An ounce of prevention

Jerusalem clinic run by women for women helps population that ignores its own health needs.

Bishvilaych clinic (photo credit: Courtesy Bishvilaych)
Bishvilaych clinic
(photo credit: Courtesy Bishvilaych)
WHEN RIVKA SCHWARTZ (not her real name), a Haredi woman, received an invitation to a women’s lecture at a private home in her Jerusalem neighborhood, she stashed it aside.
The lecture run by a Jerusalem women’s nonprofit organization called Bishvilaych – the Evelyne Barnett Women’s Comprehensive Health Center, was heavily endorsed by rabbis in her community and although the wording was vague for modesty reasons, Schwartz understood it would offer important information on breast cancer prevention. Still, her hectic schedule as a mother to a large family meant she had to pass.
It was not until five months later, after finding a lump in her breast, that she remembered the invitation. Her family doctor suggested she see a breast surgeon, and a worried Schwartz made her way immediately to the address on the invitation. Although the event had passed, she hoped the clinic affiliated with Bishvilaych (For You, in Hebrew) could offer support.
“I sat with her for 20 minutes just to reduce her anxiety,” recalls Elisheva Langner, a clinical psychologist and the organization's director of research and education.
After seeing one of the center’s doctors, Schwartz was directed to her public healthcare provider to get a mammogram – something she did immediately, while accompanied by a Bishvilaych staff member.
Although the lump she had noticed proved to be benign, the mammogram identified a Stage 1 tumor in another area of her breast, which was excised.
“They caught it before it became a problem and it was all thanks to the invitation we sent out,” explains Langner, adding that the story is just one of the many cases of early detection due to local awareness campaigns organized by the clinic.
As the only comprehensive health center for women in the country, Bishvilaych provides care combining a range of medical services all in one visit of an hour and a half. While other women’s health centers generally specialize in what Langner describes as “bikini medicine” (gynecological and breast health), Bishvilaych focuses on women’s total well-being.
Patients are treated to an unpressured session with a doctor who asks about every aspect of the patient’s lifestyle, from their diet and exercise habits to their family medical history and even their relationship with their spouse. One area that the center emphasizes is prevention of breast cancer.
This focus is due to the well-known statistic that Ashkenazi Jews are at greater risk for developing breast cancer compared with the general population.
Comprehensive care The center’s philosophy of comprehensive care owes much to its medical director, Dr. Diana Flescher, who is a leader in the field of gender-based medicine and a national advocate for comprehensive women’s health care. Flescher believes the current healthcare system with women usually getting between seven to 15 minutes with their doctor, does not fully address women’s needs.
“Everything in a woman’s body affects everything else. There are hormone receptors everywhere in the body,” explains Flescher to The Jerusalem Report. At Bishvilaych, a woman suffering headaches due to unknown causes will not only be given blood and other medical tests, but also be asked about her nutrition, exercise and the levels of stress she may be feeling.
“We know that women tend to be torn between work and home. They are breadwinners but also expected by society to be caretakers of children, aging parents and informal caretakers of husbands and in-laws. This puts stress on women,” she said.
A member of the Ministry of Health’s National Council on Women’s Health, Flescher is working to make women’s health care a more pressing part of the national agenda, thus bringing local health care in line with the medical systems in the United States and Europe.
But Bishvilaych’s belief in comprehensive care is not the only feature that sets it apart on the medical scene.
Founded by Sara Siemiatycki, a laboratory technician and manager, who made aliya from the Midwestern US some 20 years ago, the center is open to all but caters almost exclusively to Haredi and religious women, with over 95 percent of its clients coming from those communities. As she provided a tour of the clinic on a recent winter afternoon, Siemiatycki, elegant in a tailored skirt suit and stylish wig, spoke about the center with pride. The daughter of a rabbi who worked as a hospital chaplain, she grew up learning the importance of helping patients, a tradition she keeps alive at the center.
The clinic is located in the commercial district of the predominantly religious Givat Shaul and looks like any private upscale office with a pretty waiting area and clean, carpeted floors, but the discerning eye will notice some differences. The robes that patients wear for routine exams have elbow length sleeves and skirts that cover the knees. Many members of the all-female staff are dressed in modest garb, with some sporting wigs and headscarves together with their white coats.
Health outreach The organization’s uniqueness is not only cosmetic. The center does rigorous health outreach in Haredi neighborhoods throughout Jerusalem. The breast health outreach events often include an opportunity to be seen privately by a doctor for a nominal fee; for some women these visits are their first exposure to preventive health care.
Before attending an event sponsored by the clinic, some devout women check that the project has received rabbinic approbation, something Siemiatycki, who is married to a respected rabbi, is careful to procure. Several communities also prefer to approve the visual aids that will be used.
For example, some neighborhoods would object to a lecturer using a poster depicting the anatomy of the breast, considering it immodest.
The Orthodox-friendly vibe may be a key reason that the clinic, which is open four days a week, is able to attract a small but steady flow of 50 patients a month even though most national health-care providers do not provide refunds. Donations subsidize the fees, but patients must still pay between 300 ($80) to 600 shekels, on a sliding scale.
The fee for a visit is no small sum for the average Jerusalemite. For many Bishvilaych patients, however, it is well worth it.
For Lisa Goldenhirsch, who made aliya from St. Louis, Missouri, 20 years ago and sought treatment her doctor was female put her at ease.
Haredi women at risk Siemiatycki founded the organization in 2004, after hearing some disturbing statistics uncovered by Dorit Isak in her 2001 study measuring breast cancer patterns according to religious affiliation. Isak found that Haredi women were more likely to die from breast cancer than secular women.
She also found that breast cancer detection in Haredi women was more likely to have occurred at a later stage.
Working at the time at a lab in a home for the aged, Siemiatycki was surprised by the statistics. “I wanted to know who was using the medical system, if not us religious women? We are there birthing, bringing in our children for checkups, coming in because we want to give birth. So why these statistics about the high death rate for religious women with breast cancer?” She realized that much medicine practiced in the country at large, and in the religious community specifically, was illness-based and not prevention-based. Her next move was to find donors and create a place to instill a new approach to health. She was successful in creating the first clinic in Geula in 2006 and then the expanded center in Givat Shaul.
Today the organization also plays a role filled in the secular community by the Internet.
Langner quotes a 2010 Philips of Israel study stating that 97 percent of local women get health information from the Internet.
For Haredi communities, who limit exposure to many forms of media, key information is missed. Langner adds that some women who have come into the clinic had never heard of basic terms relating to women’s health.
Yet, in order to change the health habits of women in the community, the organization has to convince women to make time for self-care in addition to caring for others.
“A woman might want to go get a checkup, but then she thinks: I’m having 20 guests for Shabbos. What's more important? And obviously it’s going to be grocery shopping,” explains Goldenhirsch with a laugh In response to this tendency towards self neglect, Siemiatycki promotes caretaking in a balanced way. The organization pays much respect to the fact that the maternal role is central to the lives of its patients.
Shaking off recent talk in the press about the mistreatment of women by men in parts of the Haredi world as “blown out of proportion,” Bishvilaych’s founder says that she has always felt highly respected as a woman in her community and adds that “Judaism has a very important role for women.”
The challenge before her is not to change a patriarchal culture, but to encourage women to value themselves. “Now, I just have to get the women to take care of themselves more,” she says.