Cultural Competence in Health Services | The Jerusalem Intercultural Center

Helping to Improve Health Care for Refugees and Asylum Seekers

Our first major public event to start to help refugees and asylum seekers in Jerusalem realize their rights was the Conference we held at the Zippori Center on April 1. We are working on other levels as well, to advance the plight of these oft-overlooked groups in Jerusalem. One level includes working with the HMO’s that largely work with refugees and asylum seekers make their care more culturally competent to their needs.

Last month we held the first of what is turning into a series of meetings for 23 secretaries and nurses at the main branch of the Meuchedet HMO, which, because of its location downtown, and a special insurance Meuchedet has for foreigners, serves most of the refugees and asylum seekers in Jerusalem. These nurses and secretaries are the first line of communication with patients, and are the ones who first communicate with the refugees and asylum seekers. This encounter came about as a result of our close partnership with the refugee hotline in Jerusalem, and after a number of meetings with the branch management.

The workshop gave participants tools to better understand the numerous cultural gaps, information and tools regarding medical interpretation, and analysis of different situations that the participants encounter every day. In the second part of the workshop Dr. Michal Schuster, our senior consultant and facilitator for the Cultural Competency in Health Care program, presented background about the refugees and asylum seekers – where they came from in Eritrea and Sudan, the complexity of their situation in Israel, on the background of the country’s refusal to review their requests for asylum and refugee status. After the speakers, Barnahu, a social activist from Eritrea who works and lives in Jerusalem, told his story and of the difficulties he encountered in trying to obtain health services in the city. Many of the participants noted that this was the first time they had ever met a refugee or asylum seeker in person, and began to understand his perspective.

At the end of the workshop the Meuchedet staff was moved to action, and asked for another workshop for 25 more employees. They also asked to meet with the administration of the branch, to see how practical responses can be found to help refugees and asylum seekers receive health care services.

Naomi Roff2014-09-25T16:56:41+00:00April 19th, 2014|Asylum Seekers, Blog, Cultural Competence, Cultural Competence in Health Services, Identity Groups and Conflicts|

Cultural Competency in Mental Health Care in Jerusalem – First Graduating Class of Interpreters

We’ve written here and here about the importance of making mental health services – especially in Jerusalem – culturally competent, and the long road that lies ahead. On April 8 we made huge strides in the right direction, presenting graduates of the first class of medical interpreters at the Jerusalem Mental Health Center at Kfar Shaul with their completion certificates.

These 17 graduates – bilingual workers at the main public mental health facility in Kfar Shaul as well as at other facilities throughout the Jerusalem area – represented the diversity of Jerusalem. They came from a broad range of professions at the Center – from nurses to other treatment professionals, as well as a diversity of backgrounds, speaking Arabic, Russian and Amharic as mother tongues. “Cultural Competency is a must in every public health facility,” said Dr. Teitelbaum, Acting Director of the Jerusalem Mental Health Center, in his remarks. “Research shows that treatment is better when the facility is culturally competent. Our goal is that this new skill will improve our ability to treat the patients.”

Indeed, language-dependent care, such as therapeutic sessions or psychiatric assessment, can be unsuccessful if it is not held in the patient’s mother tongue. Research shows that it is easier to express your troubles in your native language and that psychiatric problems are more evident (and therefore treatable) when they are expressed in the patient’s native language. Thus, when caregivers are not available in the patient’s native tongue, a medical interpreter is a vital part of the treatment process. The mental health interpreter not only knows both languages fluently, he or she is also trained to translate the smallest nuances, even if at first they seem illogical or confused. It is this attention to the smallest details that enables the caregiver to more completely understand the patient’s condition.

Our Hanan Ohana, who directs the Cultural Competency Desk at the JICC, noted, “This graduation ceremony means more than 15 or so trained caregivers in the course. The Jerusalem Mental Health Center is a leader in mental health services in Israel. Their enthusiasm for the training will serve as an example for other mental health institutions in Israel, which we expect will follow suit. The support of the administration was very important in this process. Without it, implementation of the program and assimilation of cultural competency principles would be much more difficult.”

