Israelis have been responsible for countless innovations - from armaments and software programs to drip irrigation and coronary stents - that have made the world sit up and take notice. But there are only a handful that have remained unique - and admired - around the world three decades after they were first created.
One of them is Yad Sarah, the country's leading volunteer organization that provides home care support and a multitude of other services perfectly suited to those in need of help. The antithesis to Israeli bureaucracy, insolence and coarseness, its volunteers in 103 branches around the country give loving care with efficiency, humanity and dedication that few paid workers offer.
Although it is rare for any institution to have no enemies or evade criticism, one would be hard put to find someone with a bad word to say about Yad Sarah.
In fact, at least every second family in the country - or 380,000 people last year - have received its help in the 30 years of its existence. It reportedly saves the national coffers $320 million annually by reducing hospitalization and improving productivity. The organization currently boasts more than 6,000 volunteers from teenagers through nonagenarians, many of whom celebrated the organization's birthday party "Salute to Volunteers" Wednesday on the lawns of Jerusalem's Malha Technological Park, attended by President Moshe Katsav.
Yad Sarah was born when Uri Lupolianski, then a religious school teacher living in a tiny apartment in Jerusalem's Ezrat Torah quarter with his wife Michal and two small sons, lent a hard-to-find steam vaporizer to neighbors for their sick child.
Hearing about his initiative, I interviewed the bashful, soft-spoken Lupolianski about Yad Sarah for The Jerusalem Post not long after he established it as a non-profit organization in 1976.
Today, not only does Lupolianski have 12 children and numerous grandchildren, but he is also Jerusalem's mayor - elected with no small thanks to his sterling reputation as founder and then-president of Yad Sarah. Only five of the children are unmarried and living in the three-and-a-half-room apartment in Sanhedria Murhevet where they moved in 1978. But their home still serves as a lending "warehouse" for emergency equipment - which annoys the mayor's bodyguards no end when strangers seeking medical devices knock on the door late at night.
The "Sarah" in Yad Sarah was Lupolianski's paternal grandmother, whom he never knew, as she was murdered in the Holocaust and Uri was born in Haifa in August, 1951; the Hebrew word yad literally means "hand," but it also means remembrance or memorial.
"After we lent the vaporizer out once, others heard about it and asked to borrow it as well. To meet the need, I bought a few more, as well as other necessary equipment," the mayor said in a special interview with The Jerusalem Post in his sixth-floor municipal office. "When my father Ya'acov spent Shabbat with us, he was puzzled when a neighbor came and asked for an oxygen balloon. We explained what we were doing. My father was 70 and closed the shoe store he owned when he retired; he gave us some money - then 30,000 old lira - to give emergency loans to people in memory of Sarah. We decided instead to use it for buying and lending out free medical equipment - wheelchairs, walkers, oxygen balloons and other devices."
Asked by a nursing mother for an electric breast pump, Lupolianski went to a pharmacy for one and was chided by the owner for "demeaning women." The pharmacist said there was "no such thing," and that "women are not cows!" The young man in a black suit and kippa was taken aback, but he nevertheless managed to find one; today, Yad Sarah lends out 12,000 mother's milk pumps.
The project grew, and people came asking for all kinds of equipment whose names he had never heard of. With limited funds, he went to the noted Hadassah University Medical Center cardiologist Prof. Mervyn Gotsman and asked what type of equipment to specialize in.
"The main problem is heart patients who need oxygen supplies at home," Gotsman told Lupolianski.
"I went to a pediatrician who said vaporizers and monitors for children were needed," Lupolianski recalled. "Confused by what was really needed, I consulted Prof. Kalman Mann, the director-general of the Hadassah Medical Organization. He was so excited. Home care, he said, was what we needed to promote. People didn't necessarily have to spend time in hospitals; many could be treated at home, in their natural surroundings, if they had the necessary equipment."
After his retirement from Hadassah, Mann became chairman of Yad Sarah's presidium and remained so until his death in 1997.
IN 1979, Yad Sarah had 14 branches and opened its first repair shop for medical equipment. In 1980, it launched the country's first emergency alarm service for homebound sick and elderly people living alone; this beeper project was initiated when a volunteer entered an apartment and found someone dead, unable to call for help. In 1985, with 40 branches, it bought its first Nechonit van to transport wheelchair-bound people to doctor's appointments and family events. A year later, with seven more branches under its belt, it launched its equipment exhibition center and projects for the homebound.
