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29 SEPTEMBER 2016
Hope for us, hope for Israel, hope for the world Supplement
THE HERO HEALER An injured soldier who saves children is just one of Shaare Zedek’s superheroes. Noga Tarnopolsky met him
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f Asael Lubotzky were a doctor in the UK, heads would turn when he entered a hospital. Handsome, confident and with a ready smile, he is the sort of man who attracts attention, but it is the specially modified crutches on which he leans that would set him apart. Sadly this is not the case in Israel, where the sight of a young man with battle scars is all too commonplace and where Lubotzky, the senior resident in pediatric medicine at Jerusalem’s iconic Shaare Zedek hospital, inhabits two worlds, as that of healer and of the walking wounded. If people stare at Lubotsky in the hospital, it is not because they are fascinated by his crutches with torches on the handles and suction pads on the base, but because they recognise him as the young doctor who has become something of a celebrity since publishing a memoir that turned into a local bestseller. His book, From the Wilderness and Lebanon, is about his experience of battling the Shiite militia Hezbollah in Lebanon where, in 2006 at the age of 23, he was a lieutenant in the Golani brigade commanding a platoon of 30 soldiers. Lubotzky was almost killed when a missile registered a direct hit on the spot on which he was standing in the tank. He survived with extensive wounds and with one leg so badly mangled his doctors were close to amputating it. Lubotzky’s circumstances are extraordinary by any standard, but at Shaare Zedek, which in English means Gates of Justice, they have been treating the war wounded for almost 115 years and the hospital permeates with stories like his that beggar belief.
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Shaare Zedek / Safe in Their Hands
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THE FACT THAT A DOCTOR COMES INTO THE ROOM ON CRUTCHES OR IN A WHEELCHAIR ALLOWS FOR MORE INTERACTION AND BETTER CHEMISTRY
As the Second Lebanon War raged, Lubotzky, one of six children from the Gush Etzion town of Efrat, decided he would sign up for one more year in the army. After that, he planned “to return to the yeshiva and pursue an academic career in physics or chemistry”. It was a foreseeable path for a Lubotzky, who was born and bred into the academy with his grandfather, Murray Roston, a native Londoner, a professor of English at Bar-Ilan University and his father, Alex, a professor of mathematics at the Hebrew University. But that “one more year” as a soldier changed all that. “I’ll never forget the pain,” he says reflecting on the moment of the strike. “There was no time to react. I’ll never forget the feeling of the explosion burning me from top to bottom. I saw smoke, ash, and my right leg twisted inside out with the shoe facing up. And I was holding myself up with my elbows.” Critically wounded, Asael was rushed to a local hospital, where he became conscious just in time to overhear doctors discussing whether to amputate his legs. In the end, limb salvage was chosen. It is a decision he will grapple with for the rest of his life. The heavy neurological damage caused by the blast produces severe, constant neuropathic pain in both legs, “at every hour, at any moment,” he says. He undergoes daily sessions of physiotherapy. His back and right arm are
Asael Lubotzky and his brother-in-law Maru Gete, an otolarynologist at Shaare Zedek
damaged as medics took muscle from his right shoulder to rescue the leg. He walks with the aid of an ankle foot orthotic, and sometimes resorts to a wheelchair. At the time of the blast, he says, “as a healthy person, I’d had very limited exposure to medicine”. “My situation exposed me to a completely new world and to the dynamic of a medical team that includes everyone from physicians and orderlies to nurses and therapists who keep a patient on track,” he explains. More than a year later, with 15 operations under his belt, he had become something of an expert and was inspired. “I got to see how medicine is not an exact science but involves a lot of humanity,” he says. “When you’re there for so long, the hospital
becomes a second home; you discover for good and for bad how a person’s attitude, a glance, even just a word can influence you dramatically. Part of my interest in the world of medicine began then.” As he contemplated an unforeseen future, Lubotzky applied to the Hebrew University’s department of physics, as planned, and to the school of medicine. “I hesitated because it was an area I knew less well, so I spoke with the doctors. I’d show up in a wheelchair with iron pins poking out of my arms and my legs, scars all over my body and told them I was thinking of becoming a doctor. Some of the doctors said I was crazy but some said: ‘If your head is ok and you really want it, nothing will stop you.’” These days, his visible disability serves as an
