Co-existence in the Children’s Ward

Debra Kamin September 11, 2014,

http://www.timesofisrael.com/co-existence-in-the-childrens-ward/

 

At Rambam Hospital in Haifa, kids from Israel, Gaza and the West Bank are studying together in between treatments

Hodaya is 8 years old and her favorite color is pink. She is small for her age, and over her tiny, pale face she wears a green paper surgical mask.

Hodaya would have loved to join the millions of Israeli students who went back to school on September 1, but she couldn’t. That’s because Hodaya is suffering from an aggressive form of bone cancer, and like dozens of other children at Haifa’s Rambam Hospital, she can’t leave the building.

Instead, Hodaya goes to school for a few hours a day inside of the hospital building. And while she doesn’t have the shiny new backpack, the gleaming locker or the pages upon pages of homework that other students in Israel have, she has something that none of them can even dream of: friends from Gaza and the West Bank, who are hospitalized alongside her and learning in the same classroom.

At Rambam, which is the largest medical center in the country’s north and one of Israel’s most renowned, pediatric education follows the same model as it does in hospitals across the country: the Education Ministry oversees curriculum and coursework, and sets mandates for the number of hours each day that hospitalized children must attend class.

But when you have 5-year-olds on dialysis and 11-year-olds undergoing chemotherapy, nothing, not even math homework, is normal. And at Rambam, where on average half of the beds in the pediatric wing are filled by children from Gaza and the West Bank, the banalities of reading, writing and arithmetic become even more surreal.

 

Dima Chamra, an Arab art therapist at Rambam, greets

17-year-old Sana Charoob, a patient from Jenin (left),

while Amtaz Manfor, a Druze teacher at Rambam, stands

behind 8-year-old patient Simdosh Chansan Jamal, also

from Jenin (right). (photo credit: Ofer Golan)

“We try to make them feel as normal as possible, even though it’s not a normal thing to be hospitalized,” says Ilana Levy, who manages all of the hospital education centers in Haifa, including that of Rambam. “We don’t care where you are from. We have Jews here, Christians, Arabs. We have children from Gaza. During the war, while there was fighting every day, we had children from Gaza sitting next to religious Jews in class. It doesn’t matter. We love all the children here and want to keep their lives as normal as possible.”

Classes at Israel’s hospitals ramped up on the first day of September, just as they did at schools around the country. Classrooms, which are divided by age group, all have an Arab-speaking teacher and a Hebrew-speaking teacher, and several have special assistants like art therapists or volunteers doing their national service. Classes generally run from 8:45 a.m. until 2 p.m., as they do in schoolhouses throughout Israel, but students come and go depending on their treatment schedules and how they are feeling each day.

“They come and they learn, and we really get attached to them,” says Lila Yahiach, one of the teachers in the oncology unit. Yahiach is Muslim, and she shares her classroom with Yehudit Levy, a religious Jew, as well as a Jewish national service volunteer named Hodaya Toledanu (no relation to the patient). Yahiach speaks in Arabic to the Arabic-speaking students, Levy speaks in Hebrew to the Jewish students — but both insist they feel the same connection, and the same responsibility, for everyone in their classroom.

Shilat Levy, a five-year-old patient at Rambam, is

Jewish and from Haifa. (photo credit: Ofer Golan)

Asked if she believes the students inside of Rambam can sometimes learn more about the outside world than their peers in Jewish-only or Muslim-only schools in the region, Yahiach immediately says yes. “Some of the students come here, and they speak only Arabic, but, it’s like anywhere – they make friends,” she says. “So they also want to learn Hebrew. And they start to, so they can talk with each other. They are kids. Of course they want to talk to each other.”

The ratio of Jewish to Muslim students is always in flux, although hospital officials say it generally sits at an even split. This week, as the school year opens, there are four students from Gaza, all of them hospitalized full-time. Some of them have been at the hospital for years, living there with their families while they undergo intensive treatment. There are 12 students from the Palestinian Authority, including five from Jenin. In the past the hospital also housed a number of Syrian children who were brought across the border for treatment. (The Gaza and PA kids’ treatments are paid for by the Palestinian Authority and they come to the hospital as medical tourists. The education costs are covered by the hospital and the Education Ministry, which stipulates that all kids in Israeli hospitals get schooling regardless of where they live.)

