Cultural Competence in Health Services

Wisdom of Experience in Cultural Competency

After 10 years trailblazing the area of Cultural Competency we and our partners in action have garnered a broad spectrum of experience in a wide variety of areas. Throughout the country, there are many people who have developed expertise in different aspects of cultural competency, in different disciplines. They’ve dealt with countless difficulties and are proud of impressive achievements. We’ve all come a long way. After 10 years, we and our partners in action are excited to share some key aspects of Cultural Competency in Israel, and are taking a moment to reflect on the journey of the last decade.

We’ve called this reflection “Wisdom of Experience” newsletters. They detail different issues in Cultural Competency that we’ve dealt with. Each 3-5 page description includes a page introduction about the topic, plus a detailed description of the subject, written by our partners in the field.

Rabbi as a Hospital Consultant

Rabbi as a Hospital Consultant

Thus far we’ve written about (in Hebrew):

Rabbi as a Hospital Consultant (for matters concerning the Ultra-Orthodox population)

In Your Language – Language Accessibility at Hadassah Medical Centers

Assimilating Use of a Telephone Interpreting Hotline

Training at the Western Galilee Medical Center

We’ll continue publishing these newsletters monthly. Other subjects soon to be published include our Haifa-based round table with Haredim and the Maccabi HMO, Cultural Competency in Mental Health, making health services accessible to French-speaking olim, and more.

These newsletters join our series about multi-cultural and religious holidays, that we continue to revise in 2017 (on our Hebrew publications web page).

Many thanks to the Jerusalem Foundation for their continued partnership and support of cultural competency over the past decade!

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Continuing Support for Jerusalem Medical Interpreters at Shaare Zedek

It’s always nice to be praised by someone else. This time, it was by the Sha’are Zedek Medical Center’s social media team, after our Dr. Michal Schuster led a meeting for Jerusalem-based medical interpreters.

Dr. Michal Schuster, leading the workshop

Dr. Michal Schuster, leading the workshop

Here’s their Facebook post:

 

The meeting was held on July 19, for more than 20 medical interpreters. Most were from Sha’are Zedek, and others came from Hadassah Mt. Scopus and Ein Kerem hospitals, ALYN Rehabilitative Hospital, as well as from the Tene Briut organization. The first part of the meeting dealt with the role of medical interpreters in bridging cultural as well as linguistic gaps. In their training the medical interpreters had studied mainly how to translate medical terms from one language to another; the concept of bridging between cultures was not focused on. Michal raised several examples in which medical interpreters were faced with the need to bridge cultural gaps, and they discussed how to approach these differences. This discussion was important for the interpreters, since previously many had focused mainly on language translation, and the concept of cultural bridging, although an important intuitive aspect of medical interpretation, had not received as much attention. It was now brought front and center.

Afterward, participants split up into groups according to mother tongue. Each group discussed specific issues pertaining to medical interpretation in that language.

Thanks to Sha’are Zedek for the mention! And of course, many thanks to the Jerusalem Foundation for their continued partnership in our Cultural Competency efforts throughout the past decade and into the future!

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Cultural Competency in the Workplace: Health Care

We’ve mentioned here the many ways we develop cultural competency in the health care system – from the perspective of the national and local authorities (Ministry of Health, municipalities) to HMO’s, individual clinics and hospitals, schools of nursing and medicine, and more.

We continue to introduce  concepts of cultural competency wherever we can. This includes the Change Agents course of the Israeli Forum for Employment Diversity, which consists of businesses and non-profits that are working to further diversity in the workplace. This includes increasing the integration of populations with disabilities as well as a range of cultures and ethnicities.

Orna Shani, Desk Director, lecturing

Orna Shani, Desk Director, lecturing

We’ve been giving lectures to the Forum for some years now. Cultural Competency Desk Director Orna Shani recently lectured to a course for diversity managers from health care organizations, hospitals and HMO’s, from throughout the country. The main goal of these diversity managers is to integrate populations with special needs into the work force.

Of the 25 participants, only 5 had heard about cultural competency before. Our discussion included language accessibility, on the connection between diversity and employment, the current situation and the desired situation.

