluting language; sometimes they make up terms so the patient won’t understand. If it is not all clear to you, ask for details.” She advised participants not to believe in stereotypes such as that anyone who cant speak Hebrew or comes from a certain country is “stupid.” In addition, interpreters must “never get involved emotionally. “Don’t give your phone number to a patient. Don’t answer a doctor’s question instead of the patient just to save time. You must guard the boundaries.”

One of the most major issues is secrecy about patients’ medical conditions and other private matters. The course made numerous statements about protecting privacy. In a clinic where the interpreter may live just around the corner, it can be very difficult to translate or for the patient to agree. “In such a case, you really should ask if they are willing for you to interpret or find somebody else,” Schuster advised. There are very few exceptions to the secrecy rule, the instructor added. “If the patient tells you about violence in the family, against children or against herself, or that he wants to commit suicide, you are required to report it.”

Interpreters must also take care when asking patients questions not allowed by their religion or culture. An unmarried Arab or haredi Jewish teenager should not be asked whether they are virgins or use contraceptives, for example. There are also “spirits” called “zar” believed in by some older Ethiopian immigrants that have to be taken into consideration. An Ethiopian could say she had a “dry hand,” leading a physician unaware of such an expression to treat them with a dermatological cream, but in fact referred to “stiff joint” that requires a totally different treatment, Schuster said.

One of the course participants said she refuses to translate bad news, such as a patient being diagnosed with a terminal disease. “I am unable to do it. They have to find somebody else. There is nobody to give me support. You take such bad news home with you; I can’t cope with it. I once sat with a hospital psychologist who wanted me to ask the patient if he has suicidal tendencies. It was very hard for me, as I am not a social worker. I also can’t handle curses and other bad language that I sometimes hear.” A Moscow-born nurse was told by one patient that “all Russians are prostitutes” and asked “why didn’t you die in the Holocaust?” She recalled that she felt stung, especially when none of her bosses offered any sympathy.

Naomi, the Ethiopian cultural “bridger” who came on aliya as a young child almost two decades ago, said she recently encountered a patient who came to his Clalit clinic every day (a “bridger” is allowed to have separate talks and interventions with patients, unlike a translator). “He felt the doctors were not giving him all his test results, but they were. They said all tests were normal and just didn’t understand what his problem was,” but she gradually built up his confidence in the physicians.

She also helped a immigrant woman who had cancer and needed surgery. “She refused for months until we persuaded her. But suddenly she demanded that the operation be postponed. She was regarded by doctors as a ‘troublemaker.’ The woman claimed there would be ‘nobody to look after the children,’even though they were already adults. Naomi finally found out that she and her violent husband were in the process of getting a divorce. I advised her how important her health was and of getting early treatment. Finally, she agreed to the surgery.”

Agmon-Snir recalls that a few years ago, his own mother underwent hip replacement surgery. “Before she was discharged, the surgeon gave her quite a few instructions. There were some necessary accessories and equipment: a wheelchair, special pillows and devices to help lift objects. “If you don’t follow the directions I gave you and 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.”

Lying next to her in the hospital were Palestinian women from east Jerusalem who had also undergone the same operation. “They were given the same instructions his mother received and sent to the same places for equipment. Yet there is good reason to suspect that, unlike my mother, many of them are limping today. Research carried out in Jerusalem hospitals shows that about half of the Arabic-speaking patients do not understand the instructions they are given for post-treatment care.”

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2014-10-10T07:30:58+00:00February 18th, 2010|Blog, Courses, Cultural Competence, Cultural Competence in Health Services|

The Arabic-Hebrew Studies Center in Jerusalem – Beginning of the 2009-10 classes

On October 12 2009, we began our yearly Arabic courses at the JICC. This year, the beginners’ courses (two groups) started in October with the teacher Suha Kadri, while the intermediate and advanced courses started in mid-November, due to a maternity leave of the teacher Saeeda Subhi. These two excellent teachers have been working with us for four years, allowing us to offer probably the best and most extensive spoken Arabic courses in the city.

First day of Arabic Beginners Course - October 12 2009

First day of Arabic Beginners Course – October 12 2009

The JICC is NOT a language school. Our courses are primarily intended for professionals and volunteers who are required to speak and understand Arabic in their daily work. We are the first city in Israel that claims that Arabic is a MUST for such professionals. This may sound obvious, right? But it is not the case in most parts of Israel.

When we began our courses we could hardly fill the beginners’ course, and there were not enough candidates for the more advanced courses. We opened one beginners’ course and one small intermediate course. Two years ago, we had three full courses – beginners, intermediate and advanced. Last year, the waiting list for the beginners’ course was so long that we were forced to open another course. This year, we had to add a second intermediate course. Altogether, we now have two beginners’ courses, two intermediate courses and one large advanced course (and, we won’t be surprised if next year we will have to expand the advanced course as well…).

We are very pleased to note the increase in interest in these courses and we are sorry for those who did not have a place in the current year and need to wait for next year. It is important to note that the courses are highly subsidized by the Jerusalem Foundation, who shares with us the vision of Arabic as a mandatory language for those who work with Arab population.

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2014-04-07T20:15:29+00:00November 26th, 2009|Blog, Courses, Language Center|

The Arabic-Hebrew Studies Center in Jerusalem – End of the 2008-09 class

On the week of October 26, 2008, we began another year of the language courses at the Arabic-Hebrew Studies Center (see what we wrote back then!!).

Today, the courses ended (except for the Hebrew course for Palestinians that will continue through August). We had a party to celebrate our efforts in learning Arabic and Hebrew in these intensive and not-that-easy classes.

Arabic/Hebrew Celebration

Arabic/Hebrew Celebration

Most of the participants wanted to ensure that these important language trainings will also be provided next year. Indeed, thanks to the donors of the Jerusalem Foundation, we are able to assure this. Our approach, focusing on the needs of professionals, is well proven. This year we insisted that the Jewish participants, while learning the spoken dialect, will also learn to read basic Arabic – street signs, names and newspaper titles. This addition to the courses was most appreciated by the participants.

Graduates thank the Arabic and Hebrew teachers

Graduates thank the Arabic and Hebrew teachers

The party was held, as usual, in our beautiful garden. This year it was well timed with our mulberry tree… It has the sweetest fruits in the city! From the informal conversations, as well as the formal speeches – all made in Arabic! – we could tell that the participants appreciate the Jerusalem Inter-Cultural Center as a unique organization in Jerusalem: A place where professionals, who devote themselves to the transformation of Jerusalem to a more just city for all its residents, can form relations and networks for their mutual benefit.

The Mulberry Tree

The Mulberry Tree

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