Making a difference – one patient, one country at a time

Major emergencies, crises and disasters have become more frequent in recent decades – and according to reports by the World Health Organization, the poorer people are, the more likely they are to become casualties.Between 1994 and 2014, the Emergency Events Database (EM-DAT) of international disasters recorded 6,873 natural disasters worldwide, which claimed 1.35 million lives, or almost 68,000 lives on average each year. In addition, 218 million people were affected by natural disasters on the average per annum during this 20-year period, disproportionately in middle- and low-income countries.“Statistically, it seems like the places that get hit the most are the poorest places,” said Prof. Elhanan Bar-On, director of the new Israel Center for Disaster Medicine and Humanitarian Response at Sheba Medical Center – Tel Hashomer. “A lot of the damage is because these places lack infrastructure, have poor building standards and tend to be densely populated.”The new center is Sheba’s formal effort to provide what hospital officials hope will be a world center of excellence in medical preparedness and response in disaster areas, emergency situations and humanitarian aid. Bar-On said the center brings together Sheba’s long-time tradition of contributing to humanitarian relief efforts abroad.“It was part of the vision of Chaim Sheba to extend medical treatment outside of Israel’s borders,” said Bar-On.The Sheba Medical Center – Tel Hashomer was established in 1948, shortly after the founding of the State of Israel, as “Military Hospital No. 5” in the dilapidated barracks of a deserted British military base. From its earliest days, Sheba’s commitment to compassionate care extended beyond Israel. The medical center has provided support and supplies throughout the world, including to Kosovo, Armenia, Cambodia, Sri Lanka, Rwanda and the areas around the Chernobyl nuclear site in Ukraine.In 2017 alone, Sheba provided support to Tanzania, Niger, Mongolia, Nigeria, Nepal and Papua New Guinea.Bar-On said there was a Sheba medical mission to the Republic of Congo during the 1960-1965 Congo Crisis, when the Congo became independent from Belgium and a series of civil wars ensued, resulting in the deaths of around 100,000 people.“After the revolution, all the Belgians left, and there were only three doctors left in the whole Congo,” Bar- On said. “Sheba set up a hospital that operated there for quite a few months until the United Nations came. Then, the doctors were asked to go into the jungle, and they did amazing work there.”Similarly, patients come to Sheba from across the Middle East, including from the Palestinian Authority and Gaza. By Bar-On’s estimates, at any given time, 30% of Sheba’s pediatric oncologic patients are Palestinian. The hospital works in partnership with the IDF and the Peres Center for Peace to treat Syrian civil war victims.“We have patients from many other Middle Eastern countries about which I cannot say more,” said Bar-On.The center has four aims. The first is teaching and training.Bar-On said Sheba hosts teams from all over the world and prepares them to deal with natural disasters and other mass casualty incidents. These teams could be anything from medical personnel learning medical techniques to disaster management or health officials who are being trained in the organizational aspects of such emergencies.A group from China is coming in December.“It’s giving them fishing rods instead of fish,” Bar-On said, alluding to the famous idea by the medieval sage Maimonides.The second aim is to prepare teams of medical professionals who could deploy to disaster areas and provide emergency care, including screening of new and referred patients, surgical triage, advanced life support, definitive wound care, basic fracture management, damage controlsurgery, emergency general and obstetric surgery, inpatient care for non-trauma emergencies, basic anesthesia, x-rays, sterilization, laboratory, blood transfusion and rehabilitation services. These teams will operate both during the acute phase of the disaster and during the rehabilitation phase in its aftermath.Third, the center will provide humanitarian aid in under-served regions around the world during routine times. He offered that in the United States there is an average of one doctor for every 400 people, whereas in places like sub-Saharan Africa there is one doctor for every 50,000 or so people.“In Mozambique, a country that is 2,300 kilometers long with 21 million people, there are 12 orthopedists and all of them are in the capital of Maputo,” said Bar-On.“That is the equivalent of Israel having only five orthopedists and they are all in Eilat.”Finally, it will serve as a center of research.“There is not enough research being done on world disasters or humanitarian aid,” said Bar-On. “One of the reasons is that during the disaster, there is no time for research.Everyone is busy treating patients, and that makes the collection of data more complicated.”Medical innovation is especially necessary, said Bar-On, given that most mass casualty events happen in the poorest places in the world, where there is often a shortage of doctors and medical (or even government) infrastructure to ensure care. The Center for Disaster Medicine and Humanitarian Response will work closely with Sheba’s medical innovation center and its world-class Israel Center for Medical Simulation to find new and better ways to operate in places of national disaster.The center opened only several months ago – it is not even online yet. Bar-On is its first director.Bar-On is part of the IDF medical deployment team as a reservist. He has served in India, Haiti, the Philippines and Nepal during times of national disaster, and offered emergency medical training all over the world, including in Mozambique, Tanzania, China, Kosovo, and Albania.He is second-generation Sheba doctor; his father was one of the founders of Sheba. Bar-On remembers going with his dad to Ethiopia in 1962 to operate on burn victims and correct congenital deformities. His father also used to go to Gaza to treat patients, and Bar-On occasionally went, too.Sheba director-general Prof. Yitshak Kreiss has a similar background. He served in the IDF for 30 years, including as head of planning and chief medical officer. From 2011 to 2014, he headed the IDF’s aid missions to various disaster areas worldwide.Bar-On and Kreiss met on the 2010 Haiti earthquake medical mission. In Haiti, they saw a lot of good medicine, but an equal amount of bad medicine – doctors and NGO volunteers with good intentions who did not know how to operate during a national emergency.“I am talking about amputations being done in the streets, and on the other end, people who came from very highly esteemed academic centers in the US and Europe but with no disaster medicine experience,” said Bar-On.“You cannot do Boston medicine in Port-au-Prince.”Bar-On serves on a recently established World Health Organization task force to set standards for training for and care in disaster areas. Sheba will play a role, as well, and already has additional partnerships with the IDF, the Health Ministry, the Foreign Affairs Ministry, International Committee of the Red Cross, and Doctors Without Borders.In the last several months, the center has sent senior surgeons to work in Tanzania, cardiac surgeons to Nigeria, neurosurgeons to Niger, and ear, nose and throat specialists to Mongolia. A group of physiotherapists is planning to serve in Ukraine in the coming months, and a team of ophthalmologists will perform cataract surgery on a ship in Papua New Guinea.“In Sheba we see our involvement in global health, especially in under-served regions, as a way of life, not only because we are doing good for the less fortunate, which is tikun olam, but also because it makes us better doctors back home,” Bar-On said.He said there will always be cynics who say Israel’s emergency medical work is rooted in ulterior motives, but he tunes out those negative voices.“The core is that we go there, we treat people, and you have no idea the gratitude we receive in these places when we help even one person,” he said.Bar-On said others question how much help is really being provided or if Israel’s efforts are just a drop in the sea.In Haiti, Israeli doctors treated 1,111 patients out of the half-million who needed assistance.“Every person we treated, we changed his life, and beyond that, we gave thousands of people a feeling of hope at a moment when they thought the whole world abandoned them,” said Bar-On. “In a place of complete darkness, even one candle makes a lot of light.”