pediatrics ...in haredi-land!

my pediatrics clerkship was amazing! 4 of us spent 6 weeks at mayenai hayeshua hospital in bnei brak, a suburb east of tel aviv that is populated completely by haredi jews, or the "ultra-orthodox". it is one of the poorest and most densely populated cities in israel.

these are the old-school jews of your imagination, who wear black suits and hats and side curls and follow their rabbi's suggestions to the letter. the haredi population is growing exponentially in israel, and it is a society that in many ways is at odds with the more secular jewish majority. for example, the vast majority of haredi men do not work, rather spending their days studying the torah (old testament) and praying in yeshivas (roughly the jewish equivalent of a seminary). the government subsidizes this life-long education, a significant drain on the national economy which is despised by many secular israelis. the government also financially subsidizes having children in israel, with each family receiving a monthly check for each child. thus, 10 - 15 or more children per family is the norm in bnei brak, in large part because having a large quantity of children is the only way most families can afford to subsist. many israelis are also frustrated that the haredi are not required to serve in the military as other israeli jews are - an issue so charged that it was essentially the storyline of the last israeli national election. many secular israelis stereotype the haredi as being stuck in the past, exemplified by high profile altercations recently such as a haredi man spitting on a teenage girl because he thought her skirt was too short and haredi bus lines that make women sit in the back of the bus. because the haredi population has become so large and is constantly increasing, their political parties have firmly entrenched themselves as kingmakers who "punch above their weight" in israel's political system of proportional representation. that's why the subsidies continue, allowing for the continued expansion of a population whose lifestyle would not be viable without the financial support of the government.

anyway, for the most part these big societal issues weren't relevant when we were taking care of the children. i love children so much! one day each week we were in the neonatal department. the hospital has 1200 births per month, the second busiest in israel after soroka hospital in beer sheva. in the cribs of the haredi babies, instead of cartoon animals or colorful shapes, there are pictures of frowning elderly rabbis. what a world to be born into! and what fun to do newborn baby checks! palpate, palpate... is that a testicle?... urine fountain! fun time! snuggle time when its over!

mayenai hayeshua is the only hospital in israel built specifically to serve the haredi population. there is a hospital rabbi who calls most of the shots. it is a kosher zone, no outside food may be brought unto the premises. this was especially fun during the first week of the clerkship when we were living in the hospital as they hadn't found us an apartment yet. the hospital cafeteria is of course kosher, as is every hospital cafeteria in israel. this one though is also gender segregated - i wasn't allowed to sit with my female classmates at lunch. we got to chat with the hospital rabbi and he was a really interesting guy. he is a lot more liberal than many other rabbis in the community on a lot of issues. i would have loved to discuss ethics with him for hours, at least before he started talking about jewish-arab relations. he spends a lot of his time convincing people to have procedures done that they are waiting for a rabbi's permission for. a simple thing like draining an abcess is an ethical question that must be deferred to a rabbi for some people. some rabbis are wackjobs, recommending against lifesaving treatment.there is one rabbi that many consider the authority when it comes to medical issues. he promises to have a response to your question for free within 15 minutes, and is always available. he has considerable financial resources at his disposal, and has been known to fly people halfway around the world for organ transplants on the spur of the moment, which only adds to his mythical miracle-worker reputation.

if there is a man in the elevator when a women gets on, he often will turn and stand with his face in the corner. all of the women wear head coverings - wigs count. there are as many wig stores as there are bakeries. some sects in bnei brak speak yiddish. some of the children are so sheltered that they only speak yiddish - not even hebrew. that's like growing up speaking exclusively latin in inner city america - a) how does that happen, and b) how is the child going to survive? no family has any chronic diseases - when you ask them that is. they actually have quite a few. but because marriages are arranged, no one wants to ever admit to any diseases in the family, as that may harm their children's potential to get the best marriage match. nowadays genetic testing is done before marriage matches are made to minimize the prevalence of certain genetic diseases that had unfortunately become increasing common in certain jewish populations. its worked quite well!

