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The language of health

Maya De Vries Kedem19 July 2021

By Maya de Vries and Laila Abed Rabho

Person typing on a hospital computer next to a stethoscope. Source: Unsplash

In the meetings that we held with women in Dar al-Hawa, we found that most of them were suffering from various health problems, the most common ones being high blood stress, diabetes, back, and leg pain. When going to one of the local public health clinics in Dar al-Hawa, clinics that are managed by local Palestinians as well as subsidised by the Israeli Ministry of Health, they are likely to get good quality treatment both in terms of their health problem as well as in terms of their own understanding of the process, as these clinics operate in Arabic.

However, the situation is much less convenient when they are required to visit one of the Israeli hospitals in Jerusalem to receive treatment – not because they will not be seen for their health problem or accepted as patients, but rather, in their own words, will not be able to understand large parts of what is being said to them by doctors, nurses and other staff. Sitting in a doctor’s office or treatment room is a stressful situation can be a stressful situation regardless of the health issue that is being investigated. When the issue of a language barrier between the patient and healthcare staff is added to the equation, the patient(s), in this case, older Palestinian women, can be made to feel even more uncomfortable as he/she is required to seek help with translation.

Hospitals are highly stressful places where many types of individuals (whether patients or staff) belonging to a variety of social groups intersect on a daily basis. These meetings can constitute points of friction or moments of acquaintance between groups of people who may ordinarily be fairly indifferent to each other. In al-Quds, Israeli hospitals, this tension between Jews and Arabs has existed for many years, as we found out from some of the women we spoke to in Dar al-Hawa. One expression of this tension is the absence of the Arabic language from the hospital space.

This situation makes the women of Dar al-Hawa more dependent, as patients, than they already are: presently, most of them have to rely on either their husband, their children, or their grandchildren to accompany them to the hospital, or on a translator provided by the hospital – usually, there is only one on the ward. There is also the possibility that an Arabic-speaking doctor or a nurse may be around to facilitate translation, but this is not certain. What does make the experience a bit easier is the fact that all signs at the hospital are usually written in Hebrew, English, and Arabic. However, our participants told us that this is not going far enough – something that even the women in our group who do speak Hebrew agree with.

Dina, 58, remembers her period of hospitalisation:

“I stayed in the hospital for some time, they used to give lectures in Hebrew, I hope they bring doctors that give lectures in Arabic, because there were Arab patients who had had an open heart surgery but did not show up to the lectures because they didn’t understand Hebrew, many Arabs don’t understand Hebrew, or they do, but not to the extent that that they are able to answer the nurses.”

Sireen, 42, adds that other than the language barrier, she does not have any complaints about the hospital:

”I usually don’t go to hospitals; I used to go the hospital just to give birth. Honestly, during the period that I was in hospital, I felt that the staff and the service in the hospital was very good, I didn’t face any problems except for the language.”

On the other hand, Nasreen, who is 76 and speaks good Hebrew, recalls seeing people her age struggling whilst in hospital:

“I understand, read and write Hebrew. Other people who come to the hospital and do not know Hebrew bring people with them to help them and translate for them, it’s hard that they don’t give information in Arabic.”

Mona, a 60-year-old research participant, described the language problem in a more nuanced way, stating:

“Since we are treated at Israeli hospitals and the language that is used is Hebrew, sometimes I can’t communicate with them [doctors] or understand what they are saying, if there is someone that can translate that can help…or if the information is written in Arabic, all the medication package inserts are written both in Arabic and Hebrew, but in the hospitals, not everything is written in Arabic.”

