One must sympathize with the heads of public hospitals in the periphery of the country.
With costs skyrocketing and budgets shrinking, they are hard-put to compete with well-funded and well-known medical centers in the center where donors stand in line to make donations for development projects and have their names commemorated on the walls.
Dr. Orna Blondheim, head of Clalit Health Services’ Emek Medical Center in the Lower Galilee halfway between Nazareth and Jenin, has to seek out philanthropists who don’t know where the city of Afula is, let alone recognize the name of her hospital. But for hundreds of thousands of residents in the Jezreel Valley and its environs, Emek is the address for high-quality outpatient and inpatient medical care.
Unlike the directors of non-government, non-Clalit voluntary hospitals, Blondheim doesn’t have the time to go abroad frequently to raise development funds. The health fund has a fundraising office in New York, but its purpose is to obtain donations for all of Clalit’s hospitals according to priorities for infrastructure and new facilities.
“We appreciate this effort and don’t take it for granted,” said Blondheim.
Potential donors to Emek who live abroad read The Jerusalem Post, said Blondheim, who initiated an interview with this reporter, as she did eight years ago.
“I invite everyone from abroad to visit our hospital, our services and facilities and see how Jews and Arabs – staff and patients – get along so well together. We have absorbed immigrants, and you can see the waves of each aliya in our population and our staff members.”
The pediatrician and neonatologist has in several ways been a pioneer. When about 13 years ago she was named director-general of Schneider Children’s Medical Center in Petah Tikva, she made history by becoming the first woman to run an Israeli general hospital. Now, she noted, there is another one, Dr. Chen Shapira, director-general of Carmel Medical Center in Haifa. Another woman, Dr. Ilana Kramer, heads the Mizra psychiatric hospital.
BORN TO a secular family, Blondheim did her military service in Air Force operations.
After the Yom Kippur War, she decided to become observant. At Jerusalem’s Hebrew University Medical Faculty, she met and married the New York-born modern Orthodox David Blondheim, who is now a senior non-interventional cardiologist at Hadera’s Hillel Jaffe Medical Center.
After she spent two decades working in Jerusalem and two years as a pediatrician/ neonatalogist at Children’s Hospital of Philadelphia, she and her husband took the reverse path of most doctors by moving to the periphery. Together, they helped found Mitzpe Netufa – a small religious settlement in the heart of the Galilee.
“We lived in a caravan for six years, and many people thought we were crazy, because it wasn’t the ‘politically correct’ thing to do,” she said. “But we were looking for two things in our lives – to help increase the Jewish presence and raise our four children in the Galilee, and ... to practice medicine in the periphery, in places where we would be really needed.”
Soon after Blondheim was named head of Emek, she said she had no ambitions to climb the advancement ladder and was eager to continue running the Afula hospital.
Today, she has the same plans. “I came to the Galilee on a mission, and I want to continue it,” she said.
To become ready for management, women have to be 40 or 45 and have administrative experience, she said. “An MD is not enough; you also need an advanced degree in management. You need to know a lot about labor laws and budgets. You have deputies who can help in these technical fields, but it is best to have this expertise yourself.”
Although she was one of only 10 women when she studied medicine at Hadassah- Hebrew University medical school in Jerusalem, today women constitute at least half of the student bodies in the country’s five medical faculties. There are a bit fewer who are specialists, and the share of women hospital department heads is even smaller, she said. It is not discrimination against women that keeps them from entering the higher echelons of institution management, stressed Blondheim.
“In medicine, you have to work overtime and moonlight to get a decent salary,” Blondheim explains, “but women already have their family as a ‘second job,’ so advancing in a hospital hierarchy isn’t easy.”
Clalit had not had enough female deputy directors-general who could advance to the highest position. But, she continued, “today there are several women deputy directors-generals in hospitals, and as more accumulate the experience and tenure as managers, more of them will be senior administrators. There is no reason to discriminate against women in medicine.”
“They are the majority today in gynecology and obstetrics, for example, as many women want to be examined by women.
Religious women especially prefer that intimate examinations be conducted by a woman doctor, and in urology, where there are more men with problems than women, the patients prefer a male doctor and male nurses.”
Emek serves more than 500,000 people throughout northeastern Israel who are for the most part in the mid to low socioeconomic range. The region is equally divided between Jews and Arabs and includes Muslims and Christians and Jewish immigrants from the former Soviet Union and Ethiopia.
Its multi-ethnic staff reflects the make up of the patient population, and Emek boasts the highest multi-cultural patient satisfaction ratings, Blondheim said.
The hospital has some 2,000 employees, 25 medical departments, and over 60 outpatient clinics and laboratories. Residents of the area are younger than the average in Israel and very heterogeneous.
“We have a high rate of births in both the Jewish and Arab populations. There are urban and rural populations, and their average incomes are lower than in the center.”
The lower socioeconomic and educational status, she continued, means that on average, they suffer more from illness.
As a result of all these demographic indicators, few residents are able to pay for private medicine, and senior specialists are unlikely to be attracted to the periphery because they don’t have much opportunity for private patients to supplement their public hospital or clinic income.
The last wage agreement between the Treasury and the Israel Medical Association created bonuses for physicians willing to move to the periphery and who specialized in fields in which there was a shortage of experts. “The agreement did bring more physicians to the area, but unfortunately the bonuses rapidly disappeared,” said Blondheim. “Giving incentives was the right thing to do, but it was not done properly. The Treasury and IMA should have asked hospital directors what kind of skilled manpower they needed, as the situation is not the same for all hospitals.”
