Cultural Competence in Health Services | The Jerusalem Intercultural Center

Paramedical Professional Training Program – Now Physical Therapy

How sweet it is to see the fruits of your labors pay off, and to see a program expanding to fill critical needs. Thanks to assistance from the Hadassah Foundation and the Jerusalem Foundation (More recently the Leichtag Foundation has also joined us as a partner in this amazing program), this year we’ve expanded our training program for Palestinian graduates of paramedical professions to include students of physical therapy. One by one, we hope to develop courses for all paramedical professions, to enable graduates to pass the Israeli certification examinations, which are required to work legally in East Jerusalem.

We began the project last year, with seed funding from the Jerusalem Foundation (click here for links to posts one and two on the courses), and the results were fantastic – 26 of 39 nursing students passed the exam, and 8 of the 14 occupational therapy students passed the exam.

Nurses in the new course

Given the dearth of paramedical professions across the board in East Jerusalem, our main goal was to develop courses in as many disciplines as possible. Our next discipline – physical therapy. Developing a course for physical therapy was more challenging than for nursing or occupational therapy, especially since there aren’t schools for physical therapy (like there are for occupational therapy and nursing) in Jerusalem. Working with an outside consultant and the Ministry of Health, we planned the curriculum. We gathered 16 participants for our pilot course. Weekly classes began at the beginning of June and will prepare participants for the exam that will be held in November 2013.

Another meeting of the nursing course

These 18 joined another group of 30 who began studying in March for the nursing exam that will take place in September. As for Occupational Therapy, we’ve just finished helping 4 people prepare independently for the June exam, and we’ll start a proper course in September, leading up to the December exam.
We wish all graduates and students the best of luck in their studies and exams.

Naomi Roff2016-04-28T15:40:40+00:00June 10th, 2013|Blog, Cultural Competence, Cultural Competence in Health Services, Education, Employment, Identity Groups and Conflicts, Palestinians/Arabs, Supporting employment in East Jerusalem|

A Workshop about our Cultural Competence in Healthcare Handbook

Americans do it; Europeans do it; even some South Africans do it. But how do Israelis do it? How do Israelis make their health care organizations culturally competent?

We’ve been training health care staff in cultural competency since 2008, and the Ministry of Health has more recently begun training, in light of the Ministry’s 2011 Directive on Cultural Competency. But what’s been missing has been a guide that spells everything out, which coordinators can refer to once they’ve finished the training courses. One that provides the internationally-tested standards of cultural competency, adapted to the unique makeup of Israeli society and everyday Israeli reality.

We are now in the final stages of such a handbook, our Manual for Integrating Cultural competence in Health Care Organizations. This manual is not only the first of its kind in Israel to deal with cultural competency for health care, it is the first of its kind in Israel to deal with cultural competency in any discipline. It is one of our dreams to bring culturally competency approaches to other areas of life in Jerusalem and throughout Israel – from local and national government offices to the police to other public agencies.

As part of the development process for the handbook, on 22 April 2013 we held a day-long seminar for 30 cultural competency coordinators from major health institutions, as well as others who work and research the field, around the country. Our goal for the day was to improve the handbook and to learn from the many people who are already working in the field in Israel.

We were pleased by the diverse turnout. Some had taken our training course, some had taken that of the Ministry of Health, and others had taken neither. The variety of institutions represented was also rather wide: Sheba-Tel Hashomer and Tel Aviv Sourasky (Ichilov, where the seminar was held) hospitals in Tel Aviv, Rambam in Haifa, both Hadassah hospitals in Jerusalem, as well as hospitals in Tiberias and Sefad; four of the eight mental health facilities in Israel; Ministry of Health; Israeli HMO’s; and independent consultants.
Throughout the morning, we got down to work. We utilized the ‘world café’ deliberation method, with one moderator at each table, each table focusing on a different subject from the handbook: from language accessibility, evaluation and making the workplace accessible, training, and definition of the role of the cultural competency coordinator, to the first 10 steps of cultural competency. The groups discussed each area, commented, made suggestions, and brought up new ideas regarding this part. After some time, participants chose another topic, but the moderators stayed in place. In all, we made such 3 rounds, and we discussed the main suggestions and understandings in the summary session.

All told, we came away from the seminar rich in knowledge that will help us to update the handbook. And the participants were quite enthusiastic about the meeting as well, as a number expressed their desire to continue these professional encounters. “This encounter was very important,” said Maya Tzaban, from Poriyah Hospital near Tiberias. “Now I see that we are not alone, added Varda Stenger from Sheba – Tel Hashomer, “that we are a network, and can work together.”

Indeed, although we’ve held encounters with coordinators who’ve taken our courses, and the Ministry of Health has held encounters for graduates of their courses, this is the first time that all cultural competency coordinators have come together for peer discussion, learning and action as a professional network. In light of the feedback, preliminary plans are underway for follow-up meetings.

Additional take-away suggestions included:

Forming smaller, more focused groups that could discuss their common challenges and situations – such as mental health hospitals, HMO’s, etc.
Adapt the manual slightly for the different types of institutions that use it – general hospitals, psychiatric hospitals, HMO’s, primary clinics, etc.

Feedback on the manual in general was also very positive. Participants commented that that it helps to give a full picture of cultural competency and initial steps of implementation. They were also eager to provide feedback to refine the document. “I have the time and I’d love to give my input,” said Anat Revach, from the Jerusalem Center for Mental Health. “I want to be part of this process.”

jicc2014-04-04T12:57:51+00:00April 22nd, 2013|Blog, Cultural Competence, Cultural Competence in Health Services|

Assisting Medical and Paramedical Professionals in Receiving Certification from the Israeli Ministry of Health – an update and congratulations!

