The Koret Veterinary Teaching Hospital provides both basic and sophisticated health care to all creatures great and small.
By BARRY NEWMANvet feat 88 298(photo credit: )
At a little past 11:00 one Saturday night, three soldiers come running into the small Hebrew University teaching hospital in Beit Dagan, not far from Rehovot. A comrade, they frantically explain to the receptionist, has suddenly taken ill; his breathing has become strained and he's having trouble standing.
The woman behind the desk nods, picks up the telephone and calmly exchanges a few words with someone on the other end. No more than a minute or two passes before a physician accompanied by two assistants wheeling a stretcher arrive.
With practiced skill they put the stricken Shmulik at ease and place him onto the stretcher. The physician motions the three soldiers to the waiting area, promising to return once she determines what the problem is.
One of the three goes outside to grab a cigarette while the other two get on their mobiles to update others anxiously waiting for news. The three nervously pace, their faces etched with concern and worry.
After 20 stressful minutes that seem like hours, the physician returns. Smiling, she assures Shmulik's three friends that all will be well. Some tests need to be run, but it appears that Shmulik is suffering from an intestinal problem that should be easily corrected.
The three, visibly relieved, breathe easily and again get on their cellphones to let the others at the base know that Shmulik is going to be okay and that he'll soon be back scampering after wandering cats and gnawing on the liver-flavored bones he loves so much.
Welcome to the Veterinary Teaching Hospital of the Koret School of Veterinary Medicine.
Until some 20 years ago, anyone wishing to study be a veterinarian had to go abroad, more often than not to the US, Germany or the UK. But thanks in no small measure to the ongoing funding of the San Francisco-based Koret Foundation - founded by the late philanthropist Joseph Koret, whose support extends throughout Israel - the Hebrew University introduced in 1985 a seven-year course of study leading to a Doctor of Veterinary Medicine.
Forty-five students are admitted to this teaching facility each year where, in addition to the basics, they are given the opportunity to become certified in a number of specialties.
Located on the sprawling, manicured grounds of the Ministry of Agriculture and Rural Development, the school - situated next to the Kimron Veterinary Institute - opened the Dr. Irving and Edith Taylor Animal Hospital in 1988, where students receive hands-on clinical training. The hospital's 100-member staff of licensed vets, nurses, students and National Service (sherut leumi) volunteers see nearly 10,000 patients a year.
Though routine procedures are performed and ordinary ailments are taken care of, here complex hip replacements, pacemaker insertions and treatments for neurological disorders are the norm.
Operating around the clock 365 days a year, the hospital provides both basic and sophisticated health care to virtually the entire spectrum of the wild kingdom. The majority of those the hospital tends to are dogs and cats, explains Yael Maoz, the facility's spokesperson and public relations director. Horses are also brought in for treatment, and emergency rooms, operating tables and stables have been specially designed to facilitate their care.
It's not at all unusual for the hospital to treat more exotic patients. Staff vets have been trained to care for such animals as owls, parrots and even snakes. Indeed, they are extremely and justly proud of the successful brain surgery they performed last year on a lion, which was, says the hospital's director Dr. Hylton Bark, "somewhat beyond the routine."
Although there are two other animal hospitals in Israel - one in Beersheba and the other in Ramat Hasharon - neither is as extensive as the one in Beit Dagan nor as expansive in the breadth of health care services and clinical procedures offered at Koret.
A number of private vets operate what are in essence mini-hospitals complete with laboratories, operating rooms and X-ray equipment, but round-the-clock care in these private settings can be problematic and are not always suitable for an acutely ill animal. Nor are all vets trained as specialists in particular ailments or techniques, such as treatment for diabetes, slipped discs or complex re-setting of broken limbs.
Owners of pets with ailments or problems requiring specialized knowledge and experience are frequently referred to Koret for treatment.
