The doctor shortage is causing the IDF branch to open up to the public.
By JUDY SIEGEL-ITZKOVICHIDF medics in training 248.88(photo credit: IDF )
After decades of avoiding public exposure, the Israel Defense Forces's Medical Corps has realized that in the 21st century it should be getting its message out. The most prominent controversies involving soldiers' health in the past decade have been claims that Navy divers contracted cancer from training in Haifa's Kishon River despite its being polluted with heavy metals; plans for the construction of a large military training base near the Ramat Hovav chemical dumping site in the Negev; and clinical testing of anthrax vaccine on soldiers without their informed consent.
And with the growing shortage of military physicians, public scrutiny and involvement of soldiers' parents, the Medical Corps has in the past year or two begun to let the sunlight in. Tat-Aluf Nachman Ash, the OC Medical Corps for almost two years, is behind its increasingly activist and open media policy. He recently invited medical correspondents to a briefing at the Tzrifin IDF base on what is new in the corps, and discussed trends and plans.
THE BRIEFING was followed by an exercise in which IDF commandos wearing "war paint" stormed hideouts of "terrorists" in a simulated Palestinian village built inside the IDF base. Four Israeli soldiers were "wounded," and medics trained on the base appeared out of nowhere, assessing which of the "victims" required the most urgent help. The "victims" playing the part moaned and called for help, pierced plastic bags full of red liquid that simulated hemorrhaging, and wore makeup that made the "bullet wounds" so realistic that for a moment this reporter wanted to run onto the "battlefield" and offer first aid.
But it was unnecessary. The medics pulled blue rubber gloves onto their hands, held bloody legs up to reduce hemorrhaging, bandaged the soldiers, opened airways with breathing tubes and slashed uniforms with a special cutter. When the exercise ended successfully, the "wounded" stood up in their underpants and happily posed with the medics and other soldiers.
ASH, WHO earned his MD degree at Tel Aviv University's Sackler Medical School and specialized in internal medicine, noted that the Medical Corps is doing everything it can to bring the best emergency treatment to soldiers on the battlefield and to speed evacuation to hospitals. It has purchased high-quality foldable aluminum stretchers to keep soldiers with spinal injuries immobile; "smart" bandages that stop bleeding; developed a compact, portable device with ceramic pipes that produces oxygen in the field for treating the wounded, replacing heavy balloons that had to be carried; a thin blanket that when removed from a plastic bag turns warm in a chemical reaction; and a small battery-operated field device that ventilates the wounded on the battlefield and is so simple to operate that any medic can use it.
ANOTHER PROJECT being carried out with Core Dynamics, a Nes Ziona biotechnology company, is the development of freeze-dried blood processed from a pint of each soldier's blood at enlistment and then taken in a small bag to the battlefield to be reconstituted if he is wounded for immediate life-saving infusion. Ash said that wounded soldiers are now evacuated much more quickly, often undergoing blood transfusions and other procedures en route to the hospital.
The IDF is also much more attuned to the concerns of soldiers' families. "In the Yom Kippur War, families were informed that their son was wounded a week after it occurred," said Ash. "Today, this would never happen. We are in touch with them and update them as well as the patient, as it is good for morale."
Health promotion to prevent disease used to be aimed mostly at soldiers in the permanent army and much less on recruits. But today, smoking cessation courses and information on protecting health are offered to 18-to-21 year-olds as well. "We discuss ways to prevent illness - both acute and chronic - in soldiers. This includes gastroenterological and respiratory infections and, in older soldiers, exercise and diet to prevent cardiovascular disease and diabetes," Ash noted. During the current swine (H1N1) flu outbreak, the Medical Corps realized it had to take measures much more rigorous than those recommended by the Health Ministry. Anyone infected is being isolated in military facilities instead of just being sent home, Ash said.
