ByMAAYAN JAFFE-HOFFMAN

When it comes to trauma care, time can be the difference between life and death. Three years ago, for the city of Ashdod, time was the silent killer. Israel’s fifth largest city, with 250,000 residents, lacked a hospital and they were forced to drive a minimum of 30 minutes to the nearest location to receive emergency care. Sometimes people did not make it. “We have saved real lives, just because we are in the area,” said Itay Zoarets, director of trauma services for Samson Assuta Ashdod University Hospital, which opened three years ago – the first new public hospital to be built in the State of Israel in 40 years. In just three years, the numbers speak for themselves: 240,268 emergency department visits, 15,000 births, 7.6 million lab tests and the list goes on. But behind the numbers are people, many of whose lives have been improved or even saved because of Assuta Ashdod. THE STAFF includes doctors from Australia, Brazi and Canada. (Marc Israel Sellem)“Six months ago, I was invited to a feast of thanks for a 22-year-old haredi [ultra-Orthodox] man,” Zoarets recalled. “He had fallen from a fifth floor and was in a profoundly serious situation. He was intubated for a month and had so many surgeries.”Eventually, the hospital managed to stabilize the young man and he came to. He then underwent three months of rehabilitation at Sheba Medical Center, Tel Hashomer. Today, he is walking again.“When you see him, his wife, his friends, the rosh yeshiva – the full circle – you understand what you did,” Zoarets said. There was also the young woman who was run over by a truck and underwent immediate emergency surgery. She had inflammation in her head. “We were really worried,” the doctor recalled. “Her husband just recently sent a video of her laughing with her daughter. She started to teach her again. I started to cry because something like this – there are just so many crazy events.”There was also the 17-year-old who was stabbed in the chest. Zoarets clamped his heart with his own two fingers to stop the bleeding while wheeling him into the trauma room. “If he had to make even a 20-minute drive, he would have died for sure,” the doctor said. “He was almost dead and now he is heading to the army… I earned my job that day.”ASSUTA ASHDOD is located on the Mediterranean coast of Israel, halfway between Tel Aviv and Gaza. Before coronavirus, the city was a tourist magnet with its sailboats and yellow sand dunes – at least during peaceful times, when there were not too many rockets.


During 2014’s Operation Protective Edge, the city was the landing pad for 239 rockets launched from Gaza. The city’s residents are diverse, with immigrants from 99 countries. Those families, many of low socio-economic status, suffered through the 2014 war with no hospital. Those injured by shrapnel, experiencing post-traumatic stress disorder, or simply delivering a baby or enduring cancer treatment, were forced to travel nearly an hour or more to the nearest hospital for treatment. Ashdod was the only one of Israel’s 10 largest cities without a hospital.“This city needs a hospital of its own. This was the promise. This was the decision. And today it is the realization,” said Prime Minister Benjamin Netanyahu, at the cornerstone laying ceremony of Assuta Ashdod. Three years later, the facility is bursting at its seams and, according to Prof. Joshua “Shuki” Shemer, chairman of Assuta Medical Centers, plans are underway to expand by another 300 beds to a total of 600 beds within the next five years.Assuta Ashdod is a public hospital, partially owned by Maccabi Healthcare Services, the second largest non-profit HMO in Israel. According to Maccabi CEO Ron Saar, Maccabi is in the process of acquiring the whole facility – a process that should be completed within the next 12 months.The new Assuta Hospital has created a unique, game-changing model for population health management and integrated care: the deliberate organization of patient care activities between two or more providers – saving lives, improving patient outcome and increasing efficiency.Assuta Ashdod is the first fully rocket-proof Israeli hospital, built with a unique bomb shelter designed to withstand missile attacks. It is also chemical and biological weapons-proof. In the event of another Protective Edge or other major attack, the hospital “would be able to continue to work without evacuating a single patient – everywhere in the hospital, from the Emergency Department, to the operating rooms, to all of the wards,” Shemer said.It is also Israel’s first green, environmentally friendly hospital. Affiliated with Ben Gurion University Medical School, Assuta Ashdod is helping to train Israel’s next generation of physicians.One-third of the rooms are private, and the other two-thirds allow only for up to triple occupancy. In the ER, beds are separated by walls instead of curtains to maximize privacy and help deter the spread of infection.“This is one of the most important modern Zionist projects in Israel and the most dramatic event in the Israeli health system in decades,” Shemer said.
IN A MAJOR attack, the hospital would continue to work without evacuating a single patient.
IN A MAJOR attack, the hospital would continue to work without evacuating a single patient. (Marc Israel Sellem)
As the hospital was being built, independent surveys showed that only around 40% of residents felt that they would use the facility over one of the other hospitals that they were used to traveling to, according to the hospital’s director-general Dr. Erez Barenboim. However, “on the day the residents realized they had a hospital in the city they all started coming.”He said that since day one there has been a huge request for services.“If you want to evaluate success, look at what happened in the last year with coronavirus,” Shemer said. “I don’t like to think what would have happened in the area if there had not been a hospital in Ashdod.”The city was hard-hit by the pandemic, partially because of the diverse constituency that includes older Russian immigrants and a large ultra-Orthodox community, and partially because everywhere was hard hit. The hospital treated some of the most severe patients in the country, including younger patients with severe cases, whose lives the doctors saved.THERE ARE countless examples of benefits from medical advances in nearly every department, such as:

• Eyal Ben-Assa, director of Structural Heart Disease Services, brought transcatheter aortic valve replacement (TAVR) to the region, a service that Ashdod residents used to have from beginning to end only outside of their hometown. Ben-Assa said that from mid-September to December he has treated 30 patients for aortic stenosis, a narrowing of the aortic valve opening that restricts the blood flow from the left ventricle to the aorta and has a low survival rate – as low as 50% at two years and 20% at five years if left untreated. TAVR reduces mortality and also improves quality of life, Ben-Assa said. “Many of these patients [who receive TAVR] are elderly, above 75,” he explained, making open-heart surgery risky. TAVR involves only local anesthesia and patients can go home within two days.


“It’s a game changer, for sure,” he said.The actual procedure is still being conducted outside the hospital, but everything before and after the procedure can now be managed within Assuta Ashdod.• Eli Sapir, chairman of Radiation Oncology, explained that the hospital’s department is the only one like it for tens of kilometers. “Let us assume a patient has breast cancer. She would drive to Sheba or Rabin Medical Center or Hadassah-University Medical Center every day for three to five weeks. If the patient has lung cancer, he will make the drive for six weeks. If he has neck cancer, for seven weeks – stuck in traffic on a daily basis,” Sapir described. “Can you imagine a patient with cancer who has symptoms related to the disease and the treatment doing that? To be stuck in traffic for hours in each direction and suffer from all of these issues is not an easy task.”Ben-Assa said that he is glad he came to work at Assuta Ashdod because the personnel are “young and ambitious,” and the facilities and treatments are “advanced and cutting-edge.” He also said the management is flexible.Before coming to Assuta Ashdod, Ben-Assa worked for Tel Aviv University Sourasky Medical Center.Zoarets, too, said that he jumped on the bandwagon, from Sheba Medical Center, because he was “interested in building something from nothing. I find it challenging but fun to be a part of the first hospital that started in 40 years, to be a part of something bigger than myself.”He said that the staff, like the people who live in the city, is diverse. His team includes doctors from Australia, Brazil, Canada, America and more. At first, it was difficult to communicate. Now, he said, after three years, they speak a joint language.“We support each other and trust each other. We can communicate with just our eyes,” Zoarets said. AFFILIATED WITH BGU’s Medical School, Assuta Ashdod is helping to train Israel’s next generation of physicians. (Marc Israel Sellem)Maccabi’s Saar said that the hospital has set three goals: to ensure that patients are never treated in the hallways, to put a stress on interoperability and building a connection between the hospital and the community, and to run financially strong and stable. He believes that in the first three years, the hospital accomplished 70% out of 100% – and in his perspective, that is a solid percentage. ASHER BITON would likely agree. He was seriously injured in September while picking up baked goods to deliver to the needy when Gaza terrorists lobbed a rocket at the city, striking him with shrapnel. The father of 15 was hit just as Prime Minister Benjamin Netanyahu was signing peace deals with the United Arab Emirates and Bahrain at the White House in Washington.Biton took such a heavy hit that the shrapnel pierced his spleen and other vital organs and he suffered from internal bleeding that caused him to quickly lose consciousness. In addition, he lost the bone in his left arm between his elbow and hand.The journey from the incident to the hospital was four minutes by ambulance. Doctors said that 15 or 20 minutes more he would have lost so much blood he would have died for sure, as happened to Irit Sheetrit, a 39-year-old who was killed in a rocket attack in 2008. Although she managed to get out of her car and take cover on the ground, she was wounded critically and succumbed to her injuries.“We brought him here and the doctors said they would not let him die, that they would not let the angel of death take him from me,” Biton’s wife Rivka said in tears. “This whole hospital was built to save my husband.” “Assuta Ashdod is not a luxury,” Biton continued. “We are just one simple family, but I know so many other people – neighbors, friends – who feel the same way.”Over Hanukkah, the Bitons came to the hospital to light candles with Zoarets, who saved Asher, and the rest of the staff. “Those events are what give us strength to keep going,” Zoarets said, adding that he believes that after three years the entire staff can already look back and say, “Wow, look at what we built here. It’s incredible.”Added Saar: “It’s a great hospital, great culture; there is something different being built in Ashdod and I think in the long run it has the potential to change the way we deliver medicine in hospitals across Israel.”