This is a follow-up to a previous post on this issue. Over the last year, in cooperation with the Jerusalem Foundation and the Community Services Division of the Jerusalem Municipality, we’ve been working to solve the both sides of the same issue regarding health care in East Jerusalem. On the one hand there is a severe lack of personnel in all disciplines that is certified to work in East Jerusalem. On the other hand, there are hundreds of graduates of academic programs, from universities in the West Bank or Jordan, who are living in East Jerusalem but are not able to work in their fields (or are working ‘under the table’ in those fields and are not receiving full salaries or legal benefits), because they did not pass the requisite certification exams given by the Israeli Ministry of Health.

We began this journey exactly a year ago, when we began to explore the issue in two disciplines: occupational therapy and nursing. We learned that the Ministry of Health needs additional Arabic-speaking workers in these disciplines, especially in East Jerusalem. We also learned that only 1-2 nurses and occupational therapists passed the exam each year.

We learned that the first problem was language – the graduates’ Hebrew was not good enough to pass the Hebrew exam, and that the Arabic translation of the exam was a very poor one. Moreover, all of the graduates had studied in English in their universities. Thus, even though it wasn’t their mother tongue, they preferred to take the exam in English. We then learned that the occupational therapy exam had become available in English two years previously, solving this part of the problem for them. In nursing, for some reason East Jerusalem residents had not been allowed to take the exam in English. We then met with officials from the Ministry of Health, who rather easily, agreed to let them take the exam in English as well.

With one obstacle behind us, we discovered that the graduates did not have access to the necessary learning materials – their own universities were far away, and only Hebrew University students have access to materials there and at Hadassah. This was actually very easy to resolve – we bought the books, and the graduates came throughout the year to study in our offices.

And then we discovered that there are occupational therapy materials that are only in Hebrew – position papers of the Occupational Therapists Association, as well as laws, which the students must learn. We translated these position papers into English and donated them to the Association’s web site. (We also received thank-you letters from other students in Israel who used our translations…) The laws were too complicated for us to translate, so we found a successful lawyer from East Jerusalem, who agreed to study the laws and explain them to the students, thus enabling them to learn the information.

We made contact with the relevant schools of occupational therapy and nursing at Hadassah, and convinced them to join our adventure. We then held a preparatory course in English for some 15 graduates in occupational therapy. On the day of the exam, which was held in Tel Aviv, we rented a bus for the participants. We didn’t want to take any chances of them being held up at security checks at the central bus station in Jerusalem. The result: 6 passed and became certified occupational therapists! Those who didn’t pass will sit for the exam at the beginning of November, and we’re keeping our fingers crossed for them.

In nursing, the story was much more complicated. The exam is very difficult, and the preparation requires thousands of practice multiple-choice questions on a number of subjects. The problem was that we didn’t have a reserve of questions that was suitable for the Israeli exam – Hadassah’s pool was entirely in Hebrew, and it would have been exceedingly expensive to translate them. Even proofing the translations would have taken forever. We dared to do something that many thought would not help – we used large question pools in English that are used for the American certification examinations (NCLEX-RN), which is different from the Israeli. At the end of each chapter, we gave the students a small number of questions in English, based on the Israeli exam. The assumption was that in the end it was the same ‘body’ of knowledge (with a number of differences in legal aspects and ethics and emergency room protocol and first aid), and even though the type of questions are different, this model helped. No doubt that we gambled on our unique approach – it turns out that no one remembers that there was ever a preparatory program for the Israeli nursing exam in English.

Before we began the nursing program, we gave a practice test to the participants and no one passed! That was our base point, quite frightening. During the course we gave another practice test in July, and 7 participants passed. A month later, 2 weeks before the official exam, we held another practice test and 12 passed. 12 new nurses in East Jerusalem, the number that usually passes in 8 years, is definitely an achievement, but we wanted more – there were 45 participants in the course! After the exam at the beginning of September, we waited and waited (it turns out that the Ministry of Health takes a month and a half to grade thousands of exams), and yesterday the results came in: 25 (twenty five) passed the nursing exam!!! More than 50% success rate! We are over the moon, I must admit. We really didn’t imagine in our wildest dreams that we would be so successful.

It is important to understand the significance of the success of the nursing program – a large part of the graduates have worked in East Jerusalem as nurses, but without certification, they could not legally perform many medical procedures. Many times they did those procedures anyway, because they had no choice, and without the enforcement of the Ministry of Health. Now, their status is different, and with justification – they learned so many essential things in the preparation program that were important to their work, regardless of the examination. By the way, their salaries are also supposed to jump significantly. So it is good for them, and it is good for the residents of East Jerusalem – who will receive better health care in the clinics and hospitals in East Jerusalem. If we continue this trend, the legitimacy for these institutions to employ uncertified nurses will decrease drastically.

What’s next? There are many things that must be done – continuing the same disciplines and creating a sustainable system of preparatory courses for certification, as well as entering into additional professions – physical therapy, speech therapy, and more. And maybe we’ll succeed in areas that aren’t in the field of health care? We’ll know in time.

jicc2014-04-11T15:42:01+00:00October 23rd, 2012|Blog, Cultural Competence, Cultural Competence in Health Services, Education, Employment, Employment Accessibility, Identity Groups and Conflicts, Palestinians/Arabs, Supporting employment in East Jerusalem|

Professional Development for Healthcare Cultural Competency Coordinators from around the country – Final report

On May 21 we finished the first professional development seminar for 17 cultural competency coordinators in Israeli health care organizations. They came from hospitals such as Hadassah, Shiba-Tel Hashomer, Sourasky Medical Center, Rambam, and more. For some this was their first step in the cultural competency process of their respective organizations. The seminar included 5 meetings and a webinar with cultural competency coordinators from the US and Canada. For a link to the post on the opening of the seminar click here.

