Cultural Competence | The Jerusalem Intercultural Center

New Medical Interpreters Course for Mental Health Professionals

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

National Mental Health Interpreters Training

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

Simulation of an Interpreted Session in Mental Health

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

Principles of Cultural Competency

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

Hadassah College – First Academic Institution to Become Culturally Competent

Jerusalem’s everyday reality has become increasingly complex over the past few months, but that the same time, some wonderful things are happening in the field of cultural competency. About a month ago, we began a long-term process to make Jerusalem’s Hadassah Academic College culturally competent. It will be the first academic institution in Israel to undergo this process, and it is happening in Jerusalem.

Hadassah College simulation

We began with a number of in-depth discussions with different department heads and administration, since we had to adapt our curriculum, which has been developed for the health care system, to the needs of the College. These discussions culminated in an all-day seminar for 30 department heads and administration on September 30. The workshop included principles of cultural competency, as well as a number of simulations, which enabled participants to experience specific culturally sensitive situations, and have guided discussions on methods of dealing with different intercultural challenges. Much of the discussion centered around issues in relation to the college’s Arab student body, which comprises 15% of the total student population. One of the main issues discussed were the obstacles of communication and language gaps between students and lecturers. They focused on a number of sensitive points, from the admissions interview, to regarding the different approaches toward education, and more. The next step will be for the participants to decide on a broader plan of action – who else will participate in the training workshops, and what other steps will the College take in becoming culturally competent.

How did Hadassah come to this? They are very minded about diversity. They have a very diverse student body, and, since they are located close to the seam line between East and West Jerusalem, on Nevi’im Street which designates the border between the secular neighborhoods and the very Haredi neighborhoods of Geulah and Meah Shearim, diversity and multi-culturalism is on their mind. The summer war and ongoing general tensions in Jerusalem made the need even greater.

Naomi Roff2014-11-22T12:30:22+00:00November 20th, 2014|Blog, Cultural Competence, Cultural Competence in Academic Institutions, Identity Groups and Conflicts|

Empowering the African Refugee Community in Jerusalem

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

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

Well Baby Clinic first aid course

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

Mulu and Tzagai story hour

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

Well Baby Clinic demonstration

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

A Culturally Competent ALYN Rehabilitative Hospital during a Summer of War

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

Alyn Cultural Competence Training

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

Dr. Maurit Beeri writes in her article:

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

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

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

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

The JICC Calming the Waters in this Time of Crisis

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

Jerusalem Dome of the Rock

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

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

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

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

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

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

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

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

Putting Cultural Competency into High Gear

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

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

Cultural Competency in Local Authorities

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

Cultural Competency comparison

These publications join other recent accomplishments, including:

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

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

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

Climbing the Learning Curve – Results for 2013 Palestinian Nurses Certification Exam

2013 – 2014 has been a fascinating learning year for us in the Healthcare Certification Exams project for Jerusalem-based Palestinian nurses. As you might remember, in 2012 we had fantastic success – 26 out of 39 participants passed the certification exam, which enabled the nurses to work legally in East Jerusalem. In 2013 we set out with another cadre of 26 nurses, but their road turned out to be rather bumpy.

At the end of the course, even after instituting weekly quizzes to ensure that the material was being learned, only 3 nurses passed the exam. This caused us to take a deep, long look into the course – were we off the mark in the way we prepared the nurses? Was it just bad luck the second time? Was it the exam itself? Were we just very lucky the first time?

From our current understanding of the situation, it turned out to be a little bit of everything. The exam in September 2013 was indeed significantly more difficult than the fall exam the previous year. And as we learned from participants who re-took the exam in April 2014 (6 of whom passed!), the September 2013 exam was also more difficult than the April 2014 one. In addition, there was a significant group of participants who were one or two questions away from passing, indicating that there was indeed some luck involved.

After re-evaluating the course structure we decided to make a number of changes to the course – first, a number of stages, with entrance exams to each stage. All potential participants will receive background material beforehand. Not only does this ensure a common baseline of knowledge for all participants, it also shows a degree of seriousness that the participants will be able to study and learn for exams, which we’ve found to be essential to pass successfully. In helping the group of nurses to prepare independently for the April 2014, we ‘ve also learned that one specific review handbook was particularly concise and helpful in preparing participants for the exam. We’d used the handbook before, but in future courses (our next course will be geared toward preparing for the April 2015 exam) we’ll put a heavier emphasis on studying its material.

Our tally thus far – an additional 36 nurses who are accredited to practice nursing in East Jerusalem, out of 68 in two courses who took the exam. More than a 50% success rate in two years! At the previous rate (of 1-2 nurses successfully passing the exam each year), it would have taken nearly two decades to reach this number! Our thanks to the Hadassah Foundation, the Leichtag Foundation, the Dear Foundation, and the Jerusalem Foundation, for their continued support of this program.

Naomi Roff2016-04-28T15:40:36+00:00June 28th, 2014|Blog, Courses, Cultural Competence, Employment, Employment Accessibility, Identity Groups and Conflicts, Palestinians/Arabs, Supporting employment in East Jerusalem|

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

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

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

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

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

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

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|

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