Particularly annoying for Dr. Bark is the absence of recognized standards under which Israel's animal hospitals - including the privately run clinics - should operate. The American Association of Animal Hospitals (AAAH), he explains, has defined specific thresholds on the care and treatment provided in animal hospitals, thresholds that have both ailing animals and their owners in mind.
Efforts at having the Knesset deal with this deficiency have thus far proved futile, so norms for establishing acceptable levels of service, as well as the kinds of treatments that vets can offer, remain on the drawing board.
Benchmarks for defining the quality of care are essential, complemented by an evaluation program to make certain that there are adequate treatment facilities and equipment in every hospital, as well as required staff training and communications.
But clinical excellence is only part of the story; compassion for both ailing pets and their owners is another threshold demanded of animal hospitals. A bond of sorts needs to be formed between health practitioners and pets and their owners. This bond, Bark believes, is the essence of veterinary practice, one that allows the attending veterinarian to fully appreciate the condition of the animal being tended to and make a professional recommendation that the pet's owner will understand and accept.
Bark believes that the Koret animal hospital meets, if not exceeds, the thresholds defined by the AAAH, and it strives to meet the increasingly sophisticated health services that animal lovers and pet owners are demanding.
The hospital has more than a dozen internationally recognized specialists in fields including cardiology, oncology, imaging, neurology and internal medicine. And while household pets take up most of the staff's time and attention, referrals not infrequently come from such institutions as the Jerusalem Biblical Zoo, the Ramat Gan Safari Park, the Society for the Protection of Nature in Israel and the Israel Police Guide Dog School.
The hospital, however, is open to the general public, and pet owners seeking the most advanced care of an ailing dog, cat or hamster need not wait for a referral. Their pets will be in competent, well-trained hands, and readily available are state-of-the-art equipment, physicians trained in the most modern techniques and procedures, and a support staff that has a soft spot in their hearts for all creatures large and small.
Resembling in many ways a health facility for humans, the Koret Animal Hospital has areas and departments set up for the different specialties it offers. In addition to a blood bank (animals too have different blood types), there are rooms for radiology services, ultrasound testing and heart irregularities. The facility includes four separate operating rooms, an area for specialized physical therapy and an isolation ward for animals with infectious diseases. Cages line the admission ward, where animals requiring more intensive treatment are looked after, monitored and taken out to relieve themselves. Owners are free to come, night and day, to visit their pets and discuss with the attending physicians how things are going.
The services provided by the hospital come at a price - one that can get quite hefty. It's not unusual for treatments to wind up costing thousands of shekels, and more than a few pet owners have been known to walk out when faced with the estimate for a particular type of surgery or therapy.
The director is not unsympathetic to pet owners who simply cannot afford the cost associated with animal healthcare. He emphasizes, however, that the hospital's prices are based on those recommended by the Israel Veterinary Institute; but because "we perform more extensive testing - for example, we will not anesthetize an animal before making sure that it is sufficiently healthy to be anesthetized - the bottom line is not an easy one for many to accept."
Many, though, do. Tammy (not her real name) is one of them.
"Our dog," she says tearfully, "developed a prostate problem that wound up infecting and damaging his kidney. He endured two separate operations, went through a battery of tests, including an ultrasound by a recognized expert in canine ultrasound, and received drug and fluid therapy for more than two weeks in the hospital. We spent nearly NIS 10,000 and in the end had to put him to sleep. We were, I guess, clutching at a straw, even though nobody - neither our private vet nor the staff at the hospital - gave us false hope. The dog, we felt, deserved the chance to get well, and although it put us a little behind financially, that we did the right thing is not even a question."
Rafi, on the other hand, found the cost of treatment more problematic.
"Maddy - named for Madonna, whom my daughter is absolutely mad about - has some sort of a heart problem. They told me at Koret that the surgery and treatment would cost about NIS 4,000."
He pauses while looking down lovingly at Maddy. "Look, I told my son that he can't have NIS 300 for a new pair of running shoes that he really wants, and we're getting by with a microwave that's seen better days. It's not right, I know, to say that Maddy 'is just a dog' because she's more, much more. But I just don't have that kind of money. I'm not sure what we'll do, but incurring this kind of expense is definitely not an option."