opening to conversation when he meets new patients and their parents at Shaare Zedek. “They see me and realise we’re all in the same boat,” he says, acknowledging that the sight of a doctor who is also a patient can be disorienting. “The cognitive dissonance is useful,” he says. “It removes you from the stereotypes—the fact that a doctor comes into the room either on crutches or in a wheelchair, it allows for more interaction and better chemistry with the kids or the parents because they know that whatever it is, we’re in it together.” The children are not frightened by his extraneous accoutrements, which include an exoskeleton bracing his right leg. “They play with the crutches,” he says. “My kids put stickers on crutches, so there’s no need for me to bring in any toys. I have a built-in icebreaker.” Lubotzky is a prime example of how Shaare Zedek doctors treat the patient not the illness and he is able to build strong and meaningful relationships with the children he sees. Shaare Zedek is something of a family home for Lubotzky. He, his wife Avital and their three children were born there. His father-in-law, professor Michael Schimmel, directs the hospital’s neonatal intensive care unit and Maru Gete, an Ethiopian-born officer who served alongside Lubotzky in the Second Lebanon War, now works alongside him as an otolaryngologist and is also his brother-in-law. “I’m the shadchan!” Lubotzky declares with unabashed delight at the fact he introduced Maru to his younger sister, Shakked, who is finishing her doctorate in public health. They have also given him five nieces and nephews. Professor Schimmel will celebrate his 40th anniversary at Shaare Zedek this month. He grumbles cheerfully about now being more famous as “Asael’s father-in-law than for my own achievements”. Lubotzky smiles, but for all the glory, there are days when his pain is so acute he leaves the crutches at home and goes about his work in a wheelchair. If he were a doctor in the UK this might cause a stir. In Israel they merely step aside for a healing hero.
WORKING ALONSIDE ASAEL LUBOTZKY AT SHAARE ZEDEK HOSPITAL ARE OTHER MEN AND WOMEN WHO DEVOTE THEIR LIVES TO HELPING PATIENTS. THESE ARE JUST A FEW OF THEM…
NO ONE WANTS to deliver bad news but, when it’s necessary, Amran Jaber is somewhat of an expert. Coping with the pain and panic of those who have been involved in terror attacks and major accidents is a key part of his job as the chief trauma nurse at Shaare Zedek Medical Center, and no one is better equipped to allay fears or, in the case of a fatality, inform the families. Amran Jaber, 47, is so adept at handling this responsibility that last month he was invited to deliver a lecture on this very subject at the second Global Conference on Emergency Nursing and Trauma Care in Spain. Notably, Jaber was Israel’s only representative, but the fact he is an Israeli-Arab defied the global perception of Arab-Israeli relations. He lives the country’s dichotomies daily and recalls being questioned about his allegiances by Arabs and Jews alike at university.
“I am very bothered when people try to put me into one of their categories,” he says. “In East Jerusalem, you can hear people saying Israeli Arabs are traitors, but I have never been to Palestine, and I just say ‘Leave me alone. I am Israel Arab, don’t come to me with preconceptions.” At Shaare Zedek, where the conflict remains outside the hospital walls, Jaber is just a muchvalued member of staff who has taught the hospital’s students since 1995. But on those rare occasions when a patient objects to being treated by an Arab nurse, he rises above it. “If they object, that is the patient’s right, I’ve no problem with it,” he says. “ Just as one may not want to be treated by a man or another by a woman. It is perfectly acceptable. I have learnt not to be insulted.” But those who have had the misfortune of being involved in a major trauma quickly
Photos by Nir Keidar, words by Noga Tarnopolsky, Brigit Grant
THE HEAD NURSE
Amran Jaber is the chief trauma nurse whose inspiration is Florence Nightingale
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Safe in Their Hands / Shaare Zedek discover that being cared for by Jaber is their good fortune, for this tall, robust man with the kindest face cites none other than Florence Nightingale as his inspiration and he follows her lead managing the care of his patients. “I see in my profession a way of life,” he says, “a second skin.” It was his childhood dream to become a doctor, but when he failed to get into medical school, Jaber embarked on a career in nursing. “I love nursing,” he says. “You have to relate to the person in a holistic way, taking into account his pathology, but also his family, his culture, his religion.” Jaber was at his post on 18 April 2006, when victims of a bus bombing started pouring into the emergency room. “We received six people,
all of them the colour of coal. A nurse asked me: ‘What is this, where are these people from?’ They were all carbonised. In the middle of work, someone pointed at one of the stretchers and said: ‘I think he’s the terrorist’ and near him we had three of the victims. The bomber had placed the explosive in a bag between his legs. So in the same room, I was in charge of the care of three victims and the terrorist. In those moments, it is your responsibility to decide on resource management. We tried stabilising him for three hours before he died.” Jaber has many degrees in varied subjects, but the most surprising qualification is his Israeli tour guide’s licence, as one would struggle to imagine when he finds the time for sightseeing. But he does, and in a very specific
