The Ma'ayanei Hayeshua Medical Center in Bnei Brak offers Israel's poorest town some of the country's best medical care
By CARL HOFFMANhospital metro feet 88 2(photo credit: Courtesy, MYMC)
The first thing you notice when you walk through the door are the people: Haredi men, mostly young, escorting haredi women, mostly young and pregnant.
The second thing you notice comes as something of a surprise. Throughout the halls and wards of a hospital that delivers some 7,500 babies a year, performs more than 3,000 operations and deals with upward of 35,000 emergency room visits per year, there is a remarkable degree of quiet and an extraordinary feeling of calm. No one is shouting, no voices are raised in anger or impatience.
Ma'ayanei Hayeshua Medical Center (MYMC ) was founded in Bnei Brak - Israel's most religiously observant and financially impoverished area - as a community maternity hospital in 1990, after 12 years of raising money to build it. No financial help came from the government, nor were there any large grants from charitable foundations. MYMC was established from both loans and small donations - many of which were no more than a few shekel and agarot coins dropped into tzedakah boxes throughout the city's neighborhoods.
Operating on a "shoestring budget," MYMC nonetheless quickly acquired a reputation in the community for the dedication of its staff and the high quality of patient care. CEO Dr. Yoram Liwer says, "Our patients choose MYMC not just because of our expertise in medical diagnosis and treatments, but also for the personal care and commitment we offer each individual, in accordance with Jewish principles."
Director of Administration Nadav Chen adds, "We have here people who are sent to MYMC from other hospitals that refuse to do invasive procedures on people who are already very old. They don't want to do it. They say, 'What are you going to get out of an operation on someone this age - another two or three months?' Here, because of the Jewish laws that we live by, we believe there is sanctity in every minute of life, so we never give up on anyone. We say two or three months are worth the effort, and we'll try whatever we can."
Although MYMC was created to be a hospital in which the surrounding religious community would feel comfortable, not all of the hospital's clientele is religious, or even Jewish. Says Chen: "Seventy-five percent of the people who come to us are dati (religious) or haredi. Twenty-five percent are not religious at all. Some are not Jewish. If you ask the haredim why they come here, it is because everything we do here is done according to Jewish law. Ask the non-religious and they'll tell you they come to get the level of personal care we are becoming famous for. Here, you're not a number. You come here and receive a warm welcome, 24 hours a day, seven days a week from doctors, nurses, midwives and volunteers. We never close, and we welcome everyone."
MYMC also welcomes patients who cannot pay. While most of the hospital's revenues come from service fees collected from patients' health funds, many patients must be subsidized by the hospital from funds collected through charity. MYMC also provides for the needs of indigent elderly in the geriatric unit, if the patient's family cannot. Shoes, slippers, toiletries and whatever the patient needs to be comfortable are bought by the hospital if there is no other source of assistance.
Perhaps not surprisingly, the hospital almost went bankrupt around four years ago. Then new management came, under the leadership of current CEO Dr. Yoram Liwer. "He took this hospital from years of losing NIS 15 million every year, to making NIS 200,000 after only one year here," says Chen. "All the money we're making now is going right back into the hospital - expanding our facilities and building new units."
MYMC is presently enjoying steady growth and diversification. The hospital's maternity department, high-risk maternity unit, nursery, neonatal intensive care unit and gynecology departments are among the busiest in Israel, with upwards of 7,500 babies born each year - a number that is expected to double over the next decade. MYMC also provides a full service emergency department; internal medicine, pediatric and geriatric departments; a coronary intensive care unit, and a radiology department with CT and mammography facilities.
Reflecting the needs of the surrounding area of Bnei Brak - marked by both a high degree of religious observance and an average per capita income among the lowest in Israel - MYMC has pioneered in offering nutrition, whole-body fitness, psychological counseling, fertility and a wide array of other specialized medical services to the haredi community through outpatient and community clinics.
Particularly noteworthy is the hospital's nutrition program, in which MYMC doctors, social workers and nutritionists are teaching haredi families - characteristically large and low-income - to adopt healthier food purchasing and consuming habits. An in-patient psychiatric department is currently in the final planning stages.
