Cultural Competence in Health Services | The Jerusalem Intercultural Center

Building a Network of Services for Asylum Seekers in Jerusalem

We last described some of the efforts that we’re making to help African asylum seekers living in Jerusalem here . But in looking back since our first post on the subject in August 2013, we can be very, very proud. Not only can we report about achievements here and there, we can describe a whole network of services – from health care, to education, to employment, to social and welfare rights – that we have developed, together with a wide range of partners, from the Jerusalem Municipality, the Jerusalem Foundation, Jerusalem African Community Center (JACC), and many more. All work in tandem with the part-time coordinator we support, together with the municipality, to help to improve the quality of life of African asylum seekers in Jerusalem.As our Tal Kligman noted, “to have such a complete network of services after such a short time for a relatively small group of people, is nothing short of amazing. the community of African asylum seekers in Jerusalem has many needs and they are in a very difficult situation. But they are on the map, and there is a whole consortium of agencies and organizations that is looking out for them. We are proud to be part of this endeavor.” While the needs are very great, below are some examples of how far we’ve come.

Tour of Nahlaot neighborhood

Health Care. We’ve been working with the Meuchedet Health Services, which provides health care to most of the asylum seekers in Jerusalem. (Read here for an earlier blog post). This cooperation has continued, with vaccination drives for children, translation of forms to Tigrinya (the language spoken by asylum seekers from Eritrea, the most populous group), and ongoing work with the help of our Cultural Competency desk. There has also been joint work with the local well-baby clinic. We wrote here about the first aid evening for mothers that we held last year (including the black baby manikin that was used for CPR), followed by other first aid courses and workshops for parents. Workers and volunteers were on hand at the clinic on days they brought their children, to help them with language and other issues.

Education. We are part of an early childhood forum, which also includes the JEA, municipal welfare department, community representatives and other organizations, which seek to discuss the needs of the community and explore responses. We helped to translate school and kindergarten registration forms into Tigrinya, provided translation services during parent teacher conferences in the kindergartens. Together with the Jerusalem Education Authority (JEA), we held special registration days for public kindergartens with translators on hand, which included translating the registration forms, in the late afternoons and evenings, when the working parents were off work. These evenings were crazy (as in, not very orderly, but what can you expect with 3-4 year-old children running around in the evening?), but also very, very important. Until now, registration was either via the municipality’s web site (which is in Hebrew only), or physically, at the municipality building, which is also in Hebrew. Some children were registered and did attend municipal frameworks, but there were too many incidents where young children were left alone while their parents were at work. These included reports of a 4-year old child was seen wandering the streets unsupervised, or of a 3-year old girl who was babysitting for her younger siblings when her parents were at work. These children need to be in constructive frameworks.

Work with the children of asylum seekers doesn’t end with placing them in kindergartens. When there, many do not know Hebrew, which leads to behavioral problems and cognitive delays. In order to help the children, as well as the parents and the teachers, this past year the children were given didactic evaluations, thanks to the Jerusalem Foundation. The evaluations will enable the children to receive extra assistance, and help the teachers to integrate the children better into their classes.

Social Services. Programs included:

A parenting program operated by the municipal welfare department, targeting parents and children, aiming to strengthen parenting skills.
An information evening about workers’ rights, operated by the Lev Ha’Ir Community Council, together with the Worker’s Hotline organization and JACC.

In a community garden

Community. A number of initiatives aimed at integrating the community better into the general Jerusalem community. These programs are in cooperation with the Center for International Migration and Integration (CIMI) and the Lev Ha’Ir Community Council, which provides programming for all populations in the city center. Activities included:

Meetings between Israelis and asylum seekers
Story hour for Israelis as well as asylum seekers, featuring a story about about children of asylum seekers.
Hosting in neighborhood Sukkoth during the Sukkoth holiday.
Tour of the Nahlaot neighborhood, showing community members the different institutions, community gardens, and stories of the neighborhood. Participants said that this tour was something special. There were dozens of children and their parents who ran through the alleyways of Nahlaot, most of them African asylum seekers, and some Israelis. At the Community Center the community social worker told them about the different activities and services available there, and invited families to take part. At the Barbur Gallery the children made plants in the community garden and the director told them about the place itself and the community gardens in the area.

