Cultural Competency in the Health Care System – for the Haredi sector

Cultural Competency in the Health Care System – for the Haredi sector

Enabling all of Jerusalem’s populations – Palestinians, immigrants (Ethiopian, from Former Soviet Union), Ultra-Orthodox Haredi Jews – to receive the best health care possible is at the top of our priorities, and our Cultural Competency in the Health Care System project is designed to address the sensitivities of caring for all these populations. Thus, beginning April, we began holding seminars for the staff of a number of primary clinics of Clalit Health Services to help them better communicate with the Haredi populations in their areas.

The location of these seminars was important. They were held in what are considered ‘mixed’ neighborhoods – Neveh Ya’akov, Ramat Eshkol, and Ramot (A and B). These neighborhoods have quickly growing Haredi populations, but they are definitely not the ‘hard core’ (as in Meah Shearim, Geula, Romema, Sanhedria, etc.). Moreover, much of the staff of the Clalit primary clinics in these neighborhoods remains non-Haredi and unequipped to best communicate with their new contingency. Part of the problem, which we will touch on below, is that there is little or no connection between the clinics and the community – and especially the changing community – around them.

In these seminars we dealt with 3 areas:

1) Tools for practical action. Often in this type of work with the ‘other’ we think of the checklist of tips of what to do or not to do when treating the Haredi community – not closing doors, men not offering to shake women’s hands, etc. However, our workshop went beyond the checklist, and sought to change the approach that clinic staff take in treating their Haredi patients. We discussed with them how to bridge major cultural gaps. One example was raised of a Haredi man, whose wife was terminally ill, who came to the clinic to ask for a certain medicine. From the man’s point of view, this medicine, which would stop his wife’s menstrual period and therefore keep her from being ritually impure, would finally enable him to touch her, or even give her a glass of water. The doctor, from her point of view, was appalled. She could not give him the medicine he requested because it reacted with the other medications she was taking. She saw a man who was antipathetic toward his wife – here his wife was very sick and all he could think about was stopping her menstruation? It was a classic case of a cultural gap that needed to be bridged. It was then explained to her the reason behind his request; arrangements are now being made to work around the problem.

2) Community Dialogue. One of the many roles of the community clinic is to raise awareness of preventative health programs and to have an ongoing dialogue with the community to draw the community to take advantage of its services and feel comfortable doing so. Since these clinics had little contact with the community as a whole, it made their work supremely difficult. One of the goals of our seminars was to help the clinic staff first gain acceptance with the community leadership, which will significantly boost neighborhood involvement and patronage. When we surveyed the clinic staffs, we found that they either didn’t know that this fieldwork needed to be done, or did not know how to go about engaging the community. Attempts to call patients directly – without getting the leaders’ OK – led to low turnouts at events. In general, low turnouts leads to lower patronage, which is bad for constituents’ health, and also bad for the health services’ business. With our facilitation, we’re helping the clinic staffs make slow but steady inroads into the community.

For example, in Neveh Ya’akov we facilitated a meeting between the clinic’s staff and the Community Center’s lay leadership (9 out of 10 of whom are Haredi), which we anticipate will lead afterward to inroads into the community’s various spiritual leaders. After this type of connection, we expect a much higher rate of participation in Clalit’s activities in the future. We are using similar means to reach community leadership in the other neighborhoods as well.

3) A Safe Place to Vent. In each neighborhood, because the staff – themselves secular and religious, some, with no religious background – had started out in a religious / secular neighborhood that saw a rapid growth in the Haredi population, there was a general feeling of frustration and despair. They felt they were witnessing the great struggle for control in Jerusalem between Haredi and non-Haredi Jews, and the Haredim seemed to be winning easily, engulfing entire neighborhoods and forcing their beliefs and belief systems on everything around them. On the other hand, clinic staffs must draw patients in; otherwise they’ll go elsewhere and Clalit will lose money. And these workers are measured also according to their economic efficacy in the clinic.

We couldn’t really offer solutions to all the fears the staffs raised, but just the act of venting was important to them. For some, this was the first time that they’d heard other people venting the same fears, and that it’s OK to talk about it, and maybe even find solutions to some of the problems. Interestingly, these issues were raised in all 3 of the neighborhoods, independently.

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