A flood of appreciation for a drop of milk

An exhibition looks back on the history of Tipat Halav clinics from their establishments in 1921, when the infant mortality rate was shockingly high.

By BATSHEVA POMERANTZ
Dokey Express 311 (photo credit: courtesy of Issac Kaplan Old Ysihuv Court Museum )
Dokey Express 311
(photo credit: courtesy of Issac Kaplan Old Ysihuv Court Museum )
In the early 1920s pasteurized milk – an innovation at the time – was packed in ice boxes and delivered by donkey to Jerusalem mothers on the Donkey Express, which left the Old City’s Tipat Halav station and proceeded to the Rothschild Hospital on Rehov Hanevi’im. That first Tipat Halav station was opened almost 90 years ago, in June 1921.
Nurse with baby
Nurse with baby
“The donkey of Tipat Halav has gone far,” said public health nurse Moria Ashkenazi at the opening of “A Drop of Milk,” an exhibition at the Isaac Kaplan Old Yishuv Court Museum in the Jewish Quarter. “Tipat Halav services reach out to everyone. It played an important role in immigrant absorption and during times of war.”
The exhibition focuses on Jerusalem’s transformation from a city with minimal health services during Ottoman rule and the British Mandate to a public health success story. This success is due largely to the balancing act between old and new, and the uncompromising fight of the staff of the Tipat Halav Well Baby clinics to remedy the situation.
In the twilight of the 19th century, Jerusalem’s population numbered 30,000 to 40,000, including some 17,000 Jews of the Old Yishuv, forming a mosaic of various communities. Child mortality until the beginning of the British Mandate period (1917) was 80 percent.
“Four out of five children did not live to see their first birthday,” says Ora Pikel-Zabari, curator of the exhibition. “The causes behind this shocking statistic were poor hygienic conditions due to bathing only once a week, polluted water pits, early marriages and a shortage of medications.”
The overcrowded hospitals were seen as risky, so women preferred giving birth at home – on damp cellar floors. If mother and baby survived childbirth, they were at further risk due to their lack of knowledge about postpartum and postnatal care.
On permanent display at the Old Yishuv Court Museum is a room of the new mother with a canopy bed. “Also known as Himmel Bettes [sky beds], these were imported by Europeans coming to the Holy Land in the 19th century,” says Pikel-Zabari. “A husband who could afford the bed would rent one for his wife for 40 days for childbirth and postpartum recovery.”
Jews of the Old Yishuv blindly trusted folk customs and amulets to ward off the evil eye, which may not have helped but probably didn’t hurt, either. A newborn boy and his mother were especially susceptible to the wiles of Lilith (a mystical character known to harm newborn boys and their mothers) and were therefore not left alone until after the circumcision. On display in the exhibition are “Shir Hama’alot” sheets that were placed near the baby, and the Condilla (oil lamp) that Sephardi Jews would carry as they marched from the synagogue to the mother’s room the night before the circumcision and then read from the Zohar.
Lay midwives with little training were pitted against certified midwives. Ita Yellin, wife of Zionist activist and educator David Yellin, admired lay midwife Tzipa de Buba, popular among Ashkenazi, Sephardi and Muslim women, whom she described as “wise, nimble and clean.”
Nurse preparing pasturized milk
Nurse preparing pasturized milk
“Unlike Ita, David Yellin attributed the mortality rate among child-bearing and postpartum mothers to the shortage of expert midwives,” says Pikel-Zabari. “He claimed that the lay midwives were often elderly women with no other means of livelihood. They picked up their skills by delivering the babies of the poor for no charge or a minimal fee. When they worked their way up to middleclass homes, another novice would attend to the poor, where they would go from woman to woman without washing their hands. The new mothers were ignored in the crucial days following childbirth,” she says.
In 1908, after the delivery of the Yellins’ youngest child, Ahuva, by expert midwife Miriam Yitzhaki, Ita preferred certified midwives.
Certified midwives usually studied midwifery in Vienna and slowly replaced the lay midwives. The Ezrat Nashim Society of Jaffa undertook to assist the Jerusalem women by paying the expert midwives.
American scholar Henrietta Szold visited Jerusalem in 1910. Her shock at the lack of health services led to the founding in 1912 of an American national women’s Zionist organization to carry out practical projects to improve the situation in Eretz Yisrael. Initially known as the Daughters of Zion, it became Hadassah Women’s Organization.
In 1913 two American public health nurses, Rose Kaplan and Rachel Landy, were sent to Jerusalem on behalf of Daughters of Zion to help heal mothers and babies.
“Living in a small house among the poor of Mea She’arim, they started working in cooperation with other health organizations and experts like Dr. Ticho’s eye clinic, the Rothschild Hospital (to become Hadassah Hospital), the Pasteur Institute and pediatrician Dr. Helena Kagan,” says Pikel-Zabari.