From the third meeting: panel of hospital directors – from Sheba, Alyn and Bikkur Holim – and the role of management in cultural competence

The Tour of Cultural Competency in Action The fourth meeting was an all-day tour of cultural competency in action in Jerusalem. The first stop was at the Alyn Rehabilitative Hospital, which began its cultural competency process in 2007. Mrs. Naomi Geffen gave us a tour of the different departments and clinics, explaining the main issues, such as translation in medical and educational settings, ensuring patient and caregiver are the same sex in some cases, dress code, separation of boys and girls in the therapeutic pool, adapting the rehabilitation process to the patient’s culture, and more. Participants also visited the Muslim prayer room that was established in cooperation with the JICC and community members two years ago. We also received examples of materials and documents that had undergone linguistic and cultural adaptations, from a therapy schedule in the patient’s language, the internet site, release letters, and more. We were all amazed at what was accomplished here – today, hospital staff speak in a new language, one that is more advanced and without stereotypes. The second station on the tour was a well-baby clinic that provides services for the Ultra-Orthodox Jewish (Haredi) population in Meah Shearim. We met the clinic’s manager and a leader from the Toldot Aharon community, which is considered to be one of the more conservative and separatist divisions of ultra-orthodox Judaism. The clinic and its services have undergone a process of adaptation to the needs and approaches of the Haredi population, facilitated by the JICC, which included adaptation of the physical environment (pictures, brochures in Yiddish), training for nurses about how to appropriately approach mothers, and more. We intervened, with the full cooperation of a leader in the Haredi community, after a serious epidemic of whooping cough and measles in the Haredi community that spread because of a low rate of immunizations. We discussed with them a number of issues including: vaccinations and immunizations, developmental delays, and more. We also heard about a unique project for first-time mothers, and the special adaptations that had been made for the Haredi community. The third stop was Hadassah – Mount Scopus. Ms. Gila Segev gave an overview of the project that began in April 2010, just as she was appointed cultural competency coordinator. Gila recruited volunteers who were trained in verbal translation/ interpretation by the JICC and lecturers from the Department of Translation and Interpreting Studies at Bar Ilan University. Because 60% of the hospital’s patients are Arabic speakers it was decided to concentrate on Arabic. We also heard a first-hand account of the Hebrew – Arabic translating / interpreting process from a volunteer. The visit concluded with a panel of representatives of different communities to learn about the needs of patients and how to work with the different communities successfully over the long term. The panel included: Dr. Itchik Seffefe Ayecheh (from the Tene Briut organization that advances the health of Ethiopians in Israel), who felt that the focus should be on training and workshops for the medical staff to understand the importance of the relationship with the communities. Dr. Meir Antopolski (“Meeting Point” organization whose goal is to create a new cultural space for the Russian sector) who believes that the linguistic dimension is a critical obstacle in the relationship with the communities, and Mr. Fuad Abu-Hamed (who operates Clalit Health Services clinics in East Jerusalem) gave a fascinating overview of the Palestinian communities of East Jerusalem.

The panel with the Russian, Ethiopian and Palestinian community representatives

Webinar The webinar was on May 16, focusing on the experience of 3 cultural competency coordinators from abroad. Some of the speakers are full-time cultural competency workers with staffs dedicated to responding to the multicultural needs of patients, from special menus and food preparations to organizing different cultures’ holiday celebrations and commemorations. All speakers presented a model that many of the participants could strive toward. The speakers included:

Virginia Tong, Vice Presidents of Cultural Competence, Lutheran Medical Center, New York
Young Lee, Director of Training and Development, Coney Island Hospital, New York
Branka Agic, PhD., Manager, Health Equity Center for Addiction and Mental Health (CAMH), Toronto, Canada

A snapshot from the world cultural competence coordinators webinar

Summing Up The fifth meeting featured a discussion about socio-political tensions that affect the patient-caregiver relationship and how the caregiver and the cultural competency coordinator can relate to it on an organizational level. One example was of ongoing discussions amongst the staff on social-political tensions, with an understanding that these tensions are not limited to the patient-caregiver relationship, they are also found between staff members, which also requires special attention. Later on, Dr. Anat Jaffe from the Hillel Yaffe Hospital in Hadera, and one of the founders of Tene Briut, spoke to us. Dr. Jaffe surveyed the medical meeting point from an inter-cultural perspective. In her lecture she focused on her dealings with the Ethiopian community and diabetes, from her expansive experience as a doctor in the community and in the hospital. The final meeting also included presentations of the pilot initiatives that participants worked on during the seminar. For example, representatives from the Western Galilee Hospital in Nahariya created and passed around a mapping and evaluation survey of different cultural and linguistic aspects of their patients. The representative of Bikkur Holim Hospital in Jerusalem is making the hospital’s voicemail system accessible in 4 languages, and the representative of the Italian Hospital in Nazareth changed the internal signage in the departments to 3 languages. Ms. Avigail Kormes from the New Israel Fund closed the course with warm remarks and wished them success.

***

For an article in Hebrew in Ha’aretz newspaper by Dan Even 4 June 2012 click here.

A translation from Ha’aretz article :