Services grew according to need, management's initiative and volunteers' suggestions - laundry services for the incontinent, legal aid for the elderly, a medical information service, a play center for special-needs children, a geriatric dental clinic and day rehabilitation centers.
Then the awards started to flow: The Knesset Speaker's Award in 1988, the coveted Kaplan Efficiency Prize in 1990, the Israel Prize for Special Contribution to the State and Society in 1994, Health Minister's Shield in 1999, and last year, recognition by the UN as an official adviser to UNESCO.
"We were awarded this status at the UN not just because we do kindness but because of Yad Sarah's professionalism and authority in the field of home care. Now we are more professional; we have a committee that investigates what new equipment is needed. We study Internet sites for devices that are most effective, efficient and sturdy. We even give them to patients for testing in pilot projects before buying more. We have our finger on the pulse," the mayor noted. "Most voluntary organizations don't have the ability to conduct such research."
Although Lupolianski no longer runs Yad Sarah - its paid director-general is Yehudit Intract, and a small number of other professionals who head services or departments are on salary - he can be forgiven for using the word "we" when referring to it. He remains its honorary president and spends quite a lot of time in the massive Beit Hakerem headquarters on Fridays and late at night on weekdays, just to keep involved. His controversial mayoralty - in which unlike Yad Sarah he has not pleased all customers - will end one day, and he would like to return to the charitable organization when he leaves City Hall because of the unbounded satisfaction it provides.
"I want to go back; when your children marry, they are still your children," he declared. "Management people involve me when they need me. I don't see it as a conflict of interest. Every mayor seeks help for residents of his city. Jerusalem has the greatest concentration of services because this is where it started and where the headquarters are, but there is a wide variety of services around the country from Kiryat Shmona to Eilat."
HELP IS received not only by individuals in the lower socio-economic strata. Some years ago, Aura Herzog broke her leg and borrowed a Yad Sarah wheelchair, whose sticker was prominently seen in Beit Hanassi photos. Additionally, prime minister Menachem Begin had a fracture when he fell in the bathtub and was in a Yad Sarah wheelchair, and Shulamit Shamir, wife of then-prime minister Yitzhak Shamir, also fell and used its equipment.
When an accident or illness occurs, it is usually sudden and unexpected. Even if people had the money to buy a wheelchair, walker, mattress to prevent pressure sores or oxygen machine, they would have to know where to get it and how to use it. Such a runaround is eliminated by Yad Sarah volunteers, who explain everything. Often, the patient and his family don't even know what to ask or what they'll need: The organization has a special computer checklist for stroke victims to tell them what devices they'll require to live comfortably at home.
It wasn't evident then, in 1976, that patients are ideally better off at home than in the hospital, Lupolianski said behind his paper-cluttered desk as his computer donged frequently with new e-mail messages even though it was a quiet Friday morning.
"Now everybody understands that there are pathogens in hospitals that can cause infections, that when you are a patient in a ward, you become an object of care and apathetic. Only at home do you take responsibility for your health. And it also saves money. Before Yad Sarah, you could get infusions, oxygen or physiotherapy only in the hospital, but not today."
Otto van Bismarck, the president of Prussia in the late 19th century, set the retirement age at 60 for women and 65 for men - still widely accepted around the world - when life expectancy was much shorter. Yad Sarah has transformed the concept of volunteering, making it a natural activity for Israelis of all ages and backgrounds. Many modern Orthodox and haredi citizens first decided to give of their time through Yad Sarah. Today, many retirees, Jews and Arabs, Muslims, Christians and Druse, are full of energy, knowledge and experience, stressed Lupolianski, and it shouldn't be wasted. Many of Yad Sarah's volunteers retired from their careers but are enterprising and indefatigable in their unpaid jobs.
The mayor recalls a former chief of the Customs Authority who got involved in the emergency beepers project. "He waited in anticipation of emergency calls for help, and he was actually disappointed if there weren't any!"
