Ultra-Orthodox Jews

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.

 

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.

Cultural Competency Training for Hundreds of Staff at Central Jerusalem Branch of Maccabi Health Services

A few weeks ago we finished cultural competency training for over 200 staff at the main Jerusalem branch of the Maccabi HMO. This consisted of one-day (8-hour) seminars each with 20 – 25 participants each. This was our “standard” one-day introduction to cultural competency, that included theoretical and practical learning of cultural competency – cross-cultural communication, , medical interpretation, dealing with social and political tensions and more. Since these workshops sought to concentrate on providing culturally competent services to the Haredi population, in the afternoon session a medical actor and Haredi Rabbi joined us, and we practiced real-life situations. Central to the discussions was the “triangle” in Haredi society that connects between medicine, Jewish law (halachah) and Haredi culture. These workshops join other workshops that we’ve conducted in Jerusalem for the Clalit Health Services (see here for earlier blog posts), and Meuchedet Health Services (see here for earlier blog posts).

Maccabi Jerusalem

Maccabi Jerusalem

The seminars took place between October 2014 and February 2015, and encompassed a wide range of disciplines – medical and paramedical staff, as well as administration. Participants were quite enthusiastic. One remarked, “Cultural competency is the a-b-c of quality service, and it incorporates values that help us to provide the highest quality of services [to all patients].”

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!

Neighborhood Shared Living Forum in Gilo

“I lived in Ramat Eshkol before coming to live her [in Gilo],” said a secular Jew, who participated in the Shared Living Forum that we just finished facilitating in Gilo. “One day, some of the ultra-Orthodox residents were violent toward my family. I knew then it was time to leave.” ”That is not your problem,” responded an ultra-Orthodox man, another participant in the group. “It is our problem. We [the ultra-Orthodox community in Gilo] won’t let that happen here.”

These two people are part of an 80-member Neighborhood Shared Living Forum in Gilo, which sits on the southern tip of Jerusalem. The Forum includes residents from every possible group – religious, secular, ultra-orthodox, immigrants and veteran citizens, and more. Over a period of two months, in four sessions, they formulated a community vision (see the Hebrew document) for shared living community dialogue, as well as developed initiatives to advance that goal. An atmosphere of mutual respect pervaded all the discussions, and everyone was engaged in and committed to the process. In a neighborhood as diverse as Gilo, this was quite a significant achievement.

Gilo Shared Living Forum

Gilo Shared Living Forum

The first workshop concentrated on introducing the process and discussing examples of positive aspects of a diverse community in Gilo in the past, challenges of having a diverse communities, and their vision for an ideal situation in Gilo.In ensuing workshops the residents focused on principles of community dialogue, including how four principles of community dialogue – dialogue, partnership, fairness and values – can be practically assimilated into community life. Residents also came to agreement on a set of principles for shared living in Gilo, and developed a number of initiatives, from joint study of texts, to work with teenagers, to inter-generational projects to building a community mediation framework. We will be following up with the Gilo Community Council in helping to get these initiatives off the ground.

Discussing Issues

Discussing Issues

The Neighborhood Shared Living Forum is part of our greater involvement in the Gilo community over the past few years, part of our Deliberative Democracy in Jerusalem Neighborhoods project, supported by the UJA-Federation of New York. You can read about other processes we’ve facilitated in Gilo here, here and here.

“The Resident at the Center” – Empowering City Center Residents through Deliberative Democracy

For more than two years we’ve been using deliberative democracy methods to foster a sense of community and belonging among Jerusalem’s diverse populations, thanks to the generous support of the UJA-Federation of New York. We’ve been working with a number of Jerusalem neighborhoods, from Gilo and Baka’a to Romema, Kiryat Hayovel and Rehavia, as well as in regional (Jerusalem Railway Park) and citywide initiatives (training of community workers).

Open Space in City Center

Open Space in City Center

The latest neighborhood to embark on this process of empowerment is the City Center. As part of a community-building process that began in March of this year, on December 1, 2014, some 200 residents squeezed into the gymnasium at the Experimental High School in downtown Jerusalem for a town meeting based on Open Space Technology. The group was incredibly diverse – Ultra-Orthodox, Secular, Conservative, Reform, Orthodox, immigrants from all around the Jewish world, and even a few asylum seekers from Eritrea! Three elected City Council members, one of them a Deputy Mayor, joined the group and later joined the task teams.  All came to discuss issues in the neighborhood that they were passionate about finding solutions for.  For the first time, residents were excited to finally be able to give voice to their everyday concerns, and meet other people who were potential partners in finding solutions. Examples included noise, sanitation, parking, quiet on Saturdays, improving safety, the elderly, growing plants in the city center, ecology, and more. These 200 people split up into different task teams, and we will continue to mentor them to ensure that the issues are advanced.

