Search

Ensuring adequate harm reduction infrastructure in rural areas is imperative, as drug-related epidemics expand into them. Here, we explore the capacity for sustainment of syringe service programs (SSP) in Appalachian Kentucky.We interviewed all staff (n = 16) of all SSPs (n = 7) in two Kentucky health districts in 2018-2019 using semi-structured one-on-one qualitative interviews; local departments of health (DOH) operated the SSPs. Interview domains encompassed: (i) SSP establishment; (ii) day-to-day operations, participation and health impacts; (iii) perceived prospects for sustainment; and (iv) perceived influences on #i-#iii. We analysed verbatim transcripts using thematic analytic methods; Schell's 'capacity for sustainment' constructs were treated as sensitising concepts during the analysis.Most community members, law enforcement and DOH staff opposed SSPs before they opened, because of stigma and concerns about enabling and needlestick injuries; DOH staff also opposed SSPs because they believed they lacked the capacity to operate them. Training, technical assistance, visible evidence of the programs' public health impact and contact with SSP participants transformed DOH staff into program champions. As champions, SSP staff developed programs that had strong capacity for sustainment, as defined by Schell (e.g. visible public health impact, stable funding, political support). Staff reported that the SSPs had high prospects for sustainment.As in SSPs that opened in cities decades ago, staff in emerging SSPs in these rural areas appear to have become crucial champions for these controversial programs, and may serve as vital resources for expanding harm reduction programming more broadly in these underserved areas.

The ‘Israel experience’ is increasingly recommended as a means of reinforcing the Jewish identity of diaspora youth. Many secular Israelis, however, are extremely ambivalent about their Jewishness. The dichotomy between a state officially functioning according to Jewish law and the Jewish calendar and the large number of flagrantly secular inhabitants comes as a surprise to many first-time visitors to Israel. Abroad, too, the majority of secular Israeli ex-pats have no absolutely no connection to any Jewish institutions.

Would the Jewish world benefit from an infusion of new life? Have lost Jews a role to play in determining the Jewish future? Does the continuity of the Jewish people serve any larger purpose? These questions which emerged from discussions I had with over a hundred lost Jews as well as marginal Jews and communal leaders, both religious and lay, will form the basis of this final chapter. Since conditions in different countries may determine some of the answers, it is worth focusing briefly on how lost Jews fare in the diaspora communities I have visited in the course of researching this book.

To probe orthodoxy’s stance towards children of Jewish fathers became a burning quest as I researched this book, leading me to speak to 20 prominent orthodox rabbis in five countries, as well as several of other denominations.

Can the halachic definition of Jewishness still impinge on people’s lives? Can the need to conceal matrilineal ancestry that is not unadulteratedly Jewish lead to secrecy and denial? As far as the United States is concerned, Barry Kosmin, the British-born demographer, dismisses the idea of any external authority checking on the status of a would-be Jew.

The development of Jewish communities in the Western diaspora is a paradigm of radical assimilation. In Britain, France and the United States, successive waves of immigrants settled, became absorbed and, all too frequently, disappeared as Jews within a relatively tolerant society which afforded them opportunities undreamed of in their countries of origin. The Second World War wiped out the traditional reservoirs of immigration from Central and Eastern Europe and the rise of a Jewish state drew immigrants from remaining pockets of persecution as well as from the West itself. Of the large-scale Jewish communities in Western countries, only French Jewry has grown from an influx of immigrants, drawing the cream of north African Jewry in the wake of France’s colonial demise. The Jewish communities in Britain and the United States have suffered an inexorable decline.

The majority of individuals of part-Jewish descent neither identify totally with their Jewish past nor totally reject or ignore it. Theirs is that vast grey area ranging from some vague, nagging awareness of a heritage they might like to explore, to a deeper yearning to embrace that heritage, often obstructed by ambivalence, inertia or fear, as well as constraints of halacha. Some of these lost Jews may be groping towards a degree of acceptance or knowledge; others may express a more ambitious desire to belong but lack the will or energy to see the process through. Still others may have experienced an equally strong desire to be Jewish but, fingers burnt or circumstances changed, have retreated to a less intense position. This state of flux, typical of lost Jews in the west, is captured by Francesca Kaye, an artist and potter from London: ‘It’s a huge thing and a tiny thing; it’s something I don’t think about but then I would think about; it’s a very big part of me, it’s sort of a little part of me as well. It’s a combination, it varies, but I definitely feel that my identity is Jewish.’

A remarkable and largely unsung phenomenon of our times is the return of the lost Jew to some form of Jewish life. This is not a mass movement that can be quantified statistically; it is often an internal ‘call’ that resonates within the individual. For some, particularly those with suitable halachic credentials, the process is relatively natural, requiring little more than self-recognition and free choice. Others, faced with obstacles and rejection, need unfailing determination to attain their goal. A variety of journeys have led lost Jews back to their ancestral heritage.

Because of the persecution and the anti-racial laws in Mussolini’s Italy my parents did a religious wedding and my father was baptised. Before my arrival my mother wanted to separate but she changed completely and wanted to help when she saw my father was in danger. He couldn’t bear the humiliation, like when a woman spat at him in the lift and said ‘I don’t go in the lift with a Jew.’ He escaped to Switzerland at the right moment so I didn’t see him till the end of the war. Only some time after the war I realised it was because he was a Jew.

Are the Jews a dying race? Is diaspora Jewry doomed to extinction? This is the question confronting the Jewish world at the end of a century which has witnessed Jewish martyrdom on an unparalleled scale and the fulfilment of the 2000-year-old dream of resurrected Jewish nationhood. It is not the skeletal remnants of the Jewish communities of continental Europe, decimated by the ravages of Nazism, which concern the prophets of doom, however. It is the dramatic decline in Jewish affiliation in much of the Western world in an era of unprecedented freedom.

The late cartoonist, Mel Caiman, who had a non-Jewish partner and two non-Jewish ex-wives, gave me this definition of ‘lost Jews’: ‘Most of my Jewish friends are nearly lost or very lost, semi-submerged. We’re more like icebergs where the tip is showing and there’s probably stuff underneath but it doesn’t show and one doesn’t think about it unless you’re having this kind of conversation.’