He added that the Medical Corps has developed knowhow, some of it unique, on first aid on the battlefield, trauma care, protection against unconventional (atomic, bacteriological and chemical) warfare, and physiology during training. The water and sleep "disciplines" - preventing soldiers from sleeping and preventing them from drinking on a regular basis are long gone, as it became clear that these could endanger soldiers' health. "Soldiers get not only plenty of water but also salts to ensure that their electrolyte balance is normal," Ash explained. "The Medical Corps also provides two-day Advanced Trauma Life Support (ATLS) training courses that are mandatory for all civilian surgeons. There used to be two IDF field hospitals, but one deteriorated and the other was closed. Now there are plans to open an innovative, modern facility within the next two years, he said. IDF medics are trained using a lot of simulation, including computerized patient models.
ASH REPORTED that during Operation Cast Lead in Gaza, 153 soldiers were shot or otherwise injured, but only 10 died. The enemy's weapons were less deadly than they were in the Second Lebanon War, but the Medical Corps was also better trained and equipped, he added.
There has also been a significant upgrade in the diagnosis and treatment of psychological and psychiatric problems among soldiers. "Mental health is a very sensitive issue. During the past two years, we have carried out significant reform. Instead of just screening inductees and diagnosing soldiers with problems, today we assess their ability to cope with service, and offer more treatment. As a result," said Ash, "there has been a decline in the number of soldiers dropping out, so more of them remain in service."
More emphasis is put on dental health, with every field soldier examined and treated according to a personal plan. There is a shortage of military dentists, but the shortage of IDF physicians is much more severe, causing the Medical Corps to contract health funds and even private companies. It is about to issue a tender for two public health funds to provide primary care to soldiers; if the project is successful, an additional tender will bring the other two health funds in.
During the past decade, fewer high-school graduates have applied to study medicine under the IDF's academic program (Atuda). In addition, the decline in immigration from the former Soviet Union - which peaked in the 1990s - has further reduced the supply of physicians. About 150 doctors are civilians, and some work part time.
"We need 75 new doctors a year, but get only 25. Only about 40-50 high-school graduates go to the Atuda to study medicine in an average year; it is difficult for them to be accepted by medical schools, as they are discriminated against by not being able to re-take their psychometric exams to improve scores, unlike those who have already finished military service. We are short dozens of doctors, and there are 20 battalions without doctors at all," said Ash.
"But there is a light at the end of the tunnel. By the end of this year, we will start to close the gap. There are 70 doctors, including those in the Atuda, who after graduation will come into service. Their conditions have improved; we pay their tuition and for their dormitories. They even get additional grants. Yet it is not easy to close the gap. We are working with the Jewish Agency to bring more immigrant physicians. We explain to them what is expected in the IDF, and even accept older doctors. We have had some success with people from France and Argentina."
The Medical Corps closed its regional clinics and replaced them with services from the urgent-care clinics of the private company Bikur Rofeh. Although at first there were complaints of hundreds of soldiers with fever, cough or light injuries packed into the company's urgent-care clinics for hours on a Saturday night, Ash said that service now is much improved.
The main solution to the IDF doctor shortage, Ash stressed, will be graduates of the just-established Hebrew University-Hadassah Military Medical School, which is affiliated with its veteran medical faculty. About 250 men and women have applied, and 50 of them will start studying this October on the Jerusalem-Ein Kerem Campus. They will study the regular subjects required in medical school, with added courses on medicine in the battlefield, motivation, officer leadership and other relevant subjects.
"It will produce doctors who will serve in the military, many of whom will go on to work in civilian hospitals and clinics. In 10 years, it will bring a revolution for us," said the chief medical officer. "Within 15 years, I am sure a great deal of clinical research in military medicine will emanate from the school."
As for clinical research carried out in the IDF, Ash says the Medical Corps has instituted "big changes" and issued guidelines which were lacking when the anthrax vaccine was tried on soldiers who felt pressed to join the experiment without having enough information before agreeing to participate. "Our research studies are now supervised by the Health Ministry; we report to them, and some things require approval in advance - of course with protection that will enable soldiers to decide whether they want to volunteer."
The IDF has produced promotional films for its Web site that promote Atuda medical studies among high school graduates. Public relations experts call the program "Commanders for Life" and use jargon that will attract a "cool" audience - which is a turnabout from the IDF's previous printed information campaigns. Indeed, it has entered a new era.
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