The Era of Multiculturalism Reaches Israeli Hospitals

The hanging of pictures on the wall of non-blonde children, the creation of prayer rooms, and the translation of discharge papers into French – these are the new practices in hospitals of a new policy that requires cultural competency. In February 2013 a new Ministry of Health directive goes into effect requiring cultural competency in Israel medical institutions. As part of the directive, each institution is required to appoint one member of management to be in charge of cultural competency, who will be responsible to implement the new practices. Initial training sessions for coordinators in the past month reveal that the process does not include merely cosmetic changes, such as posting direction signs in Arabic, but seeks to change the atmosphere in the entire hospital to make it accessible to the multiple cultures in the state, especially during a period in which the social fabric of the country creates endless difficulties. One of the organizations that began training cultural competency coordinators is the Jerusalem Intercultural Centre (JICC), that has been advancing this topic in the capital’s hospitals since 2007, with the support of the Jerusalem Foundation and the New Israel Fund. This month the JICC held a course training for for 17 cultural competency coordinators from 14 hospitals at the Schoenbrun School of Nursing, Tel Aviv Sourasky (Ichilov) Medical Center. According to Dr. Hagai Agmon-Snir, the director of the JICC, “cultural competency is more than signage and the translation of forms. Patients need to receive all the medical services of the facility in a way that is accessible both linguistically and culturally, whether that means adding foreign language newspapers to the waiting rooms or making the pictures on the department walls more culturally applicable. When the pictures on the walls only portray blonde Dutch children, it’s most problematic, and its important to include pictures of children from diverse backgrounds, so that people will feel as much a part of the place as possible.” One of the issues that the JICC seeks to integrate in this new process is accessibility of diverse religious and cultural services in the medical facilities. “Opening prayer rooms for different religions is not a political matter, but a professional one,” says Agmon-Snir. Muslim prayer rooms currently operate in only a few hospitals in the country, including Rambam, Alyn, and Hillel Yaffe. “In every self-respecting hospital in the West it’s customary to address diverse religious needs. It appears that addressing religious needs favorably influences the medical treatment, and it is important to advance this in Israel as well,” says Agmon-Snir. Cultural competency also includes the correct usage of terminology that is sensitive to different cultures. Especially now, when social tensions are at their peak, whether related to the ultra-Orthodox, foreign workers or African immigrants, it is incumbent on medical staff to exercise more sensitivity. “It’s important to know the appropriate terminology for each culture. When dealing with the Haredi population, modesty in speech is required. In the ultra-Orthodox community, for example, it’s not customary to says ‘kaki’ or ‘excrement.’ One also has to know how to relate to rabbinic opinions which may influence the type of treatment, just as one has to adapt to secular patients who come to the doctor with information they have gotten on the internet.” Sensitivity to concepts is also required for immigrant workers. “In our training we teach how to be sensitive to every culture, even to the foreign patient from Eritrea,’ says Agmon-Snir. “In some cultures, for example, ‘no’ is not a firm refusal, but rather a request to hear more information before making a decision. In some cultures, when a patient bows his head he is showing respect for the caregiver, and it is not at all a refusal of care.” Another course for coordinators responsible for cultural competency coordinators from 24 hospitals began this month, under the auspices of the Ministry of Health, via Dortal Consulting. According to Dr. Emma Auerbuch, coordinator for reducing gaps in health care for the Ministry of Health, “Our approach is a little different. For example, anything related to places of worship, in our opinion, is the decision of the administrator of the medical facility, and should not to be imposed from above. In all matters related to cultural accessibility, one must remember that it is the goal of health facilities to provide medical treatment, and we try as much as possible to avoid tension.”

The different approach between the bodies can also be found with regards to the translation of patients’ forms. The JICC seeks to translate all the forms a patient might receive, including discharge papers, into various languages.. Auerbuch stresses that “the directive requires translation only of forms that require a patient’s signature, but we won’t prevent a hospital from offering translations of other forms as well. Recently a health fund in Netanya began offering medical information in French, since there is a large concentration of French speaking immigrants there. We can only congratulate them for that.” The courses include among other things training in preventing social tensions during the medical treatment. “This is an especially relevant topic in Israel, because people here tend to cross the lines between professional and political. Many times a patient will tell a doctor or a nurse what he thinks, for example, ‘you’re Russian and that’s why you act that way.’ The intercultural contact creates a challenging dynamic, including the use of stereotypes, and medical staff must learn how to maintain professional interaction, as much as possible,” says Agmon-Snir. “One must remember that the patient’s welfare is paramount, and the role of the health system is not to educate the patients. It’s not the doctor or nurse’s job to teach the patient manners or how to behave. A nurse may certainly put a disrespectful patient in his place, but in a professional context. Saying to a patient, ‘you Ethiopians are always late’ is not appropriate. Special attention is being given to emergency rooms. According to Dr. Agmon-Snir, “Although the pressure in the emergency room complicates the ability to give a patient detailed explanations, sometimes investing three extra minutes in explanations can save confusion and much time later on.”

jicc2017-05-26T20:05:38+00:00May 21st, 2012|Blog, Cross-Cultural Communication Trainings, Cultural Competence, Cultural Competence in Health Services, Outside Jerusalem|

Professional Development for Healthcare Cultural Competency Coordinators from around the country – Summary of Day One

We’ve taken yet another step in becoming one of the national leaders and reference points of Cultural Competency in the health care system in Israel. On Monday, 23 April we held the first meeting of a professional development seminar cultural competency coordinators from around the country. This is the first such seminar ever to take place in Israel! Our 16 participants included representatives from the major hospitals in the country: Hadassah Medical Center and Sha’are Zedek in Jerusalem; Shiba-Tel Hashomer and Sourasky Medical Center in the Tel Aviv area, Rambam in Haifa, and more.

We have been working to advance cultural competency in the health care system in Israel since 2007, and we are in constant contact with most of the cultural competency coordinators around the country. Most of these coordinators have been appointed since the publication of the Ministry of Health’s Cultural Competency Directive, published in February 2011, that will require medical interpretation services, education and training of medical staffs, environmental adaptations of all health care institutions by 2013. As a first step, the Directive requires health care organizations to appoint a cultural competency coordinator to be responsible for all the processes that work toward equal cultural and linguistic accessibility for all.

Our unique seminar is taking place in cooperation with the Ministry of Health and is a natural continuation of the Directive. The training will provide knowledge and tools to enable cultural competency coordinators to assimilate the Directive in their institutions. It is important to note that most cultural competency coordinators are already in senior management positions in their organizations.

The 5-day training seminar, which will meet weekly until the end of May, will include 50 hours of frontal lectures as well as a webinar with cultural competency coordinators from Canada and the USA. Our funders for this course are the Jerusalem Foundation and the New Israel Fund. The course is being held at the Nursing School at the Tel Aviv Sourasky Medical Center.

