Ethiopian Jews

Can Israel’s Police Force Become Culturally Competent?

The news is full of stories of the police’s treatment – appropriate or not – of civilians. Just recently Americans marked the one-year anniversary of the shooting of a young, black, unarmed man by a white police officer in Ferguson, Missouri, USA, which led to riots and civil unrest for some time.  In May of this year Israeli police officer were shown beating a soldier of Ethiopian descent, which led to a wave of demonstrations of the Ethiopian community in Israel, and unrest in the streets.

Israel’s police force – and any police force – are under constant and almost unbearable pressure to keep law and order, working among a vastly diverse population. Educators in the Israeli Police Force recognized this complexity, and requested to begin working with us to develop a cultural competency training module for police cadets. To their credit, planning work actually began before relations between the police and the Ethiopian community made headlines. But the light shown on the police during the full-force demonstrations of the Ethiopian community this spring underlined the necessity of this kind of training. As a result, we began to working with all new police cadets, as part of their 14-week basic training course. At the same time, we are beginning an in-depth process with 23 police stations throughout the country.

At this first stage we are implementing introductory workshops to different training courses – basic policing, detectives, border police, cavalry, advanced policing – all are undergoing the basic 1 1/2 hour workshop. Since the beginning of June we’ve held 40 seminars, with 20 – 30 police cadets in each group. That’s  already 1,200 cadets! After this, we will be organizing a Train the Trainers course for the regular instructors in the police academy, so the principles can be fully integrated into their training regimen.

More in-depth processes will be taking place in 26 police stations throughout the country that have high concentrations of Israelis of Ethiopian descent, including two in Jerusalem, Moriah in the south and Shufat in the north. In this process we are partnering together with the Gishurim project. The first step of this process will be a half-day seminar on cultural competency, using facilitators that we’ve trained. We will begin training the facilitators in September; they will then lead 150 seminars throughout the country.

And what do the police think about these training sessions? We’re finding that many, especially Jerusalemites, are already very in-tuned to the cultural complexities of our city, and make every effort to consider the effects that cultural sensitivity has on the residents with whom they come into contact. We are honored to be part of a process that seeks to bring law and order to all residents of the city.

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Working with Maccabi Health Services

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

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

Maccabi seminar

Maccabi seminar

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

Maccabi panel full room

Maccabi panel full room

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

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

 

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

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

Nabi Shu'ayb Druze Holiday Sheet

Nabi Shu’ayb Druze Holiday Sheet

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

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Empowering Activists to Work toward a More Tolerant Jerusalem – the Second in a Series

One of our main tenets at the JICC is to encourage and foster effective activism, empowering residents to improve their everyday lives. From MiniActive to the Emergency Readiness Networks, to the Railway Park, residents are affecting their immediate public sphere, one issue at a time.

Since last summer, one of our main avenues of activity has been fighting racism and xenophobia in the public sphere, and fostering cadres of activists to lend their passion and intensity to the effort. We hold deep respect for these activists, who are constantly thinking of new and creative ways to promote tolerance in Jerusalem. And in the most activist of ways, they are working toward turning these ideas into reality, and creating hope for all of us for the future of Jerusalem.

In order to give these activists a helping hand, three months ago, we held the first of a series of Open Space Technology meetings. At that meeting, nine initiatives were presented, several of which continue to be developed today, from engaging leaders to public campaigns to speaking with the ‘other’ in Zion Square.

As we mentor these initiatives, we know that it is also critically important to keep opening up pathways for new initiatives as well. For this reason we held a second meeting for activists, using the Open Space Technology, on Monday, March 2, 2015, also at the Jerusalem International YMCA.

YMCA Open Space March 2, 2015

YMCA Open Space March 2, 2015

This meeting was considerably smaller than the last (50 instead of 100 participants), but it was much more mature and effective and we were equally excited by the outcomes. A total of 6 initiatives were presented. They included a Facebook page aimed at summarizing news from East Jerusalem in the eyes of Palestinian residents, a new ‘debate’ format for “Speaking in the Square,” initiatives to expand the cadres of activists and different ways to instill messages of tolerance in the public sphere.

Discussing Effective Methods

Discussing Effective Methods

This time, in addition to offering assistance in developing the strategic steps of the initiatives, we are also helping the different initiatives to “get the word out.” Together with the Jerusalem Foundation, we’re partnering with the Gug design agency, who were on hand at the meeting, who have begun to lend their expertise in  public relations, public campaigning, and more. We’ll also be consulting the initiatives in other ways, as well, as needed. Definitely, this activist energy is going to grow and impact the city, and we will do everyhting to help it happen!

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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

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

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

Principles of Cultural Competency

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Banners for Inclusion

We at the Jerusalem Intercultural Center strive to make Jerusalem a place that is suited to its many identity group, and you can read all about our different activities throughout this site. However, this summer, we’ve developed another important dimension to our work, fighting growing xenophobia, and violence and racism in the public sphere. The kidnapping and murder of the three Jewish boys, followed by the kidnapping and murder of a boy from Shuafat, followed by the military action in and around Gaza and missiles throughout Israel, have left nerves in and around Jerusalem very very raw. Fear and despair of the situation, and of the ‘other’, seem to be higher than they have been in a long time.

first banner

The first banner – Jerusalem for us all

Such a situation is precisely a call to action for us at the JICC. Over the past few weeks, we have found that our expertise in bringing a number of voices to the table and finding alternative solutions is particularly relevant. We’ve been working with a number of organizations to try and combat these trends.

The second banner -We all live in Jerusalem

The second banner -We all live in Jerusalem

One example of our work has been producing hundreds 3’X2′ banners that remind us all that we are all living in Jerusalem and it belongs to all of us. Initiated in cooperation with the Shared Living Forum facilitated by the Jerusalem Foundation, the banners are written in ten (10!) languages, Hebrew and Arabic of course on top, but also Yiddish, Russian, English, German, French, Spanish, Amharic and Tigrinya (a language spoken by many African refugees and asylum seekers). The banners are plastered on public notice boards all over the city, and they have received welcome responses from a wide range of people. This activity has even caught the press’ eye – we were in two different newspapers (in Hebrew) in the same weekend! One of these articles was translated into English. Here is the other article:

Kol Hair sept 12 2014

Kol Hair sept 12 2014

The articles don’t only talk about the banners that we’re involved in. They also talk about another important aspect to our work, and that is helping other initiatives, especially those working in downtown Jerusalem which has been the site of a number of violent incidents. Two of these initiatives include those who talk with and extremist Jewish group of youngsters who have set up a stand that gives out racist literature. A different group stands near Arab taxi drivers to make sure that violent incidents are prevented. While keeping this energy independent is very important, we give these initiatives organizational help: We helped them meet together and discuss next steps; we helped them develop better dialogue tools; we are also making sure that the activities are safe. In the future, we will help in providing supplies, flyers etc.

 

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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.”

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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.”

DSCF0777

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.”

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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

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.

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

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

We can now add Jewish Passover to the list:

Passover in Health Organisations 2014

Passover in Health Organisations 2014

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

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

Easter in healthcare organisation March 2014

Easter in healthcare organisation March 2014

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Coming Attractions – Groundbreaking Cultural Competency Training Videos

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

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

From "For the Children"

From “For the Children”

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

From the video, "Our Decision"

From “Our Decision”

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

From the video, "Knows What She Wants"

From “Knows What She Wants”

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

From "Checkup"

From “Checkup”

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

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

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

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

Touring the Western Galilee Hospital in Nahariya

Touring the Western Galilee Hospital in Nahariya

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

The visit had 3 parts:

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

An example of a dual-handset telephone for interpreting

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

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