Medical clinic in Jerusalem's haredi quarter is only for observant women.
By JUDY SIEGEL-ITZKOVICHbshvilaych 224(photo credit: Judy Siegel-Itzkovich)
The non-profit B'Shvilaych medical clinic, located in a secluded lane in Jerusalem's haredi quarter of Geula, is unusual not only for the fact that it accepts only female patients. It also has no medical equipment except for a few examining tables, a scale and a sphygmomanometer for taking blood pressure.
Meaning "For You [feminine]" in Hebrew, B'Shvilaych is claimed to be the only holistic wellness facility for religious women (haredi and Modern Orthodox) in the country; founder and CEO Sara Siemiatycki and medical director Dr. Diana Flescher don't know of anything like it anywhere in the world. Yet the model could easily serve other populations such as Arab Israeli women who have large families, tend to give their own health low priority and - for reasons of modesty - prefer women doctors to examine them and discuss intimate matters.
Born in Detroit, Siemiatycki came on aliya in 1976, trained as a medical lab technician and worked in the Neve Simcha old-age home in the haredi Jerusalem neighborhood of Mattersdorf. Then, one day, the home decided to outsource its lab facilities, giving the observant Siemiatycki an opportunity to think of doing something else. She had noticed for a long time that, as primary caregivers in their large families, haredi women often ignore their own health. Thus they access medical services, undergo diagnoses and get treatment at later stages of illness.
Flescher, who studied at the State University of New York at Stonybrook and specialized in internal medicine, came on aliya in 1981 and worked for the Jerusalem Family Medicine Center in the capital. Eleven years ago, she set up her own private practice specializing in women's health at her home in the city's Ir Ganim quarter, which she continues to run.
BOTH DREAMED of providing medical examinations, education and guidance to women through all stages of their life cycles. Looking for a donor to turn her vision of a religious women's clinic into reality, Siemiatycki - who has eight children aged 14 to 30 - found US businessman Gary Barnett, whose Belgium-born wife Evelyne had died young, leaving him with five children. He agreed to donate funds to found B'Shvilaych in February 2006. Flescher was the natural candidate to be medical director. Since then, additional donations have been made by the Reichman family, the Friedberg Foundation and the Jesselson Foundation, among others. The clinic is now working to set up an executive board.
Using a minimum of advertising in the religious media and benefiting mostly from word-of-mouth, the clinic attracted 70 patients in its first year and 500 in 2007. The directors would like to handle 2,000. The youngest patient is 13.
Flescher stresses that B'Shvilaych doesn't replace the public health fund services to which every Israeli is entitled in exchange for paying health taxes. "We are not affiliated to any health fund, but our five female physicians refer patients for tests and visits to specialists," she says. The religious women's clinic, however, offers something else: plenty of personal attention, a view of the whole person, and a focus on health education and disease prevention.
"The problem," adds Siemiatycki, "is the health system; it offers only a few minutes' consultation with your health fund doctor, and doesn't focus on prevention or health education." Patients fall between cracks in the system.
For example, Siemiatycki relates the story of a middle-aged woman who was referred by her health fund doctor for mammography after feeling a lump in her breast. "The radiologist saw 'something' but didn't think it was significant and didn't refer her to a surgeon, or even tell her general practitioner. There was no followup."
B'Shvilaych staffers, she says, never leave loose strings. Everything is registered and followed up, and every patient has a card and electronic record of what screening tests they have done and should still do. Patients pay NIS 250 per visit (if they really can't afford it, they pay whatever they can); some come only for an annual checkup, while others come more regularly. The clinic eventually hopes to make arrangements with the health funds to subsidize visits.
Taking good care of religious women is in the interest of the insurer, as it is known that they prioritize differently. "Haredi women generally give higher priority to the needs of their husbands and many children, and put themselves at the bottom of the totem pole," notes Siemiatycki. As a result, breast cancer (for example) is diagnosed much later in haredi women than in their secular counterparts. "I am just describing reality. We are trying to teach our patients to become more proactive and preserve their health."
