Cultural Competence in Health Services | The Jerusalem Intercultural Center

Remote Medical Interpretation during the Coronavirus Crisis

Today’s world of coronavirus has, on the one hand, brought health care front and center. On the other hand, it has raised numerous new challenges, such as in the world of interpreting, especially – but not only – in medical interpreting.

The world of interpreting (oral translation) is undergoing significant changes during this period. Interpreters in meetings and conferences need to adapt to new conditions, such as the fact that they’re not in the same room or hall as the participants. They also do not always have the appropriate technical equipment to translate without interruption – sometime there is an unstable Internet connection, sometimes they need to translate to multiple participants, some of whom have background noise. In general – the overall uncertainty of this entire situation has upended the norms we had been used to.

Zoom on remote interpreting

Medical interpretation has faced significant challenges in Corona times. Since caregivers must provide urgent care to a broad range of communities, medical interpreters are more essential than ever. However, because of the rapid changes in healthcare provision – both for “regular” patients as well as for those with the coronavirus – many problems arise. For example, according to this recent report from the United States, in some cases, minorities who do not speak English receive misinformation or no information at all because there is no easy and available way to communicate with them through translation. In other cases, medical interpreters are exposed to infection because they do not receive minimal personal protective equipment (PPE) such as face masks. Many healthcare services did not prepare in time to provide remote interpretation services, and caregivers are not trained in using telephone or video interpretation.

At the same time, many interpreters are at home, some of them losing their jobs because they were mainly engaged in face-to face interpretation. Alongside the many difficulties, this situation can also be a great opportunity for learning and professional development. In recent weeks there have been numerous webinars about remote interpretation and we decided to be the first to discuss it in Israel.

Over 30 people in meeting

This week we held a special Zoom meeting on “Remote Interpretation during the Corona Period.” At the meeting, we presented the benefits and challenges of remote interpretation (which existed only in healthcare in Israel before the crisis), technology infrastructure necessary for remote interpretation, and tips for entering the field for interpreters who had not performed this kind of interpreting before. More than 30 interpreters: graduates of our medical interpreting courses, freelance interpreters, and students, participated.

Among the participants were representatives of the Tene Briut organization, which operates Voice for Health, the first telephone medical interpreting service in Israel. Iris Malako, a medical interpreter who was a former cultural mediator, presented the difference between face-to-face interpreting, cultural mediation, and telephone interpreting. Remote interpreting is more complex emotionally, technically, and from a communication standpoint, but it does have many benefits – it is immediate, focused, and there is more anonymity for the patient (which is why patients from a small community like Ethiopian-Israelis are happy to use it when discussing sensitive issues).

Iris Malako and Ilan Yavor, a Hebrew-English conference interpreter, helped us illustrate simultaneous remote interpreting, and we introduced several other technology infrastructures that allow freelance interpreters to provide this service from home.

The response to the meeting was excellent, and we hope it will encourage interpreters to learn more about remote interpreting now, and for the future, and broaden their professional skills.

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

rachelly2020-05-16T05:59:23+00:00May 1st, 2020|Blog, Cultural Competence, Cultural Competence in Health Services|

Diversity Management Workshop in Mental Health – for Kfar Shaul

This isn’t the first time we’ve worked with the Jerusalem Mental Health Center at Kfar Shaul, and with practitioners in mental health. You can read more about our previous work here and here.

On February 24, 2020 we began a series of four workshops, together with the Jerusalem Mental Health Center at Kfar Shaul, led by our Orna Shani-Golan and Michal Schuster.

אורנה שני פותחת את סדנת ניהול הגיוון בכפר שאול

Orna Shani-Golan at the first meeting of the Diversity Management Workshop in Mental Health – for Kfar Shaul

In these four sessions, we’ll share knowledge, tools, skills, and we’ll hold deep discussions about the implications of diversity and how to include all the identities represented in the organization in its activities.

In the first session, we introduced the principles of cultural competency to the different types of caregivers, administrators, and human resources department, and discussed how they can be used to guide effective responses for the patients, taking into consideration the cultural backgrounds of both patients and staff, which come from a variety of backgrounds. Participants were asked to choose one thing that they’d like to change in order to advance cultural competency at Kfar Shaul, and we’ll help them see it through.

