When Dr. Orna Blondheim became director-general of the 200-bed Schneider Children's Medical Center for Israel (SCMCI) in Petah Tikva about five years ago, she made history by being the only woman running an Israeli general hospital. Now director-general of Afula's 500-bed Emek Medical Center (www.haemek.co.il), the pediatrician and neonatologist is still unique. But it is not discrimination against women that keeps them from entering the higher echelons of institution management, says Blondheim, who has long worked in hospitals owned by Clalit Health Services, in an interview with The Jerusalem Post. "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 has not had enough female deputy directors-general who can advance to the highest position. To become ready for management, women have to be 40 or 45, and have administrative experience. 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." She does "feel the weight on my shoulders of being first," says Blondheim, when asked if she regards herself as a pioneer like Dorit Beinisch (first female president of the Supreme Court), Dalia Itzik (speaker of the Knesset), Prof. Rivka Carmi (president of Ben-Gurion University) and Galia Maor (CEO of Bank Leumi). "I look all the time for capable women in their 30s and 40s so as to advance them. In the coming years, there will be more." Born to a secular family, Blondheim did her military service in Air Force operations. After the Yom Kippur War, she decided to become observant (although with her pants suit, bangs and shoulder-length dark hair, she doesn't look like the conventional religious woman). At the Hebrew University-Hadassah Medical School in Jerusalem, she met the modern Orthodox David Blondheim, who is now chief of non-interventional cardiology at Hillel Jaffe Medical Center in Hadera. They married and have four children; the eldest - now 27 - was born three days after her mother's written exam in surgery. Orna took a year's leave after each of her deliveries to breastfeed each baby. After the second child was born, she decided to take up a residency in pediatrics, as she had always been fascinated by caring for children. Her sub-specialty was neonatology, dealing mostly with premature infants, which she studied at Philadelphia's Children's Hospital. RETURNING TO Jerusalem 21 years ago, the Blondheims decided to become exurbanite pioneers, moving to the modern Orthodox Galilee communal settlement of Beit Netufa, which initially had a generator and a water tank rather than pipes. The Blondheims, then with three children, spent two years in a small caravan; when their fourth was born, a nine-square-meter room was added. Working at the premature baby unit at Emek Medical Center, Blondheim was suddenly invited by the director to be his full-time deputy. She agreed, but insisted on continuing to work as a neonatologist. Two years as an administrator were enough to persuade her that by working in management, she could bring about positive change. She was hooked. The director-general of Clalit then, Dr. Yitzhak Peterburg, was aware of Blondheim's abilities and "dared" to appoint her director of SCMCI. She headed the Petah Tikva hospital for 18 months, but when the top job in Emek opened up, Peterburg offered it to her. Living not far away, she has never looked back, and with three kids in the IDF, she has to worry less about being at home. "Schneider is a small hospital that treats only children. In fact, even though other medical centers have built separate buildings and called them children's hospitals, SCMCI is the only one in Israel that can make that claim. It has special services and centers of excellence designed specifically for children." Emek, she continues, is very different. "It is much larger, a general hospital with problems and challenges that don't exist at Schneider. Clalit's first hospital when it 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. There is a gap in level of 'hotel services' in hospitals in the periphery and those in the center in the country. But people living far from the center deserve to get the same level of services and treatment." In some of Emek's wards, there are 10 patients squeezed into a single room, says Blondheim. "We try not to put beds in the corridors, but sometimes during the winter flu season, patients are all over. But this is not unique to Emek. It is all over country." There are, however, pediatric units strewn in five different buildings on the Emek campus, even though good medical practise demands they be together. Emek's patient population of 350,000 people are mostly from low- and low-middle socioeconomic groups, including residents of development towns, immigrants from Ethiopia and Russia and Arabs, plus members of kibbutzim and moshavim and soldiers from nearby military camps. "It is a microcosm of the state," she notes. With 24 inpatient medical departments and a wide variety of outpatient facilities, it has 1,800 staffers and is the largest single employer in the Galilee, and Jews and Arabs (including several department heads) generally work together harmoniously. "Sometimes there is tension," comments Blondheim, "but a hospital is not a place for politics. During the terror attacks of the second intifada, victims of terror were treated in the same intensive-care units as the terrorists themselves." Like the administrators of all other Israeli hospitals, Blondheim notes that it is not free of violence by visitors, relatives and patients against doctors and nurses. "We may have somewhat less than other hospitals. We try to head it off when an incident is sparked. We have no police in the hospital. I recall a serious incident a year ago when Arabs from a village were angry when a relative was