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wounded stretcher 298.(Photo by: Ariel Jerozolimski)
Lindenstrauss prescribes better coordination and infrastructure
JUDY SIEGEL-ITZKOVICH
07/18/2007
Comptroller praises hospital and MDA staff for their performance during Second Lebanon War.
Although the state comptroller highly praised the health system - especially hospital and Magen David Adom (MDA) staffers - for working above and beyond the call of duty and even endangering their lives during the Second Lebanon War, he nevertheless described shortcomings in the health system's organization, coordination and preparedness in 155 pages of his report - more than a quarter of the whole volume. The report - which even includes color photos taken at several hospitals - found much to complain about and made dozens of suggestions for improvement. Asked to comment, Health Ministry Director-General Prof. Avi Yisraeli told The Jerusalem Post: "We always want to do more and are never satisfied, but we are pleased that the health system functioned well during the crisis in the North. Health workers went to work without court orders [instead of fleeing the missiles] and did an excellent job. We have established committees to propose ways of making the system's performance even better." During the war, 7,439 soldiers and civilians were wounded physically or emotionally (62 percent suffered anxiety attacks). They were treated at hospitals (owned by the government and Clalit Health Services), the four health funds' community clinics and MDA medics with help from the Home Front Command. While patients were treated efficiently and with a high level of medical knowhow, most of those medical centers, as well as geriatric and psychiatric hospitals in the North, were exposed to serious danger because they lacked fortification to protect staff, patients and visitors. The Mizra Mental Health Center, just 15 kilometers south of the border with Lebanon, offered shelter from missiles for only 30 people, even though it has some 350 beds; during the war, its patients were eventually evacuated to a safe site farther south, as patients suffering from mental illness (and some in closed wards) could hardly be expected to take care of themselves. Oxygen tanks and other critical equipment were protected from exploding missiles only during the war rather than beforehand. Hospitals outside the war zone were not asked by the Health Ministry to take patients to ease the burden of overburdened ones in the North, the comptroller writes. On-site day care centers for staffers' children set up to enable parents to work were woefully inadequate, "chaotic" in some cases, and generally run by untrained women soldiers. The authorities were "completely unprepared" for providing medical services in bomb shelters, the report continues. Only during the war did some soldiers improvise and provide medications for the chronically ill living in the shelters. Most municipalities and local authorities lacked up-to-date information on the location of elderly, disabled and other needy residents. The health funds complained that they were not given the names of members who suffered anxiety attacks so they could provide follow-up care to prevent chronic post-traumatic stress. The use of volunteers in an emergency was not organized, and their altruistic services were wasted due to the lack of coordination, the comptroller wrote. The comptroller urged that a law be passed to set down the responsibilities of the health insurers in a period of emergency and to establish a supreme body that will have the authority to determine what medical and other services have to be provided to the population in an emergency. He also recommended coordinated inter-ministry plans for evacuating hospital patients and staffers in an emergency and to drill staffers in this task during quiet periods. A detailed program for upgrading fortification of hospitals in the North and other parts of the country, while setting priorities due to limited budgets, should be prepared. The transfer of information among the hospitals, the Home Front, the IDF Chief Medical Officer's office and the Supreme Hospitalization Authority must be improved, he said. Too much of the military's medical equipment had passed its expiry date or was otherwise unusable during the war. Regarding MDA, which the comptroller praised warmly for staffers' devotion and courage, there is no special budget for emergencies, and the first-aid and ambulance organization was not reimbursed for all the expenses incurred by the war. Paramedics - who are the mostly highly trained - from outside the war zone were not dispatched to the North to relieve their tired comrades. MDA facilities in the North were not properly fortified against rockets, the comptroller continued. Seventy-five of the MDA vehicles that were sent up North lacked global positioning systems to navigate unfamiliar roads and streets. Many MDA staffers lack personal protection equipment for use against unconventional warfare. There was little or no coordination between MDA and private ambulances in the area whose staff could have helped out in the emergency. In 1995, the Health Ministry's legal adviser's office prepared a proposal setting down responsibilities for medical services in an emergency but, 12 years later, the ministry has not brought it to the legislative stage in the Knesset. Again and again, the comptroller urged the gamut of state, military and voluntary agencies to sit down together and reach an agreement on authority, logistics and budgets to prepare for the next conflict.
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