Environmental and occupational medicine is a profession only for the truly dedicated idealist.
By JUDY SIEGEL-ITZKOVICHElihu Richter(photo credit: Courtesy)
One has to be crazy to go into environmental and occupational medicine - not crazy in the sense of insanity, but enthusiastic and even obsessed by a drive to protect people from pollution and dangers posed to human health at the workplace and on the roads.
There's a small cadre of Israeli physicians and public health experts devoted to this field, even though it is not financially profitable or regarded as prestigious in a country that devotes the vast majority of its health expenditures to treating disease rather than preventing it. This pro-active group can best be described as idealistic "troublemakers" as they fight business and the establishment - often tilting at windmills and arousing opposition from vested interests.
But they have also had numerous victories in persuading the authorities to remove lead from gasoline, dispose of asbestos fibers, minimize pesticide and solvent use, halt the flow of sewage and petrochemical waste into rivers, control radio-frequency microwaves, improve the environment for children and install speed cameras on the roads.
The ranks of these do-gooders have now been reduced by one, with the retirement of Prof. Elihu Richter from his post as director of the Unit of Occupational and Environmental medicine at The Hebrew University-Hadassah Braun School of Public Health and Community Medicine. But the former New Yorker and graduate of Columbia, New York and Harvard universities is unlikely to go quietly to a pensioner's life; at his modest farewell party in Jerusalem's Adenauer Convention Center on Sunday night, colleagues urged him to continue fighting as a volunteer. The same sentiments were expressed a few days before, at the conference on environmental pollution and health held at Hadassah University Medical Center in Jerusalem's Ein Kerem by Hadassah-Israel and Hadassah College.
ENVIRONMENT MINISTER Gideon Ezra, who has been in his post for only a few months but already seems enthusiastic and sober about the challenges, set the tone at the conference in a lengthy address. Announcing that he just decided to change the name of his ministry from "Environmental Quality" to "Environmental Protection," Ezra said he had met with his German counterpart, who reported that Saudi Arabia is building a new petrochemical facility 300 km from the nearest city so it would not harm the population. Ezra compared that to the situation in little Israel, where polluting facilities are on the doorstep of residential neighborhoods.
While environmental threats are so menacing, only 0.05% of the state budget goes to environmental protection, and the ability to monitor and police is limited. With only one million of seven million tons of construction waste buried yearly in legal dumps, the ministry has to depend on citizen alertness to report violations, because "you have to catch truck drivers in the act of dumping." While 93% of Israeli sewage is processed in one way or another, and some is used for irrigation in the Negev, no community is willing to have solid waste processed in thermal burners, even though such techniques have proven to be completely safe - so the mess is dumped into the Mediterranean. Employees who get leased cars from their bosses oppose a Treasury proposal to charge them much more for the benefit, and the only way the government can get highly polluting cars off the roads is to propose offering NIS 3,000 for those more than two decades old and recycling them.
Prof. Hillel Shuval, head of the environmental sciences department at Hadassah College, who came on aliya to Jerusalem in the early 50s and founded the School of Public Health's environmental health lab, said his college in downtown Jerusalem now has 60 of the college's 2,000 students who will serve as new blood in the fight for a more healthful environment. He voiced veiled criticism of the Hadassah Medical Organization's plans to build a $1 billion hospitalization tower on the Ein Kerem campus, noting that HMO should "maintain its historical balance between clinical medicine and preventive care."
Richter, who served as a US Army physician during the Vietnam war and city district health officer of East Harlem in New York, described the highlights of his 35-year career in Jerusalem.
"In public health, there is urgency in finding solutions, as delay can mean loss of life and suffering. We fail many times, and some people feel epidemiology has become an instrument for delay. I am for quick and early assessments of problems, and for timely solutions... This is not for timid souls. Young scientists will encounter adversity and political battles, and there are no means to protect 'whistleblowers' [who report dangers at risk to their careers]."
THE STRUGGLE for unleaded gasoline is an example. "It had long been thought that a certain amount of exposure to lead was harmless, but today we know that any amount is too much. It affects children's moods and school performance, and can even cause hypertension later in life," said Richter. When the lead was eliminated from petrol - the main source of led poisoning besides exposure on the job in battery factories - blood tests show levels are way, way down, he continued.
Richter, who claims to be "lazy" by nature but was drawn into action by his students and people who needed his help, also fought against asbestos, whose tiny particles - which can cause mesothelioma, a deadly lung disease - affected not only those working in factories but also their families, as the particles stuck to their clothing when they went home. They were taught to shower and change their clothes, and their wives and children were spared. After the health dangers of asbestos were exposed in Israel more than a quarter century ago, asbestos factories closed.
