Employment Accessibility

Healthcare Certification Training: Taking Stock

Over the past few weeks we’ve gotten some great news – that 6 more occupational therapists who took our course passed the Ministry of Health certification exam, and several more were very close. As the results continue to come in, we thought we’d take stock over the past 4 years of the program. We’ve really come a long way:

  • The program has increased the number of certified Arab paramedical professionals in East Jerusalem exponentially. Since it began in 2012, nearly 70 nurses, occupational therapists, and physical therapists to pass their Israeli certification exams. This includes 37 nurses, 24 occupational therapists and 6 physical therapists. Beforehand, only 1-2 would pass each year in each discipline. It would have taken many years to achieve these results otherwise.
  • The program has enabled us to more clearly map the situation of different paramedical professions in East Jerusalem, contributing to the knowledge of training in the Jerusalem area. As we developed courses for different disciplines, we have gained an in-depth knowledge of the state of diverse fields in East Jerusalem. This is the first time ever that any type of mapping has been done, and this information is now available for the first time to health care and educational institutions, as well as the Israel Ministry of Health.
  • The program has raised awareness both among Palestinian institutes of higher education and health care institutions in East Jerusalem as well as Israeli Ministry of Health. When we began the program, there was little compliance and even less awareness about the need and benefits of having staff that have passed the certification exam in their fields. Today, all the major health care institutions in East Jerusalem, Palestinian universities, as well as Ministry of Health, better understand this need. We believe this understanding will lead to an improvement in health care in East Jerusalem.
  • The program has opened a large window of opportunity for Arab women paramedical professionals to improve economic opportunities. After they pass their certification exams improves their access to employment rights, which includes an increase in pay and employment conditions.
  • As a result of the program, the JICC has earned a prestigious reputation for offering high-quality courses. Since we began these courses, graduates of the physical therapy and occupational therapy courses have had high rates of success in passing the certification examinations. As a result of this success, graduates, and even expectant graduates, of the different Palestinian universities have requested to register for courses well in advance.
  • Our reputation proceeds itself in expanding to new disciplines. As a result of the success of graduates of physical and occupational therapy, graduates of other paramedical professions – speech therapists and medical laboratory technicians – have requested we develop courses, which are now in various stages of development. Thus, we have expanded our offerings from two to six (also including physical therapy, speech therapy, medical laboratory technicians and medical Hebrew). We are also in regular contact with the medical faculty of Al-Quds University, ready to assist if needed.
A meeting of the nursing course

A meeting of the nursing course

We’ve just started a new course for physical therapists, and are developing courses for speech therapists and medical lab technicians. We’ll keep you posted on further updates.

Many thanks to the Jerusalem Foundation and the Hadassah Foundation for their support of this program.


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Qualifying Paramedical Professionals, Improving Health Care in East Jerusalem

Slowly but surely, we’re helping to improve health care, accessibility to health care, and paramedical professionals’ workers rights in East Jerusalem.

Yesterday we began a second course to train physical therapists to pass the Israeli Ministry of Health certification examination, which will take place in May 2016. This is part of our larger program to train recent graduates of paramedical professions to pass the Israeli Ministry of Health certification exams that we’ve been developing since 2012. Since the program began, we’ve helped some 70 nurses, occupational therapists, and physical therapists to pass their Israeli certification exams, when it would otherwise have taken many years to achieve these results.

This success has brought brought additional development – in light of the success in the first three fields. we were asked to develop courses for medical lab technicians and speech therapists. We’re in the process of doing so, and will be sure to provide updates here.

Physical therapists course

Physical therapists course

We have 20 physical therapists in the current course. Last time we were very successful – 6 passed, on a test that is considered very difficult even in the original Hebrew.  We wish them success, Bi-najah, Be-hatzlaha!

Many thanks to the Jerusalem Foundation and the Hadassah Foundation for their support of this program.

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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.


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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.

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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.

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