Medicine: Taking Peace to Heart
Skilled Hadassah pediatric surgeons help pave the way to a better world as they repair congenital heart defects in Palestinian kids.
Without adding an operating room or an intensive-care bed, without an extra nurse, physician, surgeon or anesthesiologist, Hadassah began performing open-heart surgery on an average of two Palestinian children every week throughout 2004 and nursed them through their demanding time of postoperative recovery to full health. It is expected that during 2005 the number of young Palestinian heart patients—from just a few hours to 16 years old—will double to at least four a week.
“These patients are in addition to the hundred or so youngsters we regularly treat in our pediatric heart surgery unit each year,” says Dr. Eli Milgalter, director of the Department of Pediatric Cardiac Surgery at the Hadassah–Hebrew University Medical Center at Ein Kerem. “In terms of the number of patients, it’s as if we’ve opened an entire new department.”
Youngsters from the west bank and Gaza are the focus of an extraordinary multinational undertaking. Involving Israel, the Palestinian Authority and Italy, as well as the United States, Britain and Switzerland, its purpose is to repair genetic heart defects and return the children to full health.
“At last I’ll be able to play a game of soccer through to the end,” a recovering Hebron teenager told visiting Labor Party head Shimon Peres through a translator last summer. Although the boy’s condition had been diagnosed when he was less than four weeks old, he had waited 15 years for surgery. No Palestinian hospital currently has the facilities or infrastructure for the surgical and postsurgical care needed. Nor does the Palestinian Authority fund treatment in Israeli hospitals, even with Hadassah’s costs shaved to a mere fraction of that of similar surgery in the United States.
“We were in the tragic situation of youngsters living three or four miles from Hadassah deteriorating and perhaps even dying from reparable heart defects,” explains Dr. Milgalter. “I’d receive phone calls almost daily from West Bank pediatric cardiologist Muhmad Nashashibi, asking for surgical help we were unable to give.”
Dr. Milgalter’s efforts to raise funds to treat these youngsters at Hadassah succeeded in raising a lot of good will but no hard cash. It was Dr. Shmuel Penchas, former director general of the Hadassah Medical Organization, who, as consultant to the medical center with discretion for a special fund, finally forced the door open.
“To his everlasting credit, Dr. Penchas recognized the importance of helping these Palestinian children,” says Dr. Milgalter. “Two years ago, he allocated $45,000, which allowed us to operate on 10 of the youngsters.”
While several patients were recuperating at Hadassah in the fall of 2003, they received a visitor who fit the next piece of the project into place. Massimo Toschi, councilor in the regional government of Tuscany, had been brought to Hadassah by Italian-born Israeli journalist Manuela Dviri. Tuscany was looking for ways to help Palestinians and was aware of the problem of congenital heart defects in the children; it had been bringing Palestinian children to be operated on in Italy, but the high cost and impossibility of follow-up care made that unfeasible. Toschi was in search of a more practical alternative with a financially transparent channel.
“I speak neither Hebrew nor Arabic, but my command of body language is fluent,” he recalls. “In my first five minutes in Hadassah’s pediatric cardiac unit, I saw how comfortable the Palestinian mothers and their children were there. The few we had brought to Tuscany had been disoriented and frightened. At Hadassah, they were visibly at home.”
Dviri, a peace activist since her 20-year-old son was killed in Lebanon, then approached the Peres Peace Center to turn humanitarian outreach, good will and surgical skill into a workable solution. The center functions both as the link between Palestinian physicians and Hadassah cardiac surgeons and as the financial channel between Tuscany and Israel.
“We’re delighted with the program,” says Dan Shanit , director of the Peres Center’s Medicine in the Service of Peace program. “Not only does it reduce mortality and improve the children’s quality of life, it also creates a direct continuous working relationship between Palestinian and Israeli civil societies, thus helping pave the road to reconciliation and a better world.”
That road begins, as it did before the project’s launch, in the West Bank and Gaza, where Palestinian physicians identify and diagnose heart defects in children. One recent patient is 2-year-old Alladdin Abu Hatzira of Gaza City. As before, patients like Alladdin are referred to Dr. Nashashibi, who confirms the diagnosis. Now, however, when he contacts Hadassah, a date can be arranged for surgery. The Peres Center then makes the often complex arrangements for bringing the child and his or her parents into Israel and to Hadassah.
“We wouldn’t have managed without their help,” says Alladdin’s mother, Serena Abu Hatzira. “Security is very strict. A Gazan can’t come into Israel without the right papers.”