Over the course of two months the participants learned the concepts of cultural competency in general, as well as the basic guidelines of medical interpreting, especially in the context of mental health treatment. “This is the first time I’ve taught a course for mental health professionals in Jerusalem,” said Dr. Michal Schuster, Senior Consultant and Facilitator for Cultural Competency, and also a lecturer at Bar Ilan University. “I definitely learned much more than I taught.”

The participants also received specialized training in interpreting into their native languages. “I thought I knew the language I was translating from, and what I was translating into,” said Solomon, of Ethiopian origin. “But this course opened my eyes to a lot of subtleties I wasn’t aware of.” Lilian, a native Russian-speaker, echoed, “After the course, we feel much differently about the interpretation we do. The course gave us so much. It showed us how much more there is to learn.” Shoshi, also of Ethiopian origin, noted, “I never knew that there were so many different inferences, even in my mother tongue. Now I’m much more careful, even afraid [that I’ll interpret something incorrectly].”

During the course

Dr. Schuster emphasized that it is that awareness, of the gravity of the task of medical interpretation, “that is the key objective of the course. “

We would like to thank the Jerusalem Foundation and the Rayne Foundation, whose support made this course possible.

Naomi Roff2014-05-09T14:36:55+00:00April 10th, 2014|Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, Jewish Religious Denominations, New Immigrants, Palestinians/Arabs, Ultra-Orthodox Jews|

Enriching the Toolbox of the Cultural Competency Coordinator: Passover and Easter Information Sheet

We’ve described here our process of producing information sheets for major Jewish, Christian and Muslim holidays for Cultural Competency Coordinators from around the country. Thus far we’ve produced pages for Muslim Ramadan, Eid el-Fitr and Eid el-Adha, Jewish Ethiopian Sigd, Christian Christmas and New Year, Druze Eid el-Hader and Jewish Tisha B’Av and Asara B’Tevet.

We can now add Jewish Passover to the list:

Passover in Health Organisations 2014

The information had two parts: a sheet that explains the main issues that are relevant for Passover in healthcare organizations, and a Word file with suggested texts for posters in Hebrew, Arabic and English about the practice in Israeli healthcare organizations not to being Non-Passover-Kosher food in to the facility during Passover. In the past, we could see posters that either were not helpful for non-Jewish people, or were written in an insulting way, and were usually only in Hebrew. We hope that our text help to solve this.

Immediately after that, we published another sheet about Lent, Easter and Pentecost (and in Israel we need to know the practices of many Christian Sects in this context, Greek Orthodox, Catholic etc.).

Easter in healthcare organisation March 2014

Naomi Roff2014-05-13T20:23:16+00:00March 25th, 2014|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|

Coming Attractions – Groundbreaking Cultural Competency Training Videos

Coming to a hospital / clinic seminar room near you! Four new training videos, produced by the Jerusalem Intercultural Center and Bar Ilan University.

Since we began the Cultural Competency in Health Care project in 2008, we’ve been aiming to offer a comprehensive, multidisciplinary training experience to health care professionals, and recently, we’ve made great strides in providing a broad range of information, training manuals and professional networks for peer learning.

From “For the Children”

This week we added a new layer – four new training videos for our cultural sensitivity training sessions. These are the first such videos to be produced in Israel, addressing specific issues faced by populations here. The videos were produced in full partnership with Bar Ilan University, and its Department of Translation and Interpreting Studies.

