last weeks of medical school

my last three selectives were radiology, otolaryngology and orthopedics, each for two weeks. interesting stuff, and quite relaxed schedule which is very nice!

i’ve also been able to do some things which were on my bucket list, like visit the israel museum in jerusalem which house the dead sea scrolls. beer sheva finally has its first ethiopian restaurant (there are many ethiopians here so it is surprising that it took this long for someone to open a restaurant). last weekend went to a hot spring spa called neve midbar in the negev desert south of beer sheva with some bros, as well as made one more trip to the taybeh brewery in the west bank, which i must say is one of my favorite locales in this part of the world, for what it represents. as glad as i am to be moving on, there are things about here that i’ll really miss.

religious persecution in israel

i regularly hear proponents of israel assert that there is complete freedom of religion in israel. while israel unquestionably does have more religious freedom than say the territory controlled by the self-declared islamic state,  i don’t think most westerners understand just how judaicized this place is. when compared to the west, there are some serious issues here with regard to religious persecution.

proselytizing for any religion other than judaism is illegal in israel.

while superficially the israeli government likes to cozy up to american christians, this probably has more to do with financial and political influence than anything else. many jewish israeli christians are harassed and intimidated on a regular basis. for example, it is not uncommon for local jewish christians to receive literature in the mail or over email explaining the perils of christianity. this makes it obvious that emails are screened, something only the government has the authority to do. at least a few times ultra-orthodox bouncer-types stood outside a bible study i was attending in a private home, and intimidated those coming and going with insults and sometimes even blocking their path. when asked, they said they were hired by the authorities to do so. i have friends who are messianic jews whose efforts to make aliyah (immigrate to israel – supposedly the “right” of any jew in the world) are being obfuscated directly due to the fact that they are christian. a few years ago the local church in beer sheva was ransacked by a mob of well-connected ultra-orthodox men, who were never held accountable for their crimes.

about 300 000 of the 1 000 000 ethnic jews who immigrated from the former soviet union are considered jewish enough to be israeli, but not jewish enough to be considered jewish by israel’s chief rabbinate. thus, many must leave the country to get married, etc. for many of these, it is ostensibly because they are christians. in any case, what kind of misguided system lets rabbis decide what citizen’s rights are based on arbitrary religious definitions? i’m not saying it doesn’t happen and isn’t even worse elsewhere in the middle east; i’m saying it happens in israel.

and this is just relating to ethnic jews, citizens of israel. the challenges faced by israeli arabs, both christian and muslim, are myriad, and don’t even begin to compare to those faced by palestinians living under marshal law in the occupied territories. that every single jew can travel freely through checkpoints in bethlehem while local christians and muslims cannot is religious apartheid as far as i’m concerned. while true that it is technically about citizenship rather than religion, but when every jew in the world can easily become an israeli citizen regardless of where they are from, but people whose families have lived in palestine/now israel for hundreds of years are barred from becoming israeli citizens except through birth, it is about religion. there are books detailing the flight of christians from the holy land, and it is due to israeli policy, not islamization of the west bank, despite israeli efforts to frame it as the latter. and then there are the injustices faced by muslims because of their faith. even myself, a white american christian, am consistently asked by bigoted security guards at the airport why i would travel to muslim countries, why i am not scared to go to muslim countries, if i know any muslims etc. there is just an overwhelming undertone of racism and religious hatred toward muslims that sadly permeates much of israeli society, including its governmental institutions, and it is unequivocally wrong. one could go on and on with examples but suffice it to say - israel is a decidedly jewish state –the assertion that it is a bastion of religious freedom is not correct.

healthcare in israel

israel has an excellent socialized healthcare system for its citizens, arguably one of the best in the world. early zionism was very idealistic and socialist, and quality and universal healthcare has always been a central theme. the current system uses an interesting model – it is single payer (the government), but there is an element of competition as well. there are three not-for-profit “sick funds” which receive a set monetary amount from the government for each citizen who is insured with them. the government requires that these funds provide a “basket” of medical services and treatments for their enlistees. for the most part, the basket includes what would be considered the standard of care in the western world. it generally does not include things such as procedures or treatments for aesthetic reasons or overpriced or experimental new drugs. typically only the generic version of a drug is covered as part of the basket if it is available. generous allotments for services like physiotherapy are also included in the basket. the lump sum payment to the sick funds for each patient, termed “capitation,” provides incentive for the fund to invest in preventative measures for its patients, as if they can keep them out of the hospital or prevent them from becoming sick in the first place then significant money can be saved. each fund receives money for their patients according to the same formula (age, gender, medical conditions, disability, area of the country in which they live, etc.). in addition to the required basket of services and drugs, the funds can provide additional services as well to attract more patients/customers. citizens can choose their sick fund and can switch between funds at any time at no penalty,, and the funds cannot refuse to insure a patient. the funds are also the operators of the hospitals and clinics, which technically keeps the government out of the business of healthcare though there is obviously close collaboration.

though required healthcare is free for the citizenry, targeted fees are permitted that aim to reduce inefficiencies. for example, due to the universal problem of overuse of emergency rooms for minor issues, a fee was introduced for emergency visits that are not either first referred by a primary care physician or do not result in a hospital admission. likewise, a large levy exists for those who call an ambulance but are not subsequently admitted to the hospital. these efforts of course sometimes result in further inefficiencies, such as people feeling the need to first contact their primary care physician when they should probably just go straight to the emergency department, or doctors admitting patients when they medically don’t need it to help them avoid the fees. overall though it is a very fair balance that allows everyone to get the healthcare they need without having to go bankrupt to do so, and attempting to limit unnecessary overuse of the system.

of course, socialized care has its limitations. while it is excellent for the poor, the rich do not appreciate waiting in line, getting a generic drug rather than the brand name one, or not being able to hand-pick their surgeon. thus, over the last few decades a robust private healthcare system has developed in parallel with the public one. the merits and drawbacks of these two-tiers are beyond the scope of this blog post, but private healthcare has become a major sector of the israeli economy and a very contentious issue for all involved.

prioritization of the family is a major focus. things like maternity leave and government transfer of money to parents is a priority, as it is a strategic goal of the government to keep the birthrate high. so much so that invitro fertilization for all israeli citizens is free, at tremendous cost to the state.

emergency medicine and disaster response are huge in israel. due to everyone spending required time in the military, most people have some training in responding to emergencies, and many have firsthand experience from wars they have fought in. israel also sends medical teams to major worldwide disasters, either privately or as a military delegation, and are world leaders in this regard.

it must be noted that healthcare benefits extend only to israeli citizens – not to asylum seekers living in israel or to palestinians, except official east jerusalem residents. still sounds pretty good though, right? israel has its huge problems, but overall i’d say healthcare is one of its gleaming achievements.