Many thanks to the Jerusalem Foundation for their continued support of cultural competency since its beginning.

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2017-06-30T15:25:41+00:00 May 18th, 2017|Blog, Cultural Competence, Cultural Competence in Health Services|

ALYN Rehabilitative Hospital – Still a Model for Fully Integrated Cultural Competency

Ten years ago we began working with the ALYN Hospital, helping to turn their facility into the first fully culturally competent health care institution in the country. Today, cultural competency is a relatively common concept not only in the health care field, but also in welfare, academia, community work, and even the Israel Police.

Opening of Alyn Muslim Prayer Room

Opening of Alyn Muslim Prayer Room

The Israel Religious Action Center was so impressed of the success of ALYN, that it recently made this video, briefly explaining the process that the hospital went through. Indeed, when organizations ask us of a good example in the field of cultural competence, we often send them to Dr. Maurit Beeri, ALYN hospital director, to get her insights on the process and the excellent outcomes they have.

We’re proud to be part of this process. Many thanks to the Jerusalem Foundation, our long-time partner in cultural competency.

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Strengthening the Network of Cultural Competence Coordinators

Part of the importance of our work in cultural competency – especially in cultural competency in health care – is sustainability. Helping the coordinators sustain and develop culturally competent practices in their own institutions. We hold period in-service days for coordinators 2-3 times a year. Our latest meeting for Jerusalem-based coordinators was on January 31.

Cultural competency coordinators meeting

Cultural competency coordinators meeting

The meeting included participants from all 4 of Israel’s HMO’s and four hospitals. They discussed a range of issues that they deal with on an ongoing basis in their respective institutions. One of the major issues discussed was communicating in what is known as ‘plain language,’ or ‘writing designed to ensure the reader understands as quickly, easily, and completely as possible.’ It is especially useful within the context of cultural competency, as a way to enable populations who are not fluent in Hebrew to understand necessary information. Dr. Michal Schuster introduced a number of examples of different forms and medical letters, and participants practiced simplifying language, to bring back to their home institutions.

Talking about different issues

Plain Language exercises

The staff from the Hadassah Hospitals (both Mount Scopus and Ein Kerem) also presented the “In Your Language” program that offers volunteer medical interpretation. They discussed the benefits and challenges of the program, including recruiting and keeping volunteer interpreters. They also presented 3 volunteers, who discussed the challenges they face, and how they deal with those challenges.   

The interpreters described a number of their experiences. One was a situation in which parents came along with their son, who suffered from diabetes. The doctor asked a lot of questions, including many nuanced questions about his everyday life, which were important for him to adjust the son’s medication and return him to everyday routine. Another example was that of a woman who suffered from repeated miscarriages. With the help of the interpreter, she received very specific instructions on different tests she was to take in order to try and prevent miscarriages in this pregnancy. There were many  more examples.

One of the challenges the interpreters face is that they are unable to be present at every situation that could be helped by medical interpretation. Another is that many of the doctors prefer in-person interpretation to telephone interpretation. A third is the emotional toll interpretation can take on the volunteers, who are often exposed to difficult situations and difficult illnesses. Thus, the support that Hadassah provides for its interpreters is of utmost importance.

Many thanks to the Jerusalem Foundation for their continued support of this program.

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2016 – What a Year!

As we jump head-first into 2017, we wanted to take a minute to reflect on 2016, and what a year it’s been! Overall, a year of unprecedented growth and development, and we can’t wait to get started in 2017. Here are some highlights:

Cultural Competence

  • The Jerusalem as a Culturally Competent City conference in May 2016, organized jointly by the JICC and the Jerusalem Foundation as part of its 50th anniversary celebrations, was a turning point for the JICC. Attended by hundreds of professionals, from Jerusalem and throughout Israel, the conference presented strides that have been made over the past 10 years, and set the stage for the next step of meeting diverse residents’ diverse needs, in all areas of life.
  • Continued work in the health care system, in Jerusalem and as a model throughout Israel, training in-house coordinators and facilitators to increase sustainability and adaptability within individual institutions. For the first time, work included a national network of hospitals and clinics.
  • Expansive work in the Israel Police Force, reaching most police stations and present and future commanding officials, and continuing to expand training in 2017.
  • Groundbreaking work with the National Insurance Institute (NII), East Jerusalem branch, the first NII branch in the country to undergo a process of cultural competence.
  • In the Jerusalem Municipality, the entire Community Services Administration, which includes welfare, public health, immigrant absorption, and more, is undergoing training, as well as the Auditor’s Office which will be able to look at the entire Municipality’s operations through the prism of cultural competency and sensitivity.
  • Santé Israël, the first web site to make Israel’s health care system accessible to French speakers, celebrated its first birthday. 
Ms. Uzma Shakir, Keynote Speaker