According to the residents, this is the first time ever that residents have been led in any community-building process in the downtown Jerusalem. Until now, many felt that they were “transparent” in relation to the business-owners in the city center, and that their needs were secondary to the businesses’. They’d tried to organize themselves around different issues (planning Nevi’im Street, the pedestrian malls, and more), but there was never an organized, long-term process that allowed residents to have their own say in the future of their neighborhood. We see this as just the beginning, and are going to help the groups that were formed to continue to work and impact downtown. We truly believe that this is a new beginning for the residents of the City 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

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

Activists Wage Vigilante Efforts against Racism in Jerusalem – Haaretz article

This summer, Kikar Zion (Zion Square) in Jerusalem became a hot spot of xenophobia. It was not the first time for the Square, but this new wave began after the kidnapping and murder of three Jewish boys in June 2014.  Nir Hasson reported in Haaretz on July 1, 2014:

Since the discovery of the three Israeli teens’ bodies on Monday, tensions have been rising between Jews and Arabs in Jerusalem with several assaults reported overnight. On Monday evening a spontaneous vigil was held in Zion Square, where people lit candles, prayed and sang. Yet on the sidelines of the vigil groups, young people gathered and began marching through the center of town yelling “Death to terrorists” and “Death to Arabs.” Most of these groups dispersed before any violent incidents occurred, mainly because many Arab workers were away for Ramadan. However, several assaults were reported overnight.

Interestingly, as documented in Hasson’s quote above, there were others, mostly students, who came to the exactly same Square to mourn and spread an alternative option for tolerance. These activists continued to come to the Square in the following months. In mid-August, we at the JICC decided to help this spontaneous group. While keeping it independent of any formal or organizational connection, we began to help in logistics, in convening meetings of the activists, in professional consultation. And yes, some of us became part of the group as activists… Hagai Agmon-Snir, the JICC director, wrote a Facebook post about his all-night experience at the Square.

Following the above Facebook post, Nir Hasson decided to come to Zion Square to write about it. He published the article in Haaretz on September 12, 2014 (Acrobat version) and the article was translated into English by Haaretz and was published in this version the following day (Acrobat version).

Here is the full text of the article:

Activists wage vigilante efforts against racism in Jerusalem

Faced with the rising prominence of Lehava, an anti-Arab organization, two groups try to promote dialogue and curb violence in the capital.

By Nir Hasson | Sep. 13, 2014 |

Every Thursday and Saturday night, Jerusalem’s Zion Square becomes a scene of confrontation. On those evenings, activists from Lehava – an organization whose name is a Hebrew acronym for “fighting assimilation in the Holy Land” – gather in the square, dressed in black shirts emblazoned with the words “Jewish honor guard,” to hand out fliers bearing slogans like “don’t let your daughters work with Arabs” and “don’t buy from stores that employ your enemies.”

After midnight, the black-shirted activists dismantle their unauthorized booth and begin to disperse, and police presence thins out. That’s when things turn violent: Youths harass passersby, attack taxi drivers and interrogate couples to determine whether they are Arabs or Jews.

Facing off against the racism, for the past two months, have been two different groups. One, which calls itself City Guard, is composed of veteran left-wing activists and sees its mission as protecting the victims. If their very presence doesn’t deter attacks, they will call the police and even physically interpose themselves between assailants and their prey. They start work around 1 A.M., when the Lehava activists begin to disperse and when people start spilling out of nightclubs, often drunk and ripe for violence.

The second group is more diverse, comprised of religious, secular and formerly religious students, mostly from Jerusalem but some from West Bank settlements. They see their job as trying to persuade the Lehava activists that racism is wrong, or at least to mitigate the violence.

Lehava activists have been instructed by the organization’s leaders not to get into debates with the students, but most ignore this order. The arguments often turn into cussing matches and even shoving spats. But occasionally, they manage to spark serious discussions about Judaism, nationalism, racism and human rights.

This summer’s war in Gaza and the rioting in East Jerusalem have been good for Lehava, turning it from a marginal group into a proud organization with hundreds of activists in many cities. Its Facebook pages may have been taken down, but it gets plenty of media coverage, which reached a peak three weeks ago when Morel Malka, a Jew who converted to Islam, married Mahmoud Mansour, an Arab.

