Most rabbis in Israeli hospitals and nursing homes focus on kashrut and Shabbat clocks, while rabbinical students generally spend the majority of their time poring over the Talmud. But patients suffering from pain and fear due to serious or terminal illness - as well as struck by the deaths of loved ones - don't have many professionals to turn to. The use of chaplains, social workers, nurses and others to provide spiritual support - not necessarily based on religion - has become widespread in the US, and its glaring absence in Israel has induced American Jewish organizations and local volunteers to promote it here. Tishkofet, a voluntary organization that trains nurses, social workers, psychologists, rabbis, chaplains and others to provide spiritual support, recently held its fourth annual conference for professionals who want to learn more about the field. Two foreign organizations - the United Jewish Appeal-Federation of New York and the US National Association of Jewish Chaplains (NAJC, which has a branch here) - as well as Joint-ESHEL financed the latest conference at Kibbutz Ma'aleh Hahamisha outside Jerusalem; they also help finance Tishkofet. RABBI MEIR NEHORAI, the rabbi of Kibbutz Masuot Yitzhak in Gush Etzion, graduate of the Netiv Meir and Mercaz Harav yeshivas and an activist in the Tzohar organization of moderate Orthodox rabbis, said in a lecture that "in yeshiva, we didn't learn much about giving spiritual support. This field is important to me. As a community rabbi, I go to mourners' homes frequently, and it's difficult to know what to say and how to support them, especially if their loved one died prematurely." One of his pupils was a teenager who died in a road accident. "One has to know what to say to the family. Communities don't want their rabbi to talk politics but offer spiritual help. And I meet mine throughout the kibbutz, not only in the synagogue. There is a real need to cry," said Nehorai, "so when I see mourners, I tell them that crying during the shiva mourning period is the healthiest thing to do. There are parents who bury their children, and this is much more complex than burying one's parents." Training he received from Tishkofet (www.tishkofet.co.il in Hebrew and www.lifesdoor.org in English) provided Nehorai with tools along with the traditional Jewish sources. During the week of lamenting at home, said the rabbi, a family should "take advantage of shiva, and talk about the deceased. "Over the millennia, there were civilizations in which mourners hurt themselves. Halacha prohibits this. It is better after shiva to work on projects that memorialize the dead." But there are people who didn't get spiritual support and isolate themselves, rarely going out except to make obsessive visits to the cemetery. This is a type of self abuse. He recalled the case of parents whose son, a soldier, was killed in a road accident 12 years ago. "They are still consumed by guilt for having allowed him to go to an appointment they set for him. 'Why didn't he take the bus?' they ask again and again, torturing themselves. There are always questions," said Nehorai. "As a rabbi, I feel I must keep in contact, but everyone is busy, and in recent years I have felt I could have done more by telling them they must go on with life." His kibbutz also has a nursing home where the founders of the kibbutz - including his own Holocaust-survivor mother - live, and many suffer from dementia or other serious problems and need complex nursing. "I didn't know how to talk to demented patients," Nehorai admitted. He turned to Tishkofet, which teaches how to use texts, music, photographs, conversation, aromatherapy, even gardening or animals to help people discover within themselves what makes them feel purposeful and meaningful. TISHKOFET DIRECTOR-general Dvora Corn, a family therapist with a master's degree in clinical sociology and family therapy and founder of one of America's leading rehabilitation therapy and consulting organizations, came on aliya with her husband Prof. Ben Corn, who had served as vice chairman of one of the largest and most profitable oncology departments in the US. Prof. Corn is today head of radiation oncology at Tel Aviv Sourasky Medical Center, and daily sees patients with terminal illness. Both modern Orthodox, they live in Jerusalem with their four daughters. The couple founded Tishkofet because they noticed the lack of such an organization. "Most Israeli rabbis and professionals in the healthcare professions receive little or no training in helping people satisfy their emotional and spiritual needs during crises," said Dvora during the conference. "I receive a few calls a month from rabbis who want to learn what to say to congregants who lost loved ones in tragic circumstances, or when an end-of-life decision must be made. Our programs are based on the understanding that, when provided with the proper blend of support, nurturing and education, the lessons of life perceived and understood by those facing life-threatening disease can be transferred to others. Such sharing can only occur when an open and honest environment is cultivated." Participants in the Tishkofet conference were a motley group, mostly women. There were a couple of haredi rabbis and non-Orthodox male rabbis, secular women, modern Orthodox social workers and nurses - and even a secular non-Orthodox woman from New York, wearing a skullcap, who is a chaplain in a nursing home populated mostly by Hispanics and blacks. "There is a strong feeling that Israel's health system has too little time for giving emotional support. Even nonbelievers may turn to a hospital rabbi, who is not equipped to handle it; they are busy with other things," said Dvora. Many hospital patients "are experiencing a physical and emotional crisis. One can help them find meaning in their troubles. Every hospital in US has a chaplain, but there doesn't have to be one for every denomination. I once worked in a Quaker long-term facility in New Jersey that had a Catholic priest and a rabbi as chaplains. In the US, the view is that you don't have to have a person of the same faith to offer spiritual dialogue - although most people would prefer it. In the US, there are hassidic rabbis participating in courses with female rabbis." In health care, she continued, spiritual support doesn't have to be based on religion at all. There is also music, art, and sometimes narratives of war experiences. "But we at Tishkofet wanted to do something uniquely Jewish and Israeli." There are no job openings in institutions for "spiritual support providers" or chaplains, she said, but psychologists, social workers, doctors and others who already work there often want to get training to expand their tools in working with patients, said Dvora. There are some grants to pay for such training, and a lot of volunteers. The Health Ministry is "interested," Dvora said, "but in a system in which there isn't enough money for nurses and social workers, one can't say that chaplains are a recognized profession." Tishkofet offers seminars in hospitals and private homes. There are several accepted textbooks and NAJC material (www.najc.org), but at the conference, lecturers spoke about everything from reading stories by S.Y. Agnon to "Integrating Shamanic Techniques." Spiritual support involves "getting to know the individual and exploring what sparks meaning and a feeling of strength from their life experience," explained Dvora. "We talk about something transcendent; for many people, but not all, that is God. Atheists respond to this too. We don't push religion on people. One atheist who was terminally ill told me he felt strength when he walks among the mountains where Abraham walked. This feeling of continuity was important to him." Prof. Corn, who today serves as the organization's executive chairman, pointed out that the field of spiritual care is coalescing into a bona fide profession. He expressed appreciation to the UJA Federation of New York for encouraging the funded organizations in Israel to establish strategic committees to define and study research-related questions that will drive this new discipline forward. Dvora concludes with a true story about a young man who finished his military service, went to India and returned home, only to be told he was suffering from a brain tumor. He underwent surgery, but most of the cancer could not be removed. "It is still growing. He was supposed to study law, but has occasional seizures and will be lucky if he lives another four years. He came up with a concept of making an exhibit that will explain to other seriously ill people what they are going through. It will be a series of rooms: One will show chaos; the second will be a gambling casino where 'doctors' give you odds. The third will be full of mirrors and optical illusions. The final room will have 50 TV screens filled with talking faces all offering different kinds of advice. "He says this exhibit, to be in Tel Aviv, will be his contribution after he is gone; he wants others to benefit from his experience."