Taking into account the stories told to us by our participants, we think that the language gap points to a more fundamental, less spoken-about problem: that of racism. Even though the issue of racism is familiar to the Ministry of Health and there is an official protocol that aims to reduce racism against patients and healthcare staff within the hospital[i], the women we spoke to think this is still an issue. Rabab, 63, says:

“I want them to treat me like any other person, I don’t want them to underestimate me, we are exposed to racism in the Israeli hospitals. For me, Hebrew is an obstacle, when I visit the doctor, I take my sisters or my children with me so they can translate. I would prefer if everything will be in Arabic. Once, my husband felt pain in his eyes so we went to Shaare Zedek medical center, I heard the doctors speak, they said that there is no ‘use’ to his eyes , so I told him in Hebrew that I didn’t understand what he meant, he answered <<you don’t live in Iraq, you live in Israel, so you must learn Hebrew>>. I wrote a complaint and sent it to the hospital.”

Reem, a 50-year-old participant, talks about her experience in a maternity department in an Israeli hospital:

“We saw there were volunteers who came to help Jewish women and teach them how to breastfeed. We did not see anyone who spoke Arabic. There is a shortage of volunteers who do such work for Arabs, and even the Arabic language was not spoken. Only Hebrew.”

To conclude, our interviewees point to the importance of the language as an important parameter that should be taken into consideration in healthcare settings and when considering the quality of care, especially in al-Quds, where the public health system is fairly well-developed due to being part of the national Israeli health system. Treatment can and should be better when it comes to not just the medical treatment itself, but also the details of patients’ symptoms and the diagnosis. In order to get a comprehensive and accurate picture of a patient’s medical problem and decide on the best course of action in terms of care, it is very important to understand ‘the little details’, and for that to happen, understanding the spoken language of health at the point of care is a must.

Below, we show two examples of the home pages of two relevant, major hospitals in al-Quds, Hadassah Hospital and Sharee Zedek Hospital. Although both are available in Arabic, Hadassah’s home page only allows the user to select a different language if the user already speaks English – the different options for languages are written in English letters: ‘EN’, ‘AR’, ‘RU’. Sharee Zedek displays the different language options in the ‘mother tongue’ itself.

Pic 1: home page of Hadassah hospital. On the right side, visitors can choose between English, Hebrew, Arabic, or Russian – but the language menu itself is in English (written in English characters).

 

The home page of Sharee Zedek hospital: on the right-hand side, website visitors can choose their choose language, with the choices being English, Russian or Arabic. Although written in a small font size, the choices are given in the mother tongue itself (I.e. using the Arabic alphabet), which makes it more accessible to non-Hebrew readers.

[i] see for example this page published in the website of the MOH: https://www.health.gov.il/English/Topics/Equality_in_Health/racism/Pages/default.aspx) See also an important article about separation in maternity departments: https://www.haaretz.com/israel-news/.premium-though-illegal-jewish-arab-segregation-plagues-israel-s-hospitals-1.6725140

 

Ramadan in times of Covid-19

Maya De Vries Kedem7 April 2021

BY MAYA DE VRIES AND LAILA ABED RABHO

The month of Ramadan is coming soon, and again, this holiday will be different in several places around the world. As the World Health Organization has advised this week on their Facebook page, while celebrating, people should still take care and keep social distancing, as COVID-19 is still with us.

Fig 1: World Health Organization Facebook page post, advising people celebrating religious holidays to maintain social distancing.

Muslim populations around the world are waiting for the month of Ramadan, and although it is a long month, it is also an opportunity to get some light in the shade: having family and guests around during this month is one of the positive things during this holiday. Time usually goes by quickly and some say time flies even though they are spending a long number of days fasting. Before they know it, preparations for Eid al-Fitr (the Festival of the Breaking of the Fast) will start. As the Messenger of God said: There are two occasions of joy for a fasting person: one when he breaks his fast, and the other, the joy of Eid.

Ramadan is a month of fasting: during this month, people refrain from eating and drinking between sunrise and sunset. Although fasting is one of the pillars of Islam, Ramadan is not just about fasting: a person must avoid everything that God has forbidden in this period and only adhere to acts of worship.