FLESCHER, WHO is not religious but had some contact with haredi women in her private practice, felt there was a tremendous need for B'shvilaych. When a new patient arrives at the tastefully refurbished clinic, located in a rented, 100-year-old building (which previously served as a Talmud Torah school), she spends two hours there. "A nurse devotes about 45 minutes to take a medical and family history, write down her lifestyle habits, check weight, blood pressure and body-mass index. Then the patient sees one of the female physicians, all of whom are internal medicine or family specialists." The physician does a complete review, including physical and breast exams, as well as a Pap test. She sends recommendations and referrals to health fund doctors if there is a specific problem.
"We have many patients who say they feel more comfortable with female physicians when they ask about urinary problems, menopause and sexuality problems, or need a breast exam," says Flescher. But the doctors are also on the lookout for ordinary and postpartum depression, physical or emotional abuse, financial distress, emotional trauma and other conditions that patients could hide. "We always gently ask patients if they feel safe at home, if they get enough help with childcare or housework, and if they have been victims of a road accident or terror attack."
There are women, she adds, who have given birth to 17 children and are fine, and there are mothers of five who are overwhelmed. "We don't ask patients if they are happy, but we do ask them to rate their own health on a scale of one to five."
B'SHVILAYCH DOCTORS encourage young women to take folic acid to reduce the risk of neural tube disorders in their fetuses before they get pregnant, as well as vitamin D, which many religious women lack because their clothing prevents exposure to sun and puts them at high risk of osteoporosis. There is also a lot of iron-deficiency anemia.
Very few observant women smoke, but many of their husbands do. The clinic staff encourage patients to get family members to quit smoking and, if unsuccessful, at least explain how to protect children from passive smoking.
As religious families generally are very willing to undergo unproven complementary therapies, the clinic doctors always ask what herbs or other treatments they take, as these can interfere with medications. Few patients reveal such things to their doctors.
Patients are also asked if they use contraception, "and not a small number do. Often brides come before their wedding for help in preventing a menstrual period on their wedding day. But others use contraception due to medical problems, or in order to space pregnancies. There are lots of women who have too-frequent menstrual bleeding. This causes a lot of problems with nida [family purity] rules. We also do a workup for fertility problems," says Flescher.
She recalls that many patients say: "This is the first time somebody really listened to what is bothering me. It's the first clinic that supported me. I feel nurtured." Not only Jerusalem residents come, but from as far as Bnei Brak, Haifa, Ashkelon, Safed and the Etzion Bloc. The religious outlook ranges from National Religious settlers to Neturei Karta and Satmar hassidism.
Flescher, who is married to a biologist and has two children, wears pants at home, and comes to the clinic with uncovered hair but wearing modest skirts and blouses. "We also have to be sensitive to the restrictions of the haredi community."
There are a few hospital and health fund "women's health centers" in Jerusalem, says Flescher, "but none is staffed solely by women physicians and geared to the religious woman. They focus on gynecology, but there is much more."
"We want to empower patients with knowledge. An increasing number of haredi families, especially English speakers, have Internet at home or at work. B'shvilaych staffers give lectures on health in the neighborhood and also at companies that hire observant women. "When I compare the health awareness of haredi women today and what they knew 10 years ago," says Flescher, "the difference is amazing. The more women are educated about health care, the more committed they will become to maintaining healthier lifestyles."
Men, the medical director continues, "would also benefit from a place like this, but we focus on religious women, as they are most in need."
Health Ministry associate director-general Dr. Boaz Lev has not visited the clinic yet, but knows of Flescher's work and the aims of B'shvilaych. He said later that he strongly endorses the clinic's approach of encouraging religious women to take better care of their health.
B'shvilaych is at Rehov Reshit Hochma 22 in Jerusalem's Geula quarter, tel. (02) 502-1096, and its Web site is at www.bishvilaych.org.
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