Outside Jerusalem

Beit Shemesh Round Table Goes Public

A few days ago, we received a notification of the following cry to public action: http://shemeshnet.co.il/articles/1769 (Hebrew article). The link relates to a round table in Beit Shemesh, which we helped to establish and operate a few years ago. Incidents in Beit Shemesh included the harassment of religious girls on their way to school, which quickly broadened to larger outcries throughout Israel against Haredi discrimination against women in the public sphere. After two years of dialogue amongst leaders from the different communities of Beit Shemesh – from the Eidah Haredit, Hasidei Gur, Shas, other Haredi communities, rabbis and central activists from the modern orthodox and secular communities in the city, the round table has finally come to a point where it could come out with a public cry for working toward common goals peacefully.

Round Table Beit-Shemesh

To the untrained eye, and to those who are not from the city, this declaration might seem a bit wishy-washy. What’s so exciting about a public cry for unity and public participation of all groups? But one first needs to remember that this is a very brave declaration in the face of the current situation: on the one hand, a mayor who refused to include non-Haredi city council members into his coalition, and who has not yet understood that it is his role to try and unify the city. On the other hand, a city council opposition that is so disappointed by the mayor that it began a campaign to divide the city. So, this is the context of the so-called pale declaration for unity and joint efforts. But it is very significant. Despite what made the headlines, everyday life in Beit Shemesh is quite nice, and the negative image that it gets in the headlines have the potential of wiping out any hope that had been there, more than any internal rifts. Our involvement was rather limited, since Beit Shemesh is still not (yet) Jerusalem. But, when the crises arose, it was clear that our experience and knowledge of all sides would be of significant assistance to them. In addition to the article, the group has also opened a Facebook page, and we’re helping to promote that as well.

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Professional Development for Healthcare Cultural Competency Coordinators from around the country – Final report

On May 21 we finished the first professional development seminar for 17 cultural competency coordinators in Israeli health care organizations. They came from hospitals such as Hadassah, Shiba-Tel Hashomer, Sourasky Medical Center, Rambam, and more. For some this was their first step in the cultural competency process of their respective organizations. The seminar included 5 meetings and a webinar with cultural competency coordinators from the US and Canada. For a link to the post on the opening of the seminar click here.

From the third meeting: panel of hospital directors - from Sheba, Alyn and Bikkur Holim - and the role of management in cultural competence

From the third meeting: panel of hospital directors – from Sheba, Alyn and Bikkur Holim – and the role of management in cultural competence

The Tour of Cultural Competency in Action The fourth meeting was an all-day tour of cultural competency in action in Jerusalem. The first stop was at the Alyn Rehabilitative Hospital, which began its cultural competency process in 2007. Mrs. Naomi Geffen gave us a tour of the different departments and clinics, explaining the main issues, such as translation in medical and educational settings, ensuring patient and caregiver are the same sex in some cases, dress code, separation of boys and girls in the therapeutic pool, adapting the rehabilitation process to the patient’s culture, and more. Participants also visited the Muslim prayer room that was established in cooperation with the JICC and community members two years ago. We also received examples of materials and documents that had undergone linguistic and cultural adaptations, from a therapy schedule in the patient’s language, the internet site, release letters, and more. We were all amazed at what was accomplished here – today, hospital staff speak in a new language, one that is more advanced and without stereotypes. The second station on the tour was a well-baby clinic that provides services for the Ultra-Orthodox Jewish (Haredi) population in Meah Shearim. We met the clinic’s manager and a leader from the Toldot Aharon community, which is considered to be one of the more conservative and separatist divisions of ultra-orthodox Judaism. The clinic and its services have undergone a process of adaptation to the needs and approaches of the Haredi population, facilitated by the JICC, which included adaptation of the physical environment (pictures, brochures in Yiddish), training for nurses about how to appropriately approach mothers, and more. We intervened, with the full cooperation of a leader in the Haredi community, after a serious epidemic of whooping cough and measles in the Haredi community that spread because of a low rate of immunizations. We discussed with them a number of issues including: vaccinations and immunizations, developmental delays, and more. We also heard about a unique project for first-time mothers, and the special adaptations that had been made for the Haredi community. The third stop was Hadassah – Mount Scopus. Ms. Gila Segev gave an overview of the project that began in April 2010, just as she was appointed cultural competency coordinator. Gila recruited volunteers who were trained in verbal translation/ interpretation by the JICC and lecturers from the Department of Translation and Interpreting Studies at Bar Ilan University. Because 60% of the hospital’s patients are Arabic speakers it was decided to concentrate on Arabic. We also heard a first-hand account of the Hebrew – Arabic translating / interpreting process from a volunteer. The visit concluded with a panel of representatives of different communities to learn about the needs of patients and how to work with the different communities successfully over the long term. The panel included: Dr. Itchik Seffefe Ayecheh (from the Tene Briut organization that advances the health of Ethiopians in Israel), who felt that the focus should be on training and workshops for the medical staff to understand the importance of the relationship with the communities. Dr. Meir Antopolski (“Meeting Point” organization whose goal is to create a new cultural space for the Russian sector) who believes that the linguistic dimension is a critical obstacle in the relationship with the communities, and Mr. Fuad Abu-Hamed (who operates Clalit Health Services clinics in East Jerusalem) gave a fascinating overview of the Palestinian communities of East Jerusalem.

