Underground COVID-19 Home Hospitals for Haredim: Non-Compliance or a Culturally Adapted Alternative to Public Hospitalization?

Abstract

This thematic study analyzed the experiences of Jewish Haredi (Lithuanian) patients in underground home hospitals during the second wave of COVID-19 in Israel. This minority comprises 12.6% of the Israeli population. Participants were 30 members of this hidden population, ages 59-78. Haredi complied with community directives rather than with the national directive of hospitalizing COVID-19 patient only at public hospitals. Compliance with community directives was driven by a distrust in health authorities and clinicians at public hospitals; by the preference of patientcentered care, a desired approach of care that public hospitals fail to implement; by the need to sustain beliefs, values, and traditions; by community leadership; and by the need to conserve political power. While health authorities view underground home hospitals as demonstrating non-compliance with the national directive, Haredi leaders view underground home hospitals as demonstrating a self-sufficient, patient-centered care alternative to public hospitalizations. Considering the benefits of patient-centered care and the growth of the multi-cultural global landscape, we call upon health authorities to explore the accommodation of patient-centered care for COVID-19 patients and the designing of an adaptive multi-cultural policy that address multi-cultural aspects of religious minorities as key to health promotion. We propose ways to implement multi-cultural policies.

Is it the “public” health system? The VOICE model for inclusiveness in universal (national) health systems - lessons from COVID-19

“…The pandemic revealed weaknesses and blind spots in responding to it as a universal health system should. Although reducing inequities by community engagement has been promoted as a key element of epidemic responses, a collaborative approach with minority leaders was found to be lacking ( 24 , 41 , 46 – 48 ). Responses to the pandemic exacerbated inequalities that already existed; marginalized underrepresented groups were reported to be left behind and discriminated against partly due to COVID-19 policy responses ( 2 , 24 , 41 ).…”

“…Health authorities and policy makers were perceived by members and leaders of religious minorities as failing to recognize the loss of community; as devaluing the spiritual leaders of religious minorities who are responsible for the continuation of community and excluding them from decision making; as unaware of potential adaptations to religious values and beliefs that were possible in previous pandemics; failing to provide resources to help community members plan for practical needs after death; failing to improve wellbeing and resilience through grief counseling and self-care for elders during this challenging time; failing to create and make accessible communication platforms that alleviate anxiety and process collective loss in order to restore social identity ( 24 , 41 , 41 , 45 , 46 ). These experiences resulted in distrust, disappointment, and anger at health authorities, rejection of the vaccine, poor compliance with guidelines, ineffective grief, deeper polarization from the majority population, and poor utilization of health services.…”

Death From COVID-19, Muslim Death Rituals and Disenfranchised Grief – A Patient-Centered Care Perspective

“…This experience of grief might pose difficulties in emotional processing, in distress expression, in social support, in obtaining compassion, all challenging one’s coping with loss in one’s ongoing life ( Doka, 1993 ). When COVID-19 guidelines clash with belief systems and death rituals of religious people, they may refuse to comply with guidelines of hospitalization in severe COVID-19 ( Boguszewski et al, 2020 ; Gabay & Tarabeih, 2021 ). Although religious beliefs and rituals are personal, they are also a social institution ( Tobroni et al., 2020 ).…”

“…The Quran and the Sunnah, however, do not have explicit answers for social issues that emerged since the revelation of the Quran and the teachings of the Prophet Mohammed ( Rispler, 1989 ). Extensive research has related to the challenge of physical distancing in religious minorities ( Gabay et al, 2021 ), but research is scant on one of the most highlighted issues in the Covid-19 pandemic, death rituals among Muslims ( Gabay & Tarabeih, 2021 ; Tobroni et al., 2020 ).…”

Sexual harassment of religious Jewish nurses by patients and its relation to the ward's listening climate, care avoidance and quality of nursing care

“…Traditional religious Jews typically engage in their religion by following Jewish law in their daily lives, including the weekly sabbath, religious holidays and life cycle events (Kelman et al, 2017; Yadgar, 2011). Orthodox Judaism advocates adherence to Jewish law and more committed religious belief and practice (Krakowski, 2012), whereas ultra‐orthodox Judaism is characterized by much stricter adherence to Jewish law and more insulation from secular life (Gabay & Tarabieh, 2021; Noble et al, 2009). At all levels of religiosity, extroverted sexual expressions and behaviours by others are not welcomed and may be threatening.…”