Half the cost of Alladdin’s surgery and postoperative care, as with all the children in the project, would be channeled through the Peres Center, most of it from the Tuscany regional government, along with contributions from corporations and individuals in Italy, Switzerland and the United States. This sum is matched dollar for dollar by Hadassah. A flat rate is charged for every patient, regardless of the type or length of treatment and care.
The success of treatment this first year has been complete,” Dr. Milgalter says with understandable pride. “Although this surgery and its aftercare are skilled and sophisticated, the surgical repair of congenital heart defects is generally very successful. The problem is essentially mechanical—abnormal holes between the chambers of the heart, faulty connections between chambers and vessels, valves that don’t open properly. Once corrected, the child grows up healthy and normal. We have not lost a patient. This is an outstanding result that compares favorably with the best pediatric heart surgery services in the world.”
The success, he is anxious to stress, is a team success. “There’s no one-man show here,” he says.
He names the two pediatric heart surgeons with whom he works, Eli Levy of Hadassah and Palestinian Bashir Marzooka from Beit Jalla, who, it is hoped, will spearhead Palestinian pediatric heart surgery services in the future. Hadassah cardiologists Azaria Rein and Zeev Perles play a pivotal role, as do Mary Pach, head nurse of the pediatric cardiology operating room, and her team; senior anesthesiologist Yaakov Gozal; and the skilled intensive-care team headed by senior physicians Ido Yatziv and Jacques Braun. Hadassah’s entire pediatrics department, under Drs. David Branski and Dan Engelhard, provides beds for the dozens of medically needy children as they recover from their extensive surgery.
“With already crowded schedules,” says Dr. Milgalter, “a large team of Hadassah staff is gladly putting in extra days and nights without complaint or remuneration.”
In another way, this “new department” is invisible, he continues. No beds or floor space, staff or equipment, salaries or benefits have been allotted to it. The money that comes in through the Peres Center pays strictly for costs. Even the hot line provided for Palestinian parents once they take their children home is informal: It is Dr. Milgalter’s cell phone, available day and night.
The rewards speak for themselves. Breathless blue babies leave Hadassah a healthy, gurgling pink. Undersized, pale, thin children begin to thrive. Palestinian mothers, who sit by their children’s hospital beds for days and weeks without complaint, make a point of quickly learning the Hebrew for “Thank you, doctor”—and use it frequently. Their connection with Hadassah continues once they return to their towns and villages, calling Dr. Milgalter day or night with concerns and questions.
The relationship between the Hadassah team and Palestinian physicians Marzooka and Nashashibi has developed beyond the collegial.
“I think all of us see this as a ray of light for a better future between Israelis and Palestinians,” says Dr. Milgalter. “It shows we can focus on the patients without allowing politics or prejudice to color the picture.”
The project’s tuscan benefactors are equally happy. Last May, six months after the program’s launch, Claudio Martini, assistant to the president of Tuscany’s regional council, came to see the outreach in practice. Three Palestinian children were among the patients in Hadassah’s pediatric cardiac intensive-care unit when he visited, each connected to a beeping monitor and IV’s, their head-scarfed mothers beside them. One mother bowed to Martini and kissed his hands, repeating over and over that he had saved her daughter’s life.
“We were led here by a greater power,” said the Italian, tears in his eyes. “Somehow, we heard the voices of these children. We didn’t expect such wonderful results or to see them so soon, but it inspires us to continue.”
In July 2004, Massimo Toschi returned to Israel and visited Hadassah with Shimon Peres, creator of the Peres Peace Center. They were invited by HMO director general Dr. Shlomo Mor-Yosef for what he termed “a strong dose of satisfaction.”
“Nothing is more noble than the work of these physicians, who have shown the height of their humanity,” said Peres.
“It’s extraordinary to see Israelis and Palestinians working together,” added Toschi, who extended to five years the initial three-year Tuscan commitment to the program.
With double the number of patients expected for the program’s second year, the Hadassah team will be making some logistical improvements, among them a hot line that won’t wake Dr. Milgalter at night. These arrangements, however, are seen by all partners as temporary.
“The Palestinians understandably want to meet their own health care needs,” says Dr. Milgalter. “They already perform some cardiac surgery procedures in the Makassad Hospital in East Jerusalem, where pediatric cardiologist Muhmad Nashashibi is based. Cardiac surgeons from Hadassah will shortly start operating on simpler cases in Makassad, assisted by the Palestinian surgical team. Once Palestinian hospitals acquire the infrastructure needed to care for post-heart surgery patients, their surgeons will be able to treat their own patients in their own hospitals.”
Until then, Hadassah’s invisible department intends to continue its very visible work of giving Palestinian children a normal and healthy future. And as they do so, perhaps help create a normal, healthy future for several million other people in the neighborhood as well.
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