Looking back, Lupolianski said, "I didn't know it would grow so much. Maybe if I had known," he added with his omnipresent smile, "it would have scared me off. But Yad Sarah forged real changes in Israel. It's not just changes, but a social and medical revolution. There were medical conditions then that don't exist anymore. Before, asthmatic children had to go to the hospital for inhalation, and when they didn't do it in time, they suffered serious complications that you don't see today because of the easy availability of our equipment. Home care prevents the decline not only of children, but of elderly who can return home fast after hospitalization for a stroke."
One type of equipment in Yad Sarah's storerooms that has made a big difference in patient care is the pulse oxyimeter that attaches to the finger or toe to determine exactly how much oxygen there is in the blood.
"It used to be that to do this test frequently to monitor oxygen levels in the arms or legs, patients had to be hospitalized. If they suffer from too little oxygen [hypoxy], they can become apathetic and suffer cognitive and physical decline. But now Yad Sarah gives patients an oxyimeter to take home, and they can live like new."
With an NIS 70 million annual budget and lacking any ongoing state support, Yad Sarah bases its operations mostly on Israeli donors for maintenance and foreign donors for development.
"Sometimes we ask the Custodian General or Health Ministry for funding for a specific project, sometimes we get it. Certainly it would be easier if we had a Rothschild, a Bill Gates to support us. But we run thanks to people, 50,000 small donors who give when they have, to recipients of our free services who contribute in gratitude or forgo return of the deposit when they return equipment. The donor base is so broad that when there were nationwide crises in charitable donations, Yad Sarah survived. And the benefit of not getting ongoing state funding means that we are not political. When people see the impact that the organization has, they also want to take part."
Lupolianski foresees the gradual addition of 10 or 15 more branches, as new neighborhoods, towns and settlements develop. "But it won't have to go beyond that. We will need more service centers for maintaining equipment and additional services as needs change."
ONE NEED that gradually made an appearance in recent years was help to Diaspora Jewish communities and developing countries. Meir Handelsman, former director of the Health Ministry's information and computer systems branch, retired eight years ago after 32 years and moved crosstown to an office at Yad Sarah. There, glued to his computer screen and e-mail program, he is in charge of professional relations with foreign organizations - from the Jewish Joint Distribution Committee to the UN.
"Yehudit Intract gave me a call," says Handelsman. "Yad Sarah's activities abroad started in 1998 right after the collapse of the Soviet Union. The Joint decided to go in and see what was happening with the Jews. We went to Leningrad [now St. Petersburg] and decided to open a center for Jewish community services, mostly elderly. The main element was to be a medical loan supply, with funding from the Joint, which asked Uri to help set it up with a workshop for maintenance. The first center was called 'Hesed' [good deed], and since then, we have helped the Joint set up dozens of such centers in the former Soviet Union."
After the Uzbekistan health minister paid a visit to the equipment exhibition center at Yad Sarah's headquarters and was impressed, the Foreign Ministry asked Handelsman to do a feasibility study and help set up equipment-lending facilities there.
"Since then, we have been active in Cameroun, Angola, South Korea, Jordan, Turkey (the first-ever cooperation between an Israeli Jewish organization and a Muslim one) and El Salvador (where the small-but-wealthy Jewish community will set up a lending center). Angola, for example, went through 41 years of war, first for independence and then a long civil war. Millions of land mines were planted and nobody knew where they were. Many thousands of people were injured and lost limbs. They had wheelchairs," recalled Handelsman, "but when they broke down, the locals didn't know how to fix them. Our Foreign Ministry gave money for a fully equipped workshop, and we set it up and trained 20 technicians."
South Korea is a rich country, Handelsman noted, "but it has growing chronic illness and aging, and the family as caregiver for the elderly has broken down. Officials looked for alternatives to institutionalization. A professional delegation came from Seoul at their country's expense, and now we have a joint project that focuses on encouraging volunteering and a lending center, homebound visits and dental care for elderly. Yad Sarah makes no profit on this, only money to cover its expenses, but it certainly earns recognition and friends for Israel."
Its foreign work also improves service to Israelis, because "we learn how to teach others and present knowhow in an orderly way."
Handelsman stressed that no donations to Yad Sarah are devoted to foreign projects, which are funded by the Foreign Ministry, other organizations or the recipient countries themselves.