The panel with the Russian, Ethiopian and Palestinian community representatives

The panel with the Russian, Ethiopian and Palestinian community representatives

Webinar The webinar was on May 16, focusing on the experience of 3 cultural competency coordinators from abroad. Some of the speakers are full-time cultural competency workers with staffs dedicated to responding to the multicultural needs of patients, from special menus and food preparations to organizing different cultures’ holiday celebrations and commemorations. All speakers presented a model that many of the participants could strive toward. The speakers included:

A snapshot from the world cultural competence coordinators webinar

A snapshot from the world cultural competence coordinators webinar

Summing Up The fifth meeting featured a discussion about socio-political tensions that affect the patient-caregiver relationship and how the caregiver and the cultural competency coordinator can relate to it on an organizational level. One example was of ongoing discussions amongst the staff on social-political tensions, with an understanding that these tensions are not limited to the patient-caregiver relationship, they are also found between staff members, which also requires special attention. Later on, Dr. Anat Jaffe from the Hillel Yaffe Hospital in Hadera, and one of the founders of Tene Briut, spoke to us. Dr. Jaffe surveyed the medical meeting point from an inter-cultural perspective. In her lecture she focused on her dealings with the Ethiopian community and diabetes, from her expansive experience as a doctor in the community and in the hospital. The final meeting also included presentations of the pilot initiatives that participants worked on during the seminar. For example, representatives from the Western Galilee Hospital in Nahariya created and passed around a mapping and evaluation survey of different cultural and linguistic aspects of their patients. The representative of Bikkur Holim Hospital in Jerusalem is making the hospital’s voicemail system accessible in 4 languages, and the representative of the Italian Hospital in Nazareth changed the internal signage in the departments to 3 languages. Ms. Avigail Kormes from the New Israel Fund closed the course with warm remarks and wished them success.

***

For an article in Hebrew in Ha’aretz newspaper by Dan Even 4 June 2012 click here.

A translation from Ha’aretz article :

