Kashouvot has introduced pastoral care as an integral part of the health care provided in hospitals and nursing homes in Israel.
By RABBI MIRIAM BERKOWITZIllustration by Pepe Fainberg(photo credit: PEPE FAINBERG)PASTORAL CARE is an essential part of a caring society. People all over the world benefit from talking, praying, and expressing their deepest concerns with chaplains at times of profound need, vulnerability, and transition. In many countries, chaplains work alongside social workers, nurses, doctors, and psychologists to provide emotional and spiritual support, help navigate end-of-life choices, witness people’s life stories, and affirm the inherent dignity of every person.The main gift of pastoral care is a fully attentive, interested, respectful witness to each person’s story and a gentle presence who allows people to speak things they have held inside for years, take control, express their needs, and connect with the highest aspects of themselves and the Divine. Chaplains look behind external labels and engage with each person’s unique combination of personal history, world view, culture, personality and spiritual needs.Surprisingly for a religious country like Israel, pastoral care is not part of the medical system and was virtually unheard of until ten years ago. Israelis experience the traumas of war and terrorism and face additional social challenges, yet do not have the means or inclination to seek out therapy or spiritual support. When they are exposed to it, however, they are able to open their hearts and find healing.Since its founding in 2010, Kashouvot has introduced pastoral care as an integral part of the health care provided in hospitals and nursing homes in Israel. It has placed professional chaplains in hospitals and nursing homes, and partners with each location to fund the chaplain’s salary. It also offers home visits and work with synagogues that need supplementary pastoral services.Its chaplains range from ultra-Orthodox to secular. Most of the people who are drawn to this work in Israel are second career women who had an experience caring for a family member and wanted to help others navigate illness and death in a personal and supportive way. Therefore the profession has developed here with less of a religious focus. Kashouvot believes rabbinic training can enhance pastoral care and has rabbis as well as laypeople on staff.Kashouvot is committed to religious pluralism, and our religiously diverse staff learn and grow together. It serves Jews, Christians, Muslims, Sabras and immigrants, refugees and tourists, adapting our care to the individual’s beliefs and spiritual needs, and working to build relationships of openness and trust.THE FOCUS is on getting to know each patient’s spiritual world, and common tools include listening, music, nature, guided meditation, breathing, poetry, and traditional texts. Chaplains enable the patient and the family to explore the spiritual dimension of their medical experiences and identify sources of meaning and support. Tools may include helping the patient write a life review of their regrets, dreams and the things of which they are most proud, traditional or personal prayer (where appropriate), facilitating healing family relationships, exploring fears about the future and finding ways to cherish the present.Pastoral training involves a great deal of reflection, writing, and peer review. The goal of examining our own beliefs and val- ues, and also our assumptions, prejudices, projections and reactivity about others is ultimately to put ourselves aside and turn our full attention to the patient. The experience of having faced our own darkness also makes us more compassionate and more able to tolerate whatever difficult feelings (pain, anger, guilt) the patient might express.This training has deep roots in Jewish tradition. The Babylonian Talmud, in a section discussing whether suffering may bring benefits, shares a story about a rabbi who undergoes a similar transformation. It is centered on Rabbi Yochanan, a sage who lived in Tzippori, Israel, in the second half of the third century CE, and was head of the academy of learning in Tiberias. It shows his evolution from a solution-based to a more holistic caregiver, after he has had the experience of confronting his own mortality and walking in the other person’s shoes.“Rabbi Hiyya bar Abba fell ill and Rabbi Yohanan went in to visit him. He said to him: Are your sufferings welcome to you? He replied: Neither they nor their reward. He said to him: Give me your hand. He gave him his hand and he raised him.”“Rabbi Yohanan once fell ill and Rabbi Hanina went in to visit him. He said to him: Are your sufferings welcome to you? He replied: Neither they nor their reward. He said to him: Give me your hand. He gave him his hand and he raised him. Why could not Rabbi Yohanan raise himself? — They replied: The prisoner cannot free himself from jail...”“Rabbi Eleazar fell ill and Rabbi Yohanan went in to visit him. He noticed that he was lying in a dark room and he bared his arm and light radiated from it. Thereupon he noticed that Rabbi Eleazar was weeping, and he said to him: Why do you weep? Is it because you did not study enough Torah? Surely we learned: The one who sacrifices much and the one who sacrifices little have the same merit, provided that the heart is directed to heaven. Is it perhaps lack of sustenance? Not everybody has the privilege to enjoy two tables. Is it perhaps because of [the lack of] children? This is the bone of my tenth son! — He replied to him: I am weeping on account of this beauty that is going to rot in the earth. He said to him: On that account you surely have a reason to weep; and they both wept. In the meanwhile he said to him: Are your sufferings welcome to you? — He replied: Neither they nor their reward. He said to him: Give me your hand, and he gave him his hand and raised him.” (B’rachot 5b)Physical suffering is connected to emotional experiences, and the will to live is important for someone who wants to improve physically. The first time Rabbi Yohanan was just interested in solving the problem. After his own illness and experience of a pragmatic healing, he gains in sensitivity and empathy. When he visits another sick person after his own recovery, the conversation is much longer and more nuanced.He notices the physical surroundings (darkness) and attempts to improve them (by adding light). He expresses concern for the patient’s physical well-being (his finances and possible hunger), and imagines that spiritual distress (childlessness) may account for some of his physical distress. He allows the patient to express regrets over his life’s accomplishments (having not managed to learn enough Torah) and, most movingly, is able to sit with the patient’s pain (they weep together and face their own vulnerability and mortality), in empathy and without judgment, before healing him. His physical touch also encourages the patient and gives him the strength to sit up and feel once again like a healthy and valued person and member of the community.Kashouvot's long-term goal is to make pastoral care an integral part of the health care system. The Israeli spiritual care association is working on PR and advocacy at the macro level. Meanwhile, we create facts on the ground by funding our chaplains’ salaries (with increasing participation from the sites), mentoring and supervising our staff, creating educational materials for rabbis and chaplains in Israel and abroad, teaching medical staff about spiritual care, offering professional training (starting in 2017) and facilitating training opportunities for Israelis to continue their training with advanced CPE (clinical pastoral education).This year we are expanding our vision from providing pastoral care to offering pastoral training for Hebrew and Arabic speakers, and to changing social attitudes toward the elderly and people with dementia. We hope to sensitize people to what it is like to be elderly, trying to complete simple tasks despite their limitations to their agility, mobility, sight, hearing and sense of awareness with a new workshop for schools, tour groups and medical staff.In all our work, we beseech God to “be attentive [Kashouvot] to the voice of our pleas” (Psalm 118) and we try to emulate the Divine aspect of compassionate attention and become the agents of that gift on earth.It has been a joy seeing the field grow from nothing over the past twelve years or so, and we, along with other training groups in Israel, hope to see it even more integrated into the medical system in the decade ahead.Rabbi Miriam Berkowitz, founding director of Kashouvot, is a certified Israeli Spiritual Care Provider and the Israeli representative of the International Neshama Association of Jewish Chaplains. Please visit www.kashouvot.org to learn more.
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