area, as Jaber has a keen interest in Jewish Studies, specifically in the Shoah and is the only Arabic-language tour guide licensed to conduct Holocaust tours. “I got interested in the subject when I worked as a chef in a sanatorium in a Judean Hills kibbutz that catered for Holocaust survivors whose treatment was paid for by the German government. I heard so many stories from them and wanted to learn more,” he says, adding that his first tour was bilingual, in Hebrew and Arabic, for friends from work. An inveterate student, he chose tourism as a secondary field for those moments in which “I can’t stand bodies and the Arab-Israeli conflict and I need to just take a day away and show people the country I love. This is
something I do for my soul, so that I am not only exposed to death and trauma.” In the early 2000s, during the Second Intifada, an old friend from Abu Gosh,whose sister had attended high school with Jaber, was killed in a bombing at Jerusalem’s Machane Yehuda market. “At these moments you feel whoa, whoa, it’s coming, it’s here.” But it as he heads off to deal with more pressing issues, he offers a bittersweet anecdote. “A few years ago, around independence day, a very sweet girl gave me an Israeli flag. I took it to put on my car, like everybody does. But as I was walking out, I heard another girl ask her: ‘Why did you give him the flag?’ I am an Israeli through and through,” he says, “and I know what I am.”
THE TRAUMA CHIEF DR OFER MERIN is a marathoner. In life and in his work, he takes the long view. Although he planned, as a youth, to study architecture, his army experience as a doctor and his father’s medical career drew him to medicine. “But my daughter is now studying architecture in London,” he says with satisfaction. From the vantage point of the average Israeli, Merin’s lean runner’s face is the face of Shaare Zedek, and as a result, the face of national authority. “It’s not simple to be exposed to the media because of terror” says Merin, 55, Shaare Zedek’s deputy director and chief of trauma medicine. “There is no doubt communications is a greater part of trauma than any other field of medicine and that as a result, we are more wellknown than other doctors. Immediately following attacks in the year-long spate of violence that has besieged Jerusalem, Israeli eyes and ears are attuned to Merin’s even voice as he transmits the condition of victims – and sometimes perpetrators –of stabbings, shootings and car rammings from the hospital’s ambulance bay. “Trauma is simple medicine,” he says. “You don’t need to be an atomic scientist. It mostly hinges on instincts, cool nerves and the will-
Dr Ofer Merin is chief of trauma medicine
ingness to work crazy hours.” His wife, he says, “doesn’t even hear the telephone. There is no other way to be married to a trauma surgeon”. “You really don’t have to be a great genius,” he emphasises. That may be, but in the popular imagination, trauma specialists are the gauchos of medicine, working in isolation and at great risk. “By definition, it’s in the character of medicine that nothing is planned – zero – and that everything is urgent and unforeseen. Within that spectrum of the unforeseeable, some patients arrive in decent condition and others are already dead. In trauma, the decisions made in the first minutes can be fateful and one’s influence as a doctor is significant,” he says. “Some people are attracted to trauma because of the adrenaline,” he continues. “When an incident occurs the only thing you know is that the wounds will never be ‘typical’.” Like so many of the ‘superheroes’ who strive to perform the impossible at Shaare Zedek, Merin has a backstory worthy of the big screen, but he doesn’t parade it. Instead, it falls to others to tell of the woman on a train headed for Auschwitz who realised the fate awaiting her and her children at the end of the journey. Kissing them goodbye, she threw her eightyear-old son and six-year-old daughter out on to the track and together they found their way to a small Polish village, where a young Christian woman hid them until the war was over. They went to Israel soon after independence, where the boy eventually became a doctor, married and had three children. Merin is his second son. Merin believes his story embodies the well-known saying: ‘To save one person’s life is to save the whole world’ and he does just that every day. In addition to his three positions at the hospital and his daily long runs, he is a reserve colonel in the Israel Defense Forces, and commander of the IDF field hospital unit, which is a self-sufficient team equipped for any situation in any country that needs their help. There are few places Merin has not gone and often with only hours of notice. His last mission was to Nepal in 2015 following the catastrophic earthquake, where his team treated 1,600 patients, performed 90 life-saving operations and delivered eight babies including six by C-section. It was on that trip, the unexpected happened when Merin found himself short of a manager for the field hospital he was putting together.