Naomi Roff2016-12-14T19:19:42+00:00June 8th, 2015|Asylum Seekers, Blog, Cultural Competence, Cultural Competence in Health Services, Identity Groups and Conflicts|

Working with Maccabi Health Services

What if all Israeli kupot holim (HMO’s) were culturally competent, from the bottom up and from the top-down? What if every time you went to the doctor, he or she – and the administrative support staff – would be better able to meet your needs, speak in your native language (or have access to someone who could), understand where your coming from, culturally speaking?

Since the Israel Ministry of Health published its directive in 2011, requiring all health care institutions to become culturally competent, things have improved, but there’s still a ways to go. Slowly, one HMO at a time, we’re helping to rectify the situation. We’ve been working with Jerusalem-based clinics and hospitals since the beginning of the Cultural Competency project in 2008 (this is the earliest blog post on the project). Last year, we began working with the Leumit HMO on a national level, the first time we had worked with national management and not primary clinics. In late 2014, we also began working with the national level of Maccabi HMO.

Maccabi seminar

We began with a 3-workshop introductory course that took place in December – January in Maccabi’s central instruction center in Tel Aviv. There were 25 participants, from all disciplines in the HMO – from nurses and physicians to administrators on different levels – from all over the country. During the course participants learned tools that will enable them to integrate principles of cultural competency into different aspects of the health organization. They also heard a lecture from Prof. Leon Epstein, one of the major researchers whose research serves as the basis for our cultural competency project , about the connection between society and culture on health an sickness. Dr. Anat Jaffe, Head of the Endocrinology and Diabetes Unit at the Hillel Yaffe Medical Center and a founder of the Tene Briut organization, shared her experience providing culturally competent care to diabetes patients from the Ethiopian community. Participants also learned from a “Community Panel,” in which different cultures’ approaches to health and health care were presented (Haredi, Ethiopian, Muslim, French).

Maccabi panel full room

Each of the participants was asked to develop and implement a project in the district or clinic in which he or she worked that would advance cultural competency. Examples included: an information sheet directed at Haredi women on sexual assault; a “Your Health is in Your Hands” handout, which lists the different recommended tests; a clinic that is accessible to French speakers; encouraging Muslims to use physical therapy through quotes from the Prophet Muhammad; engaging a volunteer to help fill out forms for Russian or Arabic-speakers; a public awareness meeting on diabetes, adapted to the needs of Russian speakers, and more.

Last week, on April 29, we held a follow-up conference for these participants. The meeting included a tour of the ALYN Pediatric & Adolescent Rehabilitation Center in Jerusalem, the first hospital in the country to undergo the cultural competency process, with our mentorship. They saw first hand how they implement cultural competency principles on a daily basis. ALYN’s cultural competency coordinator also explained how the hospital and its staff copes with different social and political tensions in a culturally competent manner. (ALYN’s Director General Dr. Maurit Be’eri wrote about this here during last year’s Operation Protective Edge.) In addition, participants heard a fascinating lecture by the director of the municipal welfare office in a Haredi neighborhood, on how to create a community context, especially during times of crisis. Her office was at the center of a crisis in mid-2009 when a Haredi mother was accused of starving her child. Out of this crisis arose a process of culturally competent work that includes local rabbis, community leaders from the Eidah Haredit, and different public offices that enable the welfare services in this area to be culturally sensitive to the Haredi population. Participants also heard updates of their respective projects.