Fasting is not just done for the sake of depriving oneself of food and drink, rather, fasting is considered to have many benefits: it tames the soul and gives the body rest and better equips the bodily organs responsible for food and drink, as well as giving people patience during times of calamities and making individuals better appreciate how people who live in food poverty may spend most of their days (not just during Ramadan). Such solidarity is significant nowadays, as following the COVID-19 crisis, the number of people who are struggling to make a living has only gone up.

In 2020, before the blessed month of Ramadan, the Coronavirus terrified the whole world, young and old. But as a virus, it was most threatening to the elderly population as it changed their lives almost completely around the world and in our fieldsite of Dar al-Hawa. It was no longer possible to hold weddings or any sort of gatherings of more than ten people in an enclosed space, and restrictions were imposed on everyone. Mosques closed their doors to the worshippers on most days, limiting services to a very small number of worshippers (not more than 10) who were allowed to attend on Fridays.

Last year, Dar al-Hawa was highly quiet during Ramadan, as families did not host any events or guests in their homes and barely met with other people. More so, the habit of going out to restaurants during the evening disappeared as places were shut down. The general feeling in Dar al-Hawa was that of despair. However, soon, an effective solution was found: families started to send food boxes and gifts to one another instead of visiting each other’s homes – boxes were also given to the poor.

During Ramadan last year, people were even prohibited from praying in the al-Aqsa mosque (a holy site). Because it was anticipated that during Ramadan, many worshippers would travel there from several regions (including Jerusalem and the areas of the Palestinian Authority in the previous year), everyone was prohibited from performing the obligatory prayer and Taraweeh prayer in the Al Aqsa. Jerusalem and Al Aqsa were sad and devoid of worshipers.

In 2021, the pandemic is still spreading across the world, but in Israel, the number of infected people has been in decline following a major vaccination operation, which has taken place over the past four months. At first, the population of East Jerusalem (including Dar al-Hawa) were sceptical of the vaccine and did not want to take it due to the abundance of fake news circulating online (see our latest blog post for more). However, vaccine uptake among the Palestinian population of Jerusalem has been on the increase, potentially because people have witnessed the lack of serious side-effects after the vaccine but also because entrance to many places is now forbidden if one does not have their green pass (this is a pass confirming that the person in question has had both doses of the vaccine). In Dar al-Hawa, 91% of the population has now been vaccinated! For now, only those who are 16 or above have been vaccinated, but this high percentage means that Ramadan, this year, as opposed to last year, and as opposed to other places in the world, can be celebrated almost as normal – in people’s houses, on the streets, and in restaurants – and people are really excited about it. The only place that is still limiting the numbers of attendees are the mosques – there is a limit on the number of people who can be inside and one must wear a mask while praying, but they are open to prayer and people can practice their worship and fulfil the holiness of Ramadan.

For this Ramadan, Islamic scholars and jurists issued Fatwas to allow people to pray inside the mosques for their relatives who cannot enter for various reasons: people who might have chronic diseases which means they are at greater risk of being infected and developing a severe form of the disease, people who have had an organ transplant, and those who have not been vaccinated yet. Their relatives’ prayers inside the mosque will be considered equal to them attending mosque themselves.

In Dar al-Hawa, people are impatient and eager to perform their Ramadan obligations the same way they would have done before Covid-19, by going to mosques and being gathered with their family and relatives to collectively eat breakfast (the Iftar).

People have already started preparing for Ramadan by decorating their homes and streets. A favourite dessert here is Ma’amuls – stuffed cookies with walnuts or cheese, and in some of the houses, people are already preparing the special dough for these.

Decorated house in al-Quds (1)

Decorated house in al-Quds (2)

In Dar al-Hawa, people are hoping that the current situation will continue to improve in order for restrictions to be lifted and celebrations to take place comfortably and with some reassurance. We are hoping that vaccine uptake will continue to stay high so that cases continue to go down during the days before people start gathering, so that religious and other daily duties can be undertaken freely and without restrictions. Until then, everyone is trying to follow the regulations set out by the Ministry of Health relating to masks and quarantine to slow down the transmission of the virus, while still celebrating Ramadan together.