Here’s Rachely’s Hebrew post from the first workshop in late February:

Many thanks to the Jerusalem Foundation for its continued support of Cultural Competency since its inception in 2008.

rachelly2020-04-11T14:42:15+00:00March 20th, 2020|Cultural Competence, Cultural Competence in Health Services|

JICC Cross-Pollination – Living Safer, Living Longer and Cultural Competence Training at Sha’re Zedek

We continue to hold Cultural Competence meetings for workers at Sha’are Zedek Medical Center. You can read more about our work with Sha’are Zedek here, here and here.

The hospital continues to provide professional enrichment to those who went through our medical interpretation course. These employees speak a range of languages, including Arabic, Russian, Amharic and French. This time, the enrichment covered preventive health and home safety. Our Aliza Shabo-Hayut, Director of our Living Safer, Living Longer project, gave the lecture.

Learning about preventive health and home safety measures

Living Safer, Living Longer seeks to reduce one of the largest problems in preventive health and home safety – procrastination. We know it’s important to perform periodic examinations and tests for the early detection of different illnesses – periodic examinations by the family doctor, mammograms for women, tests for colon cancer, and more. But the daily hustle and bustle of work and family often get in the way, as do personal and cultural fears. This leads to missing opportunities for detecting serious illnesses early. As part of the presentation, Aliza and the participants shared personal stories of early detection, which saved lives – routine skin examination, detecting of a lump in the breast and more. We hope that the employees will use this information to promote their own health and that of their family members, and serve as ambassadors for preventive health and home safety.

Learning terms, learning about tests

Afterward, we held a practice exercise related to interpretation. The participants learned about the advantages of working on online documents (such as Google Docs), where a number of people can upload and update terms for translation at the same time, to the same document. The translation instructors will review the terms translated on the document so that an accurate, up-to-date and professional file of health-related terms – for children as well as adults – can be created.

We were also happy to see that the hospital felt that the interpreters’ visibility was important as well – new tags have been made for them to use when translating! This is how we advance professional medical interpreting, showing that medical interpreting is indeed an added skill, and not everyone can translate. Well done to the hospital management.

New tags in languages they need

Many thanks to the Jerusalem Foundation for their continued support for Cultural Competence in Jerusalem for more than 10 years.

Naomi Roff2020-04-18T13:39:28+00:00March 11th, 2020|Blog, Cultural Competence, Cultural Competence in Health Services, Living Safer Living Longer|

Continuing Cultural Competency Training at the Herzfeld Geriatric Hospital

Herzfeld Rehabilitation Hospital in Gedera has begun a process of cultural competence and we’re proud to be part of it. You can read more about our first meeting, here. The hospital belongs to the Clalit Health Services and specializes in the care, support and rehabilitation of elderly patients, and for those with complex medical conditions. We’ve delivered two workshops at the hospital, and the tools and principles of cultural competency that included in the workshops were specially adapted for the needs of the hospital. Communication at the hospital takes place not only with the patients but also with their families, guardians, and caregivers, often patients’ foreign caregivers who stay alongside the patients.

A second cultural competency workshop at the Herzfeld Geriatric Hospital

About 40 employees from all professions and cultural identities participated in the workshops, the second of which took place on December 23, 2019. In the accepting atmosphere of the workshop, the different caregiving professionals shared their experiences and dilemmas. One participant shared the process with the family whose young son was on a respirator in the hospital. The father, a dominant figure in the family, who is also the guardian, is very worried about his son but sometimes his involvement can hurt the son’s treatment. The other family members cannot challenge the authority of the father, who is also the head of the clan. Sensitive and creative ways were needed to keep the son without hurting the father.

Another issue was, how do we deal both with the need for patients to rest, and with the fact that different cultural traditions encourage visits from friends and family during visiting hours? How can we How to overcome religious, cultural and gender conflicts in the food that is served at the hospital?

Learning through real-life examples

And one of the cases that made us most emotional – the daughter of an elderly Ethiopian patient, who is determined to comply with her mother’s demand not to amputate her leg, even if it costs her her life. The need to respect the mother’s wishes at all costs, which was met with a patronizing attitude from one of the professionals. The daughter was torn between different cultural values - respect for her mother’s wishes, respect for medical authority, difficulty in directly challenging authority figures, and a loss of faith in the system.