One of those students from the West Bank, Muhammad, is 12 years old. He shares a classroom with Hodaya in the surgery department, and while Hodaya practices writing the Hebrew alphabet with her Hebrew-speaking teacher, he sits alongside his instructor, a Druze teacher named Amtaz Manfor, and together they practice reading and writing English.

“English is the language of the world,” Muhammad, who also wears a mask to protect himself from contamination in the classroom, says. “So I like learning it. And my teacher likes speaking it.”

Manfor, who wears the traditional white veil of Druze women, hugs Muhammad and laughs. “I do like English,” she says. “And he is a good student.”
Also in the classroom are two girls from Gaza, who are gluing multi-colored sequins onto pieces of white paper with Dima Chamra, a Christian Arab who is a trained art therapist.

“It’s stressful here,” she says in English before giving a direction to the girls in Arabic. “The art is really helpful for them. It gives them an outlet. Some of them are here for a very long time.”

Dr. Rafael Beyar, Rambam’s director general, says that inside of a hospital, there is no place for politics.

 “This is really a way for us to show that coexistence can happen,” he says of the classrooms in the pediatric wing. “We have Jewish and Muslim kids, Arab kids, kids from Gaza, kids with cancer, kids with kidney diseases, kids that stay here for a very long time. The hospital becomes their home. And whn you live together and you also learn together.”

Rambam has recently undergone a series of massive renovations and reconstructions, including the unveiling of a cutting-edge hybrid parking garage/underground hospital facility that is fully fortified. The shimmering Ruth Rappaport Children’s Hospital, a cheerful, light-filled new pediatric building, had its soft opening this summer. The children interviewed for this story are still being housed in the old building, but Beyar says that once all the pediatric cases have been moved to the new unit, classes will be larger and offer more chances for children from across the region to learn alongside each other and even become friends.

“A life is a life,” Beyar says. “It doesn’t matter where the patient comes from or what his religion or opinions are. We are care for patients, we educate the children who live here at the hospital, and we stay out of political arguments.”

High risk pregnancies from Gaza treated at Rambam

Arrived from Gaza in critical condition, returned with healthy
twinsCommunicated 18 Feb 2014

Two-and-a-half weeks after arriving at Rambam between life and death, “H”
said goodbye to Rambam and the people who cared for her and her twins.

“This is the happiest day of my life.”

Pregnant women in Gaza rarely need to turn to Israel for medical help since medical care is available in Gaza before and throughout their pregnancies. It is even rarer that two women from Gaza, within weeks of each other, find themselves and their unborn child facing life-threatening problems necessitating the expertise of specialists at Rambam Health Care Campus - but that is what happened.

Two and half weeks ago, “A”, 29 years old and pregnant with her third child, was brought to Rambam. She was suffering from a problem common in pregnancy - Rh incompatibility - a condition in which the mother and fetus have two different blood types and which can result in the mother’s
antibodies harming the red blood cells of the fetus. However, in “A”’s case, the problem was not detected in time - she was in critical condition and both she and her unborn child were in danger.

Two days after being admitted, “A” gave birth. However, things became even more difficult when her premature son was found to also have a congenital heart problem.

“A” had two small children waiting for her back in Gaza. One week after his birth, “A” had to make the difficult choice of returning to Gaza to care for her children. Her premature son remained in the care of Rambam’s medical staff.
“It’s a very difficult situation,” Yazid Falah, the Palestinian Patient Coordinator at Rambam said. “Naturally the mother wants to stay with her baby. But in this case she is there and he is here. We are doing everything we can to help her feel as close as possible to her son.” 

A few days ago the infant underwent successful surgery for another common
condition: patent ductus arteriosus (PDA), in which a vessel in the heart does not close. The infant is gaining strength and his mother remains in contact by phone on a daily basis until she can return to Rambam and bring him home with her.

One Arrived - Three Returned

Just before “A” arrived at Rambam, "H", a 35 year-old woman in her ninth month, was brought to Rambam from Gaza - also in extremely critical condition. Carrying twins, her condition was so serious that she was barely aware of her surroundings. Since childhood she had suffered from a blood clot disorder. Now that disorder placed her in extreme danger of bleeding to death - she needed special care and medications not available in Gaza.

