"I mostly try to talk with my hands," said Mona. "I try to explain where it hurts or what is bothering me. If the doctor understands, then he understands. If not, not." Her Hebrew is virtually non-existent.
Mona (not her real name), like thousands of the other Bedouin-Arab women in southern Israel's Negev desert, struggles to cope with a language barrier that is a major factor in their inability to receive proper medical treatment.
"I am lucky because I can speak the language," said Subha, from a remote village in the desert. "Otherwise it is really hard."
The problem was especially difficult in the "unrecognised villages" - ones that were not officially on Israel's map, as the state sees their existence as illegal.
The Bedouin say their villages either existed before Israel was founded, or during the first years of the nascent state by internally displaced persons (IDPs) in need of a new place to live following the migrations - sometimes forced - during and just after the 1948 Middle East war.
According to the Israeli Physicians for Human Rights (PHR), a non-governmental organisation (NGO), about 48 percent of Arab women in the unrecognised villages are unable to speak Hebrew. Of those who do speak it, most have only a limited knowledge.
Photo: Shabtai Gold/IRIN
|Entrance to Khashem Zaneh unrecognised village, where residents have difficulty accessing public transportation|
Ad hoc translations
"When I go with my wife to the clinic, sometimes when I am in the waiting room, the doctor will come out and ask for my help in translating," said Atir, a Bedouin man fluent in both Hebrew and Arabic.
He admits this is far from ideal.
According to PHR, this method, while maybe stemming from a physician's good (but ultimately misguided) intentions to better understand a patient, presents multiple complications: the translations are not professional and sometimes inaccurate; the man can be embarrassed to translate all the woman told him; the woman can be too embarrassed to tell the full story to a stranger.
The end result can be tragic, with women not receiving full treatment for problems, or getting the wrong treatment. In cases where there might be an option - for instance natural or surgical childbirth - a woman's true wishes may not be conveyed, leading to her rights being severely violated.
"The health clinics need real translators," said Subha.
Lack of transport
The other major factor contributing to the women's troubles in accessing health services was transport. The women generally do not have driving licenses or cars and are forced to rely on their husbands or on public transport.
PHR recently told a Knesset (parliament) committee discussing the issue that some 80 percent of women in the unrecognised villages had opted to forgo medical care because of the problems they faced.
Photo: Shabtai Gold/IRIN
|A Bedouin woman walks back home from a visit to the local clinic. In some cases, the clinics are very far from Bedouin villages, making access difficult|
" I need to go on foot to the highway," Mona described a trip to the doctor. From her unrecognised village it can be anywhere between 500m or several kilometres to the main road, where a woman then has to hitch-hike.
"It can take an hour and a half to get a lift," she went on. When the woman finally reaches Beersheba, where her clinic is located, she has to take a bus, which eats up another 30 minutes.
In Mona's case, she sometimes has to do all this with an asthmatic child in need of medical help in the summer heat.
Mona and other women told IRIN that on more than one occasion they and family members had had to give up on medical care, because of the language barrier or lack of transport.
The Israeli Ministry of Health said it operated mobile inoculation units to reach women and children in remote areas unable to travel to clinics. This was meant to help alleviate at least part of the problem.
Other government officials have said many problems the Bedouin in the Negev face are a result of their living in unrecognised villages and refusing to move to the townships the state established, which are now home to about half of the community - 80,000 people.