Hospital director Professor Jonathan Halevy with his deputy, Dr Ofer Merin in Nepal
“They were unusual circumstances,” Merin’s boss, hospital director Jonathan Halevy recalls. “Merin came to me at the last minute, with a couple of hours’ notice, and told me they needed someone to run the field operation. I managed to put together a backpack. We got kit from the Home Front Command and at age 67, I went back into the army, with my deputy as my commander.” “In civilian life, I am his boss,” Halevy laughs, while Merin says: “I got to be the boss of my boss!” Although they make light of the mission, for two weeks, the two top men at Shaare Zedek hospital slept on army cots while caring for hundreds of Filipinos who went for help to the only medical aid facility on the island of Ceba. Such is the level of expertise, training, equipment and supplies of the field hospital that Merin’s most recent destination was to a meeting with senior World Health Organization officials, who are discussing the adoption of Israeli standards for dealing with trauma situations. This is a tribute to the team’s ability and is worthy of wider recognition, but that’s not why Merin does the job. “I don’t think there is any professional more filled with superstition,” Merin says, about trauma medicine in general. “There are people who always step into the operating theatre using the same foot or who wear the same socks
when they come in, but not me.” Then he says: “But I never drink coffee on days when I know I’ll be operating. I don’t want to have to go to the bathroom after five hours; these are not operations that you can just walk out of.” He adds: “I need the surgery to be quiet. There are surgeons who play music during operations, but I don’t allow it. Major surgery is not a disco. You don’t want the music to lull you into a nonchalant mood. “In extreme situations, for example in a resuscitation, there isn’t much to think about. It’s the clearest situation. Who can be ‘holistic’ if someone is bleeding to death? You just need to staunch the blood, and quickly.” But in every other respect, at Shaare Zedek and in the field, Merin focuses on the totality of a patient’s circumstances. He mentions a planned surgery he will be starting in some 10 minutes, a woman in her eighties undergoing open-heart surgery. “I’m very fascinated by the way the family circle or circumstances just before surgery – a conversation with the doctor, is one thing – can affect the outcome of convalescence. It can provide a real mental boost before surgery and, whether we understand it or not, it is part of the care we offer patients.” Ever the marathoner, Merin moves too quickly to be affected by much of his own star power, but when he crosses the finish line, he just keeps running to wherever he is needed. His grandmother would have been very proud.