Ms. Uzma Shakir, Keynote Speaker, Jerusalem as a Culturally Competent City conference

Paramedical Professionals

Making healthcare practitioner exams accessible to Arab residents of east Jerusalem

2016 was an important year for us to take stock of the past four years of this program. Our conclusions show that:

  • The number of certified Arab paramedical professionals in East Jerusalem has grown significantly.
  • The program has enabled the JICC to more clearly map the situation of different paramedical professions in east Jerusalem, contributing to the knowledge of training in the Jerusalem area.
  • The awareness both among Palestinian institutes of higher education and health care institutions in east Jerusalem as well as Israeli Ministry of Health has been raised significantly.
  • A large window of opportunity for Arab women paramedical professionals to improve economic opportunities has been opened.

Nurses studying to pass their Israeli certification examinations

Talking Coexistence – Arabic Language Instruction

Both 2015 – 2016 and 2016 – 2017 broke enrollment records. In 2015-16 there were 180 students in 12 classes, over 5 levels. In 2016-2017, there are 240 students in 16 classes, also over 5 levels. We also held several cultural evenings to enrich students’ understanding of Arabic culture. Here’s a short video about the program:

Atta’a Assistance Center for the Rights of East Jerusalem Residents

The Atta’a Center has been in existence since 2004, and in 2015 it came under the aegis of the JICC. In 2016 we have seen:

  • 70% growth in number of requests
  • Ballooning of its Facebook page to over 7,100 ‘likes,’ and launching of its web site.
  • Publication of a widely-referenced booklet on the Ministry of Interior
  • Expansion of network of partners in action, both from NGO’s and advocacy groups as well as municipal and government agencies.

Atta’a Presenting workshops

MiniActive for Arab Residents of East Jerusalem

  • For the first time ever, MiniActive activities led to a change in policy. After months of campaigning, MiniActive led the way toward the addition of 3 million NIS to the annual municipal sanitation budget for east Jerusalem, and 16 million NIS for the purchase of additional equipment for sanitation. As a result of this work, the entire Municipality is focusing their attention on garbage collection throughout
  • In January 2016, MiniActive organized the first ever Arabic language Horticulture Therapy course in Jerusalem for special education teachers, in cooperation with the David Yellin Academic College of Education.
  • Bus stops in entire neighborhoods were repaired and replaced, thanks to MiniActive.
  • 210 women – including 50 youth – are studying Hebrew through a volunteer NGO to improve the effectivity of their activism. This is a record-breaking number, which broke last year’s record of 150 women.
  • In MiniActive Youth for the Environment, teenage girls learn leadership skills while participating in major environment-improving public art and other projects in neighborhoods throughout east Jerusalem.
  • MiniActive became a model for international work, hosting a delegation that works with the Roma population in the Czech Republic in November 2016.

Take a look at MiniActive’s own year in review. It’s pretty easy to understand, even if you don’t know Arabic:

Emergency Readiness Networks

In 2016 we expanded the network to include 14 communities throughout Jerusalem. In addition to training new volunteers, the program included training of existing networks to maintain ability to respond and increase sustainability.

Planning on map

Planning strategy on map

Multicultural Participatory Democracy

In 2016 we mentored community center staffs in Gilo, Kiryat Menachem, Givat Messuah, Baka’a and south Talpiot. For the first time, residents – especially the Ethiopian community in Kiryat Menachem and the highly diverse community of south Talpiot –felt that they were able to influence issues that affected their everyday lives. Training included using Facebook as a community-building tool key to increasing residents’ engagement in community processes.