our attending physician was excellent. she was from california and had a bit of a hippie vibe going on! we got to go to clinics out in the community a few days. we lived about a 45 minute bus ride away in the secular city of petach tikva, a world away from bnei brak. petach tikva is often considered israel's most boring city. but i thought it was great - there was an epic shopping mall and an ethiopian disco-bar/restaurant that we visited on a regular basis. it was great being in the suburbs of a big city like tel aviv where it is possible to get around on shabbat (saturday). this isn't possible in beer sheva. a few of us visited the tel aviv art museum one day - it was really impressive actually with some excellent photography exhibits and warhol, van gogh, picasso, etc. we patronized the local microbrewery, jems. it was freezing for a lot of the time. i mean it was literally below freezing, which never happens in tel aviv where heaters are unknown. most of the levant got snow - it even snowed in cairo for the first time in 100 something years!

my favorite were nights in the pediatric emergency department. after countless attempts, my first successful intravenous line insertion on a baby was a happy time! best clerkship ever!!

west bank mobile clinic

one saturday during my pediatrics clerkship i was able to go into the west bank on a mobile clinic day with physicians for human rights - israel (phr-i). phr-i is an ngo that sends volunteer israeli physicians to do clinics in the west bank, has a free clinic in tel aviv for migrants without healthcare coverage, and sends physicians to check on prisoners, especially palestinian political prisoners, in israeli prisons. their overriding goal is to see the israeli occupation of the palestinian territories end, a goal which i wholeheartedly support. the reality is that human rights violations and unacceptable disparity in access to basic healthcare will always exist in palestine as long as there is a military occupation. many accuse the group of political action under the guise of medical assistance, but many others realize that the fight for basic human rights for all is far more important than which geopolitical side you happen to be supporting. the occupation is bad for palestinian's health - therefore as physicians we have an obligation to try to end it, end of story. politics and human rights are not mutually exclusive in this part of the world. many of the volunteer physicians go to the clinics in the west bank not because the palestinians particularly need a free clinic, but out of solidarity. they feel that the occupation is a disgrace and is ruining people's lives, and they want as many palestinians as possible to know that there are israelis who also want it to end. they want to see the palestinian's faces, and they want palestinians to see their faces. they want to humanize the conflict. they want to do something.

i am picked up in downtown tel aviv on a rainy saturday morning by a spunky elderly woman driving a rusted out volkswagon golf. though she is not a healthcare professional, she volunteers every saturday at the clinic, which is in a different town in the west bank each week. promptly, the car stalls, and won't start. she starts freaking out, and we try getting the car to start for about 45 minutes to no avail. i say a little prayer and the car starts! i'm not going to claim it was a miracle, but i have no doubt that God is happy that these clinics are happening. then, it was off to the border, where we meet up with a group of about 20 physicians and take a minibus into the west bank.

while i go to the palestinian controlled areas (area a) of the west bank all the time, it is technically illegal for israelis. when they do enter as groups, it is almost always under the "protection" of the army. of course, phr-i refuses such "protection" (it would likely never be provided in the first place), as it is precisely what they view as the problem. israelis in area a are well received without a military escort - having one would indeed likely make things more dangerous. it is interesting to chat with the physicians about what other israelis, including their own families, think of their volunteering in the west bank. one doctor goes to the clinics in defiance of his wife's wishes. she also wants the occupation to end but is legitimately scared for his life. like almost all israelis, she has never been to area a. the doctor rants about the ignorance of most israelis who, if they think about the west bank at all, think of it as a hell-hole that the army needs to control. these are typical israelis in tel aviv, not the settlers. we don't even need to talk about the settlers. we talk politics, and we agree. this is the first time i've ever agreed with an israeli about politics. we start talking about traveling, and i tell him about my trip to lebanon. i've never talked to an israeli about lebanon before. he loves it. he would love to go to lebanon if he could.

we go to the town of attil north of tulkarm. we arrive and the town mayor gives a big speech as the group of doctors from israel sit shivering, drinking cardamom-laced arabic coffee beneath a giant photo of yasser arafat. it is honestly beautiful. these two groups of people are supposed to hate each other. no israeli in their right mind likes yasser arafat. but when we choose to swallow our pride, the hate dissipates, and we find ourselves welcomed. hate is often for policies, not people. phr-i is welcomed with open arms by the leadership of every palestinian town they have ever gone to. i spend the day mostly looking into children's ears with a pediatrician.