Naomi Roff2017-05-26T20:04:47+00:00May 5th, 2015|Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, Jewish Religious Denominations, New Immigrants, Palestinians/Arabs, Ultra-Orthodox Jews|

Happy Passover – Happy Easter – JICC Information Sheets from the Cultural Competency Desk

Pesach Kasher ve’Sameach and Happy Easter! May you never need medical care, but if you do, in Israel, we at the Jerusalem Intercultural Center (JICC) are making sure that medical staff at hospitals as well as other health care frameworks are aware of your Jewish, Christian or Muslim holidays . Since 2013 we have been writing one-page information sheets on different customs and traditions of a wide range of religious and cultural holidays (and wrote about it here and here) and have continued to refine and expand their scope. Today this includes not only the “major” holidays of the three Abrahamic religions, such as Yom Kippur, Passover, Christmas, Easter, Ramadan, Eid el-Adha, but also holidays celebrated by particular cultural groups, such as Sigd for Jews of Ethiopian origin, and Novi Gud, celebrated by residents from the former Soviet Union, and Eid a-Nabi SNabi Shu’ayb for the Druze. In all, there are over 20 information sheets that were written or revised in the past year. Here is the full list, in Hebrew.

Nabi Shu’ayb Druze Holiday Sheet

These information sheets have a huge audience. They are distributed on a national level, not only to clinics, hospitals and other health care institutions, but they are also adapted and sent to welfare agencies and organizations as well. We see this as one more step in increasing understanding and opening communication lines of communications between the widely diverse populations in Jerusalem and Israel.

Naomi Roff2015-04-21T19:07:21+00:00April 6th, 2015|Asylum Seekers, Blog, Christians, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, Jewish Religious Denominations, New Immigrants, Palestinians/Arabs, Ultra-Orthodox Jews|

Cultural Competency Training for Hundreds of Staff at Central Jerusalem Branch of Maccabi Health Services

A few weeks ago we finished cultural competency training for over 200 staff at the main Jerusalem branch of the Maccabi HMO. This consisted of one-day (8-hour) seminars each with 20 – 25 participants each. This was our “standard” one-day introduction to cultural competency, that included theoretical and practical learning of cultural competency – cross-cultural communication, , medical interpretation, dealing with social and political tensions and more. Since these workshops sought to concentrate on providing culturally competent services to the Haredi population, in the afternoon session a medical actor and Haredi Rabbi joined us, and we practiced real-life situations. Central to the discussions was the “triangle” in Haredi society that connects between medicine, Jewish law (halachah) and Haredi culture. These workshops join other workshops that we’ve conducted in Jerusalem for the Clalit Health Services (see here for earlier blog posts), and Meuchedet Health Services (see here for earlier blog posts).

Maccabi Jerusalem

The seminars took place between October 2014 and February 2015, and encompassed a wide range of disciplines – medical and paramedical staff, as well as administration. Participants were quite enthusiastic. One remarked, “Cultural competency is the a-b-c of quality service, and it incorporates values that help us to provide the highest quality of services [to all patients].”

Naomi Roff2015-04-21T18:54:20+00:00March 15th, 2015|Blog, Cultural Competence, Cultural Competence in Health Services, Identity Groups and Conflicts, Jewish Religious Denominations, Ultra-Orthodox Jews|

New Medical Interpreters Course for Mental Health Professionals

Cultural competency in mental health hospitals is moving forward and spreading, thanks to our Cultural Competency Desk. Last month, on 23 October 2014, we finished the first part of a medical interpreting course for some 30 professionals in the mental health fields from seven institutions from all over the country. While we’ve been involved with courses for specific institutions (at Abarbanel and the Jerusalem Center for Mental Health), this is the first time professionals are coming from all over the country for such a course. The idea for the course was brought up at a meeting of the Forum for Cultural Competency Coordinators in Mental Health that was held at the Mazor (Mazra) Hospital north of Acco, which was facilitated by the JICC. What ensued was a unique partnership between public mental health institutions and the JICC, which enabled the course to come to fruition. Many special thanks go to the cultural competency coordinator at Mazra, Mr. Yaron Nachmias, and Dr. Anne-Marie Ullmann, of the Beer Yaakov Mental Health Center.

National Mental Health Interpreters Training

In all there were 27 participants, who spoke Arabic, Russian and Amharic. In the course they learned the basics of medical interpretation in the mental health fields, which is one of the most challenging areas, both for the interpreter and for all those (patients, family as well as caregivers) who are involved in the diagnosis and treatment process. Course participants learned about the challenges of oral interpretation, the practiced correct work methods, and dealing with professional and personal dilemmas. They enriched their knowledge in language-specific issues and and terminology in separate groups for each individual language.