The Era of Multiculturalism Reaches Israeli Hospitals

The hanging of pictures on the wall of non-blonde children, the creation of prayer rooms, and the translation of discharge papers into French – these are the new practices in hospitals of a new policy that requires cultural competency. In February 2013 a new Ministry of Health directive goes into effect requiring cultural competency in Israel medical institutions. As part of the directive, each institution is required to appoint one member of management to be in charge of cultural competency, who will be responsible to implement the new practices. Initial training sessions for coordinators in the past month reveal that the process does not include merely cosmetic changes, such as posting direction signs in Arabic, but seeks to change the atmosphere in the entire hospital to make it accessible to the multiple cultures in the state, especially during a period in which the social fabric of the country creates endless difficulties. One of the organizations that began training cultural competency coordinators is the Jerusalem Intercultural Centre (JICC), that has been advancing this topic in the capital’s hospitals since 2007, with the support of the Jerusalem Foundation and the New Israel Fund. This month the JICC held a course training for for 17 cultural competency coordinators from 14 hospitals at the Schoenbrun School of Nursing, Tel Aviv Sourasky (Ichilov) Medical Center. According to Dr. Hagai Agmon-Snir, the director of the JICC, “cultural competency is more than signage and the translation of forms. Patients need to receive all the medical services of the facility in a way that is accessible both linguistically and culturally, whether that means adding foreign language newspapers to the waiting rooms or making the pictures on the department walls more culturally applicable. When the pictures on the walls only portray blonde Dutch children, it’s most problematic, and its important to include pictures of children from diverse backgrounds, so that people will feel as much a part of the place as possible.” One of the issues that the JICC seeks to integrate in this new process is accessibility of diverse religious and cultural services in the medical facilities. “Opening prayer rooms for different religions is not a political matter, but a professional one,” says Agmon-Snir. Muslim prayer rooms currently operate in only a few hospitals in the country, including Rambam, Alyn, and Hillel Yaffe. “In every self-respecting hospital in the West it’s customary to address diverse religious needs. It appears that addressing religious needs favorably influences the medical treatment, and it is important to advance this in Israel as well,” says Agmon-Snir. Cultural competency also includes the correct usage of terminology that is sensitive to different cultures. Especially now, when social tensions are at their peak, whether related to the ultra-Orthodox, foreign workers or African immigrants, it is incumbent on medical staff to exercise more sensitivity. “It’s important to know the appropriate terminology for each culture. When dealing with the Haredi population, modesty in speech is required. In the ultra-Orthodox community, for example, it’s not customary to says ‘kaki’ or ‘excrement.’ One also has to know how to relate to rabbinic opinions which may influence the type of treatment, just as one has to adapt to secular patients who come to the doctor with information they have gotten on the internet.” Sensitivity to concepts is also required for immigrant workers. “In our training we teach how to be sensitive to every culture, even to the foreign patient from Eritrea,’ says Agmon-Snir. “In some cultures, for example, ‘no’ is not a firm refusal, but rather a request to hear more information before making a decision. In some cultures, when a patient bows his head he is showing respect for the caregiver, and it is not at all a refusal of care.” Another course for coordinators responsible for cultural competency coordinators from 24 hospitals began this month, under the auspices of the Ministry of Health, via Dortal Consulting. According to Dr. Emma Auerbuch, coordinator for reducing gaps in health care for the Ministry of Health, “Our approach is a little different. For example, anything related to places of worship, in our opinion, is the decision of the administrator of the medical facility, and should not to be imposed from above. In all matters related to cultural accessibility, one must remember that it is the goal of health facilities to provide medical treatment, and we try as much as possible to avoid tension.”

The different approach between the bodies can also be found with regards to the translation of patients’ forms. The JICC seeks to translate all the forms a patient might receive, including discharge papers, into various languages.. Auerbuch stresses that “the directive requires translation only of forms that require a patient’s signature, but we won’t prevent a hospital from offering translations of other forms as well. Recently a health fund in Netanya began offering medical information in French, since there is a large concentration of French speaking immigrants there. We can only congratulate them for that.” The courses include among other things training in preventing social tensions during the medical treatment. “This is an especially relevant topic in Israel, because people here tend to cross the lines between professional and political. Many times a patient will tell a doctor or a nurse what he thinks, for example, ‘you’re Russian and that’s why you act that way.’ The intercultural contact creates a challenging dynamic, including the use of stereotypes, and medical staff must learn how to maintain professional interaction, as much as possible,” says Agmon-Snir. “One must remember that the patient’s welfare is paramount, and the role of the health system is not to educate the patients. It’s not the doctor or nurse’s job to teach the patient manners or how to behave. A nurse may certainly put a disrespectful patient in his place, but in a professional context. Saying to a patient, ‘you Ethiopians are always late’ is not appropriate. Special attention is being given to emergency rooms. According to Dr. Agmon-Snir, “Although the pressure in the emergency room complicates the ability to give a patient detailed explanations, sometimes investing three extra minutes in explanations can save confusion and much time later on.”

