“My head hurts, maybe it’s because of my tooth. My stomach also hurts, and so does my heart,” bemoaned the young Ethiopian woman. The nurse at Hadassah’s Center for Community Health in the Jerusalem neighborhood of Kiryat Yovel was confounded. So many complaints at the same time. She asked the patient to describe her problems in more detail. “I’m alone here. My husband died,” said the woman. “My father and sisters are in Ethiopia and I long for them.”
“When we first started treating Ethiopians, and they complained about pains in the heart and stomach, we took them literally,” said Pnina Naveh, the clinic’s Head Nurse. “Then we began to realize that they internalize all their problems and felt them as actual pains in the body. Now we have a better understanding.” Avraham Yitzhak, now a medical student at Ben Gurion University, helped bridge the cultural gap between the medical staff and the Ethiopian immigrants. “I was translating from Amharic to Hebrew and back, but I was also trying to translate cultural codes,” recalled Yitzhak, who completed three years at the Addis Abada Medical School before joining his parents in Israel. “If a woman said that her abdomen hurt, the doctor might suggest Maalox. In fact, the woman could really be saying that she has an infertility problem.
“When an Ethiopian says: ‘I have a pain in my heart,’ he doesn’t usually need a cardiologist. What he is saying is that he is very sad and his heart is heavy. One patient said desperately, ‘My pain is blood,'” related Yitzhak. “The belief that bad blood should be removed to cure a sickness is part of the psychological, cultural tradition,” he said. In fact, Ethiopian culture views physical pain as spiritual intervention; as “punishment from God.” According to Naveh, when physical pain is especially acute, it is believed that Satan or a spirit has entered the body.
“When 14,000 Ethiopian Jews arrived in Israel in Operation Solomon in 1991,” continued Naveh, “we had no concept of their culture. We discovered very quickly that translating their language was not enough.” In Ethiopian culture for example, it is a breach of ethics to ask direct questions. “It’s simply not proper,” said Naveh. Telling an Ethiopian woman she has a serious illness is also unacceptable. “One man was very angry when we told his wife that she needed an operation. The husband must be told first.” Health workers found that separate group meetings for men and women on treating tuberculosis, nutrition, etc., were more successful than joint meetings. Women don’t ask questions or participate in meetings with men present.
Dr. Michael Alkan, head of the Infectious Diseases Department at Soroka Hospital in Beersheva, also chairs the Association for the Advancement of the Ethiopian Family and Child (AAEFC). “In Ethiopia, there were three types of traditional healers besides the medic or doctor,” said Alkan. “The herbal or folk doctor, the ‘daftara’ who writes amulets, and the ‘zarchaser’ or ‘bal-a-zar’.” ‘Balazar’ is a combination of two Hebrew words, “possessor” and “foreign.” He literally chases the evil spirit away. “Now that there is no healer or exorcist, Kupat Holim [Israel’s national health fund] has to fill the role,” says Alkan.