Simulation of an Interpreted Session in Mental Health

Now, after the end of the course, the greatest challenge is to help the cultural competency coordinators to assimilate cultural competency principles into everyday practice at their institutions. This will mean learning to utilize the services of the trained interpreters in the everyday operations of the hospitals.

Principles of Cultural Competency

Naomi Roff2018-09-01T07:31:20+00:00November 23rd, 2014|Asylum Seekers, Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, New Immigrants, Palestinians/Arabs, Ultra-Orthodox Jews|

Empowering the African Refugee Community in Jerusalem

Over the past year, we’ve been developing programming and training, together with a wide range of partners, in different disciplines to help and empower the African refugee community in Jerusalem, and to educate local service providers in how to give the community culturally sensitive care. (For more information, click here, here and here.) Here are a few examples of our work:

In late September we organized a first aid course at the Well Baby Clinic, with translation into Tigrinya, a language spoken by many African refugees. There were 9 participants, and all took the course very seriously. The translators all came from the refugee community in Jerusalem, and all were graduates of a medical interpretation course.

Well Baby Clinic first aid course

At the end of August (27/8) we held a story hour for the children and their parents. It was open to all children in the city center, both refugee and Israeli. The story teller told of Mulu and Tzagai, who had to leave their home and deal with a great number of dangers until they reached safety. After the story there were activities that helped the heroes of the story reach their destination.

Mulu and Tzagai story hour

On July 30, the well-baby clinic that serves the city center held a workshop for African refugee parents on early child development and dental health. Here, too, the workshop included translation by a trained medical interpreter. Parents showed a great deal of interest, and requested additional workshops. We and the well-baby clinic staff put a lot of thought into the workshop – and even brought a black baby to the demonstration – which the parents greatly appreciated.

Well Baby Clinic demonstration

Naomi Roff2014-11-22T13:19:02+00:00October 7th, 2014|Asylum Seekers, Blog, Cultural Competence in Health Services, Featured, Identity Groups and Conflicts|

A Culturally Competent ALYN Rehabilitative Hospital during a Summer of War

It has been a difficult summer in Jerusalem, and for the region. It has been especially difficult for Israel’s hospitals, who treat all who come through their doors, but who must also deal with the effects of the conflict – on both sides – on patients and their families. It has even been difficult for the ALYN Rehabilitative Hospital, which should be one of the institutions best equipped to deal with this tension. With our help, ALYN was the first hospital in Israel to become fully culturally competent. Thanks to the support of the Jerusalem Foundation and the Sobell Foundation we’ve been working with ALYN since we began developing our Cultural Competency in the Health Care System program in 2008. ALYN has since become the model for other health care institutions in Israel. See here for more information about our Cultural Competency programs in general, and here for more information about our work at ALYN.

Alyn Cultural Competence Training

Dr. Maurit Beeri, Director General of ALYN, recently wrote a very interesting and important article in the Jerusalem Post about their work through this difficult summer of war and hatred: “Living together when the shadows grow long“. Here is a downloadable version: Living together when the shadows grow long.

Dr. Maurit Beeri writes in her article:

“I was a young department director at ALYN Hospital Pediatric Rehabilitation Center a decade ago when I first learned of the concept of “cultural sensitivity in health.” We can take better care of our patients, I learned, if we understood better their cultural concepts of sickness and healing, their faith and their folklore.

Together with the Jerusalem Inter-Cultural Center we developed a curriculum which helped us make ALYN more geared toward our patients’ families.”

We are proud to be partners to this important success story! Reading the rest is a must to anyone who wants to learn more about the challenges and successes in cultural competence in Jerusalem and in every place in which social and political tensions are an obstacle for medical work.