Writing and submitting objections

Writing and submitting objections in Gilo

Promoting Tolerance in the Public Sphere

Since the summer of 2014 the JICC have been at the forefront of promoting tolerance in Jerusalem. 2016 accomplishments include:

  • A Different Day in Jerusalem celebrated Jerusalem’s diversity through 50 coordinated events, affecting tens of thousands of people on Jerusalem Day. It was the first time such a broad effort has been made to celebrate Jerusalem’s diversity.
  • JICC-mentored Speaking in the Square and other tolerance initiatives that came in their wake led to the redesigning of Zion Square, to be called Tolerance Square. The initiative’s Effective Dialogue methodology spread, and is now being presented in national frameworks.
  • 0202-Points of View from Jerusalem are now liked by nearly 80,000 people and reach some 150,000 people weekly on Facebook and the Internet. The network now includes pages that translate from Arabic to Hebrew, from Arabic to English and one which brings news from the Ultra-Orthodox world to the awareness of the general population.
  • The JICC was asked to be one of the leading organizations in the Coalition of Civil Society Organizations to Promote Tolerance, formed by the Center for Young Adults and the Municipality’s Young Authority.
  • The JICC is continuing to develop Tolerance Network Teams (TNT’s), a series of neighborhood-based and theme-based grassroots initiatives that seek to advance tolerance in Jerusalem.
Elhanan Miller Haaretz article

Haaretz article about A Different Day in Jerusalem

Window to Mount Zion

Since October 2015, Window to Mount Zion has bridged inter-religious and inter-community gaps that have festered between Jewish, Christian and Muslim groups for centuries. As a result of its activity over the past year:

  • In unheard-of cooperation, religious Jewish and Christian groups have issued joint statements condemning hate crimes on Mount Zion.
  • Christian ceremonies, which in the past have caused inter-religious tension, proceeded without incident.
  • The celebration of Christian and Jewish holidays that coincided simultaneously, which in the past had been the source of conflict and tension, also proceeded smoothly.
Window to Mount Zion volunteers

Window to Mount Zion volunteers

Asylum Seekers

The JICC, together with the Jerusalem Municipality, sponsor the only paid public servant in Israel to help asylum seekers, outside of Tel Aviv. We are also part of a consortium of organizations and agencies that seek to meet the needs of asylum seekers living in the city.

Tour of Nahlaot neighborhood

Families of asylum seekers on tour of Nahlaot neighborhood

Thank You!

Many many thanks go out to our partners in action and our donors. You can read about our activities in more detail either by clicking on the hyperlinks above, or by clicking here.

Looking forward to making 2017 even better!

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Assimilating Cultural Competency into the Very Fiber of Health Care

Second Cohort of Training the Trainers Course

For cultural competency in health care to work, it must be a system-wide implementation. That includes everyone – from administrators to practitioners to researchers at all levels – must undergo training. However, it was found that oftentimes it was difficult for doctors and senior staff to find time for the standard day-long training. The response – a need for shorter workshops, integrated into already-scheduled regular staff meetings. In order for this approach to work, more in-house trainers were needed. Thus was born our second cohort of Training the Trainers in cultural competency in health care, which ended on December 14. (You can read about the first cohort here.)

Graduating class #2

Graduating class #2

Most of the 25 participants come from Jerusalem-based institutions, in the course that is based at the Sha’are Zedek Medical Center. Participating institutions include: ALYN, Assaf Harofeh (near Rishon Lezion), Bnei Zion Hospital in Haifa (Nursing School), Western Galilee Medical Center in Nahariya, and 15 from Sha’are Zedek itself.

This second course is an example of how Cultural Competency in Health Care is passing the ownership of and responsibility for culturally competent processes onto the institutions themselves, enabling each to adapt the principles in a way that best meets their individual needs. We can’t wait to see how this program continues to develop.

Many thanks to the Jerusalem Foundation for their continuing support of this program. As we have seen over the years, this program is a critical part of the Foundation’s vision and mission to provide opportunities to cultivate shared living in Jerusalem. They were also very excited about the completion of this course, and wrote about it here.

 

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Bon anniversaire, Santé Israël! Happy Birthday Santé Israël!