The training course will cover:

• Introduction to Cultural Competency: Medical interpreting and translation and mediation in health services, models of intercultural communication between patient and caregiver, cultural dimensions in interpersonal communication, dealing with political and social tensions, different cultures’ approaches to health and sickness, and more.
• Practical guidance for cultural competency processes in health care organizations – from the cultural competency coordinator’s first steps to full organizational adaptation.

It will also include guest lectures on the following subjects:

• Inequality in the health care system and the role of the cultural competency coordinator in reducing gaps.
• Acquaintance with the main theories of cultural competency in Israel and around the world.
• Tools for implementing principles of cultural competency in a health care organization.
• Tours of hospitals and clinics that are undergoing cultural competency processes.
• Clinical aspects of different cultural approaches to sickness and health.
• Culturally-dictated social norms.
• Cultural competency from the viewpoint of health organization administration.
• Cultural competency from the viewpoint of social organizations dealing with community health.

The opening lecture was given by Dr. Emma Averbuch from the Unit of Decreasing Health Inequality at the Division of Health Economics and Insurance Division of the Israeli Ministry of Health. Dr. Averbuch emphasized the importance of the cultural competency coordinator and how he or she can contribute to decreasing inequality in health care. She also surveyed the Ministry’s activities thus far in advancing cultural competency and decreasing inequality in the system.

Prof. Leon Epstein speaks on Inequality in Health at the Cultural Competence Coordinators training

The participants also had the first session covering the “Guide for Cultural Competency Processes in Health Care Organizations”, which is a practical guide we developed over the past 2 years. It details the steps that must be taken to assimilate cultural competency principles in an organization. This meeting concentrated on defining the role of the cultural competency coordinator, as well as first steps in creating a suitable buzz within an organization for cultural competency. In addition, the participants related their experiences with the community, and the discussion that followed focused on the need to establish and expand these relationships to be helpful in times of crisis.

Part of the training included a practical exercise in creating change. Each participant was asked to choose a small initiative that is related to at least one component of cultural competency that he or she wanted to change by the end of the training course at the end of May. This initiative needed to be something easily implementable and with high visibility in the organization. Participants chose projects such as mapping needs and resources, linguistic accessibility of restrooms, and more.

Simulation of a case of cultural competence at the training

Two guest lectures dealt with the relationship between risk management and cultural competency, from Ronen Regev-Kabir, Deputy Director, Public Trust organization, and Netalie Goldfarb, the Care Competency Unit of the Ministry of Health. Our own Dr. Hagai Agmon-Snir closed the day with a workshop on cultural dimensions and the main values of interpersonal communication, to give a taste of the cultural competency workshop that will be the focus of the second workshop on 30 April.

In parallel to this meeting, an Internet discussion group was established that will deal with cultural competency in the health care system in Israel. There will be participants from within and without the health care system and it will enable participants to share knowledge in this area. You can view the discussion group and the course’s accompanying materials here.

jicc2014-04-11T15:37:13+00:00April 23rd, 2012|Blog, Cross-Cultural Communication Trainings, Cultural Competence, Cultural Competence in Health Services, Outside Jerusalem|

Assisting Paramedical Professionals in Receiving Certification from the Israeli Ministry of Health

Here’s an example of how our work in one area uncovers more and more needs in East Jerusalem, and opens up more opportunities to begin to close the gap in services to Palestinian residents of East Jerusalem.

We spent a long time working toward the opening of a Well-Baby Clinic in Silwan in August 2011. While working on the issue of opening more clinics, we discovered that there was a severe lack of Arabic-speaking nurses who were certified by the Israeli Ministry of Health. It meant that these Well-Baby Clinics in East Jerusalem and other healthcare institutions find it hard to find good certified nurses. The employment authority of the Municipality looked into the matter, and discovered that the problem was much larger – in general there is a dearth of Arabic-speaking medical and paramedical personnel, certified by the Israeli Ministry of Health, in East Jerusalem.

We also discovered that there are hundreds of graduates of Palestinian universities and colleges in the West Bank (for example, Bethlehem University, the American University of Jenin), who cannot work in their fields in the Israeli healthcare system. These institutions are considered ‘overseas’ institutions, and graduates must pass Israeli Ministry of Health certification and competency exams. (Israeli graduates must pass these examinations as well.) Very few Palestinian graduates from East Jerusalem pass these examinations. Paradoxically, the Israeli Ministry of Health is eager for these graduates to find work in the Israeli healthcare system in East Jerusalem, to reduce the above-mentioned lack of Arabic-speaking medical and paramedical professionals.

A preparatory meeting of nursing school graduates in East Jerusalem

A preparatory meeting for nursing school graduates in East Jerusalem

The Jerusalem Foundation, our long-time partner in creating cultural competence in the city and in creating better opportunities to all in the city, asked us to enter into the picture. Much of the initial work was investigative: we first sought to figure out the real obstacles that prevented Palestinian graduates from passing the examinations, and then proposed responses. At the outset we chose to concentrate first on occupational therapy and nursing. As part of this extended learning process, in November 2011 we held public meetings for each of the professions, which included relevant information about the certification process. Most of the participants had previously failed the exams, and they became integral partners in our learning process of constructing a full picture of the current situation.

The results were fascinating – and yet, typical – of many of the difficult problems that we have encountered, whose sometimes solutions were relatively simple. Indeed, we find many times that what looks as huge barriers can be overcome by simple solutions. Let us share these results and the response we suggested with you:

In occupational therapy, it turns out that until very recently, the exam was available only in Hebrew and in Arabic. Yet, the problem was that the Arabic translation was very poor, which hurt candidates’ chances of passing. More importantly, at Bethlehem University and at the American University in Jenin, the students learn in English! Thus, they would be much more comfortable taking the exam in English. Fortunately (unrelated to our work), in the past year students have been able to take the certification exam in English as well.

