Monday, April 20, 2009

Peace in Israel

Today, faithful readers, I turn my blog over to a friend from high school whom I haven't spoken to in more than 30 years.

His name is Dr. Sig Kharasch and he went to Israel to see how he could use his skills to help others. My friend (and high school English teacher) Mary Freund sent this missive and Sig has given me permission to share it with you. Enjoy! Please read it and let Sig know how you feel about his work!

There is peace in Israel

We rarely read or hear of good news from the Mideast and Israel. The second Lebanese war, Hezbollah, rockets raining down on Sderot, operation cast lead, Palestinian suffering, Syrian nuclear reactors, Gilad Shaleat. Iran. Even an optimist like me could see little hope for this region in turmoil.

Last year I visited a number of different pediatric emergency departments in Tel-Aviv and Jerusalem to observe and see if there were opportunities for me to contribute as a physician. (I have deep roots in Israel. My father moved to Israel in 1974 and was a physician near Tel-Aviv for 25 years before his passing 5 years ago. I have visited numerous times over the last 30 years).

I was particularly taken however with Professor Eitan Kerem, Chairman of the Department of Pediatrics at Hadassah-Mount Scopus Hospital in Jerusalem. Dr. Kerem, a renowned pediatric pulmonologist and chair of the European Society for pediatric pulmonology, guided me through his department, introduced me to some of the staff and made rounds on patients. He described to me some of the history of Hadassah Hospital, the diversity of patients and disease as well as the underserved population it serves.

The hospital “felt” very similar to where I work now at Boston Medical Center that likewise shares the mission to care for the underserved. I left thinking what an incredible place this would be to work at and by the time I landed home in Boston, my plan was in place.

After numerous emails back and forth, Dr. Kerem agreed to have me work as an attending physician in the pediatric emergency department for up to 3 months the following year and helped me obtain my temporary medical license from the Israeli Ministry of Health. I started to study Hebrew in a serious way at an Ulpan in Boston, worked out my leave of absence from work and family (I have an understanding wife!) and left for my first month last March. I was ready to care for “my people”. It would not take long for me to understand how unprepared I really was.

I landed in Israel on a Monday morning and began work in the emergency department on Wednesday. I put on my freshly pressed white coat containing my stethoscope and other paraphernalia and walked into the ER still a bit tired from the trip and a bit in a fog like state from jet lag. I blinked a few times as the scene in front of me came into focus. The ED was filled with patients and most of them were Arabs!

I was quickly introduced to the nurse manager Ashroff, a Druze Arab from northern Israel and Muhammad, a nurse from the West Bank who was working at Hadassah as an Arab translator. I met the pediatric residents working that morning with me. Amjad, an Israeli Arab from Nazareth, and Ibrahim, a Palestinian from East Jerusalem who recently finished medical school in Egypt. Having a terrible sense of direction I thought for a moment I was in the wrong place and hospital!

There was little time for reflection as within minutes the first ambulance arrived with a 4 year old Arab child whose parents were concerned he was not speaking for the last day and sleeping excessively. Although breathing, the child was comatose. Our group quickly descended upon him with IV’s, blood gasses, metabolic and toxicology studies, CT scans and spinal tap, all of which were normal. I told Michael the unit secretary (an orthodox Jew from a large settlement in the West Bank) to call the neurologists for consultation.

Muhaned, the pediatric neurology fellow quickly arrived. I would later learn that he was born in and received his medical degree in Amman Jordan and was financially supported part of a program to further advance medical care in East Jerusalem and the West Bank). We discussed (in perfect English fortunately!) the further possibilities and Muhaned rapidly arranged an EEG and assisted with transfer to the intensive care unit.

By noon that day, Oded (a Jewish Israeli pediatric intern from Jerusalem) and Leah (an American from Baltimore who completed her pediatric training there and was doing a 3 month observation period after recently immigrating to Israel with her family) arrived and would round out most of our group that worked very closely together that month.

I would come to understand the wisdom of Professor Kerem over the ensuing month. Geographically, Hadassah-Mount Scopus is located between predominantly Jewish West Jerusalem and East Jerusalem, a conglomeration of numerous Arab villages. The pediatric emergency department sees 20,000 patients per year. Fifty percent of patients in the emergency department and on the inpatient unit are Palestinian Arabs from East Jerusalem and the West Bank.

One need only to look out the window of the hospital to see how closely intertwined the populations are in the same geographical area. Because of the close proximity, the same heath care issues can impact everyone. Infectious diseases such as the measles epidemic that began in the Jewish neighborhoods of Jerusalem 2 years ago would spill into Palestinian suburbs of East Jerusalem. In such a multiethnic and multilingual population, isolationism is impractical and not beneficial to the health care needs of patients and families in this community.

To address this and other challenges, Dr. Kerem has recruited both Arab and Jewish physicians to appropriately represent the patient population. Many of the Arab residents in training remain at Hadassah after completion of their pediatric residencies as attending physicians or as attending physicians in East Jerusalem. Language barriers have been overcome with professional medical interpreters and by offering courses in medical Arabic to non-Arabic speaking staff. On the inpatient unit, there are 4 beds to each room and both Jewish and Arab families share this space together. As part of the child life program, medical clowns that speak the universal language of humor are appreciated by all families and children. To disseminate clinical information and continuing medical education, Dr. Kerem has developed forums between Israeli and Palestinian pediatricians to improve health care delivery.

During my month I would come to meet and interact with many other physicians, nurses and from diverse backgrounds and cultures. Arabs from Syria, Turkey, the Palestinian territories and Jews from Israel, Iran, South America, Sweden, Russia Australia and Canada. Together we treated hundreds of patients with diseases including pneumonia, rheumatic fever, meningitis, diabetes, bowel obstructions and a myriad of rare genetic and metabolic diseases that are prevalent in the Mideast. Children from the Gaza strip and West Bank with Cystic Fibrosis and other chronic diseases were seen regularly in the emergency department, inpatient units and outpatient centers whose health care was sponsored by and supported by non-governmental organizations.

For obvious reasons, politics were never discussed in the hospital and in fact, resolutely avoided. One's alliance didn’t seem to matter anyway. Jews took care of Arabs and Arabs took care of Jews. No one blinked an eye. It was clear to me that people here were not judged by where they came from but by their caring and respectful nature and ability to provide medical care of the highest quality for all children and families. Besides, we had more important issues to discuss.

Our emergency department team had lunch together almost every day. Ashroff’s impending wedding (I was invited), Leah's new job, Amjad’s upcoming fellowship in pulmonary medicine and everyone’s concerns about how I was managing alone here. I was invited to and attended numerous dinners after work at medical students, residents and attending physician’s homes. I think one of the most memorable however was my invitation to Amjad and his wonderful wife Lamis (a social worker in the hospital) home in East Jerusalem (an area I never imagined visiting in my many trips to Israel).

The political realities of life here took a back seat to important matters such as who was a better cook, Lamis or her mother, should their 9-month old son have a pony tail, how much television is too much and how life would be for them in Canada or America for Amjad’s further training. The dinner and conversation was unforgettable and I did not get home until 1am.

A few days before I left I asked Dr. Kerem how best he would best describe the environment, atmosphere and department he has created at Hadassah-Mount Scopus. He leaned back, folded his hands behind his head and smiled-“it is my happy ship”. It is.

I am not sure there will ever be peace in Israel but what I witnessed each day was a peaceful coexistence between Arab and Jewish families and medical staff. All shared the common belief and goal that the health and well being of children was of paramount importance. If there ever is to be peace, it seems to me that caring for each other and each others children is a good place to start.

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