Upon arrival “H” underwent a C-section to save her first children - a healthy boy and girl - each weighing 2.3 kg. However “H” remained in critical condition and was sent to the intensive care unit (ICU). It would be two full days before she was alert enough to ask about her babies. Each day the medical staff took new photos of the infants so  that she could have a record of their first days once she recovered.

After one week in the ICU “H” saw her children for the first time.

“I still remember when I left from Gaza to come to Israel,” “H” explained.

“The doctor said that my situation was very critical. During the first two days before I fully woke up,  I couldn’t contact my family and they thought I was dead. Until I saw my children for the first time I did not understand myself what had happened. Only when I saw them and held them did I realize that everything was now OK.”

For “H,” the birth of her twins has been a great comfort. A few days ago, two-and-a-half weeks after arriving at Rambam between life and death, “H” said goodbye to Rambam and the people who cared for her.

“H” smiled and said, “My entire family is waiting for us, everyone wants to get to know them and hold them. This is the happiest day of my life.”

American Doctors Vote for Rambam

On November 6th, Election Day in the USA, a delegation of 20 North American doctors came to Rambam Health Care Campus http://www.rambam.org.il/Home+Page/  and pledged their readiness to be "drafted" to help Israel in times of national emergency

The physicians have promised that in an Israeli national crisis, they will come here to help––for example, by taking the place of surgeons and other hospital doctors who have been called to the battlefront.

The physicians were given a survey of Rambam’s disaster management network, and also voted with their feet by touring the Emergency Room and the Sammy Ofer Fortified Underground Emergency Hospital http://www.rambam.org.il/home+page/Support+Rambam/Needs/Capital+Projects/Sammy+Ofer+Underground+Emergency+Hospital>.

“I’ve spent several years trying to learn best practices in emergency department disaster preparedness,” said Dr. Peter Sananman of Penn Presbyterian Medical Center. “This was a great opportunity to learn best-in-class systems and processes from those who’ve learned from experience."

The delegation was sent to Rambam by the American Physicians Fellowship for Medicine in Israel http://www.apfmed.org/ (APF, est. 1950). The organization’s flagship program gives fellowships to Israeli doctors for advanced clinical training in the USA and Canada. The APF also annually sends members to Israel for an Emergency and Disaster Management Course offered in conjunction with the Ministry of Health and the IDF Medical Corps.

The APF is the only North American body designated by the State of Israel to maintain an Emergency Medical Volunteer (EMV) Registry. Most recently, Registry members took part in a nationwide Israeli drill testing the health care system's preparedness for a massive earthquake. “Their response to the simulated call-up was phenomenal," says APF Israel Director Amir Blumenfeld, MD. "Sixty-eight physicians immediately volunteered to be in Israel within forty-eight hours."

To watch the visit of the American doctors,

Saving Children from Gaza

On the background of tensions in the South of Israel, four kids from Gaza are receiving treatment at Rambam Medical Center without which they might die.


At a time when rockets are being fired from the Gaza Strip at the communities of southern Israe, four young residents of Gaza are receiving treatment in northern Israel. The four kids, nephrology patients suffering from kidney insufficiency, have been hospitalized for several months in the Children's Hospital at Rambam Health Care Campus, where they have been receiving lifesaving therapy while awaiting kidney transplants.

Several months ago, three of the children –– Mohamed and Hadeel (both 12) and Hadeel's brother Ahmad (15) –– recently arrived at Rambam in serious condition. Since then, they have gone from hemodialysis treatments (in which blood is cleaned via an artificial kidney) to peritoneal dialysis (administered through the abdomen). The latter therapy is given overnight, which enables patients to lead more active lives; soon, for the first time in three years, the kids will be able to go back to school like every normal child of their age. The fourth youngster, six-month-old Lian, is still being treated with hemodialysis, which is appropriate for her medical condition.

Now that their health has improved, the three schoolchildren are due for release to their homes, Mohamed within the next few days, and siblings Hadeel and Ahmad shortly afterward. The families have recently spent time with the staff of Rambam's Pediatric Nephrology Unit, under the direction of Prof. Israel Zelikovic, and learned how to perform peritoneal dialysis by themselves.