Bon anniversaire, Santé Israël!

Happy first birthday, Santé Israël!

Just one year ago on September 1, 2015, Sante Israel, www.sante.org.il, which we developed in partnership with the Pharmadom Foundation and the Rashi Foundation, and the first web site that makes Israel’s health care system accessible to French speakers, went live. The site is a treasure trove of information about all aspects of the Israeli health care system, and enables French speakers to more easily navigate the system.

The Sante Israel web site

The Sante Israel web site

Over the year some 10,000 people visited the site, most from Israel but also 2,000 from France. The most popular page on the site was and continues to be the database of French-speaking professionals and clinics in different fields in Israel. Other popular pages include contact numbers, the page that directs you to the nearest clinic or hospital via the Waze mobile app, the page that tells you what your favorite medication is called in Israel, and more. And if you had any questions that weren’t on the site, you can ask the Director of Santé Israël, Marie Avigad, and she answered every query very quickly.

This past year Santé Israël did not stay behind the screen, and went out into the community to continue to make Israel’s health care system more accessible to French speakers.

Discussing health under the stars

Discussing health under the stars in Baka’a

They held a number of community meetings throughout Jerusalem, in areas such as Bayit Vegan, Baka’a and Har Homa, which have sizable Francophone communities.

Sante in Har Homa

Sante in Har Homa

They developed a Facebook page, which provides updates on a variety of health-related issues, as well as news of the Santé Israël community. They spread the word about new Israeli inventions relating to health care:

New developments by the different HMO’s

As well as health warnings and updates from the Ministry of Health (such as recent salmonella warnings and other potential health hazards).

They participated in the Jerusalem as a Culturally Competent City Conference that was held in cooperation with the Jerusalem Foundation on May 17, 2016.

Sante Israel together with other health care organizations at the Cultural Competency conference

Sante Israel together with other health care organizations at the Cultural Competency conference

And they participated in the  “Olimpiada” Aliyah information fair for French-speaking new immigrants, which was held at Sacher Park in the middle of town and was organized by Qualita .

"The first site to respond in French to your questions about the Israeli health care system

“The first site to respond in French to your questions about the Israeli health care system”

In addition, Santé Israël just began a partnership with AMI Israel, which helps French-speaking Olim in Israel. And Santé Israël has its own page on the AMI Israel web site. Here’s the Facebook post from Santé Israël:

So Mazal Tov to Santé Israël! May you have many more happy birthdays.

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“What do you say when…..” – Keeping Medical Standards High with Medical Interpreters

As a genetic counselor, what do you say when a family is struggling with infertility, or their unborn fetus has been diagnosed with a genetically-transmitted disease? How do you broach these subjects with Arab patients, or Haredi patients, or patients from different countries, where it is not acceptable to talk in public about issues relating to the child-bearing process? And how does the medical interpreter, who himself often comes from that community but is not trained in the discipline, deal with these questions?

Medical interpreting for genetic counseling was the subject of a recent workshop we facilitated for 18 Jerusalem-based medical interpreters from Hadassah (Ein Kerem and Mount Scopus) and Sha’are Zedek (main hospital and Bikor Holim, which is now part of Sha’are Zedek) – Russian, Amharic, Yiddish and Arabic-speakers in addition to Hebrew. We’re proud to have been a major part of the training and assimilation process of medical interpreters in Jerusalem, which the hospitals now consider an integral part of their care. (We’ve written here and here about these trainings in the past.) Like other aspects of professional healthcare, it is important for medical interpreters to maintain their skills through periodic professional development, and this workshop was part of an ongoing process of supervision and mentoring of the medical interpreters.

Discussing experiences in medical interpreting

Discussing experiences in medical interpreting

We chose to concentrate on genetic counseling because of its multi-layered complexity. According to the US-based Centers for Disease Control and Prevention, in genetic counseling, “specially-trained professionals help people learn about genetic conditions, find out their chances of being affected by or having a child or other family member with a genetic condition, and make informed decisions about testing and treatment.”  Because it brings together many different scientific disciplines, it is very difficult to understand, even for someone who studied advanced science. In addition, meetings with genetic counselors are stressful from the get-go, since one is consulted only when there is a problem (or a potential problem) in the child-bearing process – either before conception, during pregnancy, or after the birth of a child with genetic problems. Add to this the different approaches and viewpoints that different cultures have to the different stages of the child-bearing process, as well as their outlook on children with special needs – and the meeting with the genetic counselor is even more tension.