This story served as the basis for our practice session, with experienced medical actress Hanin Tarbia, who has been working with the JICC for a decade.

Here’s feedback we received from the hospital administration:

We would like to acknowledge the great privilege that we have had in participating in the fascinating workshop you delivered today to the staff of the Herzfeld Geriatric Hospital. The workshop was instructive, enlightening, empowering and very interesting. Your easy-to-understand language, the accessibility of the tools you taught and your vast amount of knowledge, alongside your extraordinary sensitivity and humor, will accompany us and all the participants of the workshop!

The participants felt comfortable participating and sharing and expressed a great deal of interest in this important topic, and were thirsty for the large amount of information they received.

We, too, at the JICC hope that we helped the hospital establish the foundations for a meaningful process of assimilating the principles of cultural competency at the hospital. There is no doubt that the dedicated staff who participated in the workshop can serve as ambassadors for assimilating tools and principles of cultural competence in the hospital.

Many thanks to Herzfeld Medical Center for organizing the workshop.

Naomi Roff2020-01-10T20:56:08+00:00January 8th, 2020|Blog, Cultural Competence, Cultural Competence in Health Services|

Semi-Annual Meeting of Healthcare Cultural Competency Coordinators at the JICC

For the past three years, we have organized a semi-annual meeting of Healthcare Cultural Competency Coordinators. Most of the Coordinators are from Jerusalem, but the meeting is open to Coordinators from throughout the country. This meeting was held on December 4, 2019 at the JICC’s offices on Mount Zion.

This meeting focused on two subjects: our own Living Safer, Living Longer project, and the experience of the Haifa-based Bnei Zion Hospital in assimilating principles of cultural competence in the hospital.

Aliza Shabo-Hayut, director of the Living Safer, Living Longer project, gave a short introduction and explained the connection to cultural competency. She explained that it was imperative that the project be culturally competent for it to succeed, since it teaches home safety and preventive health to the elderly and young families through awareness-raising and individual mentoring by volunteers, and the ways to achieve this are laden with culturally sensitive issues in different populations, especially in the Haredi and Arab sectors. Currently, the project operates only in Jerusalem, but the model can be copied and replicated throughout the country.

Aliza explains about Living Safer, Living Longer

Making the project fully culturally competent was not an easy task, it essentially meant needing to create and develop 3 different projects – one for the ‘general’ Jewish population, one for the Haredi population, and one for the Arab population. Content (from flyers and posters to explanatory materials for lectures and mentoring sessions) and training methods were specifically tailored for each group (appropriate for Haredi, Arab as well as ‘general’ Jewish beneficiaries), as were training aides, explanatory materials. Volunteers needed to be recruited and trained in each group as well. Checklists of what the volunteers were looking for in the homes were also adapted to both the age (elderly vs. young families) and group with which they were associated. For example, chains to secure hot water urns (used on Shabbat and often the cause of burns among Haredi children) are distributed in Haredi families, whereas there is no need for this in other groups.

We also welcomed special guests from the Bnei Zion hospital in Haifa, who shared their experience of assimilating cultural competence in the hospital. Orly Altman, a general nurse and the Cultural Competency Coordinator at Bnei Zion, and Ragda Halabi, a midwife at the hospital, told how the project began and gave a short lecture.

Orly said that the first step was to establish a steering committee for cultural competency that consisted of representatives from a variety of communities, with a goal to train agents of change to promote cultural competency that promotes mutual respect and human dignity. The committee created a document with important information about each community, including the rules of “do’s and don’ts,” and each member of the committee built a training session about the community to which he or she belongs, and chose how to present it.

Orly, presenting her experience at Bnei Zion Hospital in Haifa

Ragda, a member of the Druze community, introduced us to the principles of the Druze religion: the life cycle and different rituals, the status of women, visitng the sick, escorting Druze religious women for medical exams and more.

The meeting was fascinating and the participants learned more about Druze culture and religion and their connections to health.