"Peritoneal dialysis is preferable for children because it can be performed by an automated dialysis device at the child's home, in his natural surroundings," Prof. Zelikovic says of the method's advantages. "The treatment is performed at night while the child sleeps, which frees him for regular activities during the day. It also makes possible better nutrition and metabolic balance and reduces the burden on the heart and blood vessels."

According to Mahdi Tarabia, Head Nurse of the Pediatric Nephrology Unit, who has escorted the families during their stay at Rambam, until now in the West Bank and Gaza it has not been possible to receive peritoneal dialysis. "The hemodialysis treatment that these children were given before their arrival at Rambam was associated with medical complications, resulting in a worsening of their condition and many hospitalizations," he explains. "Now, these families have the skills to administer peritoneal dialysis, which represents a significant improvement in the children's circumstances and will enable them to function almost normally." The families will receive the equipment required for peritoneal dialysis and the solution used with it from Teva Pharmaceuticals, which will convey it to Erez Checkpoint.

Mr. Tarabia points out the cooperation between the Pediatric Nephrology Unit at Rambam and the medical authorities in Gaza and the West Bank, who jointly have the children's best interests at heart.

Over the past year, the Pediatric Nephrology Unit has cared for tens of Palestinian children from the West Bank and Gaza, who have arrived at Rambam Medical Center with various kidney diseases. The Unit, which specializes in dialysis for infants and small children, has performed more than 4,000 dialysis treatments this year.

And that is a story no international newspaper or media outlet will print!!!

Rambam treats Palestinian with Parkinson's

This summer, a 51-year-old Palestinian resident of the West Bank came to Rambam Medical Center for Deep Brain Stimulation (DBS) therapy in a successful bid to control the disabling symptoms of Parkinson's disease.


Tarik Sadek Abu Baker, an accountant by profession, developed an aggressive case of early onset Parkinson's disease at age 39. Twelve years down the line, he had stopped responding to Parkinsonian medications. On his behalf, the Palestinian Authority turned to the Movement Disorders Center at Rambam, directed by Senior Neurologist Dr. Ilana Schlesinger.

Deep Brain Stimulation therapy to correct movement disorders was pioneered by French neurosurgeon Prof. Alim-Louis Benabid in 1987 and has been available to the medical community since approximately 1999. It has been available in Israel since 2003 and at Rambam since 2008. The surgery involves implanting two electrode-equipped leads in the brain and two battery operated neurostimulators in the chest

See and hear about this story

RAMBAM SURGEONS CHANGE THE LIFE OF A 12 YEAR OLD

Kirill, a 12-year-old boy from Latvia was born with a congenital defect making right arm movements impossible. He is now able to function normally and return home, thanks to surgeons at Rambam Medical Center in Haifa.

Kirill suffered from brachial plexus palsy, a defect that occurs in one of 3000-5000 births. But in 90 percent of cases, the disability passes by the age of three months. In the case of the Latvian boy - and in approximately eight Israeli children a year - it never did.

A week ago, the boy arrived in Haifa to undergo a relatively rare and complicated operation by Dr. Mark Edelman, head of the pediatric orthopedics department at Rambam. The surgeon rotated the boy's wrist 65 degrees and set it in its new location with six screws.

Edelman said that it was only the second case he had encountered in his career as a surgeon.

"Kirill taught himself to cope with life using only one of his hands. This is a very difficult disability for such a small child," he said.

After the three-hour operation and one day of hospitalization, he was discharged last week. Kirill feels well, and for the first time in his life, is able to use both hands.

Motherless Twins Leave the Premature Unit

On July 18th, a pair of motherless twins, a boy and a girl, were released from Rambam's Neonatal Intensive Care Department. Even the department's senior nurses - who have seen it all - wept, as the twins' story is truly unique.


For close to ten years, the twins' mother had tried to get pregnant. The woman, who had married young, began fertility treatment. To her and her husband's delight, she became pregnant. At the beginning of her seventh month of pregnancy, the catastrophe began. The young woman started suffering from unexplained breathing difficulties, and arrived at the Department of Emergency and Urgent Care Medicine at Rambam. Her examination revealed a painful picture - a tumor in her lungs. The young woman was sent for further testing, which showed, to her doctors' sorrow, growths that had spread throughout her lungs and metastasized to her liver.