From “Our Decision”

The four films are based on actual events. The film “Knows What She Wants” describes a meeting between a patient from the immigrant Ethiopian community, who is requesting an injection of the Depo-Provera contraceptive , and the family doctor who is trying to convince her use alternative methods. The film “Checkup” presents a meeting between a Russian speaking patient who comes with her teenage daughter for a routine visit to manage her diabetes, and a Hebrew speaking nurse. In the film “Our Decision” a Muslim-Arab hospital patient diagnosed with a malignant growth on her thyroid is torn between the opinion of her doctor (also a Muslim-Arab), who thinks that immediate surgery is essential, and that of her husband, who wants her released back home quickly. The film “For the Children” takes place at a charged meeting at the welfare department between a social worker and a Haredi family (from the “Eida Haredit”), regarding the temporary transfer of their children to relatives. All the films have subtitles in Hebrew, Arabic and English. Each film deals with a different cultural group, yet each one addresses all the main core issues in cultural competency.

From “Knows What She Wants”

The videos are used to trigger discussions in our various training and follow-up workshops. Each of them brings up critical points that are essential in striving toward culturally competent care in the health care and welfare systems. And all are helping us make culturally competent care in the health care and welfare systems more of a reality. We’d like to thank the Jerusalem Foundation for their ongoing support of this program since its earliest stages. These videos were also supported by the New Israel Fund.

From “Checkup”

Naomi Roff2014-07-11T09:35:17+00:00March 15th, 2014|Asylum Seekers, Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, Jewish Religious Denominations, New Immigrants, Palestinians/Arabs, Ultra-Orthodox Jews|

Learning from a Model, Adapting to their Needs: Visit to the Western Galilee Hospital in Nahariya

It’s not easy being a Cultural Competency Coordinator. There are so many aspects that need to be dealt with it can seem overwhelming. It is exactly for that reason that we formed the Cultural Competency Coordinators’ Forum, so that they would not need to go it alone. Even more recently we formed an offshoot – a Forum for Cultural Competency Coordinators from Public Mental Health Institutions – since the field of mental health is drastically different than general health care. The 8-member forum includes representatives from all 7 public mental health institutions in Israel – from Acco to Beer Sheva to Jerusalem to Tel Aviv – and was formed on the heels of our networking / feedback session, before the Manual for Cultural Competency Coordinators was published. This forum meets monthly.

Members have already learned a great deal from one another. For example, the coordinator from Be’er Ya’akov heard about the medical interpreter’s course at Abarbanel, and the course is being implemented at Be’er Ya’akov. Similarly, the coordinator from Mizra heard about the workshops we did for the administration at the Jerusalem Center for Mental Health, and in January it will start workshops for its 50 administrative and managerial personnel.

On November 5, 2013 mental health forum had a special treat – a visit to the Western Galilee Hospital in Nahariya. Why Nahariya? The first few meetings of the Forum had included introductions, peer learning and setting goals for the group, and after that it decided that it was time to learn from the field. Nahariya is a model example of both administration and staff being committed to making its care culturally sensitive to all its patients, and using creative means to do so.

Touring the Western Galilee Hospital in Nahariya

The Cultural Competency coordinators at Nahariya had participated in our first course for cultural competency coordinators in 2012, and have come a long way in a short time, thanks to the continued support of the management at all levels. We came to see how they did it, and how we can adapt their methods to mental health institutions.

The visit had 3 parts:

A presentation on how the hospital led the Cultural Competency training sessions for its staff. It was very important to the administration that local hospital staff lead the training sessions. This showed seriousness on the part of the hospital and sent a message to the staff that ‘we value this enough to dedicate two staff members for in-house training and integration, who will be here to follow up and make sure that the principles are implemented.’ Because the training was performed by local staff, there was more motivation, there was no need to wait for the training, and more help was on hand in assimilating the principles.
A tour of the hospital. Participants were taken to the hospital’s Muslim prayer room, one of only a handful in all Israeli hospitals, which was established in cooperation with the Ministry of Religious Services. They were also shown the hospital’s creative method of multi-lingual signage. The hospital had already had signage in Hebrew and English, but needed to add signs in Russian and Arabic, and did not want to spend the high cost of re-printing all the hospital’s signage. Its solution – printing the requisite signs on giant stickers that were stuck to the floor. What a novel idea!
Participants were also shown the pilot of a telephone interpreting system, which is being funded by the Ministry of Health. They first learned how the telephone system works. It uses a special telephone with two handsets – one for the patient and one for the physician. Both are listening to the interpreter, who is on the other side of the line, in a call center. The idea is that eventually all health care institutions in Israel will be hooked up to this system, and will be able to use it all day, every day, without having to wait for an interpreter to be on call in the building.

