Medical cultures in collision: Primary care of soviet immigrants in Israel

In Israel immigrant absorption is part of the national ideology. Family doctors cannot look at some patients as belonging and at others as aliens, but must make every effort to understand the culture of each immigrant group as they arrive. This is equally true for the North Africans, the Iraqis, the European Holocaust survivors, the Persians, and the Yemenites, to mention just some of the larger groups.^1,2 Despite being such a multicultural society, it is the Anglo-American tradition that most strongly influences modern Israeli medicine. For many of the new immigrant groups this is an unfamiliar environment. The 1990's brought to Israel, a country of under five million, almost half a million new citizens from the former Soviet Union. In this article we follow the recent immigrants from Russia to Israel in the process of their absorption into their new health-care system. Although these immigrants decided to move to Israel for many different reasons, whether they be financial, medical, religious, national or social, they all shared the difficulties of migration. Migrants go through three phases. At first they identify with the culture of their country; then they go through the experience of migration; and finally they meet with the new host culture.³ Perhaps the most obvious barrier to be overcome is the new language. This is more than a merely technical problem, and Mirsky has identified the difficulty of changing to a new language, with its 'deep sense of loss of self-identity and of internal objects'⁴.