From this point, the situation rapidly deteriorated. In her 31st week of pregnancy, the woman was rushed in for an emergency Caesarean section, which would allow her to begin chemotherapy in a desperate effort to halt her illness. The woman did not successfully make it through surgery, however, and was rendered unconsciousness and in need of respiration. At the Intensive Care Unit, doctors made every effort to return her to consciousness. "The mother had to be respirated because her lungs had collapsed," explained Mirit Barzilai, a nurse from the unit. "Nevertheless, we succeeded in returning her to consciousness for a short period. We told her the twins had been born healthy and everything was all right. Because of the respirator, she couldn't talk, but she started to cry. Soon after, we had to anaesthetize her again."


Meanwhile, the twins, who had been delivered by C-section six weeks earlier, were transferred to the Neonatal Intensive Care Department. The mother, still unconscious and respirated, began to receive chemotherapy at the Intensive Care Unit. The new father ran between departments from his infants to his wife. Ten days after the operation, the young mother died.


In an unorthodox move, Professor Shraga Blazer, director of the Neonatal Intensive Care Department at Rambam, asked the twins' grandparents to enter the department and help out with the infants: "I understood that the grandparents would have to learn once again how to take care of little babies, but there was no choice, as the father had to return to work," says Prof. Blazer.

Currently, Rambam's premature unit is especially busy, with triplets, several pairs of twins and other infants, resulting in a 20% increase in the number of premature babies being treated. In spite of their numerous new patients and full schedules, senior nurses at the unit say they will remember the twins for years to come.

33 Operations in Four Days

Rambam orthopedist took part in a surgical "marathon" in Ecuador: within four days the surgeons performed 33 operations, most of them on children


A senior Rambam orthopedist, Dr Mark Eidelman, recently participated in an international medical delegation to the city of Loja in southern Ecuador. There, delegation doctors treated local patients with various orthopedic problems, some of them severe. Dr Eidelman and another Israeli doctor held a surgical marathon: within four days they performed operations on 33 patients, most of them children from neighboring villages. By way of comparison, surgeons at Rambam, northern Israel’s largest hospital, carry out five to ten pediatric orthopedic surgeries weekly.


The delegation acted under the auspices of a voluntary US organization, ‘Operation Rainbow’. The California-based organization sends surgeons to different Latin American countries, to areas lacking medical knowledge, equipment and personnel. Among those on the 22-member delegation were five doctors, nurses, and physical therapists, accompanied by two and a half tons of medical equipment.


According to Dr Mark Eidelman, director of Rambam’s Pediatric Orthopedic Department, the doctors faced a difficult challenge. “The university hospital in Loja, where we performed the operations, publicized our mission about a year ago. Since that time, some 350 candidates requested operations, and doctors at the hospital chose 75 cases that seemed most urgent,” explained Dr Eidelman.


On their first day in Loja, the doctors examined the cases and ranked them according to severity. During the four following days, the delegation doctors performed surgeries and treatments on patients of different ages, with varying problems. “Every day we arrived at the operating room at 7:00 am and finished working at 11:00 at night,” recalls Dr Eidelman. “The pace was insane, but we wanted to treat as many patients as possible.”


Despite the fact that this effort involved orthopedic patients with limited mobility, people covered great distances to receive treatment. “Most of the patients came from villages in a range of 500 kilometers from the hospital, but these people had little choice. What can an eight-year old girl who has waited five years for treatment do if there is no pediatric orthopedist in her region?” said Dr Eidelman.


Patients ranged in age from 65 years to a five months, and Dr Eidelman remembers nearly every case. Though he has returned to Israel, the surgeon’s memories of Ecuador remain vivid. “This was the first time I took part in a delegation like this, and it was an incredible experience. I hope that in the near future I can participate in this crucial effort once again.”

INDONESIANS ATTEND RAMBAM SEMINAR

Indonesia, the world’s most populous Muslim country, has no diplomatic relations with Israel. Despite this gulf, five medical experts from Indonesia are currently at Rambam, learning to build a system for treating victims of catastrophe, both natural and manmade.

At Rambam, 27 doctors and nurses from 17 countries are taking part in a unique simulation. This staged Mass Casualty Event (MCE) is not unusual in itself. What is special is the human mosaic of participants from Albania, Ecuador, Ethiopia, Burma, Georgia, India, Vietnam, Jordan, Nepal, Kenya, Nigeria, Chile, Peru, Kosovo, Thailand, Ghana and New Zealand. Even Indonesia, the largest Muslim country in world, which has no formal diplomatic relations with Israel, has sent five representatives.