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Professional Development for Healthcare Cultural Competency Coordinators from around the country – Summary of Day One

We’ve taken yet another step in becoming one of the national leaders and reference points of Cultural Competency in the health care system in Israel. On Monday, 23 April we held the first meeting of a professional development seminar cultural competency coordinators from around the country. This is the first such seminar ever to take place in Israel! Our 16 participants included representatives from the major hospitals in the country: Hadassah Medical Center and Sha’are Zedek in Jerusalem; Shiba-Tel Hashomer and Sourasky Medical Center in the Tel Aviv area, Rambam in Haifa, and more.

We have been working to advance cultural competency in the health care system in Israel since 2007, and we are in constant contact with most of the cultural competency coordinators around the country. Most of these coordinators have been appointed since the publication of the Ministry of Health’s Cultural Competency Directive, published in February 2011, that will require medical interpretation services, education and training of medical staffs, environmental adaptations of all health care institutions by 2013. As a first step, the Directive requires health care organizations to appoint a cultural competency coordinator to be responsible for all the processes that work toward equal cultural and linguistic accessibility for all.

Our unique seminar is taking place in cooperation with the Ministry of Health and is a natural continuation of the Directive. The training will provide knowledge and tools to enable cultural competency coordinators to assimilate the Directive in their institutions. It is important to note that most cultural competency coordinators are already in senior management positions in their organizations.

The 5-day training seminar, which will meet weekly until the end of May, will include 50 hours of frontal lectures as well as a webinar with cultural competency coordinators from Canada and the USA. Our funders for this course are the Jerusalem Foundation and the New Israel Fund. The course is being held at the Nursing School at the Tel Aviv Sourasky Medical Center.

The training course will cover:

Introduction to Cultural Competency: Medical interpreting and translation and mediation in health services, models of intercultural communication between patient and caregiver, cultural dimensions in interpersonal communication, dealing with political and social tensions, different cultures’ approaches to health and sickness, and more.
Practical guidance for cultural competency processes in health care organizations – from the cultural competency coordinator’s first steps to full organizational adaptation.

It will also include guest lectures on the following subjects:

• Inequality in the health care system and the role of the cultural competency coordinator in reducing gaps.
• Acquaintance with the main theories of cultural competency in Israel and around the world.
• Tools for implementing principles of cultural competency in a health care organization.
• Tours of hospitals and clinics that are undergoing cultural competency processes.
• Clinical aspects of different cultural approaches to sickness and health.
• Culturally-dictated social norms.
• Cultural competency from the viewpoint of health organization administration.
• Cultural competency from the viewpoint of social organizations dealing with community health.

The opening lecture was given by Dr. Emma Averbuch from the Unit of Decreasing Health Inequality at the Division of Health Economics and Insurance Division of the Israeli Ministry of Health. Dr. Averbuch emphasized the importance of the cultural competency coordinator and how he or she can contribute to decreasing inequality in health care. She also surveyed the Ministry’s activities thus far in advancing cultural competency and decreasing inequality in the system.

Prof. Leon Epstein speaks on Inequality in Health at the Cultural Competence Coordinators training

Prof. Leon Epstein speaks on Inequality in Health at the Cultural Competence Coordinators training

The participants also had the first session covering the “Guide for Cultural Competency Processes in Health Care Organizations”, which is a practical guide we developed over the past 2 years. It details the steps that must be taken to assimilate cultural competency principles in an organization. This meeting concentrated on defining the role of the cultural competency coordinator, as well as first steps in creating a suitable buzz within an organization for cultural competency. In addition, the participants related their experiences with the community, and the discussion that followed focused on the need to establish and expand these relationships to be helpful in times of crisis.