An example of a dual-handset telephone for interpreting

The day ended with participants discussing their thoughts on the most important points, and how they can assimilate any of the ideas into their own institutions. One action item that arose was the need for a Cultural Competency Manual dedicated to the unique needs of mental health facilities. We will begin to write this manual at the next meeting, which is in the middle of December 2013.

Naomi Roff2014-07-11T09:32:26+00:00November 10th, 2013|Blog, Christians, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, Palestinians/Arabs, Ultra-Orthodox Jews|

Let’s Make Ourselves a Holiday: Multi-Cultural Holiday Information Sheets to Improve Cultural Competency

Hag Sigd Sameach. Yesterday, October 31, was the Sigd holiday, which is celebrated by the Ethiopian Jewish community. As part of our comprehensive support for cultural competency coordinators and health care providers in general, we prepared a special information sheet to help health care providers to give better care to their Ethiopian patients. It includes a short description of the holiday, special traditions that might affect patients on that day, and links to resources that can provide further information.

This isn’t the first time we’ve prepared these information sheets. We also prepared them for the Muslim holidays of Ramadan and Eid el-Fitr and Tisha b’Av, as noted above, and we’re going to continue to produce them for Eid el-Adha (Muslim), Passover and the 10th of Tevet (Jewish) and more. We’ve found that these information sheets have been immensely popular. They’ve been sent not only to our mailing lists, but we’ve found out that they’ve also been distributed throughout the different health insurance companies (Kupot Holim), and more.

In general, these information sheets offer comprehensive, concise overviews of the holidays, and cover particular issues that can affect patient care such as:

Special meals or foods related to the holiday;
Special fasts related to the holiday, and how it affects taking medication;
If there are conflicts regarding the taking of certain medications, who is the religious authority to turn to to discuss the issue;
Special daytime schedule during the holiday – more prayers or family visits, and more.

We work very closely with different organizations to ensure that important points are not missed, and that they are presented in a respectful, informative manner. For example, for Eid el-Fitr we consulted with the Al-Taj organization, which seeks to advance awareness of health issues in the Arabic-speaking population. We consulted with Rabbi Moshe Peleg of Sha’are Zedek Hospital for the Fast of the 10th of Tevet information sheet. For help on the Sigd information sheet, we consulted with the Tene Briut organization, which seeks to advance health care among Ethiopian immigrants in Israel.

When we are all finished we’ll have an entire year’s worth of holiday information sheets – an incredibly valuable resource for cultural competency coordinators and anyone who works in Israel’s multicultural health care system.

Naomi Roff2015-12-01T19:23:46+00:00November 1st, 2013|Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, Palestinians/Arabs, Ultra-Orthodox Jews|

Making a Mental ‘Switch’: Cultural Sensitivity Professional Development Workshop for Staff at the Jerusalem Center for Mental Health, Kiryat Hayovel Clinic

What is the essence of cultural competency? More than the manuals, more than the training sessions – cultural sensitivity is the switch in approach to the patient-caregiver relationship, from ‘let me make you better’ (on my terms, using my rules) to ‘let’s work together to enable you to heal’ (mutual communication, bridging communication gaps of language and culture, realization that one’s background and culture dictates one’s actions and reactions).

The intention of the workshop held on October 21, 2013 for members of the Kiryat Hayovel public mental health clinic, part of the Jerusalem Center for Mental Health, was to help the 25 participants make that switch in their approach. The all-day workshop included a discussion of the present situation, and staff members raised a number of examples of social and political tensions in the clinic. As in other Cultural Competency Workshops, we also covered a theoretical section, in which we went over basic aspects of cultural competency – interpersonal communication, core issues, cultural dimensions, medical interpretation, social and political tension and more. In the afternoon the medical actress joined us and we practiced 2 real-life situations.