But this was only the beginning of the story. We discovered that part of the required material for the exam included position papers in occupational therapy that exist only in Hebrew; knowledge of Israeli laws, which is also available only in Hebrew; and the guidelines for occupational therapy in Israel, which exists in Hebrew, Arabic and English, but that the students knew nothing about! In other words, the Palestinian graduates were sitting for exams, for which they did not have access to or did not even know about significant parts of the material. Many graduates received scores between 50 – 60 (passing is 60), and this is without knowing about a good deal of the required materials.

This information enabled us to respond quickly. We translated the position papers into English (the language preferred by the graduates for the exam); we obtained guidelines for occupational therapy in Israel in English; with assistance from the Hebrew University Hadassah School of Occupational Therapy, we developed a program to prepare graduates for the exam that will take place in June 2012. This program began a week ago with 17 dedicated participants. The course will include 11, 3-hour meetings as well as 2 concentrated days as the exam nears.

Our follow-up is both group and individual – we purchased occupational therapy textbooks that are important for the exam, and participants will be able to use these materials. We helped each and every one of the participants register for the exam with the Israeli Ministry of Health, and more. We are very optimistic, but we will of course be calmer after the results of the June 2012 exams are released…

The situation in the field of nursing was more complicated. Here, too, graduates from East Jerusalem could take the exam in only Hebrew or Arabic, with very poor achievements (1-2 graduates passed the exams each year). The exams themselves are considered difficult – many graduates of Israeli universities also fail the exams each year. After a meeting with the Ministry of Health, it was clarified that from now on it wouldn’t be a problem for East Jerusalem residents to take the exam in English. Thus far we’ve given some 50 nursing school graduates a pre-test, similar to the real examination, to find out what we need to concentrate on in the course. We identified that 20 received between 50 – 60 on the pre-test (60 is the passing grade). This result encouraged us, since the graduates didn’t have much time to study, and if such a large group is so close to passing, the chances of at least 15 passing the certification exams in September after a program of intensive preparation and study, are good. In addition, we learned from the exams on what areas we need to focus more in the preparations.

Based on this information, a preparatory program for Palestinian nursing school graduates is being developed to prepare them for the government exams in September 2012. It is important to note that those who pass the nursing examination in a language other than Hebrew must also pass an additional exam in Hebrew language in order to receive a license to be a nurse in Israel. Yet, the Ministry of Health allows East Jerusalem residents who passed the exam not in Hebrew to work in Palestinian institutions in East Jerusalem. This means that those who pass the exam would only be able to work there. Although there is also a severe lack of personnel in East Jerusalem, we hope to provide participants in this course with Hebrew instruction, so that they will be fully qualified to work in nursing, anywhere in the healthcare system in Jerusalem.

We will be following these women and men through the examination and (hopefully) placement process. We hope that at the end of this process we will not only helped dozens more people receive employment in their chosen professions, we will help more of the 280,000 Palestinian residents of East Jerusalem receive better health care.

jicc2014-07-11T09:19:43+00:00April 15th, 2012|Blog, Cultural Competence, Cultural Competence in Health Services, Employment, Employment Accessibility, Identity Groups and Conflicts, Palestinians/Arabs, Supporting employment in East Jerusalem|

The JICC in Sefad at the Ziv Medical Center

Even though the JICC is focusing on the Jerusalem area, we find more and more cases in which the expertise we gained in the city is important in capacity building in other places. One example was today, when some 20 members of the senior administration staff of the Ziv Medical Center in Sefad gathered for a unique workshop on cultural competency, facilitated by the Jerusalem Intercultural Center (JICC). The workshop was organized by Dr. Sarah Nissim, Deputy Director of the Nursing School and Cultural Competency coordinator for the hospital. Dr. Nissim had asked the JICC to present cultural competency to the senior managers, before they began to assimilate the principles in the hospital. Sarah, who is a veteran colleague of the JICC in cultural competency, sought to engage the JICC to facilitate the assimilation of cultural competency principles in the hospital, as per the Ministry of Health directive, in the 2012 work year.

Dr. Shapiro Klein, Deputy Director of the hospital and Dr. Sarah Nissim (Cultural Competency coordinator) began the workshop with opening remarks.

The JICC in Sefad at the Ziv Medical Center

At the beginning of the day the participants shared their experiences of intercultural encounters in the different departments. Thus, for example, one person detailed the difficulties dealing with a Druze girl with an eating disorder. Another doctor spoke about the difficulty working with the Haredi community and its rabbis, despite the dialogue that takes place from time to time between local rabbis and medical staff. We saw the huge difference between the Jerusalem hospitals that deal with diverse communities within the Jerusalem region, as opposed to Ziv, which deals with diverse communities over a vast area (mostly the upper and eastern Galilee and the Golan Heights), which requires a different type of communication with the different community heads.

As such, the first ‘theoretical’ part of the workshop dealt with tools and ways to bridge the gaps between cultures. These tools followed a clarification of the concept of ‘cultural dimensions’, and an analysis of dialogues between patient and caregiver in which different cultural values are presented.

The second part provided practical tools for professional medical interpretation, as well as practical suggestions on how to relate to non-professional interpreters, through movies and analysis of case studies, from Israel and around the world. Immediately after lunch the participants practiced their knowledge of intercultural issues – a specially-trained actress played a Haredi and Palestinian patient in two separate scenarios.

Role play

This workshop was used as a kickoff to the process of assimilating cultural competency principles into the hospital, which will be led by Dr. Sarah Nissim. Part of the plans discussed with her include a workshop for bilingual staff members to overcome the communication problems with the Ethiopian community and training of facilitators from among the hospital staff to establish a set mechanism of training medical staff at the Ziv Medical Center in Sefad.

jicc2014-04-11T15:30:21+00:00March 26th, 2012|Blog, Cross-Cultural Communication Trainings, Cultural Competence, Cultural Competence in Health Services|

Cultural Competence and Mental Health – Beginning to work with the Jerusalem Center for Mental Health

We are on the verge of yet another transformative process in the field of cultural competency. On March 14 – 15, the JICC was invited to present its introductory cultural competency workshops to 70 senior managers from the Jerusalem Mental Health Center, at its annual management conference at the Dead Sea. This Mental Health Center includes hundreds of staff who are responsible for 300 hospital beds (active and extended stay departments) over 2 campuses (Kfar Shaul and Eitanim), Mental Health Centers in west and south Jerusalem, in Ma’ale Adumim, Mevasseret Zion and in Beit Shemesh. The Center also serves the Arabic-speaking population from East Jerusalem. The focus on cultural competency at the annual conference is a kickoff to the process of making the Jerusalem Center for Mental Health culturally competent. The Jerusalem Center was the first mental health center in Israel to commit, through the JICC help, to assimilate principles of cultural competency throughout its system of care.