"We are developing services in those areas where we feel the community has special needs," says Professor Mordechai Ravid, MYMC's Medical Director and part of the senior management team that brought the hospital back from its 'near-death experience' four years ago. "A notable example is in the field of cardiology. Heart disease is very prevalent in the religious community. They don't exercise, they overeat, their health awareness is zero, they don't have checkups and they don't go to a doctor until they feel very, very sick."
Ravid expressed a gradualist approach to expansion. "Our general philosophy is to make what we have excellent, before moving on to other developments. So we are building cardiology here from the ground up. We start with non-invasive procedures, and when that gets established with experience and staff, and works flawlessly, then we will build on top of that."
Working in the heart of a largely haredi community presents other challenges to the hospital, Ravid says. Doctors are often forced to balance their own treatment recommendations with rulings by local rabbis. Some patients even refuse to agree to a procedure until they receive their rabbi's approval.
The hospital has, however, attempted to work closely with the rabbis of the surrounding community for the past 17 years, and tries as much as possible to hire religious staff. "For doctors, it's a bit of a problem," Ravid admits. "We have almost no religious doctors out of 94 working here. There is one Orthodox doctor and perhaps five whom we could define as traditional - the rest are secular. This is because the number of religious physicians in Israel is small - much smaller than the percentage of religious people in the community in general. Forty-five per cent of our nurses are religious, and the administrative staff are mostly religious."
Overall, Ravid is quite proud of the advances MYMC has made since the new management took charge. "We do not have external sources of funds. We depend on what we earn. Yet we've built a new maternity department this year, we've opened neurology and cardiology, we have renovated the ICU, we have renovated gynecology, we are renovating and expanding our neonatal intensive care unit, we are renovating and enlarging the delivery rooms, we have upgraded computers, and renovated laboratories, So we've done quite a lot over the past four years. We have a system of dual management: administrative and financial on one side, and medical on the other," Ravid says with a growing smile. "And up to now - through no lack of trying, I assure you - we still have not succeeded in having a major fight," he adds, laughing.
However much MYMC has expanded and diversified in recent years, the delivery and care of newborn babies remains the centerpiece of the hospital's mission. Dr. Benny Chayen, chief of obstetrics and gynecology, remarks: "According to the number of beds, we are the 24th-largest hospital in Israel. In the number of babies delivered, we are sixth in the nation. Around 7,500 babies are delivered a year, or one every hour. Our patient population comes from all over the country, from Safed in the north all the way to Dimona in the south. We have girls coming in here aged 17, and the oldest woman who gave birth here was 60. They come here because they like the calm and relaxed atmosphere, and the way they are related to by the staff - soothingly, affectionately. We train the staff on how to understand and handle different situations and how to calm people down."
Many women, particularly from the Orthodox community, come to MYMC for its extraordinarily low number of cesarian births. The hospital's rate of cesarean deliveries is the lowest in Israel at 12%, as opposed to a nationwide rate of 22% and 30% in the US. Chayen explains, "Cesareans are not bad, per se. If you're planning to have a family of two children, and you've had two cesarians, it's not the end of the world. But if you're planning to have a large family - and many of our patients have families of 12 or 14 children or more - then there's a limit to the number you can have. The more you have, the more dangerous it is. That's why our policy is to try to deliver babies vaginally after one Cesarean section, or if possible even after two, so that the women can get back on track and deliver as many children as they want, as long as they're not compromising their health."
The maternity department's new pride and joy is a post-delivery ward on the hospital's seventh floor, designed to have the look, feel and amenities of a luxury hotel.
This section - with its elegant rooms, cozy dining area, good food and vacation-like atmosphere - is provided to patients at no extra charge. Says Chayen, "I've worked in many, many hospitals in Israel and the US. There's just something special about this place. The atmosphere, the attitude of the staff toward the patient and family. It's a place of hesed. That's the key issue here: compassion. That's why we have so many non-religious and even non-Jewish people coming here as well. We even get people from the foreign embassies. They come here because they feel the compassion."
Ma'ayanei HaYeshua Medical Center is a registered, tax exempt charity in Israel, the US, Canada and the UK. For more information about MYMC, and all contact information, visit the hospital's website at www.mymc.co.il http://www.mymc.co.il/.
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