Part of the training included a practical exercise in creating change. Each participant was asked to choose a small initiative that is related to at least one component of cultural competency that he or she wanted to change by the end of the training course at the end of May. This initiative needed to be something easily implementable and with high visibility in the organization. Participants chose projects such as mapping needs and resources, linguistic accessibility of restrooms, and more.

Simulation of a case of cultural competence at the training

Simulation of a case of cultural competence at the training

Two guest lectures dealt with the relationship between risk management and cultural competency, from Ronen Regev-Kabir, Deputy Director, Public Trust organization, and Netalie Goldfarb, the Care Competency Unit of the Ministry of Health. Our own Dr. Hagai Agmon-Snir closed the day with a workshop on cultural dimensions and the main values of interpersonal communication, to give a taste of the cultural competency workshop that will be the focus of the second workshop on 30 April.

In parallel to this meeting, an Internet discussion group was established that will deal with cultural competency in the health care system in Israel. There will be participants from within and without the health care system and it will enable participants to share knowledge in this area. You can view the discussion group and the course’s accompanying materials here.

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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

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

Alyn training may 2009

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Diversity SWAT Team Webinar 1 – London!

Our new series of webinars is dedicated to what we call “Diversity SWAT Teams”. We brought together Rabbi Bob Kaplan from the JCRC-NY, Alex Goldberg from the London Jewish Forum and Hagai Agmon-Snir from the Jerusalem Inter-Cultural Center, to detail the ways by which they effectively manage cross-cultural community conflicts in their respective locations. These three organizations perceive such interventions to be part of their role.

Alex Goldberg at the Diversity SWAT Team Webinar

Alex Goldberg at the Diversity SWAT Team Webinar

Today we had the first webinar in the series. Alex Goldberg presented the approach the London Jewish Forum is implementing in London and other British cities. Mainly he focused on how they engage the government, police, businesses, civil society and NGOs in their processes. Following the presentation, the two other panelists, Rabbi Bob Kaplan and Dr. Hagai Agmon-Snir, added their perspectives on the issues and raised questions that may help in this inter-city learning.

For us at the JICC, this series is very important. Increasingly we find ourselves involved in creating and training Diversity SWAT Teams in mixed cities in Israel, together with local municipal agencies.

You can find the presentation and additional information (also about the next webinars in this series) online at the NYJEE site.

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Lod – Cultural Competence Training to Service Providers

As an outcome of the work of Lod’s Multicultural Forum, a first training on cultural competency for service providers has begun. This is probably the first training of this kind at the national level.

Today’s meeting, the first in the series, was facilitated by Najuan Daadleh and hagai Agmon-Snir from the JICC. The meeting with attended by 15 participants coming from various departments of the Lod municipality, the local employment service, non-profit organizations, community centers and more.

The first two meetings focus on cross-cultural communication and an introduction to cultural competency. Additional meetings will provide models for better communication with a client of a different cultural background, using interpretation, adapting a service to various client groups, and other relevant topics. Case studies and simulations will enhance the learning process.

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Lod – Pipe bomb incident in Lod claimed to be terror-related

One of the headlines today, probably connected to the sad events in Gaza and South Israel, reads: Investigation of pipe bombs thrown at building inhabited by religious-nationalist Jews in central city of Lod leads police to believe attack was nationalistically motivated; search for suspects among Arab sector continues.

This morning we received a call from the Community Worker of Lod, Orit Ulizary, who is also the initiator and coordinator of the city multicultural forum, for which the JICC consults regularly. Orit gave an update about the pipe bombs that were thrown near the houses of national-religious members of the multicultural forum. It seems that their community experiences at the moment extreme tensions, including calls for “a proper response”. Based on the situation, meetings of Orit and ourselves with main leaders of the national-religious community, as well as with leaders of the Arab population in Lod, all members of the forum, will probably be held on Saturday evening (Motzaei Shabbat). No doubt that the situation is very sensitive at the moment, and we can only hope that the Lod Multicultural Forum will be able to be of help.