The simulation is part of the eighth course of its kind, titled the “Eighth Seminar on Developing and Organizing a Trauma System and Mass Casualty Event (MCE) Organization. Held from November 6-19, the course is jointly sponsored by Rambam, the Ministry of Foreign Affairs and the Ministry of Health. It is aimed to teach participants to develop systems for medical operations in emergency, trauma and MCE situations suited to their countries.

Of course, the seminar’s Rambam setting is no coincidence. RHCC ‘enjoys’ the dubious distinction of being an expert in trauma, emergency and mass casualty situations. For years, the hospital has received soldiers injured on Israel’s northern border and beyond, as well as civilians caught in home front wars and terrorist attacks in Northern Israel.
“In the course, we learn how to build a system for operating in emergency, trauma and MCE. We did not come to seek medical information, but guidance on how to get organized in case of these situations,” said Prof of Neurology Andi Asadul Islam, from Hassan Udim University, Makassar, East Indonesia. “Rambam’s system for trauma is the best there is, and we can learn a lot from it.”

“We don’t have a good system,” continued Prof Islam, who explained that Indonesia’s broad geography presents specific challenges in supplying medical care. With 250 million citizens scattered among five large islands and thousands of smaller ones, Indonesia spans an area, from west to east, equal to the length of the United States.

Further, RHCC houses the only trauma system in the region. Severe trauma patients from nine general hospitals feed into Rambam, making it the busiest center for trauma in Israel. The hospital’s Teaching Center for Trauma, Emergency and Mass Casualty Situations [MCS] leads instruction in this field nationwide, and regularly holds international seminars for physicians and nurses from throughout the world. In addition, the center sends representatives to different countries to teach courses and holds workshops for NATO personnel.

“I had heard about the Rambam course from colleagues who had taken it, and they said it was great,” said Asti Puspita Rini, who manages the 118 Emergency Ambulance Service Foundation in Indonesia’s capital, Jakarta. “It has been an excellent course,” she continued, “we won’t be able to implement each and every thing we learned, but will certainly adopt parts of the program.”

The course involves theoretical lectures, as well as tours in Rambam and different Israeli hospitals. This program allows participants to receive a wide view of activities of the various emergency medicine units. Additionally, they visit IDF simulation centers, and Magen David Adom (MADA) headquarters.

The seminar is hardly all-work-and-no-play. Participants get to know another side of Israel as they visit a number of tourist sites, among them Yad Vashem, and other sites in Jerusalem, Nazareth, Jaffa, Acre, Zichron Yaakov and others

“As a Muslim, it was especially interesting for me to see the Muslim quarter in Jerusalem,” said Prof Islam. “Some of my friends and family were afraid and didn’t want me to come here because of what they see on television,” said Rini, “but it’s totally different than what the media shows.”

“Everything is well-organized and perfect,” added Dr Edi Prasetyo, Medical Advisor of Home Care in Jakarta. “We get to see the big picture – how the whole nationwide system works.”

Judging from these comments, it was obvious that the only connections these Indonesians do not have with Israel are diplomatic. Warm, open and enthusiastic, these visitors had nothing negative to say about the course or the country, except perhaps regarding the national food, hummus, for which they showed no great passion.

And while the visitors clearly learned their lessons on trauma, emergency and MCE, one hopes they will never have to use them.

THAI Princess Makes Official Visit To RAMBAM

As part of ongoing cooperation between Thai research centers and Rambam Hospital in Haifa, Princess Chulabhorn of Thailand and her royal entourage visited the medical center this week. At Rambam, the princess signed a formal memorandum of understanding, paving the way for future joint efforts.

Prof. Dr. Her Royal Highness Princess Chulabhorn Mahido arrived on May 15, 2011 for an official visit at the Rambam Health Care Campus. The princess was accompanied by her royal entourage and by representatives of the Thai embassy in Israel, the Ministry of Foreign Affairs and the Municipality of Haifa.