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24 HOURS AT SHAARE ZEDEK A closer look at the trauma, trials and life-changing moments that take place on a single day in this Israeli hospital
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here is no such thing as a typical day at Shaare Zedek. Doctors and nurses will always be in attendance and the sound of sirens never far away, but that is as typical as it gets, for not even veteran staff can predict how 24 hours will pan out at this hospital, where everyone is welcomed. But sometimes a patient grabs everyone’s attention. On the last day of August, it was a 10-year-old girl with a pink flower band in her hair. Two days earlier, the unnamed little girl had been stabbed in the heart with scissors, in front of her younger sister, by her father. Initial news flashes said only “Stabbing in North Jerusalem,” so the public assumed another terror attack had taken place. The team at Shaare Zedek deals in facts, not assumptions, and witness the tragic results of brutal acts every day. The mother of the injured girl had fainted when she saw her child and doctors knew they were dealing with an act of domestic violence. Repairing the girl’s heart was the job of trauma surgeon Danny Fink who, having done his very best to save her, watched as she was wheeled to the pediatric intensive care ward. Near the little girl on the same ward, a four-month-old baby from East Jerusalem was recovering from abdominal surgery, while in a bed opposite, a 12-year-old Arab boy suffering from cerebral palsy was unable to breath after repeated cardiac surgery. Silence on a children’s ward is unnerving, but not for the nurses who move from bed to bed, constantly checking the little ones in their care. Down a hallway in the children’s emergency room, Dr Giora Weiser was handling the cases that had come in during the day. The list is daunting. An 18-month-old boy with pneumonia. A 17-year-old with anxiety attacks and a two-year-old with extreme facial swelling who was suffering from nephrotic syndrome and required emergency care. They are all priority cases, with anxious parents standing by waiting for news. Weiser is at the front line faced with the challenge of making sure the boy with epilepsy is seen as quickly
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Naama Bagrish, head nurse of the emergency department
Professor Jonathan Halevy, hospital director
as the teenage paraplegic who was back at the hospital with another of his “unending complications”. And more children were coming in. In the outpatient pavilion, a healthylooking Shachar Cohen, 13, from the northern Israeli town of Kiryat Motzkin sat in an easy chair with his arm attached to a drip. His father, Yossi, stood next to him, his face a mixture of fortitude and worry. A genetic test had recently found that Shachar has Fabry disease, and he was undergoing the first of what is predicted to be a lifetime of enzymatic replacement therapies – that is, if the therapy works. For now, it’s in experimental stages. But for all the sorrow, there is always joy and this day was no exception, for outside the children’s ward, an elated woman in her mid-70s was asking to be directed to maternity, where her great-granddaughter had just
PROTOCOLS SAY NEWBORN RESUSCITATION SHOULD BE HALTED AFTER 10 MINUTES, BUT THESE DOCTORS DIDN’T WANT TO LET HER GO. THE BABY BREATHED AFTER 13 MINUTES
given birth. She was beaming. Everyone in the vicinity shouted “mazeltov!” Upstairs in a conference, teachers and educational staff of the school at Shaare Zedek, 15 in total, gathered to plan for the new school year, while in the therapeutic pet room Sophie, a 12-year-old whose mother is an intensive care nurse and Diana, a 17-yearold suffering from acute Crohn’s disease, dressed in pink pyjamas, contemplatively stroked the spines of Nachum, a mustardyellow Eastern Bearded Dragon. Parrots, rabbits, guinea pigs and chinchillas formed part of the surrounding menagerie. Downstairs, Naomi Amsalem, 33, the deputy chief nurse of the emergency ward, reigned over her realm with preternatural calm. She had, she said, some good, or sort-of good, news: an 85-year-old man, a widower who devoted his existence to a memorial to his only son, who fell in battle, had finally accepted he had pancreatic cancer and agreed to be admitted to hospice. The problem Amsalem confronted was that the hospice required specific tests before admission, and no one could perform them before morning. He’d have to stay overnight. What if he changed his mind? Amsalem sighed. Behind her counter, an elderly woman in the apparent throes of a stroke was being wheeled in, with her son, a betweeded
man in his 60s, carrying her paperwork and her grandson lucidly outlining her medical conditions to the speed-walking doctor. Amsalem mentioned that the life of a 38-year-old woman had serendipitously been saved that day. She’d been accompanying her mother to a scheduled oncology treatment when tram inspectors accused the two women of not having properly purchased their tickets. An argument ensued, and someone called the police. The older woman fainted, at which point an ambulance was summoned. In the emergency ward, while her mother was recov-