seriously ill. Breaking into a rage, they broke equipment. Instead of declaring a work stoppage, we sent a message to leaders of the village and threatened to call the police unless they apologized. I was alone in my office one day when 18 of them arrived. They politely apologized for what they had done and paid for the damages. The story spread far and wide. Sometimes there is also oral violence, screams. But dealing with it the way we did is more educational than to hold a few hours' strike." It doesn't have a neurosurgery department, like many hospitals outside the main cities, "but it doesn't need one," insists Emek's director-general. But it also doesn't have radiology services for oncology patients - which it really does need, as people have to travel to Tel Aviv or Haifa for these. What prevents our getting radiology is not money but politics. We need approval by the Health Ministry, and other hospitals don't want to lose their patients. Any hospital that serves so many people must, according to guidelines, have radiology services, but we don't. I am fighting it." Emek is currently hoping to build a new surgical building with 12 operating theaters. Donations are slowly coming in from Clalit and abroad, but Blondheim would "love to find a major donor to name the building for him or her." It may be more difficult heading a Clalit-owned hospital than a state hospital, says Blondheim, as the Health Ministry worries about its hospitals more, and their development is more rapid. "But all Israeli citizens deserve the same level of care. The Health Ministry now recognizes the need for modern infrastructure and allocated some money to us to start construction on the surgical building, which will cost $35 million and take five years to complete." She concedes that one of the reasons she initiated an interview with The Post was to try to locate a philanthropist from abroad who would be willing to donate. It isn't easy competing for donors with Hadassah Medical Center and other large public hospitals, but she hopes to find people who want to have a major impact on the health of Galilee residents. During last summer's war in Lebanon, Afula was the target of many Hizbullah rockets and long-range missiles, though it didn't take a direct hit. Nonetheless, Blondheim had to juggle patients, moving those on top floors to lower ones for safety. "Rockets landed in the vicinity before the alarms sounded. [Hizbullah leader Hassan] Nasrallah said several times that he wanted to destroy Afula, so he knows where we are. But regular Katyusha rockets are enough to cause harm if they come someday from Jenin, which isn't far away. We need protected space for about a fifth of all patients and for operating theaters. During the war, we didn't receive any emergency funds for protection. It took us four hours to evacuate several departments. For two or three weeks, it was very crowded because of that. I will have no way to protect patients without improved protection against attacks in the surgical building. But even when there is no war in the north, the hardest part of the job is "the responsibility. There is no limit to working hours. I wake up with the hospital on my mind and go to sleep with it. I always make a midnight call to ask what's new. Even when abroad I stay in touch. The proof of the pudding is that patient satisfaction is very high. The biggest challenge is to be able to ensure innovation and attract highly regarded professionals. This is not so easy in the periphery." The Klebsiella pneumoniae bacteria that are resistant to most antibiotics - reported in the media to have caused dozens of deaths by nosocomial infections (those arising in a hospital) - did not come as a surprise to Blondheim. "Reducing the risk of infections is a daily challenge, she says. "We have a higher rate of hand disinfection than in Tel Aviv-area hospitals. We teach awareness. We have found that female personnel wash their hands more than men. I have a special bottle of alcohol gel in my room, and when I returned there from the wards with a senior Health Ministry official, he was surprised that I automatically disinfected my hands. 'Do you always do this?' he asked with surprise. "We do screening for resistant bacteria on an ongoing basis, and do not have Klebsiella. But the test is not if a hospital has such an infection, but what it does to prevent it from spreading. No hospital has enough intensive care or isolation beds, and it is worse in the periphery. We have to discharge patients too soon, and when the wards are very crowded, sometimes patients are treated for days in the emergency room." In the years ahead, medicine will change, as more day surgery will be performed in the community, and in hospitals, operations will be minimally invasive, with robots brought in and consultations held via computer. "But, she insists, "there is no replacement for the human touch. And the health system must do a lot more to prevent disease rather than just treat it - even though the benefits take years to show up." She worries about the decline in Israeli medical research, which can't be funded from regular hospital budgets. "We will give a prize for outstanding research, with seed money and scholarships." Although Blondheim starts her day in the office at 7 a.m. by reading medical journals in pediatrics and hospital management, she doesn't treat patients anymore. "If I could do a clinic once or twice a week, that would be nice, but that can't be done in neonatal intensive care, which has to be daily." But Blondheim is not seeking yet another promotion. To be director-general of Emek Medical Center was her dream, and the people of the Galilee to whom she has dedicated herself have reason to be grateful.