Healthcare in uniform

Lieutenant-Colonel Dr. Hadar Marom, head of the IDF’s Medical Services Branch, speaks to the 'Post' as August enlistment begins.

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August 11, 2013 02:46
Dr. Hadar Marom

Dr. Hadar Marom. (photo credit: IDF Spokesman)

 
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When sons and daughters don an Israel Defense Forces uniform for the first time, their parents’ responsibility for them ends and the military takes over. The IDF feeds and houses them, worries about their lives and takes charge of their physical and emotional health.

In August, as large numbers of young civilians enter the military following their graduation from high school (or higher education, in the case of the Atuda academic officers’ program), soldiers (and their parents, who have paid health taxes for them) may wonder what happens to their membership in one of the four public health funds; how they get medical care on their bases and where to go if they feel unwell during home leaves. Given the shortage of physicians and nurses around the country, does the IDF have enough medical personnel to meet the needs of all soldiers? Many young men and women who intend to go to medical school prefer first to complete their three years of IDF service and then to launch their studies in the various medical faculties, free from obligations.

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Some have preferred the Atuda track, studying medicine at the expense of the IDF and making a commitment to serve as a career physician in the military for a number of years. But that too has not filled the ranks of military physicians and nurses, and some were hired by the IDF as civilians.

Some three years ago, the IDF Medical Corps teamed up with a new Jerusalem military medical studies track called Tzameret to produce physicians customized according to the actual needs of the military and to implement research advances on the battlefield and off. This went beyond the usual Atuda program in the country’s medical faculties. The establishment of Jerusalem’s IDF/Hebrew University- Hadassah Medical School’s military medicine track – known by the Hebrew acronym Tzameret (“the Acme”) – is currently producing future physicians promoting joint military medicine research by its two “parent” institutions. The growing shortage of career physicians in the military and the special type of doctors needed in the IDF were the impetus behind the move. Jerusalem was chosen for the special school after beating Beersheba’s Ben-Gurion University of the Negev in the tender.

Tzameret students, who commit themselves to serve in the IDF for a number of years after graduation, study all the subjects on the regular HU-Hadassah Medical School curriculum, in addition to taking additional courses relevant to the military, including military physiology and ethics, crisis management, emergency medicine and leadership development.

Nevertheless, it’s only the beginning. It will take a minimum of seven years before Tzameret’s first physicians graduate and join the IDF. In the meantime, the military is doing its absolute best to meet the healthcare needs of all its soldiers.

Lieutenant-Colonel Dr. Hadar Marom, a family physician who was an Atuda graduate of the Rappaport Faculty of Medicine at the Technion-Israel Institute of Technology, spends all of her worktime on military healthcare. Working out of the IDF’s huge facility at Tel Hashomer, she serves as head of the IDF’s Medical Services Branch and has served in the IDF for 19 years.



The first thing that draftees should know is that when they join the IDF, it informs the National Insurance Institute – which collects monthly health taxes from all residents – that they are now part of the military and that the money is no longer to be deducted from parents’ salaries or bank accounts. The soldier’s membership in one of the four health funds is also suspended.

Soldiers then receive all their healthcare via the IDF Medical Corps, from clinics with primary care physicians, public hospitals if they need significant medical treatment; and private Bikur Rofeh clinics in the community if they feel unwell on leave. The primary care clinics that form the backbone of military healthcare are at the level of battalions and units. “Some of the facilities are open around the clock, but most observe regular office hours,” said Marom in a recent interview with The Jerusalem Post. Soldiers are each assigned a personal primary physician who gets to know them, as in civilian life; this is preferable to going to any doctor who is free. These physicians are military personnel or civilian employees working for the IDF. There are also non-MD medics and paramedics to give first aid.

A few decades ago, a soldier sleeping in a tent as bitten by a small rabid animal and, paying little attention to the wound, he went without rabies shots and died. Marom stated that today, all soldiers are giving detailed instructions from their commanders on what to do to avoid snakes, scorpions and other harmful creatures and what action to take if they are hurt.

An experimental program was set up two years ago for soldiers at the Tel Hashomer base and at the Kirya in Tel Aviv; they are permitted to receive routine medical care like any civilian from the health fund of their choice. But, said Marom, “this is only a pilot, and we don’t know yet if it will continue, expand or be cancelled. We have to determine if it’s been successful.”

At induction, soldiers receive a small bound notepad with basic information, addresses and phone numbers; among the numerous subjects are health services. But there is no booklet devoted just to health, and the notepad is viewed only by soldiers, not by their parents or other members of their families. When I suggested to Marom that such a booklet be produced, she said it was a “good idea” and would seriously consider producing and distributing such a publication. A round-theclock information and appointment service for military healthcare can be reached at *6690 and 03-9489999.