The director of the Kiryat Hayovel Clinic was very cooperative, both during and after the workshop. He told us that he received positive feedback from his staff, and that everyone recognizes the need for changing their approach, with an emphasis on everyday work. He noted that many of the staff were aware of the concept of cultural competency, but this all-day workshop allowed them to concentrate solely on how cultural competency / or cultural sensitivity influences their work as mental health caregivers.

The workshop also made the director as well as the staff more aware of the need for medical interpreters (translators) when working with patients whose mother tongue is not Hebrew. The workshop therefore increased his motivation for including his staff members in the upcoming medical interpreter’s course at the Jerusalem Center for Mental Health in Givat Shaul.

Naomi Roff2014-04-11T18:41:23+00:00October 23rd, 2013|Asylum Seekers, Blog, Christians, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, Jewish Religious Denominations, Jewish-Palestinian/Arab, New Immigrants, Palestinians/Arabs, Ultra-Orthodox Jews|

Creating a Cultural Competency Learning Community

We’ve talked about our growing national network of cultural competency coordinators here before . As part of this effort, we held our quarterly workshop for 25 cultural competency coordinators from around Israel at the Tel Aviv Sourasky Medical Center (Ichilov) on October 7. Participants came from hospitals as far north as Tiberias and Hadera, as well as the Jerusalem and Tel Aviv area. There were also representatives of the different HMO’s as well. This workshop focused on the Connection between the Community and Health Care Organizations.

The meeting included a panel discussion of 4 different perspectives:

Mr. Pekadu Gadamo, director of the Tene Briut organization, which works to improve health care for the Ethiopian community in Israel.
Mr. Or-El Ben Ari, director of the Ministry of Health’s clinic for migrants and political asylum seekers at the Central Bus Station in Tel Aviv.
Rabbi Zvi Porath, rabbinic consultant to the ALYN Rehabilitative Hospital
Mr. Gabriel Pransky, the Pransky Project

Each member of the panel spoke about his organization, and the connection each one has to health care organizations. Mr. Ben Ariand Mr. Paransky also distributed information sheets about their organizations. Click here to see the Refugees Clinic information sheet and here to see the information sheet on the Pransky project.

We’d like to focus on two of them, Mr. Ben Ari, from what was formerly referred to as the Refugees’ Clinic, and Rabbi Porath, from ALYN. Mr. Ben Ari first described his clinic. Located in the Central Bus Station in Tel Aviv, the clinic serves the tens of thousands of refugees and political asylum seekers that live in the Tel Aviv area, none of whom have health insurance. Instead, they often rely on hospital emergency rooms for care, and then only in real emergencies. And it was found that many of the emergencies could have been prevented if they had sought medical care earlier. The clinic was established in 2008 by the Israel Medical Association and other partners and staffed largely by volunteer doctors and other medical personnel. In January 2013 the clinic came under the auspices of the Israel Ministry of Health. Today it includes a staff of 20 and offers a range of medical services, from regular clinics to urgent care facilities, operated by the Terem organization. In the discussion, Mr. Ben Ari asked the cultural competency coordinators to make the clinic known to the refugees / asylum seekers they treat, since after they are released they rarely seek follow-up care that the clinic can provide.

