Nursing bodies and souls

Israel's first academic Orthodox nursing college offers degrees in ethically guided medicine.

By JUDY SIEGEL-ITZKOVICH
nurse 248.88 (photo credit: machon tal)
nurse 248.88
(photo credit: machon tal)
If you want to study at Israel's first and only Orthodox college of nursing - the Nursing School of the Jerusalem College of Technology's Machon Tal - you will need to learn not only a wide variety of medical subjects but also Jewish ethics and halacha (law). There is already a serious shortage of nurses, but predictions are that the situation will get much worse. Although there are two fine non-academic nursing schools for religious women - at Jerusalem's Shaare Zedek Medical Center and Netanya's Laniado Medical Center - they don't offer a degree, which is gradually becoming the expected standard. Machon Tal Nursing School director Chaya Greenberger, previously the head of accreditation and licensing of the Health Ministry's nursing division, says there were nearly 40 students in the freshman year in 2007 and 65 new ones were admitted this past fall. The number of enthusiastic applicants was at least double that, she adds. JCT RECEIVED rabbinical approval for establishing the school before its senate agreed on it and the Council for Higher Education gave permission to launch it. Next summer it will receive full academic accreditation retroactively. One has to be female to be accepted, says Greenberger, who came on aliya with her family 25 years ago with a bachelor's degree in nursing and earned her doctorate in gerontology at Hebrew University. One doesn't have to be Orthodox, but women who are not are unlikely to devote eight extra hours a week to religious subjects in the school's midrasha. "We wouldn't attract others when they can attend another nursing school," she notes. She would like enrollment to reach 250 students, not only women new to nursing but also those working as non-academic nurses who want to upgrade their qualifications. Although about 95 percent of the country's nurses are women, there is considerable demand for male nurses, especially observant ones, among haredi and even some modern Orthodox health fund members. Perhaps it won't take long before men can study there; Machon Tal has applied for permission from the Council for Higher Education to open a separate school for Orthodox men. "It is a genuine possibility," says Greenberger, "but it would take some time to assemble a suitable male faculty." A school for men could be set up on the JCT's growing Machon Lev campus in the capital's Givat Shaul quarter, where only men - mostly national religious men after military service or as part of the Israel Defense Forces' academic program - study engineering and management. JCT also offers academic degrees in scientific fields to haredi women at its Machon Lustig in Ramat Gan and an evening program for haredi men at its Givat Mordechai campus so they can pursue yeshiva studies during the day. Machon Lev students enjoy a modern campus; Machon Tal is less fortunate so far, with a rented building on Rehov Beit Hadfus. JCT rabbis will not allow the women to move into the Givat Shaul campus, even with a wall between the men's and women's areas. But even the rented space has a modern simulation center with mannequins and suitable classrooms. The third of its students who live outside the Jerusalem area may stay in the dormitory of Machon Tal, which offers its female students degrees in hi-tech engineering and marketing similar their counterparts in Machon Lev. MOST OF Machon Tal's student body are graduates of national service. Their ages range from 19 to over 30. Quite a few are married, and some are already mothers. They have long study days of up to 45 hours per week, and tuition is like that for university. The faculty are full- or part-time nurses, some with nursing doctorates and the rest with master's degrees and clinical specialties. Greenberger said the nursing school is not affiliated with a single hospital. "We outsource the clinical part of the curriculum with Shaare Zedek and the Hadassah University Medical Center. In the future, we will also work with other Jerusalem hospitals, such as Bikur Holim, the Alyn national center for physically disabled children and Herzog Hospital (a psychogeriatric and rehabilitation hospital nearby in Givat Shaul). An English-language nursing school "would be a nice idea. There are observant women abroad who would like to earn an academic nursing degree in a school like ours and return - or come on aliya. But such a college would be a whole new kettle of fish. It's not on our front burner," says Greenberger. A RECENT seminar on bone marrow transplants for second-year students was held at the nursing school, with lectures by two religious physicians - Prof. Reuven Or, head of the bone marrow transplant department at Hadassah University Medical Center in Jerusalem's Ein Kerem, and Dr. Bezalel Perl of Shaare Zedek's internal medicine and emergency departments. The women listened attentively, took notes and seemed to comprehend the complicated medical and halachic issues. Bone marrow transplants may be indicated mostly for leukemias, lymphomas and occasionally some solid cancers, as well as for immune and stem cell deficiencies, according to Or. An identical twin is the best source, but these are rare. If not identical, a