And when the medical interpreter is tasked with being the agent of communication during such a stress-filled meeting, it can be one of the more challenging of situations. Medical interpreters are trained to translate for all types of medical issues from cardiology to orthopedics to oncology, and are not trained as genetic counselors themselves. Sometimes, they feel uneasy with the subject matter, since it often breaches sensitive issues such as birth defects, sex, ending of a pregnancy, and sometimes their initial reaction is to skip over probing questions. At the same time, these questions are vital to the genetic counseling process, and it is critical that an experienced interpreter translate everything.

In the meeting we approached the subject from a number of different angles. After an opening exercise that focused on professional dilemmas in interpretation, participants heard a lecture from Shachar, a genetic consultant from Sha’are Zedek. They learned about the field of genetic counseling, for whom it’s targeted, the challenges in meeting with patients and the challenges in interpreting for patients. The genetic counseling process seeks to understand and evaluate medical and psychological information as well as family complexities related to genetic diseases. In addition to understanding the situation, genetic counselors also try to understand the different options appropriate for each patient and their families. This is why interpersonal communication, and interpreting into the patients’ native language, is of utmost importance.

After the lecture the interpreters discussed a number of challenges they’ve faced. In one example, a patient, who didn’t have the patience to hear what the genetic counselor was saying, told the interpreter, “Just tell her [the genetic counselor] whatever you want.”  Such an answer is sometimes difficult to translate, and makes the interpreter feel uncomfortable, but from the standpoint of the genetic counselor it is actually important information in the communication process between them. In this case, the interpreter must overcome his or her discomfort and translate exactly what was said.

They also discussed mediating and advocacy in medical interpretation – two terms that mean a deeper involvement of the interpreter in the meeting. They discussed situations in which these unusual cases might take place, and especially how to do it correctly.

In the end, they broke up into groups according to non-Hebrew language, and different lecturers taught terms specific to genetic counseling, pregnancy and birth in Arabic, Russian, Amharic, and Yiddish.

We hope to have additional peer learning sessions for medical interpreters in Jerusalem – they deserve it! We’ll keep you posted here!

Many thanks to the Jerusalem Foundation for its continued support of cultural competency in health care in Jerusalem.

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2016-08-26T14:22:44+00:00 July 21st, 2016|Blog, Cultural Competence, Cultural Competence in Health Services|

End of Cultural Competency Training the Trainers Course at Assuta Hospitals

We’re writing here to report about the end of a series, but it’s actually just the beginning of a process.

When I talk about cultural competency I feel....

When I talk about cultural competency I feel….

We wrote here about the beginning of Training the Trainer workshops on Cultural Competency at the Assuta Medical Center Hospital and Medical Center system for 60 professionals from their School of Professionalism (They have been chosen as outstanding in their respective fields). This is the first time ever that an entire chain of health care centers has undergone such a process.

Assuta Medical Center

Assuta Medical Center

We met with these professionals for three full days (the last was last week), in which they received tools, knowledge and insights into how to facilitate cultural competency workshops. Since the beginning of June they have been leading the workshops. In October, they will present cultural cultural competency workshops to all of Assuta’s 2,800 employees.

Facilitating the workshop

Facilitating the workshop

The workshops included peer learning according to different cases. One participant told of a critically ill patient from a religious family. It was clear that the patient’s days were numbered. The family emphatically insisted on hooking him up to a sophisticated machine that was very noisy, expensive to operate, and did not help him medically in any way. Only when the medical staff asked why they insisted on this specific machine, they explained that it was important for them to know exactly when the patient died, so they knew when his soul left his body and they could say the Shema Yisrael prayer. Upon hearing this, and understanding that it was part of the family’s mourning process, they found other solutions. In the end, it was found that a simple, quiet blood pressure monitor would suffice for the family. Thus, the family was able to mourn in the way it needed to, without being an unnecessary burden on hospital resources.

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