“S.” was 19 when she met her husband for the first time.

Family members were present and the couple didn’t speak much. The same happened in the two subsequent short meetings. The man, also young, seemed shy, but “S.” was shy, too. She’d never met a potential groom before.

“S.” liked the idea that she would be living in Jerusalem. She was excited and happy as the wedding preparations moved forward.

Only on their wedding day did “S.” realize to her dismay that she was marrying a mentally challenged man. There was no way out. Her family would never take her back.

The worst was knowing that her parents were aware of her husband-to-be’s limitation and had made the match anyway.

This isn’t a story from a 19th-century novel. I met “S.” when she spoke publicly at Hadassah Medical Center about how her life had suddenly gotten better. She was among some 45 women who came to the hospital to celebrate their participation in and completion of health courses under the auspices of the Linda Joy Pollin Cardiovascular Wellness Center for Women, with the support of the Jerusalem Municipality and Efshari Bari, the Health Ministry’s health promotion program.

“S.” is one of 11 children in a family with a hand-to-mouth family existence in a periphery village within the Palestinian Authority. Today she’s 38, still married, a mother of four children – one of whom has severe learning disabilities. Her husband doesn’t work and they live on disability insurance.

Another of “S.’s” personal frustrations was not being allowed to go to high school beyond the 10th grade. So when she heard about a free course on women’s health at the community center in nearby Wadi Joz, she wanted to attend. At first, her husband’s extended family with whom they live protested her attending but she overcame their objections. The workshop had 22 sessions, each three hours long, and was adapted from the American Diabetes Prevention Program to fit the Jerusalem community’s needs. At each meeting, the women from Isawiya and Wadi Joz would hear from a medical professional in Arabic and take part in discussion groups.

“What we added to the American program was mostly the element of resilience,” says Dr. Maha Nubani Husseini, who directs the program curriculum and implementation in the Arab sector. “Our women deal daily with the challenges of lower socioeconomic conditions, plus the restrictions on women’s independence within the norms of Palestinian society. Even in better-off neighborhoods, we have husbands who show up at the community centers to make sure that what their wives are doing conforms to their strictures and values.”

A shocking statistic: by age 70, half of Arab women have diabetes, and they have a 60% higher rate of cardiovascular mortality than Jewish women.

“There are not significant genetic differences between the Jewish women and the Arab women in Jerusalem that explain the disparities in heart disease,” says Dr. Donna Zwas, the Harvard-trained cardiologist who heads the Pollin Center. “The major differences are lifestyle and dietary choices that can be changed, which ultimately will prevent disease and save lives. Arab women in Israel are diagnosed with heart disease 10 years earlier than Jewish women.”
But how can a university hospital get to women like “S.” in hard-to-reach communities most in need of health intervention?

“Everyone knows that eating well and exercise prevents disease, but the challenge is to get women to find the culturally and personally appropriate way to make the changes,” Zwas says.

One effective method is to train the women themselves to be the leaders, an ongoing process that requires a carefully crafted empowerment program that won’t draw ricochets that undercut women’s efforts. This will improve women’s health and have a ripple effect on the entire community.

Potential leaders are spotted within the graduates of the basic course and invited to a smaller leadership training program where they design projects, learning to write proposals that require specifying goals and needed resources. There’s also training in public speaking so they can do effective outreach to their neighbors.

At the graduation, many women rose to speak, practicing their hard-won new skills. Among the women who told their stories were a young woman taking the course despite undergoing treatment for breast cancer, and a feisty retired schoolteacher with a long history of community service.

The graduates sang on the bus that brought them to and from the Ein Kerem campus. They wore their holiday clothes, mostly intricately embroidered Palestinian dresses. Absent from the buffet table were the usual burekas and cheese danishes. Instead, there were dessert bowls of yogurt, vegetable-laden tabbouleh and fruit.

“S.” says that what stuck to her most in the first course was the idea that she needed to do something for herself. “There were sessions on how to manage stress, and I realized I had to get over the justified anger at my mother for limiting my education and for making such a match for me and do something for myself,” she said.

The planning and implementing program in which she was involved is a workshop on eliminating the home accidents that plague Arab neighborhoods.

According to Dr. David Rekhtman, who heads the Pediatric Emergency Room at Hadassah’s Mount Scopus hospital, adjacent to Isawiya and near Wadi Joz, the most common accidents include falling from roofs, summertime drownings, burns and accidents from children playing in the street for lack of sidewalks and play areas. There are also hand injuries from cap guns and firecrackers during Ramadan, and even bullets that go astray at wedding celebrations. “Awareness campaigns targeting not storing kerosene in cola bottles have eliminated most of the cases of kerosene-poisoning, a proof that health activism in the area of home safety can be impactful.”

“S.” was delighted when she was chosen to take part in the advanced leadership course. She said, “I knew that I would feel better about myself if I was involved in something that would help my family and community. I finally believed that I had the potential to do something this important. It has brought me joy.”