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Safe in Their Hands / Shaare Zedek ering, the younger woman suddenly said: “I can’t feel my arm.” The doctors examined her. She had a huge blood clot in her neck. It was a matter of minutes, but she was saved. Meanwhile, Amsalem juggled a young man who came in racked with pain and guilt, confessing to having had a single drink the night before. He had appendicitis. A 21-year-old motorcyclist with a shattered heel lay in one bed, while in another, a 75-year-old patient suffering from pulmonary disease looked on. “Her family keeps asking us why she’s not getting better. She can’t quit cigarettes. We treat her and she keeps on smoking,” Amsalem said, bemoaning the ravages of addiction. “So she doesn’t get better.” Naama Bagrish, head nurse of the emergency department is another Shaare Zedek employees who does over and above what is expected of them every day. And within those days are moments when she has cared for victims of terror attacks and she is visibly moved as she reflects on this. “It shakes you up emotionally and you think about your own family. But when a seriously injured patient recovers and they leave here on their own two feet, that is the beauty of this profession. And a nurse who doesn’t cry or break down shouldn’t be here any more.” In his office, professor Michael Schimmel, the head of neonatal intensive care, was preparing a paper about the resuscitation of a baby girl who was born with no detectable pulse and no heartbeat. A team of three senior physicians got to the maternity ward within seconds of the emergency alarm being raised. For 10 minutes, they massaged her heart. Monitors showed her blood circu-
lating – but still, no pulse. International protocols require that resuscitation for newborns be halted after 10 minutes, but these doctors didn’t want to let her go. At the 13th minute, the baby started breathing. Days later, she left the hospital in good health. “It’s a real ethical dilemma that’s being addressed all over the world,” said Professor Schimmel “The 10-minute protocol is being re-evaluated, and we’re part of that process.” The professor paused. “Did you hear about the girl who got stabbed by her father?” he asked quizzically. It was the story that had captured the hearts and minds of all the hospital medics on this typically untypical day and they all wanted to know about the girl’s condition. It was Dr Sarit Shahrur, the head of the department who announced that the child was awake and reported her first words. “She asked if her father was home and then said she has a heart-ache.” The doctor shook her head and shuddered at her young patient’s “inadvertent wisdom” . Later it fell to Dr Ofer Merin, the hospital’s deputy director and chief of trauma medicine, to announce that the breathing tube had been removed. “Now it’s convalescence and the attending issues: this girl had her faith in the most sacred thing shattered, her trust in the people who should take care of her. So now we’ll bring in psychologists, social workers – this is all part of the support we give.” In the weeks to come, the last day of August will not stand out in the memory for the staff at Shaare Zedek. For them, it was just another day.
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Shaare Zedek / Safe in Their Hands
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SCIENCE OF DEDUCTION Noga Tarnopolsky meets the geneticist changing the world
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anked among the top 50 of the world’s most influential Jews, Professor Ephrat Levy-Lahad is the ultimate can-do woman. With prevention rather than cure as her mantra, the director of the Medical Genetics Institute at Shaare Zedek is an expert of global renown in the genetics of breast and ovarian cancer and the identification of genes underlying rare diseases. As a young science-oriented soldier pondering her future, Levy-Lahad wanted to do something that brought people and research together. Her mother’s experience as a talented chemist who gave up her career to raise a family was at the forefront of her mind as she settled on medical school “because,” she says, “one advantage of the medical profession is that if, in the end, you can’t do science, at least you’ve acquired an important and interesting career”. She enrolled in medical school knowing she wanted to deal with something scientific. “I didn’t want to go into paediatrics because it is either heartbreaking or they have a cold,” she says, before acknowledging that no medical speciality can inure you to anguish. Levy-Lahad’s work first made headlines while she was on a post-doctoral fellowship at the University of Washington, in Seattle, and discovered