Mental health services are a special challenge for cultural competency, since most care is based on verbal communication. At the same time, it is important to note that public mental health services are required comply with the Ministry of Health directive (February 2011) on cultural competency, as other health care organizations. In this conference the issue was introduced to the senior management, including department directors, as well as those in key roles, before cultural competence is being assimilated in all departments. The spotlight given at the conference is the result of many meetings between the JICC and the Jerusalem Center administration, as well as with the Jerusalem Foundation, to explain its importance in psychological care.

Practicing Dialogue

Throughout the first day the participants told stories about intercultural challenges and events they had encountered. In addition, Dr. Hagai Agmon-Snir, JICC Director, presented a workshop on intercultural communication and cultural dimensions and how awareness of this subject influences mental healthcare.

During the second day the participants were exposed to the importance of professional interpreting in therapy sessions, and shared examples, from Israel and around the world, of therapy being compromised because of language barriers. Senior staff understood the need and seemed willing to change the existing situation (which today uses non-professional and unskilled interpreters) to make the services more accessible. The day included a fascinating discussion about the boundaries of multiculturalism (“How much should I give up my professional and personal values in order to adapt the therapy session to the patient that comes from a culture that is entirely different than mine?”).

Workshop of the Jerusalem Center for Mental Health March 15, 2012

It was obvious that the 2 days of the conference were a first taste, and that this will be a long process that will require close cooperation between the JICC and the Jerusalem Center for Mental Health. The process will include training the medical and administrative staff in CC skills, and training bilingual staff in a medical interpretation, as has been done in other Jerusalem hospitals (Bikur Holim, Alyn, Hadassah) and HMOs. We believe that the products of this lengthy process can be a prototype for similar accessibility processes in other mental health centers around Israel.

jicc2014-07-11T09:25:08+00:00March 15th, 2012|Blog, Courses, Cross-Cultural Communication Trainings, Cultural Competence in Health Services, Jewish-Palestinian/Arab|

“Haaretz” article on our interpreters course in Bikur Holim: medical staffers are learning Arabic, Yiddish and more and learning cultural sensitivity to bridge gaps with communities in need of care

Following our interpreters course at Bikur Holim(see our blog entry about it!), Haaretz published an article that covers the story.

You can find the Article in English here, and the Hebrew version here.

We loved this excellent article very much. But we have two minor comments:

The English headline is misleading – it says “To give better care, Israeli doctors learning Yiddish and Arabic”. Well, this course was for bilingual staff who already speak two languages, but need to learn the professional tools for medical interpretation. We are very happy to see that medical staff is learning the languages of their patients, but frankly, we prefer that they use expert medical interpreters rather than relying on the basic language course they had.
We do not recommend saying “Abi gezunt” to a sick person…. it means “health is the most important thing”. You use this phrase when someone lost money or when his/her car was damaged in a car accident. The idea is that never mind the money – health is much more important. It is a bit cynical to say it to a sick person. Better use “Sei gesund” (be healthy). 🙂

Yet, great article! Here is the full text:

To give better care, Israeli doctors learning Yiddish and Arabic
Medical staffers are learning Arabic, Yiddish and more and learning cultural sensitivity to bridge gaps with communities in need of care.
By Dan Even, “Haaretz”

“Abi gezunt” (be healthy ) is a common refrain used by members of the ultra-Orthodox community in Jerusalem when fulfilling the religious commandment of visiting the sick.

But patients from the mostly Yiddish-speaking community who need medical treatment sometimes find it difficult to communicate with the doctors in Hebrew, which they use for prayers only.
Doctor with translators

A doctor and two translators simulating a Russian-Hebrew conversation.
Photo by: Olivier Fitoussi

In the past decade there has been an increasing awareness in Western countries of the importance of training teams in medical interpretation, in order to improve communication between doctors and patients from different cultures.

The medical system in Israel, an immigrant-absorbing country, has also recently instituted a special training program. After the opening of interpretation courses in Arabic, Russian and Amharic, last month a first course opened in Jerusalem to train interpreters in Yiddish.

“The Israel health system is good, but the issue of cultural competence has skipped us as though it never existed, maybe because it sounds too political or too leftist,” said the director general of the Jerusalem Inter-Cultural Center, Dr. Hagai Agmon-Snir, who initiated the program.

“Maybe it’s because of the melting pot concept, which led to a belief that if a patient speaking a foreign language arrives at the hospital, it’s preferable that he make an effort to speak Hebrew,” said Dr. Michal Schuster, a graduate of Bar-Ilan University’s translation studies program, who is participating in the project.

The interpreters’ course that began in May for the staffs of the Bikur Holim Hospital in Jerusalem was designed to train medical interpreters in Yiddish, the mother tongue of the ultra-Orthodox patients who use the medical institution. On the obstetrics wards, for example, 80 percent of the women are Haredi.

“It’s no secret that as opposed to the ‘State of Tel Aviv,’ here we have patients from specific populations, and there are patients from the Haredi and Arab populations who are in need of a sensitive attitude in various medical situations,” said the medical director of Bikur Holim, Dr. Raphael Pollack. Agmon-Snir says while the patients know a little Hebrew, they shouldn’t have to stumble for words when in a hospital setting.