One of Richter's former colleagues, Dr. Jerry Westin, sounded alarm bells a few decades ago about carcinogenic residues in human and cow's milk, apparently from pesticides used in cow sheds that affected lactating women because they drank the milk. Although regarded as an oddball or worse, his claims were proven and action was taken. Environmental health experts also discovered that unscrupulous pesticide companies had been using dangerous sprays in homes, causing families to vomit and suffer from insomnia; today, said Richter, these compounds are barred from home use. He reported that counterintuitively, recent studies have shown that reduced use of pesticides on cotton crops actually increase their yields.
A FEW YEARS AGO, Richter was involved in examining the claims of former Israel Navy commandos who had dived for years in Haifa's polluted Kishon River, with at least 20 of them contracting cancer, and he testified before the Shamgar Commission that in 2001 called for an immediate cessation of diver training in the river.
"One hour of diving in the Kishon was equivalent to smoking one pack of cigarettes" in terms of harm to the body, Richter said. Fortunately, the health condition of divers whose exposure to the filthy waters ended have improved, and their risks of disease have dropped to normal levels.
Richter notes that there are "many 'Kishons' in Israel that
have never been investigated. The Kishon River case was very 'sexy' and got attention."
He recalls a 53-year-old man who came into his office at the end of a long day. The environmental health expert was tempted to ask him to come another day, but he didn't. The man said he had two kinds of cancers and respiratory disease - unusual for a person of that age. When Richter questioned him about colleagues in his Israel Military Industries factory in Jerusalem's Beit Hakerem quarter having similar medical problems, it was gradually revealed that the factory - since demolished, and now the site of expensive apartment buildings - used very toxic materials that seeped into the ground. "There was lots of noise, but it was too late to save most of the workers."
He also recalls the case of a school in Jerusalem's East Talpiot quarter, two of whose employees developed breast cancer and multiple myeloma. It turned out that radon building up under the foundations seeped into the building and caused the diseases; the school was vacated so that digging could be carried out to drain the dangerous natural gas. Richter, who has demonstrated the risk (especially to children) of high-power lines and other extreme low-frequency radiation, argues for the burial of such lines underground.
BUT RICHTER is best known to Jerusalem Post readers for his passionate jeremiads on how "Speed kills; kill speed!" He insists that the time has come to halt all road building, which instead of alleviating traffic jams just encourages more people to put cars on the road, and instead to invest in environmentally friendly public transport. Finally, after years of lobbying by him, the Metuna organization and others, 300 Israeli-developed speed cameras will gradually be installed to catch and deter speeders and tailgaters.
"Money for road construction goes to friends of politicians. He has also voiced his strong opposition to the Safdie program for building tens of thousands of homes on the forested hills west of Jerusalem, as the sprawl will only increase pollution, increase road accidents, divert money from health and other social causes and eliminate the city's green lungs.
"We wish we could clone you and put you in the water supply," said Richter's longtime colleague Prof. Elliot Berry, an internal medicine and metabolism specialist who recently ended his tenure at the School of Public Health and handed it over to Prof. Shmuel Shapira.
THE DESCRIPTION by Ben-Gurion University Prof. Shifra Shvarts of a little-known historic achievement - the establishment of a network of playgrounds around the country by the Hadassah Women's Zionist Organization of America (HWZOA) - held the audience's rapt attention. Hadassah philanthropist Bertha Guggenheimer of Virginia established the first playground in Eretz Yisrael in 1925, launching a general educational and environmental health program that brought together thousands of Jewish and Arab, religious and secular boys and girls.
It began during the British Mandate on Mount Zion near Jerusalem's Old City, and soon served as a model for another one in Mahaneh Yehuda. Shvarts noted that bedraggled and impoverished children spent their time away from school throwing rocks, gambling in Arab cafes and digging into garbage cans without any place to play or learn about hygiene. They had no idea what swings, slides, seesaws and showers were, but these were offered to them in the spacious outdoor facilities. Escaping from crowded, one-room hovels and numbing poverty, the children eagerly went to play, but many haredi and Arab parents forbade participating, especially since the two sexes, Jews and Arabs and secular and observant children were mixed together, said Shvarts, who offered detailed documentation with documents and photos.
Rahel Schwartz, mother of Ruth Dayan and Reuma Weizman, who was in charge of the Mahaneh Yehuda playground project for Hadassah, was taken to a rabbinical court by the head of the Etz Hahaim Talmud Torah. There were death threats from both Jewish and Arab parents, who punished youngsters for sneaking away to the playgrounds. Undeterred, Schwartz went to then-Ashkenazi chief rabbi Avraham Yitzhak Hacohen Kook and pleaded with him to allow children to attend. "Go to your work, and all will be solved," he told her, endorsing her project, which offered kosher food and observed Shabbat.
Such rabbinical tolerance and openmindedness, rare in the present day, led to years of fruitful public health achievement.
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