Friday, 14 February 2014

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!!