Medicine: Shuttle to the Front
Nahariya, in northern Israel, was under daily rocket attack when Hadassah doctors, nurses and social workers answered the call to help its besieged population.
While a million people in northern Israel shuddered in underground shelters and thousands more fled south from the almost 4,000 missiles fired at them this past summer, life in the rest of the country was outwardly much as usual. In Jerusalem, people thronged malls, cafés and summer festivals, their obsessive monitoring of news broadcasts the main tangible evidence of their preoccupation with the war.
With the capital well out of rocket range, the Hadassah–Hebrew University Medical Center at Ein Kerem—which came under Jordanian guns in the Six-Day War and treated the bulk of casualties during the two intifadas—was unaccustomedly far from the fighting.
“It was July 16, the war was [several] days old and other than some of our doctors helping out in the hospital in Safed or called up to the Army, it was scarcely affecting us,” says Yael Bossem-Levy, Hadassah Medical Organization spokesperson. “Every hospital in Israel was opening hotlines to the north. Internet support sites were being set up. Everyone was trying to help. But no one was actually going there. So I said: ‘Why don’t we go?’”
Less than 24 hours later, at 7:30 A.M., the first Hadassah team left Ein Kerem for the Katyusha-ravaged northwest coastal town of Nahariya.
“All it took was a few phone calls,” says Ron Krumer, head of HMO’s external-relations division. “Our first was to Esti Galili. Her immediate answer: ‘Yes, I want to go.’”
The gut reaction of dr. esti galili-weisstub, head of Hadassah’s Department of Child and Adolescent Psychiatry, was repeated by personnel throughout the medical center. That day, and for six out of seven days of every week that followed until the August 14 cease-fire, Hadassah’s internists, pediatricians, psychiatrists, psychologists, nurses, social workers—and even medical clowns—lined up for places in the ambulance that made the daily 15-hour, 224-mile roundtrip to Nahariya.
“From senior department heads downward, people clamored to go,” recalls Bossem-Levy. “Those who went immediately put their names back on the waiting list to go again. Nonmedical staff—Hadassah patient services representative Nahum Gedalia was one—queued to drive the ambulance, even after the hands of one driver, Meir Cohen, were spattered with shrapnel from a Katyusha blast.”
Since July 13, when a Hezbollah rocket rammed into the Nahariya apartment of Argentinean immigrant Monica Seidman Lehrer and killed her, missiles had rained down daily, first in the dozens and then in the hundreds, on this town of wide boulevards and old-fashioned lampposts. Six in every ten residents fled south. Those who stayed kept to the shelters. Sidewalks were empty, and cars on the road were so sparse that the traffic lights were switched off.
“We could help, so we went,” says Dr. Motti Muszkat, a clinical pharmacologist and attending physician in internal medicine at Hadassah. “We would go from shelter to shelter, measuring blood pressure and blood sugar, prescribing antibiotics, painkillers and sedatives. There were ear infections and stomach upsets to treat and diminishing insulin and Ritalin supplies to replace. But the central issues were anxiety and insomnia, and our medical work was more about support and reassurance than advanced health care.”
Think of a single mother who’s been sitting in a shelter for days on end with three young children, two of them severely ADHD,” says psychiatrist Forto Benarroch, director of Hadassah’s Orion Center for the Treatment of Pediatric Trauma. “She is herself terrified by the missiles, and at the same time she’s trying to cope hour after hour with hyperactive children in circumstances hard even for a normal child.”
“I consulted with the mother of an autistic teen,” says Dr. Galili. “She and her son had spent 20 days in the shelter, and he had not let go of her hand for a single minute.”
“There was a woman who had fled the town some days earlier,” explains Rita Abramov, Hadassah’s director of social services. “She had bedridden parents in Nahariya, Holocaust survivors aged 85 and 94, who had refused to go with her, and she had left them with a caretaker who brought them their food and gave them their medication each day. But now, the caretaker had run, too….”
The parents were assisted on two levels: Abramov and the distressed daughter worked together to persuade the elderly couple to join their daughter in southern Israel. At the same time, Abramov coordinated the details of their move with the Health Ministry and arranged for volunteers to bring in their food and medicines until they could leave the city.
Each day, the multidisciplinary Hadassah teams met shortly after 7 a.m. at the Ein Kerem Hospital. They boarded an ambulance packed with basic medical supplies and, as time went on, with cartons of books, toys, groceries, toiletries and baby food collected by Hadassah-Israel to relieve life in the shelters.
During the long drive north, the hospital personnel discussed the war or dozed, while the ambulance windows framed a countryside that became steadily emptier and more missile-scarred. Helmets and bulletproof vests were donned when, by midmorning, the ambulance pulled into the ghost town of Nahariya.
Hadassah’s first stop each day was city hall, where the social worker on board left the ambulance to help out at Nahariya’s Crisis Control Center. The rest took a list of urgent cases from the municipality and went to work.
“The first couple of times Hadassah came, we were unprepared and they simply went out looking for those who needed help in the shelters and among the housebound,” says Ada Schenfeld, director of psychological services for the Nahariya municipality. “Once we knew we could rely on their coming, however, we compiled lists of people in particular distress. Because of the mix of specialties they brought, they could diagnose and usually solve a very wide range of medical, psychological and social problems.”
