Ethiopian Jews | The Jerusalem Intercultural Center

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Creating a Cultural Competency Learning Community

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

The meeting included a panel discussion of 4 different perspectives:

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

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

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

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

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

Naomi Roff2016-02-27T15:01:19+00:00October 10th, 2013|Asylum Seekers, Blog, Christians, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, Jewish Religious Denominations, New Immigrants, Palestinians/Arabs, Ultra-Orthodox Jews|

Publication of First-Ever Manual for Israeli Cultural Competency Coordinators

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

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

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

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

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

“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|

Cultural Competence Training – Gonenim Clalit Clinic – November 9 and 16, 2009

After the workshops at the Clalit primary care clinics at Ir Ganim and Talpiot, we continued this week with two half-day trainings for the staff of the Gonenim clinic, conducted at the JICC premises on Mount Zion. These three clinics serve most of the Ethiopian Jewish immigrant population in Jerusalem, and we adapted our cultural competence training to focus on the needs of this group. All clinic staff members, from physicians to administrative staff, attended the workshop, as we see the response to diversity at the clinic as an integrative task.

Gonenim Clinic Training 2009

The workshop was in general very similar to the ones we conducted before. However, we used many more examples, which participants in the previous workshops raised, and based the training on case studies and simulations. This made the training closely related to the practical issues brought up by clinic staff members.

Gonenim Clinic Training 2009 – roleplaying

Following this training the Gonenim clinic now joins the support system we are creating to enhance the Clalit Health Services’ capacity in providing better and more adapted services to new immigrants. We will conduct follow-up meetings with the clinic’s management and mentor them in implementing Cultural Competence in the clinic.

Gonenim Clinic Training 2009 – roleplaying

jicc2014-04-07T20:11:50+00:00November 16th, 2009|Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts|

Cultural Competence Training – Talpiot Clinic – June 11 and 25, 2009

Today we finished a set of two training sessions on cultural competency in serving the Ethiopian community in Jerusalem. The training was delivered to all staff members of the Clalit Primary Care Clinic in the Talpiot neighborhood and was basically the same training as the one delivered to the Ir Ganim clinic. Our next step in the near future is to deliver the training also in the Gonenim and Neve-Yaakov clinics. By that we will cover all four clinics that serve the Ethiopian population in Jerusalem.

Talpiot Clinic Training 2009

It is important to note that following these trainings we continue to support the clinics in their efforts to give better and adapted services to new immigrants. In a follow-up process we found that many of the skills that were taught in the trainings are now being used in the clinics. In addition staff members report that patients demonstrate higher levels of satisfaction than before.

jicc2014-04-07T19:55:24+00:00June 25th, 2009|Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, New Immigrants|

Cultural Competence Training – Alyn – May 18, 2009

Today we held the third Cultural Competence training to a group of staff members in the Alyn hospital in Jerusalem. This training is part of our efforts, together with the Alyn Hospital’s management, to transform Alyn into a cultural competent hospital, the first of its kind in Israel. The work with Alyn is a component of the Jerusalem Cultural Competence in Health Project initiated by the Jerusalem Inter-Cultural Center and the Jerusalem Foundation.

Alyn training May 2009

Towards each training in Alyn we interview several intended participants and based on their input we adapt the case studies that will be used in the training to the needs of the specific clinic. Today for example we added an extra focus on Ultra Orthodox patients and invited experts in the field to share their knowledge. We also improved two of the learning modules by using more dialogues for analysis and real-life stories. Thus the modules became more interesting and interactive.

Alyn training may 2009

jicc2014-04-07T19:26:12+00:00May 18th, 2009|Blog, Courses, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Outside Jerusalem, Ultra-Orthodox Jews|

Ethiopian Community, Talpiot, May 13, 2009

A month ago, we updated on our efforts, together with Mosaica, to train establishment agencies, such as the Community Council, the Welfare Department, the Absorption Authority etc., to work with the Ethiopian community in the Talpiot neighborhood. Since then, we met again with representatives from the community, from organizations that advocate for them and from establishment agencies.

Some of the Training Participants

Today we held the first cultural competency training for representatives of agencies that work with the Ethiopian community, focusing on cross-cultural communication. We learnt about the communication style of Israelis and compared it with the communciation style of Israeli-Ethiopians. In fact, Israeli-Ethiopians tend, as all multi-identity individuals (or, in other words, every individual…), to use both systems of communication, even though they seem to contrast with each other.

Dr. Hagai Agmon-Snir at the training

We invented a case study specifically for this training about an Ethiopian community leader who gets in conflict with the establishment over community issues. It was striking, but not surprising, to see how much the participants identified with the case study, feeling that the story resembles many of the incidents they encounter daily. We began analyzing the case and many issues were raised. On our next meeting we will have to think about solutions – how does one crete a bridge between these two cultures.

jicc2014-04-07T19:21:14+00:00May 13th, 2009|Blog, Courses, Cross-Cultural Communication Trainings, Cultural Competence, Ethiopian Jews, Identity Groups and Conflicts, New Immigrants|

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