“If you will it, it is no dream.”  Theodor Herzl

INTRODUCTION

From the time of my first visit to Israel 10 years ago, which included a lightning-fast visit to Soroka Hospital in Be’er Sheva, I have dreamed of spending time with my Israeli counterparts, seeing first-hand how medicine in general and radiology in particular are practiced in Israel.  Last month, I was able to fulfill that dream, and the experience far exceeded my expectations.

I traveled under the auspices of Partnership 2Gether, the successor to Project Renewal and Partnership 2000.  Here in Nashville, we are part of a consortium of southeastern Federations paired with Hadera-Eiron area, with the Israeli side organized by the Jewish Agency for Israel and volunteers like you and me.

Our Partnership has successfully arranged for exchanges of delegations of teachers and firefighters, but we had never before achieved an exchange of healthcare professionals.  This was the pilot program, which included a handful of us from Nashville and Knoxville: an internist, a military physician, a radiologist, a former paramedic, a healthcare social worker, and a physical therapist.  (Sounds like the beginning of a joke, nu?)

Each of us was paired with an Israeli counterpart, and most of us opted for home hospitality during our visit.

RADIOLOGY, ISRAELI STYLE

I spent several days in the radiology department at Hadera’s 450-bed community hospital, Hillel Yaffe.  I sat at the workstations with the radiologists, viewing cases with them, observing their practice, meeting some of the patients, asking questions, and discussing work and life in general.  It was an eye-opening experience in more ways than one.

There are five levels of  health insurance coverage in Israel ranging from the basic coverage, which is universal, to health maintenance organizations and premier health insurance.  This system, to a significant extent, determines where people go for their health care. 

I was surprised to find that Hillel Yaffe, the main hospital for the region, does not offer any breast imaging services, my particular specialty.  Those services are provided in local clinics. 

Because of cost-containment issues, expensive new technology such as MRI units are rationed in public hospitals.  Hillel Yaffe has use of a mobile MRI unit once or twice a month.  Within the next year, the Israeli government will be providing 8-10 new MRI units to public hospitals, and one of these is slated for Hillel Yaffe.  Contrast that with the department of my 600-bed private hospital here, which has 3 MRI units.  With typical Israeli ingenuity, these radiologists have learned to maximize their available ultrasound and CT to answer the questions that we here would require MRI to unravel.

Since dictating reports to a transcriptionist is a rare luxury throughout Israel, and since there is no voice recognition software in Hebrew, doctors have to type their own reports.  Given the constant demand for efficiency in our American health systems, I cannot imagine many doctors here tolerating that situation.

In spite of the 6000-mile distance between us, I found far more similarities than differences, at least in radiology.

-- The radiologists I met were bright, articulate, knowledgeable, and well-trained.  You could plop them down in almost any department here, and they would perform well.

-- Most of the radiologists speak English quite well.  Even those whose English conversational skills are somewhat limited have a good basic command of medical English.  Their reference books are all in English – the same books that I have on my shelves – and most of the reference articles pulled from the Internet are in English.

--  Like the majority of American radiology departments, all of the images are digitized and are viewed on high-resolution computer monitors.

--  The radiology imaging equipment itself is equivalent or identical to what we have.

-- Even given the somewhat limited resources of a public hospital, these physicians – both primary care doctors and specialists – are practicing sophisticated medicine.

-- The hospital interiors and hospital rooms themselves look very much like ours, although there are some minor architectural differences.

Many of the radiologists had as many questions for me as I had for them.  It was Partnership in the truest sense, an exchange of ideas between peers.  What a fascinating and delightful experience!

MEDICAL TRAINING

For most physicians, the progression is from high school to army, to 6-year combined undergraduate and medical school, to a year of rotating internship, followed by residency.  Radiology residency there is 5 years (4 years here).  Radiology fellowships (subspecialty training beyond residency) are rare in Israel.  If someone wants to do a radiology fellowship, one has to go abroad, usually to the U.S.  Other types of medical fellowships are available in Israel but are competitive because of limited slots.

After regular army service, these folks enter the army reserve and are called up to serve periodically, sometimes a few weeks each year.  Therefore, most of the doctors I met in civilian life are also army doctors.

Doctors who immigrate to Israel first spend time in regular Ulpan (immersion language school), learning to speak Hebrew, followed by several months in a special medical Ulpan, learning medical Hebrew terminology.  Then they have to pass three exams in order to practice in the Israeli health system.  One of the radiologists I met had emigrated from Baku, Azerbaijan 20 years ago at the age of 40.  What enormous courage and fortitude it must take to leave a home and established practice at that age to come to a new land and learn a new language!  I am filled with admiration.

HOME HOSPITALITY

I admit having had some initial reservations about accepting home hospitality.  The Jewish Southern belle in me felt awkward, perhaps even downright rude, about essentially inviting myself into a stranger’s home.  Turns out that my host family had also questioned their wisdom in volunteering to put me up in their home.  The wife, a radiology technologist at Hillel Yaffe Hospital, was concerned about her perceived status differences with an American doctor.  Her husband, who operates heavy machinery to dig house foundations, worried about his limited English and my non-existent Hebrew.  Their 18 year-old high- school senior daughter and 11 year-old son stewed about their imperfect English. 

