IDF in Nepal: Small country, big heart, warm hands
Less than three weeks has passed since the highly successful IDF field hospital team returned from saving lives and limbs in Nepal. The sights and sounds still remain with them.
By JUDY SIEGEL-ITZKOVICHDr. Ofer Merin (top, second from left) and Prof. Jonathan Halevy next to him; Prof. Amos Peyser (bottom row, second from left) (photo credit: SHAARE ZEDEK MEDICAL CENTER)
One of the smallest countries in the world – Israel – surpassed by far the largest in the world – China – in providing search-and-rescue and medical assistance to the victims of the 7.8-magnitude earthquake that devastated Nepal on April 25.Not only was the Israel Defense Forces’ field hospital by far the largest, with 260 people, including 45 physicians and with nurses, x-ray technicians and more. It was also among the speediest to arrive, even though the team came from nearly 5,000 kilometers away, and it included the director-general of a major Israeli medical center and senior department chairmen rather than only junior physicians.China, the next largest, sent only 37 professionals, and Japan four.Between April 26 and May 13, the 122-member Israeli medical team treated 1,600 patients, performed 90 lifesaving operations and delivered eight babies (including six by cesarean section).They brought 95 tons of humanitarian and medical supplies and left some behind for the use of local hospitals. The cost of several million shekels was shared by the Treasury and the IDF. By comparison, other countries sent minuscule teams.The medical director of the field hospital was Lieutenant-Colonel (res.) Dr. Ofer Merin, a senior cardiothoracic surgeon and trauma expert who is deputy director-general of Jerusalem’s Shaare Zedek Medical Center.Merin has been responsible as a reservist for the IDF Home Front Command’s humanitarian relief program and field hospital for six years and has participated personally in five missions to treat victims of national disasters, in the Philippines, Japan and Haiti. He first learned of the Nepal disaster in a call from the IDF on Shabbat, April 25, soon after the earthquake occurred.His permanent IDF unit includes 300 soldiers.“Heading the field hospital is what I do for my reserve duty. The earthquake occurred on Shabbat at 10 a.m. Israel time. We were informed that there were many dead [it turned out to be nearly 10,000].”By 4 p.m. they had already held meetings, and Prime Minister Benjamin Netanyahu and IDF Chief of Staff Lt.-Gen. Gadi Eizenkot took the final decision. The team left on Monday morning, less than 30 hours after learning of the quake.“We had 100 tons of passengers and equipment on the jumbo 747 jet. The Nepalese,” said Merin, “were afraid that the weight would cause damage to the runway – the only one that was usable in the area. Finally, they granted us approval to land.”“About a quarter of the physicians on the team came from Shaare Zedek. “The IDF decided who would go, and I was a partner in the process,” he told The Jerusalem Post. “I know many physicians personally, so I had no problem calling any of my colleagues at any time of the day or night and knowing they would agree to participate.”His first choice was actually his own boss, SZMC’s longtime director- general Prof. Jonathan (Yonatan) Halevy, an internal medicine and liver specialist who, at 67, had not worn his IDF uniform and his rank (major, obtained during the First Lebanon War) – or slept in a tent – for two decades. Ironically, this situation made Merin, as head of the field hospital, Halevy’s superior.“Yonatan is one of the most experienced in the health system. He had never before been on such a mission, but when I called, he said yes within seconds,” said Merin.“It was near midnight when I took the call,” Halevy recalled. “I asked my wife, who agreed immediately that I go. I didn’t have even a uniform to wear, but when I got to the meeting point, several sets and my officer’s insignia were waiting for me, and I got my immunizations. We left less than 30 hours after being called – with a fully equipped tent hospital, x-ray machines, electric generators, respirators, computerized medical record systems, operating rooms, medications, bottled water, kosher food and a synagogue complete with a Torah scroll and kippot,” Halevy said.“Yonatan is an excellent doctor and executive,” Merin explained.“Having a very senior physician on the team raises its level of legitimacy and gives a good feeling to the whole delegation. And he didn’t get any leniencies due to his seniority. He hauled heavy crates of equipment when we set up the field hospital, just like everyone else.” (Halevy returned home with a tighter belt and minus two kilos.) The team included medical staffers from nearly every other Israeli general hospital, including Sheba, Rambam, Hadassah, Carmel, Bnai Zion and Kaplan Medical Centers.As physicians and Israelis, “We regard humanitarianism as a strategy. We take responsibility for others, and we have abilities,” said Merin. Cynics might argue that saving 1,600 victims whose future is uncertain is “only a drop in the ocean.” But the cardiothoracic surgeon declared that Jewish tradition regards saving just one life as “saving a whole world. The influence we had was so much greater than those we treated and saved.It encompasses their families and those who heard about what we did. When the people of Nepal see that we have come from so far away to help them, they come to the realization that they should help themselves too. The Nepalese disaster is a wakeup call, and it does something to a country when others arrive to help. This means a lot of drops in the ocean.”The IDF regarded the mission and its team as so important that the commander of the Home Front Command, Maj.-Gen. Yoel Strik, and Surgeon-General of the IDF Medical Corps Brig.-Gen. Dudu Dagan flew over specially and met with the commander in chief of the Nepalese military forces.One woman who made a vivid impression on the Israeli team was a Nepalese woman in her 20s who had been pulled semiconscious out of the rubble by international rescuers and brought to the IDF field hospital after five days of being trapped.