The Hebrew Women’s Organization joined forces with Hadassah Women to direct resources to care for the mother and her newborn. Focus was on pregnant women who were reluctant to go to Hadassah physicians for help and guidance. They feared the evil eye, believed rumored horror stories about physicians and rejected weighing infants because they believed that the good cannot be measured.
“When women finally overcame their concerns and went to the hospital, they were sent home due to the shortage of beds, which were saved for difficult cases,” says Pikel-Zabari.
In 1921, Jerusalem was divided into 12 districts. A woman in advanced pregnancy was entitled to checkups and a house call of a physician, who decided whether or not she should give birth at home. If she needed ongoing medical treatment, the physician would give her a card for admittance to the hospital, which would not accept impoverished women. Following childbirth, these women would be visited daily by midwives for a week, when they were most at risk. Hadassah Women took care of the medical assistance, while the Hebrew Women ran the household during the new mother’s recuperation.
The next mission was care for the newborn. Only neonatal pediatricians were authorized to give instructions on proper baby care, but overcrowded hospitals prevented mothers from going there. It was therefore decided to establish stations where mothers could receive special training.
“The name is Tipat Halav [“a drop of milk”], but the idea behind it is education and prevention,” says Judith Steiner-Freud, who served as the director of the H. Szold Hadassah Hebrew University School of Nursing from 1968 to 1983. “Most of the practical work of the nurses in Hadassah’s nursing school in its first years was as community nurses. Hadassah’s Tipat Halav clinics were opened throughout Israel.”
As a young nurse in the 1940s, Steiner- Freud knew Szold and American public health nurse Bertha Landsman. The dynamic Landsman led the struggle for the new station in June 1921, refusing to accept “no” for an answer from mothers reluctant to go the station. She sent and ordered her nurses to plead to mothers at home: “If they don’t let you in the front door, go in the back door. And if they don’t let you in the back door, go through the window. But get in!” Landsman’s offer of free layettes and pasteurized formula milk was conditional on mothers giving birth at Rothschild Hospital. She would then convince them to visit the station to increase their babies’ chances of survival.
Landsman’s efforts proved successful. During 1923, nurses entered from the front door and advised mothers on baby cereal preparation and refrigeration.
Since many mothers were unable to nurse, pasteurized milk was produced at the Old City station. The production was initially managed by Flora Solomon, and then the Hebrew Women took over.
“Mothers coming to the station for the first time received a gift of a tin container,” notes Pikel-Zabari. “Except for the extremely poor, most mothers paid a token fee for the milk, since the staff wanted to shift the responsibility of caring for the child to the parents.”
Pediatrician Dr. Helena Kagan volunteered at the station, instructing expectant Arab and Jewish women and new mothers on child care to lower the mortality rate. Tipat Halav’s services expanded to clothing infants. The exhibition includes a 1928 film by Ya’acov Ben-Dov, which shows women from the Old City Tipat Halav station sewing diapers for newborns.
Follow-up on the infant’s development was done up to the age of four. Then Tipat Halav stations celebrated Transition Age Ceremonies, marking the transition from Tipat Halav authority to the pediatrician. With schoolage children, the Tipat Halav staff fought trachoma and ringworm and instilled the principles of oral hygiene.
On display in the exhibition are two Tipat Halav nurse dolls from the pantheon of national pioneer dolls popular in the 1950s and 1960s.
“Tipat Halav advice assisted in implementing the Zionist dream of creating a new person – healthy in spirit and body,” says Pikel-Zabari. Hygiene, part of the modernization process, involved a change in the physical and spiritual character of the new Jew and the creation of the Sabra legend.”
“Today’s frontiers for Tipat Halav are the ‘new morbidity,’” says Dr. Lisa Rubin, head of the Health Ministry’s Department of Maternal, Child and Adolescent Health. “This includes giving support and counseling to promote infant and early child development, identifying developmental disability; giving support to mothers and fathers for infant-parent interaction and identifying those who need assistance; promoting healthy lifestyles and preventing obesity.”
Awareness of postpartum depression (PPD), one of the most important conditions that adversely affect maternal- infant interaction, is increasing. “Nurses and physicians receive training to identify PPD,” says Rubin. “We do not currently have mandatory screening for this disorder but are working to improve our identification and support of this all too common condition.”
While in the early years of Tipat Halav, pasteurized milk was the key to infants’ health, today the support of nursing is increasing. “Tipat Halav wholeheartedly supports breastfeeding,” says Rubin. “In the past decade we have done much to increase and improve our support for this. All Tipat Halav nurses receive training in promoting and supporting breastfeeding. We have instituted ‘nursing corners’ in the clinics. The public health service has recently begun to promote breastfeedingfriendly workplace in the public sector.”
The “A Drop of Milk” exhibition is on display at the Isaac Kaplan Old Yishuv Court Museum, Rehov Or Hahaim 8, Jewish Quarter until May.
Tel: 627-6319