This marks the sixth visit to Israel of the princess, the youngest daughter of King Bhumibol Adulyadej and Queen Sirikit of Thailand. This current visit is being held as part of scientific cooperation between Thai and Israeli research organizations. Within this initiative, Rambam is conducting cancer research with Thailand’s prestigious Chulabhorn Research Institute.

In addition to her royal title, the princess is a Doctor of Biochemistry, and is committed to advancing scientific research in her home country. Likewise, she heads the research center that bears her name, and lectures at different academic institutions. The princess oversees funds that grant scholarships and prizes to researchers, and is a senior member of the UK's Royal Society of Chemistry. In 1986, UNESCO awarded her the Einstein Medal for her promotion of international scientific cooperation.

Upon her arrival to Rambam, the princess was greeted by representatives of the hospital administration. She then attended a seminar delivered by different Rambam researchers and physicians. Opening this event, Rambam Director Prof Rafi Beyar stated that in the last three years, “Delegations from both sides have been cooperating in the fields of oncology and cancer imaging. There is no doubt in my mind,” he continued, “that within ten years, the field of oncology will be transformed through breakthrough technology and a deeper understanding of genetics, imaging, personalized medicine and tailored treatment.”

This Apartheid State? Another Rambam Success

SAVING WALLAH: EMERGENCY BRAIN SURGERY SAVES GAZA TODDLER

A month and a half ago, two-year old Wallah Omar arrived at Rambam Health Care Campus from Gaza City, listless, apathetic and completely paralyzed on her left side. Her condition was rapidly deteriorating, explained her distraught father, Ayad Hamis Omar.

Wallah had been diagnosed in the Gaza hospital as having a large tumor that was pressing on her brain. The growth had to be removed, but her parents were hesitant about performing the surgery in the small local hospital. On the advice of her oncologist, Walla’s parents opted for what the doctor termed “the first hospital on his list,” Rambam. According to the child’s father, Ayad, the oncologist had likened medical care in Israel with that in the United States. “He told me, ‘Once your daughter will be in Rambam, everything will be fine, and your family can rest assured,’ ” said Ayad.

Having decided that their daughter must get to Israel, Wallah’s parents obtained a letter of request from their local hospital and sent it to Rambam. Without hesitating, Director of Pediatric Hematology and Oncology, Prof Myriam Ben Arush, replied: Transfer Wallah to Rambam at once. Upon her arrival at Rambam, the child had an MRI scan, which showed that the tumor had reached the size of a large orange. Director of the Pediatric Neurosurgery Unit, Dr Joseph Guilburd operated immediately, removing the entire growth.

Shortly after surgery, Wallah went home to Gaza for a week, and then returned to Rambam for a series of 30 radiation sessions, under the watchful eye of Rambam oncologist Dr Sergey Postovsky. Now a month at the hospital, she has finished the bulk of the treatments, which will be completed within a week.

“She is recovering amazingly. She is perfect, laughing and playing,” says her relieved father, who adds that his daughter looks forward to seeing her sister, Dua, five, and brother, Ahmad, seven months old.

“I feel at home at Rambam,” continues Ayad, who used to work in an events hall in Ness Ziona, and is frequently visited at the hospital by friends, Arab and Jewish. “I like to see the way people live and work together here. The care we received at Rambam saved my daughter’s life. ”

Wallah’s story began four months ago, when she started vomiting. Her family doctor thought she had a stomach virus, which her family treated with common home remedies. The vomiting continued, and her situation was compounded by neurological problems: she was unable to move her fingers or even hold her spoon.

Today, according to Wallah’s surgeon, Dr Guilburd, the girl’s chances for full recovery are very good. "To see a child who recovers so beautifully is a physician's greatest satisfaction," he says.

The Children's Hospital at Rambam provides treatment in oncology, nephrology, orthopedics, cardiology, and neurosurgery to seven hundred children from throughout the Palestinian Authority annually. In past half year Rambam has treated 200 adults and children from Gaza alone, twice the number treated during the same period last year. Of these, 25 have been pediatric oncology cases. Says Prof Ben Arush, "Our department is really a microcosm of an ideal world: Jewish, Christian and Muslim children from all countries receive the best possible care."


Watch Wallah’s recovery on You Tube:http://www.youtube.com/user/rambamhospital#p/u/6/fUaU7cVfE0Q

Rambam Hospital Does It Again - Put On A Happy Face

By participating in a voluntary medical delegation to India, two Rambam doctors put broad smiles on the faces of more than 200 patients with congenital facial defects.