The hospital, Bark points out, became a non-profit organization in 2001 and must, by law, make every effort to maintain a balanced budget. The hospital runs on the income from the cases it handles, the teaching services it provides to the Hebrew University and private donations. And, like many non-profit organizations, the financial challenges it faces are considerable.
Major items of equipment, he and Maoz explain, cannot be purchased due to budget restrictions and the unlikelihood that many pet owners would be able to afford the cost associated with using them. The hospital is consequently forced to do without dialysis machines or specialized devices related to nuclear medicine. Nor can the hospital be overly charitable as far as fees for services are concerned.
Although it does not yet exist here, health insurance for animals is not unheard of, and there is discussion with local insurance providers to create a policy that would cover some of the more expensive types of care and treatment. Such coverage has been successfully implemented in the UK, which is being used as a model for these discussions.
Nonetheless, every effort is made to be understanding and accommodating. Where possible, the hospital provides options and alternatives to pet owners, offering recommended forms of treatment - usually involving extensive testing - as well as those involving minimal expenses and physician intervention.
"We also try to offer generous payment plans and allow pet owners to spread payments over a period of time. And we will not begin any treatment without first explaining to the pet's owner what exactly is going on and how much it will cost. Transparency is, we believe, a key to trust and confidence," says Bark.
Nor will the hospital turn strays away. Although not an official or advertised component of the services they provide, abandoned or lost dogs and cats often wind up in their care.
"We make sure they are reasonably healthy and give them some basic healthcare, if needed, then try to find them suitable homes or turn them over to one of the various pet adoption services that exist in Israel. Our budget does not allow for much more than that."
Nor does the budget allow for what is perhaps the hardest hurdle a pet owner faces - final separation.
"Some animals," Bark acknowledges, "cannot be treated. Inoperable or untreatable cancer is not at all uncommon, and treatments for some ailments that might work on a younger dog will not work on an older one. We are, of course, absolutely honest and advise pet owners of such circumstances."
Until recently, a psychologist on the hospital staff provided grief counseling to pet owners facing the need to put, in essence, a member of the family to sleep. Budgetary restrictions forced the hospital to cut this position, but hospital staff regularly hear lectures and attend seminars on the subject.
While primary healthcare is a crucial part of the hospital, the clinical training it provides to the veterinary school students is regarded as no less significant. Bark emphasizes the need to have high-quality veterinarians to meet the short- and long-term demands of the profession.
The hospital introduces students to cutting-edge medical care and enables them to participate in important research studies.
Both Bark and Maoz bristle when the subject of animal experimentation is raised and find what some researchers do in the interest of science utterly offensive. "Our research," Bark explains, "is limited to case studies, observations and comparisons. With the owners' approval, we might give two sets of animals suffering from the same ailment different medication and monitor the effects - both positive and negative - on each. Or, if there is a new form of drug therapy or surgical procedure that has gained acceptance in the veterinary community, we might ask permission to apply this new approach to one of our patients. The owners receive a significant price discount if they agree, and in some cases the treatment is provided free of charge."
It's not yet 10:00 in the morning and the hospital's parking lot is nearly full. The emergency room is bustling with activity, and the physicians and students are making their rounds. Blood pressures are checked and recorded, evaluation meetings are convened and operating rooms are getting readied. Panicky owners such as Shmulik's are being calmed with patient explanations of what their beloved pets are ailing from and how they are to be treated.
The Koret Animal Hospital is, in short, a place of considerable drama, not unlike what goes on in human hospitals, but intensified by patients who can't tell you how they feel or where it hurts. And yet you get the distinct feeling that the animals being tended to understand that they are being helped and that the splints restricting their movement and catheters they're forced to wear are for their own good.
An understanding, no doubt, forged by the practitioner-patient bond Dr. Bark speaks about.
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