Naomi Roff2014-10-13T13:42:14+00:00August 4th, 2014|Blog, Cultural Competence, Cultural Competence in Health Services, Featured, Identity Groups and Conflicts, Jewish-Palestinian/Arab, Palestinians/Arabs|

The JICC Calming the Waters in this Time of Crisis

It’s been a difficult few weeks here in Jerusalem and in Israel in general. First the kidnapping and murder of 3 Jewish high school boys who had been studying in a yeshiva in the West Bank, then the kidnapping and murder of an Arab boy in Jerusalem, which sparked demonstrations in Jerusalem and even throughout Israel. And then missiles and air strikes and increased fighting.

Jerusalem Dome of the Rock

We have been working to ease tension and conflict, and to promote civil engagement in Jerusalem’s future, since we were established in 1999. Thus, when tensions heightened and reached breaking points, we were there, trying to help residents re-gain order, first in their everyday lives, and then on a community and city-wide level.

Over the past few weeks we’ve played a key role in Jerusalem. We helped to spread a message of calm and a return to routine, through our broad network of contacts throughout the city. In consultations with key figures we advised using a range of methods that successfully brought quiet to the streets relatively quickly. These consultations also returned routine services – garbage collection and sanitation, for example – back to the residents, reinforcing the feeling that everyone wished to get back to normal as quickly as possible.

It seems that these actions – and the influence of their messages – proved true in the field. Shuafat, the neighborhood where Muhammad Abu Khdeir (the Arab boy who was kidnapped and murdered) was from, became completely quiet during the day and incidents at night decreased quickly as well. Outbursts of violence and vandalism in different Arab neighborhoods were handled similarly, with similar calming results.

As soon as the military activity began in Gaza (July 6) and the missile attacks throughout Israel, including Jerusalem, we moved into a different mode of operation. We summoned the independent Emergency Readiness Networks that we helped to establish in East Jerusalem, which are a central component of the readiness of East Jerusalem in any emergency situation (from the snow storms in December 2013, to potential rocket fire like there is today) , and they continue to be on alert today. We are also helping many community councils in west Jerusalem that needed help in responding to the current crisis. For example, in the Greater Baka’a Community Council we helped to draft information and special messages of calm from the Community Council, which offered volunteer psycho-social professionals to help neighborhood residents. We advised other community councils regarding their responses to the situation as well.

In addition, because of our deep and extensive work in cultural competency in the health care system, we prepared special guidelines for health care workers for when social and political tensions are high, as they are now. In more normal times, hospitals and health care systems are often rare examples of coexistence and cooperation – between Jews and Arabs, religious, secular, ultra-orthodox (Haredi) Jews, etc. However, in times like now, when tension is palpable throughout the country, the situation inside hospitals and other health care institutions is affected as well. Indeed, in the past, there have been numerous instances of verbal and physical violence within hospitals, between patient and caregiver, between patients, and in rare cases, between caregivers. The guidelines help to delineate a professional response to prevent these situations and to deal with them quickly and effectively when they occur.

While today most of the attention is not on Jerusalem, we continue to work hard to maintain an everyday routine – and quiet. Under the circumstances it has become a state of “Emergency – Routine”. Much of the work continues to rely on the MiniActive and Emergency Readiness networks. The Emergency Readiness Networks continue to be on alert, ready to spring into action if necessary. The MiniActive groups continue, especially now, to contact service providers and report problems and demand repairs and improvements, which are able to take place because of the relative calm in the city. A lot of the work is being in contact with as much of the network as possible; the situation is not easy for any Jerusalem resident. Both Jews and Arabs are feeling the polarization and tension in the air.

Let’s hope for better times to come, soon.

Naomi Roff2019-11-16T13:41:16+00:00July 22nd, 2014|Blog, Courses, Cross-Cultural Communication Trainings, Cultural Competence, Cultural Competence in Health Services, Deliberative Democracy, Effective Activism, Emergency Readiness Networks, Identity Groups and Conflicts, Inter-Cultural Community Dialogue, Jewish-Palestinian/Arab, Larger Baka Community Council, MiniActive, Palestinians/Arabs|

Putting Cultural Competency into High Gear

We’ve been working to improve cultural competency in the health care system for quite awhile (See here for more information). We’ve even gotten some nice press articles over the years. Now, together with our partners in academia, we’re putting cultural competency into high gear, and getting the word out on all levels.

