Israel Course 2005

DAY 5:

We began the last day of our comprehensive training program with a trip to the Ha’emek Medical Center in Afula.

Afula is a small city located in the Jezreel valley in northern Israel. Its origins are Biblical: Gideon of Judges (chapters 6-8) hails from Ofel, which is thought to be the ancestor of present day Afula. The city was founded on 31 March, 1925, by American immigrants. In-between, several Arab villages stood on the spot: al-Affulah was built by Saladdin, which later came to be called al-Fulah. This disappeared around the turn of the century. Now it's a municipality of more than 200,000 people. Many of those live up on the hill below which the rest of the city lies. This hill is called Givat Hamoreh, and the section of the city that sits on it is Afula Illit ('upper Afula'). Down below is the commercial section of the city, which is a perfect miniature version of the cultural diversity and unique dichotomy of ancient and modern that characterizes Israel itself.

Afula is a cross-section of Israel is to just watch the people in this traditionally lower-income city. You will, on any given day, see ultra-Orthodox Jews, Sephardic Jews, Ethiopian Jews, Russians, and Arabs all interacting in the same small space. Russian is in fact heard almost as commonly as Hebrew, and many stores will have signs only in Russian. Arabic and Amharic can also both be heard frequently. And, like everywhere in Israel, nearly everyone speaks some English.

According to the Orna Blondheim, the director of the Ha’emek Medical Center,the hospital was founded 80 years ago by pioneers who were draining the swamps in the Jezreel valley and were afflicted by infectious diseases such as Malaria. The hospital grew into the largest community hospital in Israel and the largest local employer (1800 staff members). It currently has 490 beds, 24 departments, 60 outpatient clinics, a School of Nursing and is serving a population of 500,000 with a staff of 250 doctors and 600 nurses.

According to the hospital statistics last year the medical staff performed 4500 deliveries, 16,000 surgeries, and managed 130,000 emergency room visits, 200,000 clinic visits and 40,000 admissions. The hospital has an academic affiliation with the Rappaport Faculty of Medicine at the Technion in Haifa and its Department of Family Medicine is affiliated with Chaim Sheba Medical Center in Ramatgan. In 2004 Ha’emek Medical Center was voted as the Outstanding Hospital in Israel.

Afula is not only surrounded by kibbutzim and moshavim, but also by several Arab villages and towns. The Israel - Arab population grew from 150,000 in 1950 to 1,200,000 in 2000 and Jews and Arabs attempt to live together peacefully. The city is also only a stone throw away from the former “Green line” and the proximity of Jenin contributed to a wave of devastating suicide attacks. Even though the construction of the separation wall has contributed to a dramatic drop in terror attacks, homicide bombers still target the city and its surroundings.

The hospital has carried a heavy burden in caring for the victims of such attacks and therefore has acquired experience in the management of trauma victims.

Ha’emek Medical Center has the ONLY trauma center in the region treating 800 terror victims since 10/2000. This would translate to the equivalent of 150,000 terror victims, if the same amount of terror attacks would have occurred in New York!

The hospital can only deal with this enormous burden of trauma victims by optimizing its emergency and disaster response system.

It has currently 175 trauma beds with a surge capacity of 350 beds. In case of a multiple casualty event (MCE) automatically mobilizes its entire medical staff to be able to receive a maximum amount of trauma victims. It is limiting its use of diagnostic facilities to speed up the diagnostic testing for the trauma victims, strictly abides to a uni-directional patient flow model (patients do not return to the ER after diagnostic testing was performed), and assigns the available medical personal according to each patients injury level. The order of activities in a MCE includes the evacuation of the ER to free available capacity, stop of routine activities, immediate assessment of the severity of the situation, rapid personnel deployment to the ER, recall of all medical staff and opening of all available treatment facilities within the hospital. Furthermore, an immediate capacity assessment of the OR, ICU, respirator, medical equipment, blood bank and specialized medical staff (i.e. anesthesiology, surgeons, ER nurses etc.) is being performed.

Afterwards, we also heard two presentations from leading geneticists, who discussed the relatively high level of genetic diseases among the local population. This is directly related to the high degree of consanguinity (46%) within the Arab population. Intermarriage within large families or tribes introduces new recessive mutations leading to the appearance of affected individuals with Thalassemia, Familial Mediterranean Fever, Cystic fibrosis, Retinitis Pigmentosa, Congenital Deafness and Nieman Pick Disease.

Following the presentations we were given a tour of several hospital departments and I was impressed by the professionalism and dedication of the medical staff.

On the last leg of our long journey we traveled along the Jerusalem - Tel Aviv highway to Latrun, the site of the Armored Corps Museum located next to a monastery, which is well-known for its wines. There are some memorial sites, as well as remains of a Crusader fortress and scenic views, along a short loop trail around the Latrun monastery.

The museum is also a memorial site of the Israeli Armored Corps and an open-air exhibition of more than 200 tanks and other armored vehicles. Some of the exhibits date back to World War I, but most of them participated in the War of Independence (1948), The Six-Day War (1967) etc. Both Israeli tanks and hostile armies' vehicles are presented.

The museum contains a memorial wall in which the names of all those brave soldiers are engraved who fell in battle for the defense of Eretz Israel. There the relatives of the fallen heroes congregate each year to honor the memory of their loved-ones. It also serves as a ceremonial site for the Israeli Army, where young soldiers receive their certificates of honor and swear their oath of loyalty to the Israeli State and its people. We were privileged to participate in such a ceremony and after a moving tour throughout the memorial site we concluded our exciting course with a similar ceremony. Boaz Tadmor led us in the Oath of the Israel Defense Forces Medical Corps and we swore to extend a helping hand to the wounded and to the sick..whether common or exalted, friend or foe.. and to be our brother’s keeper, whether in battle, on a stretcher or at the bedside.. and never to leave the wounded in the field. THIS I DO VOW. We received our certificate for the successful completion of the Emergency and Disaster Preparedness Course and were thereby qualified to volunteer in the Israeli Medical System in times of need.

After this moving ceremony we said tearful goodbyes from all of our teachers and friends and vowed to come back. B'shana haba B'yerushaleym, next year in Jerusalem.

Shalom and Goodby Israel.

# posted by Bernd Wollschlaeger,MD,FAAFP @ Thursday, November 17, 2005