List in hand, the team headed as directed, though if Katyushas fell nearby, they went into the nearest shelter, both for safety and to try to ease the trauma there.
“The second time I went to Nahariya, the sirens wailed and a missile fell just as we arrived at a shelter,” recalls medical clown Jerome Arouche. “The kids inside were panicked. I started picking up cushions, clothing, bits of paper, anything that came to hand, and throwing them at the kids, yelling ‘Katyusha!’ each time. Soon they were laughing and throwing things back at me. I managed to translate the crisis we were experiencing into something they could handle. Just as in the hospital, I didn’t consciously plan what I did. I just responded to the individuals and to the moment.”
With the youngsters laughing and playing, Arouche turned to an elderly woman, who sat rocking back and forth. He softly began to sing Edith Piaf’s “Non, Je Ne Regrette Rien” and got her not only to sing with him but also to get up and dance.
In the next shelter, he found a woman who was so panicked she could hardly breathe. “I went over and started ‘panicking’ myself—but as a clown panics, waving my arms and legs and pulling faces,” he says. “She began laughing at me and that calmed her down.” After, he approached a stir-crazy boy in a similar way, exaggerating his restlessness until he, too, was laughing.
“Occasionally, people were aggressive and demanded: ‘What do you want from me?’” Arouche adds. “I’d answer, ‘What would you like from me?’ and within minutes, they’d be pouring out their feelings.”
“Certain kinds of situations tended to repeat themselves under the bombardment,” says Dr. Benarroch. “There were usually two levels on which to deal with them. One was technical: adjusting dosages of regularly taken stimulants, such as Ritalin, for this special situation, and dispatching volunteers with prescriptions to any Nahariya pharmacy still open. The other was giving emotional support and guidance—helping distressed parents and suggesting how they deal with their children and their own fears.”
Not all, however, fit the pattern. One situation that city hall asked Hadassah to address concerned a family of five that had emigrated from Russia. “Several months earlier, the father had been brain-damaged in a car accident, after which he experienced explosive outbursts of anger several times a day,” says Dr. Benarroch. “This unfortunate personality change resulted in divorce shortly before Nahariya came under bombardment. The couple’s three children were already in crisis, but in the shelters, the 8-year-old son deteriorated further and began raging against his mother.”
Initially uncooperative, the youngster finally revealed the cause of his anger to Dr. Benarroch.
“He mistakenly believed his mother was preventing his father coming into the shelter, leaving him exposed to the Katyushas,” explains the psychiatrist. “The truth served not only to defuse the boy’s anger, but also to reconnect the children with their all-but-estranged father,” who was brought to see them.
Sometimes a call for help for one family member revealed another problem altogether. “The city asked me to check on a 5-year-old whose mother had reported her abnormally distressed,” says Dr. Galili. “She, her parents and five siblings aged 14 years to 10 months had been shut in a shelter for days. According to the exhausted mother, the child ran a fever each evening and, as there was no apparent cause, the parent attributed it to anxiety.”
Dr. Galili suggested to the parents that they try to structure their lives by establishing a daily routine in the shelter. “No,” said the mother. “I’m at the end of my rope. I’ve no energy for that kind of thing. I just want out of here.”
Turning to the 5-year-old, Dr. Galili watched her play happily with her siblings and engage trustingly with her parents. “I asked her to draw a picture, and she used bright optimistic colors,” she says. “I asked her how she felt when she heard the Katyushas come, and she articulately described how her stomach clenched and, filled with fear, she waited for the noise to end.
“In short,” Dr. Galili continues, “I saw a strong and well-adjusted child—and a mother at the end of her resources. Before I could work further with the family, however, they found hosts in Ma’aleh Adumim and thankfully left Nahariya.”
Like hadassah’s physicians, nurses and psychologists, the medical center’s social workers know they made a genuine contribution to the welfare of people in Nahariya.
“We’re experienced in working with the sick and the elderly,” says Rita Abramov. “We know how to calm people so they can explain their problems and think with us how to solve them. And we have the necessary professional contacts with national health and welfare bodies. All this uniquely qualified us for an interventional role in this situation.”
In normal times, Nahariya’s Crisis Control Center’s 30 phone lines handle local problems with water, housing, trash collection and electricity. Assisted by Abramov and members of her staff, the call service was given over to social welfare difficulties during the war in southern Lebanon.
“I answered a call from the mother of a family of four, the eldest of whom is 22 and severely mentally retarded,” recalls Abramov. “He was terrified of the bombardment but would not go into the shelter, and she didn’t know what to do. Within two hours, we had the whole family on its way to Jerusalem for a one-week stay in a hotel.”
This was just the beginning. The family, which depended on social security, had no funds since Nahariya’s National Insurance offices had closed because of the bombing. Abramov arranged for payment to be made through the Jerusalem office. She found a Jerusalem organization for the handicapped to care for the eldest son during the day and obtained accommodations for the family in another hotel for a second week.
“The Hadassah teams added immeasurably to our manpower and to our resources at a time when we desperately needed both,” says Ada Schenfeld. “I stayed on in Nahariya after half the population left because Nahariya is where I live and work. Hadassah came here because they wanted to.”
“Many medical centers promised to help us,” says Jackie Sabag, mayor of Nahariya. “Hadassah is the one that came.”