Its opponents say Lehava is the wellspring from which violence against Arabs in Jerusalem flows.

Ofek Birnholtz, a doctoral student in physics, is one of the founders of the group of students that tries to reason with Lehava members. Last Thursday, he had a long and stormy discussion with one activist about Judaism’s attitude toward the stranger. “I won’t convince him,” Birnholtz admitted, “but maybe I’ll make him think a little more. The very fact that we’re here creates a dynamic of less violence and more dialogue. It’s a holding action.”

Hagai Agmon-Snir, director of the Jerusalem Intercultural Center and another member of the dialogue group, added, “When we talk with these teens, they insist they aren’t violent and aren’t coming from a place of racism or hating Arabs, that they just oppose assimilation. I’m not so naïve to think there’s no racism there, but this says it’s important to them to remain within the camp that says it’s not racist, and that’s a thread we can work with.”

Yovel Zim, a religious Jew from the settlement of Tekoa, said the Lehava activists “find it harder to deal with people like me. They immediately brand me as a leftist or say I’m not really religious because according to the Torah, all Arabs are enemies.”

But the one who annoys the Lehava members most is Yuval Ben-Ari, who insists on telling them about both his Arab roommate and his army reserve service. “I’m here because I returned from 35 days of reserve duty and heard that friends of mine had been beaten because they’re leftists,” he said.

One night, a Lehava activist tried to make him leave, shouting, “You’re nothing; you’re a wretch; you don’t care about anyone; you’re a disgusting egotist!” Soon Anat Gopstein, the wife of Lehava founder Benzion Gopstein, chimed in. “You don’t look to me like someone who does reserve duty and cares about the state,” she said. “You act like a sick person, a deviant.”

The harsh words aren’t unusual. Shoving ensued on the night in question, and the students say they are sometimes spat at. On one occasion a lit cigarette was thrown toward one of them. Nevertheless, they persist.

‘Authorities turn blind eye’

Some within the second group, the so-called City Guard, view the students’ efforts as wasted. Others even claim that their attempts at dialoge legitimize racism.

“It normalizes the situation,” says Eyal, a Jerusalemite and a co-founder the Guard. “You see the dynamic: There’s a booth that distributes racist flyers, and it’s surrounded by people who are standing around and talking like everything’s fine.

“There should be more physical resilience, awareness must be raised to make the authorities wake up,” he added.

Both groups agree that Israel’s authorities and mainstream society are turning a blind eye to racist activity.

“These days, shouting ‘death to Arabs’ in the middle of Jaffa Street is okay; nothing should be done about it,” Aviv Tatarsky says wryly.

“We shouldn’t be here,” adds Eyal. “We should be in East Jerusalem, shouting ‘occupation, occupation.’ The mainstream groups should be here – the youth organizations, city workers, and the police. But no one is here. Except for Reuven Rivlin, who spoke out, everyone is silent.”

According to Eyal, “Arabs are scared to walk around here … and the vast majority is willing to accept this.”

The municipality’s helplessness is evident as it disregards Lehava’s illegal booth, the leftist activists say. The dialogue group had asked the city to dismantle the stand early in the evening and was promised that action would be taken. Yet four hours later, no official had arrived on the scene.

The municipality, however, denied failing to enforce the law. A spokesman acknowledged that the booth was set up without a permit, but claimed the city had it dismantled immediately. The booth’s operators were informed that they must receive the city’s authorization to set up the stand, as well as for the content of the flyers it distributes. If they set up the stand again without a permit, it will be confiscated, according to the spokesman.

Both groups were founded on the evening that three Israeli teens who were murdered in the West Bank were laid to rest – hours before the murder of a Palestinian teen, Mohammed Abu Khdeir. On that day, a rightist demonstration turned into a series of violent acts targeting Arabs in Jerusalem’s center. Two days later, a leftist rally gathered in a Jerusalem plaza known as Cat Square to protest the violence. Some 1,000 activists arrived at the demonstration, organized by the Tag Meir organization. Once the speeches were over, the protesters quickly dispersed, to be replaced by Lehava activists.

“They started yelling ‘death to Arabs,'” recalls Birnholtz. “The [protesters] left and the city was once again forsaken, and we knew that we had another long night ahead of us.”

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.

 

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 herehere 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.

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