sibling may have a similar tissue type. In addition, he said, a total stranger found via a bone marrow registry in Israel or abroad may also be compatible; Jews of the same ethnic origin are usually much closer in tissue type than non Jews. There are 12 million people around the world who have had their blood sampled for tissue type, and an amazing 400,000 are Israelis, Or says, as they have "stayed together" for so many generations that finding a suitable donor is easier. Receiving stem cells from another person is called an allogeneic process. Sometimes, for a form of blood plasma cancer called myeloma, oncologists will perform autologous transplants of stem cells that are collected from the patient and given back to him after he undergoes high-dose chemotherapy to destroy malignant cells. All fetal blood is like stem cells. After the umbilical cord is cut, these stem cells settle in the ends of the long bones and circulate in the blood supply. Thus umbilical cord blood can be used after processing, freezing and defrosting to treat blood-cancer patients with compatible tissue types. However, adds Or, paying thousands of shekels to store your baby's umbilical cord blood is questionable. "The private banks sell dreams of organs that could be repaired after suffering from chronic disease, but one can't know now if it will be of use," he declares. Such cells may be usable for about two decades but there is no proof that they remain viable beyond that. However, he urges new mothers to agree to have their umbilical cord blood taken to a public bank for use by others. If one has plenty of money, Or says, it's like an unproven insurance policy, "but if it comes at the expense of [food for the baby], forget it." However, bone marrow transplants are far from simple, and fewer than half of the recipients survive. The greatest dangers are infection and rejection by the recipient's immune system. "The transplant," explains Or, "transfers a new immune system to the recipient, and this can attack the patient himself -a process called "graft vs. host disease." Before a transplant, the patient's immune system is weakened with chemotherapy and even irradiation. "It is very difficult physically and emotionally." The recipient is then put into intensive-care isolation for two or three weeks to reduce the risk of infection. Such immunosuppression is needed to reduce the risk of rejection. Although treatment is not yet very efficient, it has saved thousands of lives. It has also been used to cure a few types of solid tumors such as kidney cell carcinoma and even some lung cancers. PERL, WHO received a modern Orthodox education but became haredi, regularly consults with leading rabbinical arbiters and medical ethics experts such as Rabbi Yitzchak Zilberstein, rabbi of the Ramat Elhanan community in Bnei Brak, about ethical and halachic issues that pose real dilemmas. He recalls that 20 years ago, he examined a 30-year-old mother of two in Shaare Zedek's hematology department. She was diagnosed with chronic myeloid leukemia, which could allow her to live - unpleasantly - for years. Today, the drug Gleevec can do wonders, although it's not a cure. "Some patients become sicker and develop acute myeloid leukemia, which can kill. Without treatment, the annual transfer rate from chronic to acute was 25% per year. But a bone marrow transplant could also have killed her." Perl stresses that solid-organ transplants have much higher success rates than bone marrow transplants. "Things change, however. In the 1970s, [the late American sage] Rabbi Moshe Feinstein deemed a heart transplant 'double murder' - of the donor and the recipient. But in the past 20 years or so, better drugs and technologies have significantly reduced organ rejection." Even donating a kidney, Perl says, can pose some danger - but there is no danger from giving stem cells; the risk is the recipient's. The rabbis and the patient himself must balance the risks and possible benefits. Should the patient remain with what he has, hoping some procedure or drug can save him later, or take a chance with available treatment? Perl recalls another memorable case two years ago of an old religious woman in Shaare Zedek's emergency room who had a severe blockage of blood to the intestines. If she had refused surgery, she would have definitely died. With an operation, she would have a 20% chance of survival. She refused, as permitted by Jewish and civil law, but after being at her bedside for a few days and unable to watch her suffering, her family begged her to have the operation. "She couldn't even give written consent and was asked to press their hand if she agreed. She did - and died two days after the operation. Risking one's own health is reshut (permitted) in certain circumstances. "Usually," said Perl, "halacha dictates how you should live. Taking risks when there is a chance of successful treatment or even a cure is not mandatory but depends on potential benefits, and whether one has a short or a long time to live without treatment." The Jewish People, Perl concluded, received the Torah some 3,300 years ago. It remains immutable, and studying it provides scholars with a way of learning what God would want in contemporary circumstances. "The more we learn Torah, the more we are uniting with the Giver of the Torah. It was not given once; we are still receiving it."