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.
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).
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.