'Post' Health editor tells of her quest to promote ritual baths as women’s health education centers.
By JUDY SIEGEL-ITZKOVICHMikve attendant 390(photo credit: Courtesy)
The average mikve-going Jewish woman regards the ritual bath as a place to go under the cover of darkness, prepare herself and then immerse while observed by an eagle-eyed attendant, dress quickly and return home to be “permissible” for intimacy with her husband. For some, it is a routine to “get over with,” for others a moment of holiness and anticipation that can lead to a hoped-for pregnancy. Sadly, for the overwhelmed, it could mean another round of spousal abuse, inability to get pregnant or an unwanted baby.But besides being an integral part of local religious services, the mikve could also serve as a center for the education of women on a myriad of health-related subjects, presented informally – woman to woman – by mikve attendants carefully trained by public health experts.That was my idea – carefully thought out three years ago – upon realizing that there are so many medical and emotional problems that are better prevented than treated; that observant Jewish women, especial haredi (ultra-Orthodox) ones, have little exposure to educational media about health issues and less formal education; that bath attendants are among the lowest-paid and have the lowest status of anyone in public service; and that many young mothers have time to attend lectures only in the evenings when their husbands are watching the children.But I knew there would be opposition.When I covered religious affairs decades ago and suggested to several chief rabbis of Israel and of Jerusalem that women be encouraged to perform breast exams on themselves (at the perfect time in their menstrual cycle) while taking a shower, I was given a unanimous ‘No!’ The mikve is a place to think happy thoughts, not about the possibility of disease, all the rabbis agreed.Still, certain that mikve health education centers for women was a good idea, I wrote a letter to Deputy Health Minister Ya’acov Litzman, an Agudat Yisrael MK and a Gur hassid who had been ensconced in his position for almost a year. Surely, I thought to myself, a haredi head of the Health Ministry would embrace an idea that would get more Jewish women to the ritual bath, even if they could go there to learn and not be required to take a dunk.“The bath attendants,” I wrote, “are usually intelligent, experienced women and mothers who earn very low wages; they are not very well educated about health and do the same boring but religiously important job many times every evening, even on Shabbat. But they know how to speak to other women and can be trained to educate in small groups traditional, modern Orthodox and haredi women in a program for promoting their health and safety and that of their families. They can also be taught to look for signs of possible physical abuse on the women’s bodies, talk to them and refer them for help if necessary.”The free classes held in small groups, I continued, “should also be open to older observant women who no longer are required to go to the mikve. If the program were well advertised, many secular woman who want to learn about health would also go for lectures and presentations at the ritual bath, which are present in every city and many neighborhoods. They would become community- based health promotion centers. As haredi women have very little exposure to the media and Internet sites to learn about health but have large families – ‘breast cancer’ isn’t even written in haredi publications – they would be the most important target, but any other Jewish woman must be made to feel welcome.”I SUGGESTED to Litzman that his ministry initiate and fund a pilot project in Jerusalem and perhaps in Beit Shemesh or Bnei Brak, together with local religious councils, the health funds and other partners. Mikve attendants could be paid a bonus to take courses with university school of public health experts (there are three such schools, in Jerusalem, Tel Aviv and Haifa). The graduates would then teach and guide the women – and get paid higher salaries – using material prepared by the ministry’s health promotion unit in a variety of languages from Hebrew and Yiddish to Russian, French, English and Amharic.I dubbed the suggested program “Project Hai” (meaning “Life”) because I had thought of 18 major subjects that could be covered (more have joined my list since 2009). The attendants, my email to Litzman went on, should be prepared to answer all relevant questions and have consultation for backup from health promotion professionals who could advise when the attendants don’t know the answers. “Before the first mikve courses begin, a questionnaire could be handed out to the women to test their pre-course knowledge about these subjects. After the women complete a course, a follow-up questionnaire to test increased knowledge and changed behaviors should be carried out. This would prove the actual benefits of the pilot program; if successful, it could gradually be expanded to the hundreds of ritual baths around the country,” the proposal continued.