THE SHORTAGE of medical personnel “is a challenge to the IDF. To try to cope with the shortage, we established Tzameret with Hadassah, but it will still take years to see the students graduates. There’s a lack of physicians around the country, especially in the periphery. We also opened a school for nurses at Tel Aviv University for those who will work in the IDF,” the lieutenantcolonel said. “We have nurses in the mostly larger clinics. The new school should help bring more of them into service.”

When soldiers are away from their bases, including Shabbat and holidays, they can go to any of 12 Bikur Rofeh urgent-care clinics. Two of them were opened only recently. Details on their location and opening hours are available on the website of Bikur Rofeh, which was chosen by a public tender.

A few years ago, a TV program that investigate Bikur Rofeh urgent-care services for soldiers was highly critical, claiming that large numbers of feverish, coughing and aching IDF personnel sat around on Saturday nights waiting in the queue for hours until they reached their turn. “There is criticism,” Marom said. “But the company’s services for urgent care has improved, and it is good. We make surprise visits from time to time. The Defense Ministry’s agreement with Bikur Rofeh states that the soldiers must be seen by a doctor within 90 minutes of waiting. We are satisfied. If there are complaints, we always check them.”

THE IDF has a new arrangement with the four health funds – Clalit Health Services, Maccabi Health Services, Kupat Holim Meuhedet and Kupat Holim Leumit – in which they automatically transfer soldiers’ medical files to the IDF so its doctors are well informed about previous illnesses and conditions. The data also helps the IDF set soldiers profiles. Although some might protest that this violates privacy and knowledge of such transfer could deter some soldiers from telling their civilian doctor about their full medical histories, this is necessary so military physicians can assess the soldiers’ conditions, said Marom. If a young person has an existing condition that exempts him from military service, he can apply to serve as a volunteer, and many do, even if they are deaf, blind or – for example – are an HIV carrier.

If a healthy soldier develops an illness or suffers an injury that no longer requires him to serve, his medical profile will be reduced and he may serve as a volunteer, with medical services from the IDF.

Newly inducted soldiers who take medications for chronic illnesses are asked to bring enough with them when then begin service so that they won’t run out before military doctors get for them a regular supply.

More than six decades ago, the young State of Israel inherited military hospitals from the British, But the state then transferred all these venerable institutions to Health Ministry ownership and operation. “We cooperate very well. We aren’t contemplating the idea of building a military hospital of our own.”

When a soldier is hospitalized, the IDF sends representatives from what have been dubbed YAKAR units who coordinate and help provide all necessary assistance.

These serve as a matter of course in every general hospital in the country. If a soldier is sent to a rehabilitation hospital where there is no such permanent presence, it is arranged there as well.

Decades ago, certain combat units required mishma’at mayim – literally, water discipline. For the soldiers to cope with the possibility that they may have to fight without enough water, they had to undergo arduous training without being able to drink as much water as they liked. This practise actually endangered some soldiers’ kidney function. Some combat soldiers also had to function without sleep.

But Marom said that since she enlisted, she knows of no such policy. Soldiers can drink as much water as they like, and six hours per 24 hours are set aside for sleep.

Military gynecologists are available to consult on any relevant problems and to treat them in women soldiers.”They can also go to women doctors if they like.

They can receive free contraceptive pills if they like. A woman soldier who becomes pregnant reports to a special adviser of the IDF chief of staff’s office. If she decides to go through the pregnancy, she is released from service, while a woman who prefers to terminate the pregnancy gets all necessary assistance,” Marom said.

Dental care is also provided to soldiers in the regular army at IDF expense with their own dentists or civilians on reserve duty.

AS FOR prevention, the IDF invests a significant amount of effort, she continued.

“Getting soldiers who smoke to kick the habit and discouraging non-smokers from starting is very important to us,” said Marom, who is well aware of the Annual Smoking Report’s statistics showing that more soldiers leave the service with a cigarette between their fingers than when they were inducted. “We offer smoking-cessation courses. Officers are more likely to be included, but we really try. No smoking is allowed inside buildings,” she insisted.

“They have to go to designated outdoor areas if they smoke.”

While she said that while the sale of water pipes (nargilas) is forbidden in canteens run by Shekem, the purchase of cigarettes there is allowed. The IDF doesn’t generally decide what is sold there, except nargilas and alcohol, whose use in the IDF is prohibited and punishable if it is discovered.

When asked why the sale of cigarette packets on bases is not prohibited (given the IDF’s efforts to minimize tobacco use in the ranks), thus discouraging smoking by inconveniencing soldiers who would have to bring them from home, Marom said she would “look into it.”

Marom, who was only the second female military physician in the IDF, concludes that “we have purchased better equipment” for dealing with anything from battlefield injuries to migraines. “Soldiers get everything they need. We listen to them.

It’s important to promote soldiers health.

We trust every soldier. There may be some malingering, but if a soldier insists he is ill, he is free to explain, and every complaint is examined seriously.”

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