Thanks to Michal Schuster for organizing the meetings. And of course, many thanks to the Jerusalem Foundation, for its continued support of Cultural Competency over the past decade.

orna2019-12-23T07:32:24+00:00December 15th, 2019|Blog, Cultural Competence in Health Services, Living Safer Living Longer|

Cultural Competence Workshop at Herzfeld Geriatric Hospital

Herzfeld Geriatric Rehabilitation Medical Center, operated by the Clalit Health Services, is located in the southern town of Gadera and serves populations in the Gadera / Rehovot area. As part of the hospital’s efforts to integrate cultural competency into the hospital, we were invited to lead Cultural Competency workshops for staff members.

Cultural Competency workshop at Herzfeld Geriatric Hospital

The workshop, which took place on November 21, included staff from all professions in the hospital – doctors, nurses, paramedical and administration – who shared with us the unique challenges of caring for an elderly population, often for a long time. Patients from different cultural groups come to the hospital, often accompanied by foreign workers. Family involvement is also a key factor, as are the physical, mental, and cognitive difficulties of the older people. The staff itself is also very diverse, sometimes assisting patients or families from his or her cultural group in bridging cultural gaps. On the other hand, treating a person from one’s own group can also cause conflicts and dilemmas. One participant told of how she recently gave birth, and in her culture it is customary to give money to the mother right after giving birth. One of the patients approached her during a shift and gave her money. What should she have done? On the one hand, she’s not allowed to receive money or gifts from patients. On the other – this was a cultural convention and it is difficult to change older people’s habits, especially in this type of situation.

In the workshop, we talked about our key cultural values and those of the patients. We tried to identify them in hospital situations, find ways to bridge the gaps, and most importantly – try to interpret behavior, which may at first seem strange or even irritating to us, positively.

Discussing important cases and different cultural situations

In order to understand worldviews, practices and health considerations of a patient, dialogue is a must. Such a conversation, which is based on asking open questions, is especially important when there are gaps between the caregiver and the patient. After watching a short tutorial video produced by the JICC, the participants shared how they identified with the cases where different people in the room have different agendas, and it is the caregiver’s job is to reveal them, and to consider them when communicating with the patient and those accompanying him.

As part of the discussion, we also talked about cases where cultural competence is not the correct or desired response – cases in which adapting to one patient will hurt another (family member or staff member), or when it would cause unethical medical behavior (such as delivering bad news to the patient instead of his or her family, as is customary in some cultures).

The workshop opened up new horizons for all. One participant commented:

We would like to thank you for the great privilege of participating in the fascinating workshop you delivered today for staff at the Herzfeld Geriatric Rehabilitation Hospital Rehabilitation. The workshop was instructive, enlightening, empowering and interesting. Your excellent delivery, the accessibility of the tools you taught and the vast amount of knowledge you have, along with the extraordinary sensitivity and humor will accompany us and all the participants of the workshop! Participants felt comfortable in taking part and in sharing, and expressed great interest in this important topic and were thirsty for the great amount of information they received. Looking forward to the [next] long workshop.

In our next workshop we’ll work with a professional actress, who will help participants to practice the tools they learned, including through role playing.

Many thanks to Herzfeld Medical Center for organizing the meeting and assistance in preparing the content adapted to their needs.

Naomi Roff2019-11-29T13:52:21+00:00November 28th, 2019|Cultural Competence, Cultural Competence in Health Services|

Cultural Competency Renewing Skills at Sha’are Zedek

In recent years, we, together with the Shaare Zedek Medical Center, have organized two training courses in medical interpreting. Both courses were joined by bilingual workers and volunteers from Hadassah and ALYN hospitals.

It is very important for Sha’are Zedek to maintain the interpreters’ professional skills, who are called on to translate and interpret patient encounters, in addition to their daily work, sometimes several times a day. Therefore, these professional development days are organized, not only to give them additional skills and updates, but also as a way to appreciate their work.

Encounter for Medical Interpreters

In late June we held a meeting that was attended by interpreters who speak Arabic, Russian, Amharic and French.