“I am certain that it would be well-received by haredi women among those who go to the mikve – as they are interested in health subjects but not exposed to much reliable information – especially if the ministry can obtain endorsements (haskamot) from leading rabbis in the various sectors. As women, according to Jewish tradition, are akarot bayit (heart of home life), what they learn will influence the whole family. The effort could save a lot of money that would otherwise be spent on treating disease and harm caused in accidents.”I concluded that as the Arab sector constitutes a fifth of Israel’s population and produces many of its children (but these women, of course, do not go to the mikve) some variation of the program could later be devised to reach them as well.TO MY shock, although I was told the deputy minister was presented with the idea, he didn’t even respond to my email. Months later, when I told Litzman’s second director-general Prof. Ronni Gamzu and he asked for a copy of the proposal, he, too, did not respond. More than two-dozen public health experts within the ministry and outside it, however, did respond, and were all highly enthusiastic; they called the idea “innovative,” “promising” and even “brilliant” – but added that they couldn’t get anywhere if the ministry heads did not endorse it.I was given no explanation for the proposal being ignored by Litzman, and concluded that the Agudat Yisrael MK simply does not like suggestions from outside his office – especially if they come from journalists.Other free ideas of mine to advance public health that I had sent them were rejected by Litzman and Gamzu outright, without examination. These included a simple, cheap way to reduce the number of children (many of them haredi) who die every year after being left in hot vehicles – requiring drivers to have special warnings (in any of a dozen languages) not to leave children in the car even for a second; adults do not want to kill kids; they forget or get confused. But if they see the warning every time they go enter and exit the vehicle, it will stick in their minds. If the sticker were not there stuck on the inside the driver’s door, a vehicle license would not be renewed. Disappointed, I took the idea to Eli Beer, founder and head of United Hatzalah, who pulled out his checkbook and ordered thousands of stickers, which he designed and distributed.More recently, he found an insurance company to sponsor 400,000 more, and I was told the stickers have saved lives here and abroad – even though their presence is not checked by the Licensing Bureau.Another idea I suggested as a public service was – given the pitiful enforcement by municipal inspectors around the country of no-smoking laws – to privatize it, issue a public tender for a company to learn the laws and train young people on motor-scooters who would respond to called-in complaints and catch people in the act. The fines would then be shared by the company and public smoking-cessation programs. Here too, the idea was rejected out of hand, and ministry deputy director-general for information, Yair Amikam, told me at Litzman’s Smoking Report press conference as well as a press conference he hosted on children’s deaths from accidents that “a journalist should only ask questions, write down our answers and not make suggestions!” MY MIKVE idea remained dormant until this month, when I learned that academic women in Jerusalem who had never heard about my idea had launched two years ago a small and much-less-comprehensive but expanding voluntary project for making mikve visits more pleasant and “providing a platform for the interface of Jewish law and women’s health.” Called Eden Center (TheEdenCenter.com), the project has built coalitions of voluntary and public bodies and gives free health education courses to bath attendants, including how to identify problems and refer women for help.Encouraged, I went back to the Health Ministry last week and asked for Litzman’s and Gamzu’s opinion of the Eden Center’s initiative and an explanation of why they didn’t support it – or even respond to my own in 2009. On their behalf, ministry spokeswoman Einav Shimron-Greenboim avoided answering the questions, but she did say that the ministry has projects for health promotion in all sectors, including the haredi sector. Among them, she wrote, is a public campaign for taking folic acid supplements to reduce the risk of neuraltube disorders in infants and for brides to get chicken pox and German measles vaccinations.The ministry, she said, “is putting out a book on health promotion for haredim in the center of the country and supports the Bishvilaych organization that gives workshops to haredi groups.”I met with Dr. Naomi Marmon-Grumet, a sociologist, mother and dental hygienist who started the Eden Center idea. Also with her was her friend Lizzie Rubin, a nurse and family therapist with a master’s degree in clinical sociology, who joined her in the project.Rubin, who has six children of her own, says there are dramatic moments in the mikve, such as a woman after mastectomy who does not want to be pitied for having lost her breast. “Women who have gone through physical abuse or have sexual or fertility problems in their marriage need help. If they can be referred to the right place, they will go home happy,” she said.Marmon-Grumet added: “There are 25,000 to 30,000 women in Jerusalem alone who visit the mikve every month. Thirty-six ritual bath houses are run by the Jerusalem Religious Council, while there are also six to eight private ones. The council employs about 200 attendants in all.”The large number of women who visit regularly “creates a huge potential to help women on health matters. We at the Eden Center wanted to make it holistic, for lots of different needs, and to be a model for other places. The attendants need to be more accepting, understanding and sensitive to those who are different. What do you say to a woman who has started menopause? How are they helped to say goodbye to their fertility?” said Marmon-Grumet. “The attendants are badly paid. One woman I know works six nights a week and comes home with NIS 2,700 a month. The hours are very inconvenient. They have to wait until the last woman is finished, dressed and has dried her hair.”One of the women to have participated in Eden Center’s program is Gila Ohana, a mikve attendant for more than 25 years, said she had worked in many and had passed a comprehensive rabbinical council course.