Asked why the Yad Sarah model has not been adapted en bloc in the US, Handelsman explained that Medicare there provides some needs through profit-making organizations.
"There were efforts by Jews in New York to start an organization based on our model, but they came up against problems from suppliers of medical equipment," explains Handelsman. "They are a very powerful lobby there. They want patients to buy equipment, not borrow it. So there are hundreds of thousands of wheelchairs provided by health insurance companies after accidents that are stored unused in garages across the US. People keep them for sentimental reasons, because their parents or grandparents used them. It would be great, at least, if the American Red Cross collected them and donated them to Africa.
"Not one country in world today has all the services that Yad Sarah offers Israelis."
Handelsman is also proud of being behind the establishment of 12 Yad Sarah equipment loan branches inside hospitals.
"When a person becomes stable but paralyzed on one side after a stroke, his family is told he will go home. But how do they take him home? The wife goes to a Yad Sarah branch to get a wheelchair, but what size and type are suited to his weight? What side is he paralyzed on? She returns to the hospital to find out, but by then, back in town, the branch is closed. When in the hospital itself, they are saved all this trouble, and even though space is at a premium in medical centers, they donate it because they know how much it helps patients who can borrow everything they need for the patient to live at home."
ALTHOUGH EQUIPMENT lending is Yad Sarah's middle name, there are many other services not widely known, because it doesn't spend the money on advertising and has to depend on media coverage and word of mouth.
Naomi Mizrahi, a social worker with a master's degree in management of non-profit organizations, is a paid employee - coordinator of the home and community rehabilitation branch in Jerusalem and its vicinity from Modi'in to Ma'aleh Adumim. She is in charge of 400 volunteers of all ages, mostly middle-aged women, but also men, teenagers and students, who undergo careful training to do their tasks and pay their own busfare.
Some go once a week for an hour or two to a homebound person who lives alone to bring arts and crafts supplies and show them how to knit, embroider or beadwork. Some of the male volunteers study Torah with homebound men. There are also two dozen volunteers who go to homes to teach the elderly and disabled how to use computers (older machines donated to Yad Sarah and lent out or sold at a low price), Internet and e-mail.
One of Mizrahi's lesser-known but amazing programs is the "Life Story Project." Volunteers make about a dozen visits, during which they interview the subject on tape about his or her life in Hebrew, English, French, Russian, Yiddish or German. Then the story is transcribed, written and edited, with illustrations and a graphic cover added. Printed copies are given to the interviewee, with more displayed (with permission) at Yad Sarah and another donated to Yad Vashem if a Holocaust survivor is involved. "So far, we have done 158 such books. And when the person dies, this Life Story is what is inevitably displayed on the coffee table during the week of mourning."
More intensive help is given to seriously disabled people whose caregivers need a rest; well-trained volunteers spend four hours a week, often presenting themselves at the hospital at discharge to smooth out problems and then settling them at home.
"We inform municipal social welfare departments and hospitals of the service, and they refer people to us. But we need additional volunteers, and could help more if we had them," says Mizrahi.
Few Yad Sarah volunteers burn out. "They want to use their potential and make a real contribution," notes longtime organization spokesman David Rothner. "Some have been doing it for many years, and their work gets impetus from courses, workshops, quality control and surveys on satisfaction of clients."
Elaine Pomrantz, who made aliya from New York eight years ago and has been giving of her time for seven of them, is a good example. Physically disabled herself, she maneuvers her electric wheelchair with her left hand manipulating a joystick.
"Yad Sarah fixed my wheelchairs when they got damaged on airline flights," she says. "Now I advise disabled people - 160 Israelis and tourists last year - on how to manage. We make it possible for disabled people to visit Israel who otherwise wouldn't be able to."
While efficient, she and her colleagues are not "businesslike." She recalls a woman in her fifties whose husband had a stroke and was paralyzed.
"She didn't know what to do and cried. His doctors told them he'd never walk again. But we said: 'They're doctors, but they're only doctors. Be strong. There can be miracles.' A year later, she called and told us she was so grateful for the encouragement; her husband was able to dance at his son's wedding. We provide hope, not just equipment."