There is less verbal and physical violence against hospital staffers by patients, relatives and visitors in emergency rooms and inpatient facilities than there used to be, said Blondheim. “We have more guards, but not policemen. The guards do good work. We have run workshops for staffers about how to identify scenarios in which violence is likely to break out so we can prevent them,” said the director-general.
“But society in general is more violent than it used to be.”
The hospital offers a wide variety of specialized services and units, including eight surgical departments, oncology services, emergency medicine, cardiology services, perinatal services and pediatric services.
“We have a center of excellence in genetics.
There is no neurosurgery department, but that is not needed. We don’t have a nuclear accelerator for radiation of cancer patients, but we are in the planning stages for such a facility, along with a breast center,” Blondheim point out.
The hospital is getting an MRI (magnetic resonance instrument) by the end of 2015 following the receipt of ministry approval.
“We still need approval for a PET/CT scanner, which will be a struggle. We have a new rehabilitation and two more internal medicine departments.”
As land is relatively cheap in Afula, “We construct two buildings of seven floors each instead of one with 14 stories. It’s also safer, as the Jezreel Valley has a higher risk of earthquakes,” she said.
As for technology, the Treasury “understands today that a computerized tomography [CT] scanner is cheaper than an MRI scanner, but it doesn’t release dangerous radiation. The MRI is better for many diagnostic procedures, but it can’t be used for everything,” she explained.
Emek continues to suffer from a lack of budgeted hospital beds. “It is worse in the winter, when there are more patients with flu complications and other problems, but the shortage occurs even in summer. We don’t place patient beds in the corridors in inpatient departments, but we have had to convert a cafeteria for accommodating patients in beds. The main crowding problem is in the emergency department. We use screens and drapes to preserve privacy, which is very important to us, but conditions are sometimes very crowded as they wait even 24 hours for an inpatient bed.”
As Emek – Clalit’s first hospital – was established in 1924 to treat victims of malaria and other infectious diseases among the pre-state Galilee pioneers, it has many old buildings that have to be replaced.
ALTHOU GH EMEK’S catchment population is younger than average, it is “aging fast, and we don’t have a geriatric department.
We will need it soon. Emek will also require an inpatient neurology department; we offer only outpatient neurology care.
“Middle and old age means more strokes, which are generally treated with injections of the drug tPA to melt blood clots in the brain, but it can’t be used for all. Another option is catheterization (thrombectomy) of blood vessels in the brain via a catheter from an artery in the groin.”
But Emek has not yet received ministry permission to do this “even though our cardiologist do heart catheterization [angioplasty], which is very similar. Thrombectomy should be as accessible as coronary angios,” said Blondheim. “The health and finance ministries should be interested in allowing us to do this stroke procedure, because is cheaper to do it than to provide long-term care to those disabled by stroke,” she said.
Patients “expect to get treatment close to home where their families are rather than being sent to another region. Such family support is very important in healing,” the director-general said. “It’s unfortunate that there are no government ministers from this region and few in the periphery, because then they would be familiar with us and be our representatives.”
Blondheim is disappointed that healthcare has been a non-issue in the current election campaign.
“I had hoped that the subject of health would occupy the parties, but it doesn’t seem to concern them. Healthcare is in a crisis. All the public hospitals are suffering from large deficits, and the four health funds are in the red to the tune of NIS 3 billion. Patients here often have to wait for diagnostics, surgery and other basic services, because they can’t afford to go to a private hospital.”
Emek’s top administrator said she was “very worried” about the construction of a public hospital in Ashdod by the private Assuta Medical Centers at the initiative of the health and finance ministries. The new facility, where a quarter of all procedures will be private, “Will hurt Barzilai Medical Center in Ashkelon and Kaplan Medical Center in Rehovot. They already have a shortage of doctors and nurses, so when these have to compete with the higher incomes at the Ashdod hospital, it will be harmful. Instead, the government could have added beds in both Ashdod and Rehovot at a much lower price. Clalit officially opposed private medical services.”
The health funds, including Clalit, are investing much more in prevention of diseases and health education that they did decades before. Over half of Emek’s doctors and nurses voluntarily received a flu shot this winter. The Israel Medical Association, apparently concerned more about individual liberties than the possibility of infecting patients with their own viruses, came out against the idea of hospital staffers around the country wearing tags announcing that the bearer was protected against the flu.
“I don’t understand why the IMA came out against this idea,” said Blondheim.
In addition, “there is much less smoking on campus. We have a special outdoor structure where people can smoke if they insist. We occasionally run workshops to help smokers on staff to kick the habit.”
Finally, Blondheim encourages doctors and nurses to conduct research, even with their limited time, as this raises the quality of medicine.
“We have two research labs, and we also do it in conjunction with the Technion-Israel Institute of Technology in Haifa. At any one time, we have over 100 research projects being conducted in the hospital.”
As for Blondheim, she starts her day in the office at 7 a.m. by reading medical journals in pediatrics and hospital management; she doesn’t treat young patients anymore.
“If I could do a clinic once or twice a week, that would be nice, but that can’t be accomplished in neonatal intensive care, which has to be daily.”