“By the time we left the country, she was talking and no longer attached to a respiratory machine. Individual cases like this remain in your memory, and you feel an emotional connection to them,” Merin noted.Although there were a few interpreters on hand at the hospital – including some Nepalese who had worked in Israel – in most cases the medical teams couldn’t communicate with the wounded and sick because few locals spoke English.“It’s a different medical culture than ours. They have a different way of speaking to others, different views of the end of life. What is good for Israelis is not necessarily good for Nepalese,” Merin said.As Israel, on the edge of the African Rift Valley to the east, is overdue for an earthquake of its own, coping with and treating quake victims is also good practice and raises our expertise, said Merin, who had never been to Nepal before.HALEVY DIDN’T give a thought to the possibility that the mission might be dangerous. “Ofer suggested to me that I be director of the field hospital’s internal medicine department. You don’t forgo participating in such a mission.I didn’t think of the personal risk, that there might be another earthquake [which there in fact was, with a 7.3 magnitude] soon after the team left Nepal. We slept in the tents we brought, not in buildings that could have collapsed. And the IDF sent experts in the prevention of communicable diseases. I have been a physician for 42 years. It doesn’t cross your mind that there might have been danger.”Communication with Israel was made possible with satellite and local phones; there was no Internet connection during the first week.“But the IDF always encouraged us to call home. There were women in the team who left as many as four or six children at home, and their husbands and other family members took care of them.” Halevy said.As Nepal’s people live in a very different climate – it was winter and monsoon season – the doctors witnessed diseases they don’t encounter at home. Halevy remembers a 35-year-old man who showed signs of weakness and who was suspected of having multiple sclerosis. But his problem turned out to be neurocysticercosis – with worms in his brain.He was successfully treated with the same drug as another patient, who had suddenly vomited a large worm, the result of the accidental ingestion of tapeworm eggs in contaminated pork.“I had last seen such a case when I was an intern decades ago at Petah Tikva’s Beilinson Hospital,” said the Shaare Zedek director.Of all the 1,600 treated, including 80 with very serious injuries, “just” three died. About a third of the patients were children, some of whom had lost their parents. As most patients did not suffer from internal diseases but injuries from the quake, Halevy’s department cared mostly for people who suffered from orthopedic injuries and needed surgery or casts.“We helped prevent infections with help from two of our infectious disease experts, Prof. Eli Schwartz and Dr. Tamar Lachish.”The IDF’s chief psychiatrist also helped out with victims suffering from psychological trauma. The team included medical clowns who tried – and succeeded – to win smiles from children who had lost everything in the quake.Although Halevy was busy throughout, he held daily debriefings in his department after the medical team woke up, ate and sang Hatikva. Halevy gave lectures of more than an hour on risk management, liver disease, complementary medicine (on which he wrote a book) and other subjects to whoever wanted to listen every morning.“I felt the same satisfaction and joy at helping people in Nepal as I do every day when I arrive at Shaare Zedek. Personnel from the local hospital situated 250 meters away from us came to listen as well. We also went to the oncology department there to give advice after we were invited to come.”AMONG MERIN’S other senior Shaare Zedek colleagues who were on the team was Prof. Amos Peyser, head of the orthopedics department.“Most of the injuries were orthopedic. Those whose abdomens were crushed by the rubble rarely survived. We saw a lot of open fractures with bones exposed, and we had to do amputations. They will get prostheses in the future, but I can’t say they will be of the quality that they would get in Israel.”Like Halevy and Merin, Peyser had never been to Nepal before, but also like them his children had gone on treks to the Far East.“I learned from being in Kathmandu that there are many layers in Western culture that one can do without. Things at home look necessary and urgent, but here, you see you can do without them and just sleep in a wet sleeping bag in a tent and take cold showers,” said Peyser, who performed about half of all orthopedic operations there.“It was hot during the day and cold at night. We surgeons ourselves carried the patients around on stretchers. When we got a tent with an actual floor and aluminum ribs, we felt grateful and at home. It’s a territorial thing.”With so much destruction, “You can’t solve all the problems. There remained humanitarian problems we couldn’t deal with; they weren’t part of our job. But the work we managed to do was way beyond our expectations. We are still in contact by email with local orthopedists who are treating patients we cared for. We arranged for one to come to Israel for more advanced training.”Many of the members of the medical team were not religiously observant Jews; there was at least one Druse. A Jewish prayer service was held thrice daily and on Shabbat, complete with everything one could think of.“Shabbat was different,” said Peyser, who like Halevy is modern Orthodox. “We felt the difference. We were out of our uniforms then. There was a lot of camaraderie. Maybe 100 Israeli backpackers also joined the services.”It was these Israelis who helped locate Or Asraf, the one Israeli backpacker who died in an avalanche during the quake.Hours after their return home, the three senior Jerusalem physicians learned of the tragic second earthquake that had struck Nepal and killed many dozens more.“It was hard and very painful to think about it,” concluded Merin.“We had connected emotionally with local people. We would have returned if it had been possible. But at least we heard that those we had dealt with had survived the second quake.”