The Other Side

This week began with trips to Jerusalem visiting a major hospital called Hadassah Medical Center which is the only Level 1 trauma center in the area. The facility is amazing with state of the art equipment and great design for efficiency. Our rotation there began with a Terror Workshop coordinated by Julie Benbenishty who spoke about the mobilization and coordination that takes place in a Mass Casualty Event (MCE). Intensive Care Unit (ICU) nurses call it the Mass Doctor Event because anyone who has any healthcare experience or has been involved with such incidents flood the hospital to support and help in their respective ways. It is interesting to note that their schedules are designed for an MCE with someone placed in charge and a hierarchy of services below. A family notification and identification system goes live. Volunteers and the community help at the MCEs in conjunction with social workers.

Julie explained that an effective way to understand an MCE from a healthcare perspective is to focus on the location of victims. For example, after a MCE the epicenter is at the site itself, 20 minutes later it will be the Emergency Room, and about 1.5 hours later it will be the ICU or the inpatient floors. 2-3 months later, the rehabilitation services will begin accepting those with long-term injuries. Anyone from the incident is treated regardless of his or her political or religious background. As much as I don’t want to admit it, I was surprised at the balanced presentation Julie gave since I came into it with pre-judgments. It was a very enlightening experience with so much valuable information about MCE and how Hadassah Hospital functions in the context of recurrent mass casualty events.

The next few days we spent with the Israeli medical students and did the rotation as they did. We were in the cardiology department and were divided to go into one of three groups: echocardiograms, catheterization, or ICU. I went to the ICU because that is my interest and it was fascinating to see Jews and Arabs lying next to each other receiving healthcare services. That reinforced my notion the health and healthcare can be a unifying force in a time of conflict and turmoil.

When speaking with the medical students, we got a better understanding of Israeli healthcare system in addition to Julie’s presentation about Hadassah and MCEs. Israel has a socialized healthcare system that is taken from their taxes and services administered by 4 Israeli HMOs. They have the 28th best health care in the world according to the World Health Organization in 2000 with one of the highest doctor to patient ratios in the world. Everyone who pays taxes can get all of their services free of charge with a moderate waiting list depending on the surgery or service, elective or urgent. Physicians are not paid hardly as much as American physicians with payments starting around $2,000/month during residency compared with $3,750/month in America, increasing year to year with status. An interesting feature about Hadassah is that it is the only hospital in Israel with a private system in addition to the government system. Patients who want a specific doctor with specific services in a timelier manner can pay out of pocket. Physicians that have built a reputation for themselves can then do both government and private services if they have the demand.

With our group’s cost saving spirit, we decided to use public transportation to return to the old city Jerusalem and go to a site each day after the hospitals. I can tell you my heart was beating rapidly the entire time! Public transportation is often increased risk areas of incidents so it was an experience to put myself in the place of an Israeli with the day-to-day fears. This was obvious since almost every area with large groups of people involved a security check. It then truly stuck me that the Israelis were a society living in fear and the Palestinians a society oppressed; helping to really grasp the vicious cycle that the Middle East faces. Of course I have talked about both concepts but it is completely different if you live it.

When watching the news, other media outlets, or hearing stories from people (including myself), I encourage everyone look at the macroscopic perspective rather than the microscopic perspective. How did we get to this point and can we look at this in a human approach rather than political? The Palestinians have been under occupation for 44 years by the Israelis while the Israelis have tried to create as stable a country in a volatile region. I continue to believe that a two state solution is the only solution to resolve the Palestinian-Israeli conflict. We can only see what will happen in September when the Palestinian Authority approaches the United Nations (UN) for recognition as a country, in the setting of being UN deemed capable to manage a country recently.

 

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