“Theoretically there’s no need for interpreters into Yiddish, but there are members of the Haredi community who are capable of expressing their distress more easily in Yiddish, and we should make communication easier for them,” the doctor said.

The language training consists of 40 academic hours over a period of six weeks, and is being taught to 36 Bikur Holim nurses and administrators. The course includes introductions to anatomy, in order to become familiar with common medical terms such as EKG or blood count, the study of precision in translating and of medical ethics. The cultural competence course, which is designed for a larger number of staff members, also includes content related to the cultural differences among patients of different origins.

Schuster says that they make sure not to perpetuate stereotypes about minority groups, “instead, we provide tools for dealing with a patient from a different culture, principles of listening and understanding the cultural nuances,” she said.

Shake hands

“In the Ethiopian community, at the beginning of treatment the doctor is supposed to stand up and shake the patient’s hand,” says Dr. Idit Dayan, the coordinator of welfare at the Jerusalem Foundation, which is a partner in planning the project and promoting cultural competence in the Jerusalem health services, and supports it to the tune of hundreds of thousands of shekels annually. “There are Russian doctors who confessed to us that they don’t understand the custom, but it constitutes a code of honor in the Ethiopian community, and it helps to improve communications and breaks the ice between the doctor and the patient.”

Cultural misunderstandings are liable nowadays to lead to medical negligence claims, and Israeli courts have already dealt with scenarios originating in an absence of cultural competence on the part of medical staffs.

In January 2007, the Jerusalem Magistrate’s Court granted compensation of NIS 250,000 to a couple from Bueina-Nujidat in the north, after the woman miscarried and claimed that at Poriya Hospital, where she was under supervision, they were negligent in treating her.

It turned out that during the period of supervision the woman, who is an Arabic-speaker, was given medical explanations in Hebrew. One of the doctors testified at the trial that she had given the expectant mother explanations in Arabic, but it turned out that she had explained the nature of the treatment the woman required at home using only isolated words rather than sentences.

In the ruling, Judge Arnon Darel said “the hospital did not meet its minimal obligation of providing the explanation in a manner understandable to the patient.”

The present project began in 2008 with the support of the Jerusalem Foundation, and continued with a pilot in the Alyn Pediatric and Adolescent Rehabilitation Center, when staffs were trained in medical interpretation and directional signs in various languages were posted.

The project has since expanded to the Clalit health maintenance organizations in Jerusalem, especially in the clinics that serve the Ethiopian community, and the Arab community in East Jerusalem.

In the past year the program was also expanded to Hadassah University Hospital at Mount Scopus and at Ein Kerem, and is slated to also be used at the Kfar Shaul Mental Health Center.

The profession of medical interpretation is still in its infancy in Israel, but the vision for the future includes the development of a new career path. At Alyn there is already a salaried Arabic interpreter. The increasing awareness of cultural differences and the fear of lawsuits have led the Health Ministry to publish a director general’s circular on the subject of cultural and linguistic accessibility in the health system.

According to the circular, by February 2013 all the institutions in the health system will be required to provide medical translation services to patients by means of a professional hotline, by employing cultural experts or by employing staff members who speak foreign languages, after they undergo training, and to refrain insofar as possible from using a family member as a translator.

jicc2014-07-11T09:12:02+00:00July 4th, 2011|Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, New Immigrants, Palestinians/Arabs, Ultra-Orthodox Jews|

First time in Yiddish!! – opening of medical interpreters course in Bikur Holim Hospital

Today we began implementing our cultural competence program at the Bikur Holim hospital in Jerusalem. Bikur Holim is one of the oldest hospitals in the city (founded in 1826). From the article in Wikipedia about the hospital, we have chosen to cite the following:

Situated near the religious neighborhoods of Geula and Mea Shearim, Bikur Holim admits a very high percentage of Haredi Jews, and tries to cater to their needs. Shabbat is strictly observed. Non-Jewish employees record medical information and answer telephones on the Sabbath. Food is warmed in ovens operated by a timer, in keeping with Orthodox religious rulings.

The Haredi (Ultra-Orthodox) orientation of the hospital is very much known in Jerusalem. Yet, it is not surprising to find out that since most of the medical and non-medical staff are non-Haredi, there is still a need for improving cultural competence for Haredi patients and families. When we approached the hospital management, half a year ago, as a part of the program of cultural competence in Jerusalem (a program we share with the Jerusalem Foundation), we were warmly invited in. The staff also emphasized that the hospital accepts patients from all around the city, including high percentage of Palestinians (Muslims and Christians), new immigrants from all around the world and migrant (foreign) workers. Together, We planned a cultural competency program for the hospital.

Bikur Holim Medical Interpretation Course

The first step of the implementation was today – a medical interpretation course for more than 30 bilingual staff members. Well, we did such 30-40 hour training courses before, in Alyn hospital, in Clalit HMO and in Hadassah. But this time, in addition to Arabic, Russian and Amharic interpreters, we have a large group of Yiddish interpreters! Indeed, although most of the Haredi community can speak in Hebrew, many of them are much more used to Yiddish, and Hebrew for them is a kind of a second language. Also, medical terminology and explanations in English or in Hebrew are hard for many of them to understand. We believe that using Yiddish can help many of them and would make them feel more “at home” in a Western hospital.

Bikur Holim Interpretation Course – on the left Rabbi Shlomo Pappenheim, main Eda Haredit Leader and a Board Member of the hospital

Definitely, if this works well, we will advise other medical institutes in Jerusalem, that also serve large Haredi populations, incorporate Yiddish into their list of interpretation languages.

The next step will be providing our staff training workshops of cultural competency. One of the urgent needs is to make Arab patients feel “at home” in a hospital that is seen as oriented towards religious Jews. With the help of the wonderful staff of the hospital, we are sure that this challenge can be met.

jicc2016-10-22T07:31:15+00:00May 25th, 2011|Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, New Immigrants, Palestinians/Arabs, Ultra-Orthodox Jews|

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