It took less than 5 minutes in their beautiful home in Moshav Maor for me to fall in love with the Shuker family.  Judging from their warm welcome, I would say that the family felt the same.  Yocheved – Yochi – was born to a family of Moroccan immigrants.  Eyal comes from a Yemenite family and walks to the nearby shul before and after work for daily prayers.  Tom, the daughter, is beautiful and sweet.  Raz, the son, is a typical young boy, full of energy and constantly bouncing all over the place.  Mai, the oldest at 20, is in the IDF (Israel Defense Forces), and I did not get to meet her, but I stayed in her room and saw photos of her lovely face.

This family was the most affectionate, hospitable, and genuine I have ever met.  They made me feel entirely at home.  Oh, and Yochi’s cooking – unbelievable!  Shabbat dinner in their home, surrounded by extended family, was a feast for all the senses.  She even made lunch every morning for me to carry to the hospital.  I have never been so well or so lovingly fed.

Yochi speaks English quite fluently, so most of my in-depth conversations at home took place with her.  However, the rest of the family understand English better than they realized, and we were able to communicate amazingly well.  Besides, a smile and a hug are universal language.

THE MATZAV  -- THE SITUATION

Foremost in my mind in recent months has been the threat from Iran, as well as the constant background threat of terrorism.  Israel, after all, is on the frontlines of the war on terror.  Yochi tells me that they don’t think very much about these issues.  They cannot agonize over them and still manage to go about their daily lives.  To work; to put food on the table, gas in the car ($8 per gallon), and a roof over their heads; to raise a family – these are the challenges that consume their thoughts.

Yochi’s most significant worry for her oldest daughter in the IDF is not the potential dangers of military service but the traffic safety risks of driving back and forth to her base.  In contrast, some of the radiologists I met also have children in the IDF and are as anxious as I would be about their security.

“Something there is that doesn’t love a wall…
Before I built a wall, I’d ask to know
What I was walling in or walling out.”  -- “The Mending Wall” by Robert Frost

One of the things that this trip brought home to me in a completely visceral way was the proximity of the threat of Palestinian terrorism.  From the moshav fields next to the house, I could see the nearby Arab Israeli village on the hill overlooking us and knew that just beyond it, within walking distance, was the Fence.

On my last day with the family, Eyal drove me to that Arab village, Baqa al Gharbiyye.  We wound through the narrow streets of this picturesque hillside village, where beautiful new homes nestle among older, sometimes dilapidated structures.  As we drove past one house, Eyal spotted a long-time friend, who was sitting on his front porch with his wife and grandsons.  The friend invited us up, and the wife brought us the ubiquitous glass of coffee.  The two men settled down for a schmooze in Hebrew and Arabic, while I soaked up the sunshine and watched the two adorable little boys devour the treats they had purchased from the passing ice cream truck.  The scene was so reminiscent of home, and yet so exotic at the same time.  It is a meaningful statistic that the average Israeli Arab enjoys a higher standard of living than the average Arab living anywhere else in the Middle East.

After smiles, handshakes, and hugs, we took our leave and drove a few blocks to the Fence.  This structure, which currently extends over 700 km with more construction planned, is a barrier of separation between Israel proper and Palestinian territory.  In many places, it is a barbed wire electrified fence with electronic monitoring.  In more heavily populated areas, it is a high wall topped with barbed wire.  Aesthetically, this is not a pleasing sight.  However, the knowledge that this barrier has significantly reduced suicide bombings and protects the family that I now love and claim as my own brings enormous comfort.  The realization that there was no such protection from the perils of Intifada prior to the building of the Fence chills me to the soul.

A TASTE OF PARTNERSHIP

I had an opportunity to spend a day with a small group touring Tzfat (Safed), the birthplace of Kabbalah and now a mecca for artists.  As we climbed the curving mountain roads overlooking the Kinneret (Sea of Galilee), I was struck by a resemblance to the scenery of East Tennessee.   It is awe-inspiring to stand in the highest town in Israel and look out over the dramatic vistas.

At the end of my individual travels, I met up with the Taste of Partnership group, 35 other travelers from our Southeastern Consortium group of Nashville, Knoxville, Chattanooga, Charlotte,  Jacksonville, and Pinellas County (not represented here).  This was a celebration of the 10th anniversary of Partnership 2000/Partnership 2Gether.  We divided our time between meeting Israelis in Hadera-Eiron and touring attractions in Hadera, Caesaria, Tel Aviv, and Jerusalem.  We even had some time to marvel at the gigantic strawberries and unique Israeli fruits at the open-air HaCarmel market in Tel Aviv.  Everyone in the group was cordial, and I enjoyed making many new friends.  In fact, I savored the entire tour, especially snow in Jerusalem (who’d have thunk it?). 

I have to say, though, that the experience of living with an Israeli family and sitting side-by-side with my Israeli colleagues was by far the most thrilling, gratifying, and memorable privilege of all.  I got to live my dream, and it was very sweet.  I can’t wait to go back!  Will you join me?

If you are interested in knowing more about Partnership 2Gether, please contact Harriet Schiftan: harriet@jewishnashville.org.

Patricia Tepper Lutkowitz,
(Patricia Tepper, MD)
Medical Director of Breast Center
Centennial Medical Center
ptlutkowitz@comcast.net