Most recently, we’ve been partners in the publication of a unique document in Hebrew. It was written in cooperation with the Ruppin Academic Center’s Institute for Immigration and Social Integration and the JDC-Israel, on using training workshops for introducing principles of Cultural Competency into local municipalities and authorities, with an emphasis on the welfare departments. Click here for the complete document.

Cultural Competency in Local Authorities

A second document was an article in the Ministry of Health’s periodical by our colleagues from the Ruppin Academic Center and Ben-Gurion University of the Negev, who wrote a comparative survey of cultural competency in the health care systems of England, Australia, the USA and Israel. Click here for the complete document. We are mentioning this article since the pages about Israel show how central is the role of the JICC in the field of Cultural Competence in Israel.

Cultural Competency comparison

These publications join other recent accomplishments, including:

Publication of the Manual for Assimilating Cultural Competency principles in Health Care Institutions in Israel, which was published in July 2013. Click here for the document in Hebrew.
Production of four training videos, together with Bar Ilan University, the first such training videos in Israel;
Development of peer networks for cultural competency coordinators from throughout Israel, including special networks for mental health institutions;
Publication of information sheets in Hebrew on a number of Muslim, Jewish, Christian and Druze holidays, available here;
Offering of free consultation services for solving issues concerning Haredi clients / patients, in cooperation with Rabbi Zvi Porat of ALYN Rehabilitation Hospital.
Delving into cultural competency issues in mental health, which require a completely unique approach.
Publication of guidelines on a number of relevant topics, from writing on the Sabbath for religious Jews to dealing with heightened emotions during times of social and political tensions.

All the while, continuing our training and supervision of staffs from the gamut of health care organizations. We’ve come so far, yet there’s so much work to do.

Naomi Roff2014-07-18T13:31:01+00:00July 17th, 2014|Blog, Cultural Competence, Cultural Competence in Health Services, Cultural Competence in the Workplace, Featured|

New in Healthcare Cultural Competency Services – Consultation on Issues Pertaining to Jewish Law

Most doctors in Israel are Jews, but even to them, Ultra-Orthodox (Haredi) patients are an anomaly. There are so many different Jewish laws that the Haredi populations abide by (who are often more stringent than other Jewish groups), and so many different Jewish laws followed differently by so many different groups, it is difficult to know where to begin in addressing cross-cultural issues that arise in health care.

Helping health care professionals adapt their approach to Haredi populations’ needs, which in turn makes their health care more effective, has been an integral part of our efforts in the Cultural Competency in Health Care program. (See here, here and here for previous examples on the blog.) However, until now, our assistance has been per HMO (Clalit), per holiday, per project (calendar, videos, national network). Now we, together with Rabbi Zvi Porat of the ALYN Hospital, will be able to help everyone, across the board.

In May we opened up a consultation service for health care professionals on issues pertaining to Jewish law, in full cooperation with Rabbi Porat, who is himself Ultra-Orthodox and who works with the ALYN Rehabilitative Hospital in this type of capacity. As part of his work there, Rabbi Porat is in continuous contact with Haredi Rabbis of different communities in order to clarify and resolve issues and questions. Professionals who have questions can send them to a dedicated e-mail, and we, in conjunction with Rabbi Porat, will be in touch with them to help to resolve issues. This service is currently free of charge.

Until now, ALYN has been the only health care institution – or any type of institution in the fields of welfare, education, or health – in all of Israel to offer this type of service. We’re proud to be trailblazing yet another aspect of cultural competency, which we hope will further understanding between different communities not only in the health care context, but in other areas of life as well.

Naomi Roff2014-06-30T16:16:03+00:00June 17th, 2014|Blog, Cultural Competence, Cultural Competence in Health Services, Identity Groups and Conflicts, Jewish Religious Denominations, Ultra-Orthodox Jews|

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