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Rabbi Bob Kaplan in Acre

Rabbi Bob Kaplan, Director of Cause-NY (of the JCRC-NY) and our New York partner in the New-York Jerusalem Experts Exchange, toured Acco today as part of his visit in Israel. Rabbi Kaplan presented to local leaders and mediators the inter-identity crisis intervention model he uses in NYC. With the help of the Gishurim Project, a Community Dialogue and Mediation Center is currently being established in Acco. The meeting was set in order to help the center in its research and development process for designing the optimal implementation of such an institute in Acco. The recent events in Acco highlighted the urgent need for community dialogue and mediation in the city.

Acco

Acco

About 40 participants from various identities and agencies arrived to the meeting where  Rabbi Kaplan and Dr. Hagai Agmon-Snir (JICC’ director) presented various models from NY and Israel.

Kaplan and Agmon-Snir at the Acco meeting

Kaplan and Agmon-Snir at the Acco meeting

The principal invitees to the meeting were the Imam of Acco, Sheikh Samir Asi and the Chief Rabbi of the city, Rabbi Yossef Yashar. They both had to attend a meeting with Israel’s President, Mr. Shimon Peres, on the same morning, but Rabbi Yashar saw it as important  to open the meeting and discuss some of the issues with Rabbi Kaplan.

Acco Chief Rabbi Yashar and Rabbi Kaplan

Acco Chief Rabbi Yashar and Rabbi Kaplan

Following the main assembly, the Community Dialogue and Mediation Center staff conducted a working session with the visitors from NY and Jerusalem, where next steps were formulated and peer consultation with the JICC and CAUSE-NY was put in place.

Acco Community Dialogue Center staff and the guests

Acco Community Dialogue Center staff with guests

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Last Meeting of the Distance-Learning Community Dialogue Course

The 14-weeks long Distance-Learning Community Dialogue Course concluded today. The course consisted of five distance-learning units and five face-to-face meetings. The twenty participants requested an on-going peer group that will accompany their community dialogue initiatives. We hope that the Gishurim program that sponsored the course will be able to provide this service. The course facilitators, Dr. Orna shemer and Dr. Hagai Agmon-Snir, will probably facilitate these peer meetings.

Feedback Session of the Community Dialogue Course

Feedback Session of the Community Dialogue Course

In their feedback, the participants stated that the course has significantly leveraged their ability to plan and initiate responses to community conflicts and opportunities. During the course they presented and discussed the various initiatives they were developing in their community dialogue and mediation centers. This was the first ever community dialogue course of the Gishurim project and we hope it will be repeated in the future.

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Lod – Rabbi Bob Kaplan meets the Mayor

Rabbi Bob Kaplan, Director of Cause-NY (of the JCRC-NY) and our New York partner in the New-York Jerusalem Experts Exchange, visited Lod today as part of his visit to Israel. The purpose of the visit was to present the Inter-Identity Crisis Intervention model Bob uses in NYC. In a special meeting of the Lod Multicultural Forum, together with Lod’s Mayor, the NYC model was introduced and compared to the model currently implemented in Lod, with the support of the JICC.

Rabbi Kaplan at the Lod Mayor's Office

Rabbi Kaplan at the Lod Municipality

Orit Yulzari, Director of the Lod Community Dialogue and Mediation Center, was an intern at Cause-NY a few years ago. Upon her return to Israel she began receiving on-going consultation from the JICC. As aprt of her work she initiated the Lod Multicultural Forum which focuses on ways to make Lod a more culturally competent city and importantly it also serves as the city’s inter-identity crisis intervention team. A few weeks ago when there was an arson of a synagogue in Lod the forum was used for this purpose.

During the presentation, the Mayor and all the participants emphasized the importance of the Crisis Intervention Team. Insights and tips from similar work in NYC were discussed.

Update, Nov 25:     just a few days after this visit, Orit Yulzari received a call about an incident at an Arab school. A 10-years old kid threw a stone at a police car and the police officer slapped him and called him “Hammas member”. Orit and the Mayor immediately got to the place and ensured that the incident was appropriately dealt with. The fast intervention assured that no disinformation and incitement took place. Later on that day other members of the Forum met with all the relevant sides.

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