We started the day with a discussion about advanced technological tools (artificial intelligence) that can help medical interpreters, and the biggest question of all – can a robot replace the medical interpreter? The answer right now is – absolutely not. Artificial Intelligence experts have made great progress in developing automatic translation tools, or tools to assist interpreters during work (currently for conference interpreters only). But these tools are not yet designed to deal with the unique features of medical interpreting – silence, repetition, a great deal of emotion, slang, various dialects and more. Not to mention complex situations and ethical dilemmas (the husband does not want the interpreter to translate into a wife, for example).

In short – artificial intelligence technologies for translating human languages are getting better every day. What looks like science fiction today will probably be a reality in a year. These tools will not replace human medical interpreters, but it is important to follow the developing technologies to see how we can improve the quality of medical interpretation, without fear of being replaced by robots.

Afterward, Shweki Majed, a hospital employee who is also a regular interpreter and who has taken several interpreting courses, shared with the newer interpreters how interpreting changed him personally and professionally. He told stories openly and honestly of dilemmas he encountered. Here’s an amusing story – One day, as part of his job as an interpreter he translated in the first/ second person, as advised in the training (“you should take the medicine” instrad of “the doctor tells you to take the medicine). Afterward, the patient insisted that he was the doctor, and not the actual doctor. After a few months, they met again at a family event and the person again insisted he was the doctor who treated them. No explanations helped …

Shweki Majed speaking to the forum

Ms. Vered Huber – Machlin, Director of the hospital’s Physical Therapy Department, was the third speaker. She has studied the field of patient experience. The health system and physicians are often focused on the illness, and she is bringing the field of medical interpreting to a patient-centered treatment regime – how the disease affects him, his concerns, the basic information he needs to receive, and ways to get him involved in the treatment. She talked about the interpreter’s unique role in this context, as well as its limits.

Interpretation as part of a patient-centered experience

Many thanks to everyone who organized this wonderful day, and especially to Tali Arazi and Efrat Cohen.

And of course, many thanks to the Jerusalem Foundation, for its continued support of Cultural Competency over the past decade.

Naomi Roff2019-09-15T15:28:50+00:00July 18th, 2019|Attaa, Cultural Competence, Cultural Competence in Health Services|

Graduating a New Class of Medical Interpreters

On April 16 we held our graduation ceremony for yet another class of medical interpreters. It marked the completion of a 45-hour course in basic skills of medical interpreting, which was held at Shaare Zedek Medical Center.

Integrating more medical interpreters into health care staffs

The course helped people working in medical institutions to learn interpretation skills in order to volunteer in the institution in which they work. The 27 participants came from Shaare Zedek, Hadassah Ein Kerem, ALYN Rehabilitative Hospital, as well as additional places outside of Jerusalem. The course dealt both with principles of interpreting, various issues in the field, as well as relevant vocabulary in Arabic, Amharic, Russian and French. A special thank-you goes to Messele Mamo, who joined the team at the last minute to teach the section for Amharic-speakers.

Course graduates are already being integrated into interpreting teams in the institutions in which they work. We just got an SMS from one participant, thanking us for the tools he learned in the course, and exclaiming how they help him make health care more accessible to the French-speaking patients he translates for.

Many thanks to Dr. Adit Dayan, Director of Community Services at the Jerusalem Foundation, who distributed the graduation certificates. And many thanks to the Jerusalem Foundation for its strategic partnership in developing Cultural Competency for more than the past decade.

Naomi Roff2019-05-11T04:38:43+00:00April 29th, 2019|Blog, Cultural Competence, Cultural Competence in Health Services|

Course for Medical Interpreters in Jerusalem

Have you ever waited for a doctor’s appointment at an outpatient clinic and the nurse comes out and asks, “Can someone help us in translating into Arabic / Russian/ Amharic / French?” Usually, a passer-by will volunteer to help translate the conversation between the specialist and the embarrassed patient, whose secrets are now being exposed to an inexperienced stranger at best. Research tells us the chances are that the quality of translation will be poor, and the chances of making a mistake in such a non-professional translation are very high. And who knows what the quality of health care will be like?

Medical Interpreting Course held at Sha’are Zedek Medical Center

In January 2019 we opened another course for medical interpreting (i.e. oral translation) skills for medical professionals and volunteers in Jerusalem hospitals. There, the 30 participants are learning to do it right. (because even the Russian and Hebrew-speaking nurse will interpret poorly if he or she hasn’t learned best practices, ethics and proper terminology.) Participants come from Hadassah, Sha’are Zedek, ALYN Rehabilitative Hospitals. There are also some independent participants.