a gene for Alzheimer's disease. “In the 1990s when I began my career as an internist with a primary interest in adult diseases such as Alzheimer's, geneticists were mostly pediatricians,” explains the professor. “The idea that an adult disease could also be related to genetics was new.” So new that a man who had read some of the media coverage on Levy-Lahad’s findings called her to say that his mother had just been diagnosed with Alzheimer’s and hoped the young scientist could provide medication that would reverse the disease’s course. “It broke my heart,” she says, “and even now, until today, there is no treatment.” But the absence of cures only makes LevyLahad more driven and meeting Mary-Claire King, PhD, the discoverer of BRCA1 while studying in Washington, this pioneering Israeli scientist returned to her own country to set up one of the world’s first cancer genetics clinics. It is in that clinic that she has done ground-breaking research in to the BRCA1 and BRCA2 cancer genes, which has had such an enormous impact on Jewish women. The BRCA1 and BRCA2 are cancer genes that we are all born with and they normally help protect cells from cancerous changes. However in some people a gene muta-
contrary, if you are a carrier, you can prevent disease”. “This is not what we do when we test for blood sugar,” she says pointedly, where only a person at high risk is informed about possible consequences of disease. She is right now in the midst of a randomised control trial, in which one set of women receive today’s standard protocol while another receive only a short written explanation and are called, as is standard in other blood tests, only if she is found to have the mutation or has a family history. Shaare Zedek’s Pre-implantation Genetic Diagnosis (PGD) department is the most active in Israel. PGD utilises an advanced technological process to identify genetic flaws in an embryo before it is implanted in the uterus. This enables couples who are known to be carriers of specific genetic diseases to know with a high level of certainty that their child will not be born with that disease. Shaare Zedek is a national leader in this all-important partnership between medical genetics and reproductive medicine. Professor Ephrat Levy-Lahad is the director of the Medical Genetics Institute at Shaare Zedek Alongside cancer research, Professor LevyLahad is looking extensively in to paediatric tion occurs and cancer develops. BRCA1 we mustn’t.” hereditary diseases such as microcephaly, and BRCA2 gene mutations account for 11 The Hollywood star Angelina Gaucher’s, Tay-Sachs, Duchenne percent of breast cancer and 40 percent of Jolie, who is not Jewish, has and other muscular dystrophy. ovarian cancer in Ashkenazi women, but until become the symbol of preWith all of the research, recently women had not been screened for emptive care chosen by Levy-Lahad’s topmost breast or ovarian cancer unless there was a women who are carriers goal is prevention and family history of the disease. of the gene. Using she would impress this “My main focus is using what is known her as an example, upon anyone who about breast cancer genetics to improve Levy-Lahad says wants to help fund prevention strategies,” states Levy-Lahad. that once a woman the work being done “I was one of the first who said you have to has completed at Shaare Zedek. test. It is common sense to check. There her family, “ovary “In terms of is a dichotomy when it comes to precision removal is a very prevention, genetics medicine. In those areas in which we really do simply procedure, holds huge promise know what we are doing, we get cold feet, and but ovarian cancer and certainly in is devastating. There the curing of breast should be no question cancer,” she says. about genetic testing”. “I can envision a not In fact, she affirms: too distant future where “Every Ashkenazi woman we can understand most of should be tested for the common the genetic predispositions to mutations in these genes even if Angelina Jolie cancer. Even though I am a genetithere is no history of breast cancer in cist, I know that not everything is the family and they don’t show signs genetic. So there will be other risk of the illness. ” factors, but understanding what's genetic will What this demands is a change of allow us to weed out what is genetic and what mentality about the significance of the test, is not. according to Levy-Lahad. Until now, when a “Even now, when you look at treatment women comes in to be tested, she is solemnly of breast cancer, there has been tremendous informed of the possible consequences. progress. I think finding a cure will happen The test itself becomes “a heavy thing,” at a much faster pace because we'll undershe laments, when in reality, “a minority stand more of the biology. I think it's a of women are carriers, and being a carrier combination of prevention, early detection, BRCA gene mutations cause cancer does not mean you have the disease. On the and treatment.”