the executive director of phr-i, a bro named ran cohen, comes along to hang out at the clinic that day. really cool guy. big white-man afro. gives me numerous high fives. he is at the forefront - indeed phr-i is in many ways the vangaurd - of the "leftist" human rights movement in israel. you know there is something wrong with the perspective of most of society if the fact that you support human rights automatically makes you a "leftist". the israeli knesset (parliament) is trying to pass a law that would ban ngo's that are anti-nationalist. this is widely perceived to be an attack on ngo's that oppose the occupation. ran cohen is the real patriot, fighting for what is right whatever the government legislates. remember, all these israeli physicians are breaking the law just by coming to these clinics in area a. i love it! i give him another high five, just because i can. he's quoted in news publications all the time. his girlfriend is cool too. she directs documentaries.

at the checkpoint on the way out of the west bank, our minibus is stopped and the young israeli soldier asks the one muslim woman on the bus with a higab to step outside the bus for further questions. this woman is a speech pathologist who lives in israel and was translating for the physicians. racial profiling happens all the time, and one typically just begins to acquiesce to it. but not on this minibus. ran cohen announces that if they need to question the woman in the higab further, they'll need to question all of us. we all get off the bus. ran has a good long talk with the soldier. it is inspiring to see israelis who care about these issues. in israel, these are my people.

a weekend in poland!

i chanced upon some unbelievably cheap airline tickets, so one weekend in november i went to poland! i flew into katowice, and promptly took a bus to krakow. it is a really beautiful and historically rich city! i was there for only one full day, so i just wandered around. lots of old churches, and a famous christmas market that was being set up but unfortunately wasn't open yet. i tagged along with a tour group through the corridors of the ancient wawel castle, where there are nice views over krakow. went to kazimerz, the famous historical jewish quarter, and visited the great synagogue of krakow. krakow was one of the biggest centers of judaism in europe and indeed the world prior to world war two. unfortunately a ghetto was created for jews there during the war, and about 300 000 lost their lives there. auschwitz concentration camp is also nearby, but as it takes the better part of a day to get to and visit, so i didn't make it there this time. every jewish high school student in israel makes a trip to krakow and auschwitz to learn first-hand about the holocaust. on that topic, i also visited a new museum on the site of oscar schindler's factory. he was a man who saved over 1000 jews during the war by employing them undercover in his factory - the famous film schindler's list tells the story. excellent museum. right beside it is the kocak, or the museum of modern art in krakow, which i also patronized as admission is only $2. and i would be remiss not to mention that krakow has at least 2 amazing shopping malls, where i giddily and frequently purchased starbucks coffee. it was an excellent weekend!

internal medicine in ashkelon

this was our first clinical clerkship of the year. we drew a lot of blood each morning. i spent some good time in the emergency department, especially toward the end when i made some orthopedic resident friends who took care of all the little lacerations. every day for 10 weeks, 4 great ladies and i got to commute 1 hour each way from beer sheva to ashkelon in a school provided shuttle. every day we would drive by the erez crossing into gaza (and i'd wish i could go in), and through the town of sderot which is famous for being the town in israel always hit by hamas rockets (so it is where all the american politicians go for photo opportunities if they want to be known as the israel-loving type). ashkelon is also just a few kilometers from gaza, and barzilai hospital where we were at is having a new rocket-proof wing built. i guess evacuating the emergency department every five minutes during the gaza wars was hampering some people's style.

thankfully, i found a bro in the hospital who offered me a room in his apartment for a few weeks so i didn't have to commute as much. later i was able to sleep in a hospital provided room. evening runs along the beach followed by swims were excellent, and ashkelon has a few remnants of its history as a philistine and later muslim city. overall though, nowadays ashkelon isn't really considered a desirable place to live by many. it does have a lower cost of living than many other cities in israel, so there are huge numbers of immigrants, especially from the former soviet union. indeed, all the elderly patients on our ward spoke russian, usually exclusively. at times it was difficult to find a patient on the ward who even spoke hebrew. its interesting - because any jew can move to israel and receive free health care from the state, there are stories of elderly russians who don't even really want to be in israel moving here in their old age, after being diagnosed with a chronic disease, for example. not the majority of course, but it happens.

the highlight of the clerkship occurred one day in the gastroenterology suite. as the gastroenterologist was pulling the colonoscopy probe out of the patient's anus, we heard a loud rumble and before we knew it a projectile splattering of moist diarrhea coated everything in the room. as we and gastroenterologist wiped it out of our eyes, we shared a good laugh. medicine is fun!