The coordinators were fascinated by the clinic. For most this was the first time they had heard of the clinic and its activities. They were so excited about it that they asked to have a tour. This is now being organized.
Another of the speakers was Rabbi Zvi Porath, of ALYN Rehabilitative Hospital. Rabbi Porath, himself Ultra-Orthodox, has done groundbreaking work in his position as an advisor to the staff and on Jewish law. In most hospitals the Rabbi deals mainly with issues regarding Kashruth and Sabbath observance, Rabbi Porath is the first hospital Rabbi in Israel to utilize his role for cultural competency issues as well. He advises both the staff and patients, especially when there are instances in which there are questions of Jewish law as it relates to specific treatments. Rabbi Porath not only gives his own advice, but also knows whom to go to when other authorities’ opinions are needed. This is because each community within the Ultra-Orthodox world follows its own community leaders, but not necessarily leaders from other communities. In this way Rabbi Porath is not only a consultant and an advisor, he is also a mediator, helping the ALYN staff provide the best care for all its patients, sensitive to the cultural traditions of its Ultra-Orthodox patients and their families.

The participants were also very interested in Rabbi Porath’s work, since all of them deal with issues of caring for Ultra-Orthodox patients in ways that are in line with their strict reading of Jewish law. Many even scheduled private meetings with him, to see how he could help in their respective organizations.

Naomi Roff2016-02-27T15:01:19+00:00October 10th, 2013|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|

Publication of First-Ever Manual for Israeli Cultural Competency Coordinators

Two weeks ago, in mid-July, we celebrated the publication of our Cultural Competency Manual in Hebrew. It’s been almost 2 years in the making, and a labor of love for a long list of people, from lecturers and researchers from throughout Israel, to cultural competency coordinators in major health care institutions, to officials in the Ministry of Health. It is the first manual of its kind in Israel, and one of the only significant ‘how-to’ guides in the world.

This is a major accomplishment, but we have no intention of resting on our laurels. This manual is only a part our full-service cultural competency support system (see here for more information), from soup to nuts. We start with introductory workshops for cultural competency coordinators and staff – what is cultural competency? How can we be sensitive to others’ cultures and traditions, without being experts? Our services also include training courses for medical interpreters in a number of languages – Arabic, Russian, Yiddish, Amharic, and more. Medical interpreters and not medical translators? Yes, because they are doing more than translating word for word, they are interpreting the needs of the patients and their families to facilitate full communication with the treatment staff. We just finished a course at Sha’are Zedek Hospital, and not only was the feedback was very positive, participants noted that the issue of translation / interpretation was one of the most important sections in the course. The courses mean little without the day to day mentoring and follow-up with the cultural competency coordinators in the different clinics and institutions – how to increase translations of the different signage and forms to the different languages, helping to assimilate concepts of cultural competency into the different institutions, even with staff who had not yet taken part in a training seminar. Our work does not stop there.

In April, in preparation for publishing the manual, we held a seminar in which one of the original goals was to get feedback for the manual. But a second goal, not less important, was the formation of a peer network of professionals and academicians who work in cultural competency throughout Israel, which is leading to sub-networks according to specific disciplines (mental health, primary clinics, hospitals, etc.), all which have their similarities and whose implementations in the field are slightly different. In addition, we provide supplemental materials to help those involved in cultural competency have a better understanding of major holidays, traditions, and other issues. See the attached explanations on the Jewish commemoration of Tisha b’Av and on the Muslim celebration of Ramadan. Together with the Department of Translation and Interpreting Studies at Bar-Ilan University, we are also working on short films, which will further enhance the training process.

We’d like to thank the Jerusalem Foundation for its partnership in this project since the beginning in 2008, and for the assistance from the New Israel Fund, which has enabled us to expand the project throughout Israel.

Naomi Roff2014-04-11T18:35:02+00:00August 5th, 2013|Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, Jewish-Palestinian/Arab, Palestinians/Arabs, Ultra-Orthodox Jews|

Cultural Competency in the Health Care System – for the Haredi sector

Enabling all of Jerusalem’s populations – Palestinians, immigrants (Ethiopian, from Former Soviet Union), Ultra-Orthodox Haredi Jews – to receive the best health care possible is at the top of our priorities, and our Cultural Competency in the Health Care System project is designed to address the sensitivities of caring for all these populations. Thus, beginning April, we began holding seminars for the staff of a number of primary clinics of Clalit Health Services to help them better communicate with the Haredi populations in their areas.