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Safe in Their Hands / Shaare Zedek
THE SECRET OF
OUR SUCCESS Realising the dreams for a world-class hospital only happens with the right support
IN THE SUMMER OF 2015, Shaare Zedek Medical Centre celebrated the opening of its cutting edge new children’s facilities. British support was crucial to the project, with over more than £3 million raised for what the hospital’s director general, professor Jonathan Halevy, calls “one of the most ambitious development projects in the hospital’s 113-year history”. In a city in which 34 percent of the population is 14 or younger, more than 60 percent of Jerusalem’s children live below the poverty line. Poverty in childhood has profound effects on children’s health throughout their lifetime. Shaare Zedek was one of the first hospitals in Israel to recognise the need for specialist paediatric medical facilities. With this demand for paediatric and maternity services growing each year, Shaare Zedek launched one of the most ambitious development projects in its 113 year history: the Next Generation building. The first of its kind in Jerusalem, the eightstorey building houses all paediatric, maternity and neonatal services and provides the most comprehensive medical care available to women and children under one roof. The new building incorporates Shaare
Professor Halevy with donors from the Juliet Keldan Institute
Zedek’s approach to personalised holistic care with a design that best limits the emotional trauma associated with hospitalisation and ensures that patients can be closely supported by family members. Every detail has been designed with the needs of the children in mind. The building is colourful, playfully decorated and full of play areas and family space. The medical services are complemented by comprehensive educational facilities and holistic treatments including art, music and pet therapy and support from medical clowns. Shaare Zedek UK has raised funds for the Next Generation building project since 2007. Many of the hospitals’ prestigious departments and centres of excellence bear the names of British donors: The Lincoln David Abraham Paediatric Educational Institute is home to all the children’s educational activities, including the school and complementary art, music and pet therapy programmes. The Vivienne Wohl Department of Paediatric Surgery is truly unique, with dedicated paediatric facilities designed around the specific needs of children during surgery. Each operating theatre is connected to an elaborately engineered computer network that maximises the surgeons’ control over the procedures and also allows the operations to be observed by physicians outside the theatre via the internet. The Leon and Lesley Berman Pediatric Dialysis Unit treats from as far away as Dimona and the Negev. Most suffer from chronic renal failure and are waiting for transplants. They require dialysis between three and six times each week, making the department their second home. Since more than 50 percent of the patients are from the Arab sector, many friendships formed cut across religious and ethnic divides, making the department a flagship for coexistence and
understanding. The department made headlines in 2002 when the kidneys of Glaswegian terror victim Yoni Jesner were transplanted to seven-year-old Yasmin Abu Ramila, a Palestinian Shaare Zedek paediatric dialysis patient. The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition has become an international leader in its field. The prevalence of serious digestive disorders within the Jewish and Arab communities has led to rapid expansion of paediatric gastroenterological services, research and groundbreaking new procedures. The department houses The Anne and Joe Turner Pediatric IBD Center, which hosts regular workshops to support children coping with Crohn’s and ulcerative colitis. Practical sessions teach the children and their families cooking – led by Israel’s top chefs – while social and emotional needs are addressed in confidence building and team building exercises. One of the first departments to open in the new building was Neonatal Intensive Care Unit (NICU). It is the largest in Israel and among the largest in the world, caring for up to 70 babies at any time. UK supporters have provided the NICU with a six crib area, a four crib area, a nurse’s station, a family room, and eight state-of-the-art giraffe incubators to treat babies who need the most intensive care. Shaare Zedek UK executive director Simi Ben Hur said: “British donors have supported the hospital for nearly 80 years, raising more than £29m in the past 10 years alone, and have created the ideal environment for scientific innovation. We are immensely proud of the strong British contribution to the most advanced women and children’s health facility in Jerusalem. This has been a truly communal project to ensure the health of the next generation is safe. Thank you to everyone who has helped make our vision a reality.”
As the man who paves the way and leads the team at Shaare Zedek, director-general professor Jonathan Halevy is well placed to know what makes the hospital special. “We are proud of our international reputation for excellence. The great diversity of population, which you see both in intake and among our staff, is what makes this place great,” he says. “We are a control group of multiculturalism and multi-ethnicity among our staff and patients, because that reflects what Jerusalem is. Here we have secular Jews, traditional, Orthodox and 35 percent of our population is Arab. “The most riveting thing, and what has compelled me to refuse all offers from hospitals that at the time were much bigger than us, is the uniqueness of this institution and my fascination with the varied staff and the results of the work here. It’s a very special challenge. I think a hospital like ours spearheads any movement towards peace. This is where you see and live our shared destiny.” Professor Halevy also appreciates that the hospital is able to function as well as it does because of the generosity of those who support it.
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EVERY BRICK AND EVERY PIECE OF EQUIPMENT IS A PERPETUAL TESTIMONY TO THE ENORMOUS GENEROSITY OF DONORS PAST AND PRESENT,” HE SAYS. “ALL THESE DEVELOPMENTS ARE ONLY MADE POSSIBLE THROUGH THE GENEROSITY OF FRIENDS AROUND THE WORLD. SO THANK YOU FOR YOUR KINDNESS AND SUPPORT.”
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Jewish News 29 September 2016
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