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1IN MILE & GREENFIELD

Problems Cause
Pains Of Body

SHARON KANON SPECIAL TO THE JEWISH NEWS

M

y head hurts; may-
be it's because of
my tooth. My sto-
mach also hurts,
and so does my heart," be-
moaned the young Ethiopian
woman. The nurse at
Hadassah's Center for Com-
munity Health at the
Jerusalem neighborhood of
Kiryat Yovel was confounded.
So many diverse 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 internal-
ized all their problems and
felt them as actual pains in
the body. Now we have a bet-
ter understanding. Avraham
Yitzhak, now a medical stu-
dent at Ben-Gurion Univer-
sity, helped bridge the
cultural gap between the
medical staff and the Ethio-
pian immigrants."I was
translating from Amharic to
Hebrew and back, but I was
also trying to translate
cultural codes," recalled Mr.
Yitzhak, who completed three
years at the Addis Ababa
Medical School before joining
his parents in Israel. "If a
woman said that her ab-
domen 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 car-
diologist. What he is saying is
that he is very sad and his
heart is heavy. One patient
said desperately, 'My pain is
blood,' " related Mr. Yitzhak.
The belief that bad blood
should be removed to cure a
sickness is part of the
psychological, cultural tradi-
tion," he said.
In fact, Ethiopian culture
views physical pain as
spiritual intervention; as
"punishment from God." Ac-
cording to Ms. Naveh, when
physical pain is especially
acute, it is believed that
Satan or a spirit has entered
the body. To relieve pain, the
Beta Isarel frequently asked

the doctor to be bloodlet.
"Ethiopians lack
knowledge of anatomy,
physiology and disease," said
Dr. Benjamin Wondemeneh,
an Ethiopian now living in
Israel, who was sent by
former Ethiopian President
Haile Selasie to Moscow to
study medicine, and went on
to Sweden to study
psychiatry. "Somatization —
in which emotional problems
are expressed by the body —
is a result of the Ethiopian
cultural code," he explained.
"They believe in tolerating
extreme suffering without
losing patience or showing
emotion, and without telling
anybody. Their problems are
not communicated, they are
accumulated in the stomach."

Health issues
have to be
handled very
delicately.

"When 14,000 Ethiopian
Jews arrived in Israel in
Operation Solomon in 1991,"
continued Ms. Naveh, "We
had no concept of their
culture. We discovered very
quickly that translating their
language was not enough." In
Ethiopian culture, for exam-
ple, it is a breach of ethics to
ask direct questions. "It's
simply not proper," said Ms.
Naveh. Riling an Ethiopian
woman she has a serious ill-
ness is also unacceptable.
"One man was very angry
when we told his wife that
she needed an operation. The
husband muse 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.
These days, according to
veteran Ethiopian communi-
ty worker Benny Nadav, "The
younger people are getting
used to the health system in
Israel and taking medication.
But the older Ethiopians still
feel more comfortable with
traditional healing methods."
Injections are often re-
quested by patients. "When
the Italians colonized