The location of these seminars was important. They were held in what are considered ‘mixed’ neighborhoods – Neveh Ya’akov, Ramat Eshkol, and Ramot (A and B). These neighborhoods have quickly growing Haredi populations, but they are definitely not the ‘hard core’ (as in Meah Shearim, Geula, Romema, Sanhedria, etc.). Moreover, much of the staff of the Clalit primary clinics in these neighborhoods remains non-Haredi and unequipped to best communicate with their new contingency. Part of the problem, which we will touch on below, is that there is little or no connection between the clinics and the community – and especially the changing community – around them.

In these seminars we dealt with 3 areas:

1) Tools for practical action. Often in this type of work with the ‘other’ we think of the checklist of tips of what to do or not to do when treating the Haredi community – not closing doors, men not offering to shake women’s hands, etc. However, our workshop went beyond the checklist, and sought to change the approach that clinic staff take in treating their Haredi patients. We discussed with them how to bridge major cultural gaps. One example was raised of a Haredi man, whose wife was terminally ill, who came to the clinic to ask for a certain medicine. From the man’s point of view, this medicine, which would stop his wife’s menstrual period and therefore keep her from being ritually impure, would finally enable him to touch her, or even give her a glass of water. The doctor, from her point of view, was appalled. She could not give him the medicine he requested because it reacted with the other medications she was taking. She saw a man who was antipathetic toward his wife – here his wife was very sick and all he could think about was stopping her menstruation? It was a classic case of a cultural gap that needed to be bridged. It was then explained to her the reason behind his request; arrangements are now being made to work around the problem.

2) Community Dialogue. One of the many roles of the community clinic is to raise awareness of preventative health programs and to have an ongoing dialogue with the community to draw the community to take advantage of its services and feel comfortable doing so. Since these clinics had little contact with the community as a whole, it made their work supremely difficult. One of the goals of our seminars was to help the clinic staff first gain acceptance with the community leadership, which will significantly boost neighborhood involvement and patronage. When we surveyed the clinic staffs, we found that they either didn’t know that this fieldwork needed to be done, or did not know how to go about engaging the community. Attempts to call patients directly – without getting the leaders’ OK – led to low turnouts at events. In general, low turnouts leads to lower patronage, which is bad for constituents’ health, and also bad for the health services’ business. With our facilitation, we’re helping the clinic staffs make slow but steady inroads into the community.

For example, in Neveh Ya’akov we facilitated a meeting between the clinic’s staff and the Community Center’s lay leadership (9 out of 10 of whom are Haredi), which we anticipate will lead afterward to inroads into the community’s various spiritual leaders. After this type of connection, we expect a much higher rate of participation in Clalit’s activities in the future. We are using similar means to reach community leadership in the other neighborhoods as well.

3) A Safe Place to Vent. In each neighborhood, because the staff – themselves secular and religious, some, with no religious background – had started out in a religious / secular neighborhood that saw a rapid growth in the Haredi population, there was a general feeling of frustration and despair. They felt they were witnessing the great struggle for control in Jerusalem between Haredi and non-Haredi Jews, and the Haredim seemed to be winning easily, engulfing entire neighborhoods and forcing their beliefs and belief systems on everything around them. On the other hand, clinic staffs must draw patients in; otherwise they’ll go elsewhere and Clalit will lose money. And these workers are measured also according to their economic efficacy in the clinic.

We couldn’t really offer solutions to all the fears the staffs raised, but just the act of venting was important to them. For some, this was the first time that they’d heard other people venting the same fears, and that it’s OK to talk about it, and maybe even find solutions to some of the problems. Interestingly, these issues were raised in all 3 of the neighborhoods, independently.

Naomi Roff2014-04-11T18:27:36+00:00July 12th, 2013|Blog, Cultural Competence, Cultural Competence in Health Services, Identity Groups and Conflicts, Ultra-Orthodox Jews|

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