tabletmag.com/BY ELI REITER
Purim, perhaps the most social and certainly the most alcohol-infused Jewish holiday, came on March 9 this year, in the early days of the coronavirus pandemic. For the already social, Hasidic community of Crown Heights, a holiday of passing food and drink from house to house created a crisis. This was at a point in the path of the virus when top officials from the White House to New York City Mayor Bill de Blasio were still downplaying the threat—and before de Blasio had decided to single out the city’s Jewish community for special punishment. Compared to the social distancing and other measures practiced in Crown Heights only a few weeks later, public health protocols during Purim were lax and the number of cases started growing soon after.
The toll of the virus in Brooklyn’s religious communities has been severe. According to the numbers released by the New York City Health Department in May, 1 in 3 Crown Heights residents tested positive for COVID-19. Many local residents have adopted the grim ritual of turning on their phones after Shabbat on Saturday evening to see who has passed away. But for some of the same reasons the virus spread quickly in the densely populated and highly social Hasidic community in Crown Heights, local leaders were able to quickly take action. A consortium of representatives from each of the neighborhood’s local schools met on Friday, March 13, and closed yeshivas a half-week before the city closed public schools. Tablet computers were secured for students to learn remotely from a local businessperson who refurbished them, according to Motti Seligson. And, critically, when it came to public health, the neighborhood did not rely on a one-size-fits-all approach. Instead, local doctors and health care providers with knowledge of the community’s culture and specialized medical needs were able to treat and educate local residents.
Yosef Hershkop, regional manager of the local Kāmin Health Urgent Care Center in Crown Heights, suspected he saw patients with coronavirus as early as January and February. “They had flu-like symptoms but tested negative for A and B influenza tests,” he said, referring to the standard nose and throat exams.
Crown Heights is famously international. Residents and visitors come from all around the world to pay homage to the global headquarters of the Chabad Lubavitcher movement at 770 Eastern Parkway. Events like Kinnus Hashluchim and the Kinnus Hashluchot draw Chabad emissaries from across the globe together for annual conferences, spiritual and social rejuvenation, and to learn skills like fundraising. In the fall, yeshiva students from France and Israel come to study at the Chabad headquarters for the High Holy Days, praying and studying in 770 during the Jewish month of Tishrei. Some internationals stayed in Crown Heights for the year to study in yeshiva. Each of these populations—whether a shaliach visiting from abroad, an Israeli student, or one of the approximately 15,000-20,000 full-time residents—need customized care.
According to Dr. Denise Anthony, professor of health management and policy at the University of Michigan, who studies issues of patient trust and health disparities, the quality of medical treatment can be negatively impacted when a patient feels stereotyped or pigeonholed by a provider unfamiliar with their culture. For instance, gay men have reported unhelpful interactions with health care providers. “They sometimes feel narrowly profiled by their sexuality,” explained Dr. Anthony, pointing to the example of a patient who comes into a doctor’s office with a sore throat and gets a “conversation about risky [sexual] behaviors.”
Similarly, a Hasid might be less than forthcoming with a secular provider if they feel their religious identity is likely to become the locus of the interaction. “It will affect how the patient shares information with the clinician,” said Dr. Anthony of such fraught interactions. “It changes follow-through.” If there is pushback from the provider, a patient may not feel comfortable to share what’s going on in other aspects of their life, or even follow the advice of the provider. She offered the example of a large family together not wearing masks. To passersby, they might not understand that that is normal and that’s how the community lives, with larger families sharing the same roof. “We have to interpret how the rules fit then in the way this community lives, in a way that is appropriate for the community’s needs, but also stops the disease from spreading.”
A Hasidic mother of four from Borough Park, who spoke on condition of anonymity, explained what specialized care looks like for her: “My doctor speaks Yiddish, so my kids are more comfortable. It’s that cultural understanding.” She offered other examples where shared understanding led to better pediatric care. Medical practitioners give vision exams to see if there are early signs of vision problems. “In the vision test, they use aleph beis on the eye chart.” To respect customs around modesty and gender, she explained, “they always have a male PA to see the older boys,”
The local Hatzalah in Crown Heights provides an example of the positive effects of trust-building. “The volunteers [EMTs] follow up with patients when they are in the hospital,” according to Hershkop, the urgent care center manager. They care about the entire community and offer individualized care, “regardless of what kind of yarmulke you wear.”
According to research done by economist and physician Daniel Meltzer, a better understanding between doctor and patients is connected to better medical outcomes. His team examined physicians who lingered with their patients and asked questions about other aspects of their lives. They found that holistic care led to discovering chronic issues that might have been missed in a more rushed visit.
Dr. Eli Rosen, a Crown Heights family medicine specialist, has acted as a community physician and de facto public health official during the COVID-19 crisis. In addition to being from the Chabad community, Rosen has the prestige of having provided medical care to the most recent rebbe. With the outbreak of COVID-19, Rosen went from his standard routine seeing patients to regularly issuing community guidelines and updates on a blog. Along with the Gedaliah Society, a network of Chabad men and women training or working in health care fields, the blog released numerous updates a week to keep local residents informed of new developments.
A doctor who is unfamiliar with Hasidic beliefs and culture may not appreciate community norms that require balancing Jewish purity, family planning and other demands within a Halachic (Jewish legal) framework. Hershkop described the experience of a female relative seeing an OB-GYN at a large hospital in Crown Heights. “The doctor treated her like a streetwalker and gave her a lecture about STDs.” According to Hershkop, the physician even scolded her for the birth control she took. The chances for misunderstandings are compounded by the common fear among many Hasidim of encountering anti-Hasidic sentiments from outsiders. As a result, health care providers who are not familiar with Hasidic customs and practices might lack the authority and in-group knowledge necessary to convince people to alter their behaviors. In contrast, when almost a dozen local Crown Heights doctors signed a letter asking Lubavitchers outside New York not to visit Crown Heights on the recent anniversary of the rebbe’s death, it’s far more likely to have an impact than a similar notice from a government bureaucracy.
A poll of Crown Heights residents from the Gedaliah Society garnered almost 4,000 responses. With 15,000-20,000 Lubavitchers in the area, that puts the response rate at 20% at the low end and greater than 25% at the high end, which would mean that the locally led effort has produced better results than comparable city-run surveys. In addition to receiving higher per capita participation, the 22-page Gedaliah survey asked about COVID-19 nasal tests, antibody test results, and severity and persistence of symptoms, whereas the city’s data only accounted for positive or negative results of COVID-19 tests, hospitalizations, and deaths.
Getting data from a large sample size of the community is critical to doing good analysis and forecasting trends. The Gedaliah survey is also conducted routinely, leading to fresh data being collected and results being constantly updated to give residents an ever-evolving snapshot of the situation in their community. For instance, a recent update from the Gedaliah Society and Dr. Rosen showed the possibility of the virus returning to those who might have tested positive for antibodies a few months prior, and the doctor urged residents to exercise caution.