“We learned how to greet women and all the Jewish laws about preparing for and undergoing immersion. But we never learned how to do other things. If a woman with postpartum depression came, we knew only to give give a glass of water. We didn’t know about Nitza, the Israel Center for Mother’s Health, which helps many women cope with PPD.And if the mother of a bride told us her daughter had been the victim of rape, we didn’t know there’s an organization that helps so the bride could build her new home without trauma. When a woman with obsessive compulsive disorder comes to the mikve, it is very difficult to deal with it. Now that I’ve finished the Eden Center course, I know better how to cope with these situations and really help women in the community.Sometimes one can even say that a single telephone number or business card changed things.”Yehudit Shabta, a translator and editor who “moonlights” as a Jerusalem mikve attendant as a good deed, not to make money, told The Jerusalem Post that her colleagues are mostly haredi women who barely graduated from high school. Attendants earn NIS 100 per shift, no matter how many hours they work; winter hours are much longer than summer ones because of the different in sunset times. Shabta added that she didn’t know how the attendants made ends meet.“Many support their husbands who study Torah full time and have very low social status because of what they do and earn. But though they earn less than the minimum wage, they are very good, fine and sensitive women.”The religious councils’ mikve administration, which has for decades been very conservative, is gradually opening up to new ideas. Although Eden Center volunteers are still not allowed to hang posters in the mikve advertising lectures and courses, they nevertheless allow the attendants to participate in the courses.Marmon-Grumet concluded that if there were a promise of extra wages for additional work, “attendants would be very glad to be trained and so many of the things in Project Hai, while always keeping in mind the privacy and respect needed for the intimate nature of the mikve, or – as in the Eden vision – create the center around the mikve in which all these topics can have expression.”The 18 suggested health topics covered by ‘Project Hai’Preventing home accidents such as burns from Shabbat and Hanukka candles, hotplates and samovars and how to avoid home fires, as well as preventing child choking on foreign objects and unswallowable pieces of food,• Preventing accidental poisonings from cleaning materials and medications and drowning in buckets during the pre-Pessah period• Preventing falls (especially by putting bars on windows and balconies)• Reducing road deaths and injuries on the way to school and back and elsewhere in the neighborhood and teaching women how to safely cross streets (especially with baby carriages)• Encouraging first-aid and resuscitation education and teaching where and how to play safely in playgrounds, supervise older children who take care of their smaller siblings• The importance of taking nutritional supplements such as vitamin D, calcium, iron and folic acid• The need to go for a mammography after 50, or earlier if there is a family or genetic history of breast cancer• The importance of avoiding sunburn• Taking infants, toddlers and older children for all the necessary vaccines, including against flu• The dangers of smoking, how to quit, and teaching children and husbands not to smoke• Keeping teeth healthy by brushing, eating healthy snacks and not cheap junk food, often given to children as Shabbat treats, and advising parents not to put babies and toddlers to sleep with bottles filled with sweet liquid and always to put infants to sleep on their backs• The need to lock doors to prevent kids from wandering out of the home• Encouraging regular exercise by all family members• Teaching about the risks associated with obesity and anorexia and offering advice on how to eat healthy• The importance of undergoing genetic tests and scans in pregnancy• Never leaving children alone in vehicles, even for a moment• Seeking help early for postpartum depression (PPD), obsessive-compulsive disorders and other psychological and psychiatric problems• Storing medications and taking them properly in the correct dosages as well as avoiding unproven and potentially dangerous “alternative medicine treatments”Comments may be made to the office of the deputy health minister at sar@moh.health.gov.il or to the ministry’s director-general at mankal@moh.health.gov.il with a copy to the Eden Center at theEdenCenter@gmail.com and jsiegel@jpost.com
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