30 participants, from throughout Jerusalem

Our Dr. Michal Schuster, who has led with us the field of Cultural Competency for over a decade, is leading the course. She’s noted, “One of the things I most like to do in these courses is to take things apart and build them back up. To deconstruct existing viewpoints (either conscious and unconscious) about language, translation and interpreting, and, together with the participants, build a strong basis for proper and more accurate interpreting. It’s not an easy process at all – neither for me nor for them – but it is very rewarding.”

The team working with Michal are the language experts: Tanya Voinova, Salih Sawaed and Messale Mamo.

Learning what medical interpretation is, its main challenges, and why it is so complex

One more step in making Jerusalem friendlier – and more culturally competent and culturally sensitive – to all its residents.

Many thanks to our partners

This course could not have taken place without the partnership of the Jerusalem Foundation, our strategic partner in Cultural Competency for over a decade. And many thanks to our partners in action Sha’are Zedek Medical Center (who are graciously hosting the course), Hadassah Medical Center, and Alyn Pediatric and Adolescent Rehabilitation Center.

Here’s the Facebook post written by our Director, Hagai Agmon-Snir:

And Michal’s post:

Naomi Roff2019-03-02T12:43:12+00:00February 24th, 2019|Blog, Cultural Competence, Cultural Competence in Health Services|

Celebrating a Decade of Cultural Competency and Looking to the Future

Over the past year we, together with the Alyn Rehabilitative Hospital, the Jerusalem Foundation, and numerous partners in the field, have been celebrating a decade of cultural competency. (You can read about this here, here, here and here.)

On Monday, December 17, 2018 we held the final event – a panel entitled, “Where do we go from here?”

“Where now?” with leaders in the field

Panelists included: Nawal Aliyan – Nubader, from the Novader organization, Shaher Shabane, Chair of the Parents Forum for Children with Special Needs in East Jerusalem, Ariel Kandel, from the Qualita Organization for French-speaking Olim, Ella Mano, Director of Public Health Services and Early Childhood from the Jerusalem Municipality, and Dr. Maurit Be’eri, who began the journey with us a decade ago, and who today is the Director of ALYN.

“It was both exciting and sad to hear the personal stories from East Jerusalem,” noted our own Dr. Michal Schuster in her Facebook post afterward. “Parents who are not aware of their children’s rights, who, because of the stigma [against people with disabilities] are not integrated into society and are closed in at home.”

Ariel Kandel, spoke about the French-speaking population’s difficulties here. While they might not be as severe as those from East Jerusalem, there are difficulties nonetheless – language difficulties, economic difficulties as new immigrants, shock from Israeli bureaucracy, and more. Ariel told of someone who went to the emergency room with a headache, and the doctor told him that there’s nothing to worry about and that he take a pill. The man understood that he had a tumor…..

Relating issues and complexities of cultural competency

It is difficult for service providers as well. Ella Mano told about the issues and conflicts nurses in Well-Baby Clinics are facing now, as they try to prevent the spread of measles, even though the very nature of the Well-Baby Clinics must be culturally competent, in order for the clinics to gain the trust of the parents.

Dr. Be’eri described the frustration that jump started the process in 2008 at ALYN, when they stopped and started to ask why patients weren’t advancing from checkup to checkup, and were even getting worse. And they decided to see what they were doing wrong.

Sharing with other cultural competency professionals

What a change the hospital has gone through.

“Lots of circles were closed today, and I hope it’s the start of Cultural Competency, the 3rd Generation,” summed up Michal.

And of course, many thanks to our partners in the journey – the ALYN Rehabilitative Hospital, the Jerusalem Foundation, and our many partners in action.

Naomi Roff2019-01-19T16:04:08+00:00December 31st, 2018|Blog, Cultural Competence, Cultural Competence in Academic Institutions, Cultural Competence in Government Institutions, Cultural Competence in Health Services, Cultural Competence in Jerusalem Municipality, Identity Groups and Conflicts|

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