Sponsored by the organization Operation Smile, the delegation provided corrective surgery to people of different ages who had been born with cleft lip or cleft palate.

The operations relieved patients of both physical limitations and social stigma.

At the end of December Dr Itzhak Ramon, a senior physician in the Department of Plastic Surgery and Dr Zach Sharony, who is completing his specialization in plastic surgery, returned from a medical mission to Assam in northeast India. Their delegation was sponsored by the international charity organization, Operation Smile, which is devoted to correcting congenital facial defects, like cleft lip and cleft palate, in places where medical help is limited.

For ten days, more than 50 medical personnel from around the world treated more than 200 patients ranging in age from six months to the mid-forties. The multi-disciplinary team included plastic surgeons, dentists, anesthesiologists, pediatricians, nurses, and speech therapists.

According to Dr Ramon, this was a mission in the truest sense of the word. “These operations improve the health and quality of life for many patients who would otherwise be unable to attain or pay for such treatment,” he says.

Likewise, the team benefits from a sense of great satisfaction, and from coping with unusual medical situations. “I learned a great deal in India – all the doctors share their knowledge and everyone learns from everyone else,” says the plastic surgeon.Dr Ramon first went on an Operation Smile mission in the Philippines over 10 years ago. “The experiences I had there as a young surgeon are still very much alive for me,” says Dr Ramon. “This time I was able to participate as an experienced doctor.”Upon their arrival to India, the Rambam doctors met their colleagues and set out together for the city of Guwahati in Assam. “When we arrived at the local hospital, hundreds of people were already waiting,” recalls Dr Ramon. “There are not enough surgeons or resources there to perform these operations, so Operation Smile decided to send four medical missions there yearly,” says Dr Ramon.

Working in 10 operation rooms simultaneously, the team operated daily on five patients in each room. “You derive immediate reward from performing these operations,” says Dr Ramon. “Already at the end of the procedure, patients can see results and their smiles give us tremendous motivation.”Dr Ramon is glad to report that congenital facial defects are rare in Israel, and when children with such deformities are born here, surgery is usually performed during their first year of life. “In many countries, these deformities are very widespread. Due to lack of resources, people are forced to live with them all their lives,” he says. A trip to India is always a transformative experience, and Dr Ramon also returned with a fresh perspective: “Treating these patients allows the doctor to see everyday reality differently. I was delighted to be able to help, but above all, I felt proud of our own health system, which provides proper treatment to everyone who needs it.”

First Israeli Arab Woman Becomes a Plastic Surgeon

Another first for the Rambam hospital in Haifa - click on the title to link to a video of this story

For Dr. Rania Elkhatib, the first Israeli Arab woman to become a plastic surgeon in Israel, the job at Rambam Medical Center is a chance to be an emissary for her community.

The first Israeli Arab woman to become a plastic surgeon, Dr Rania Elkhatib works at the Rambam Medical Center, the largest hospital in northern Israel.

After studying medicine at the Technion -- Israel Institute of Technology in Haifa and then specializing in general surgery, the 28-year-old doctor decided to focus on plastic surgery: "... It was important to me because in our community plastic surgery isn't very advanced and it's not well accepted so I feel a bit like an emissary for my community, to go into this field and take it forward," she says.

Situated in Haifa, Rambam is the referral center for 11 district hospitals. Its plastic surgeons treat a number of conditions, ranging from burns, war injuries and cleft palates to breast and facial reconstruction for cancer patients.

Thirty percent of doctors at Rambam are women, and the representation of Arab physicians is proportionate to the numbers in the population in the north.

While the hospital is committed to providing equal opportunities, Prof. Yehuda Ullmann, head of the plastic surgery department, stresses that doctors are chosen purely on merit: "Plastic surgery residency is the most wanted residency in medicine not just in Israel but all over the world, and she was elected not because she's Arab, not because she's a woman, because she is Dr. Elkhatib and she is good and she is a very good doctor over here so we are lucky to have her here."

The Alternate National Service

Not everyone is army material in general wherever one lives. Israel is no exception. For different reasons, perhaps of politics or health, some young Israelis cannot, or do not wish, to serve in the military. Through Sherut Leumi (National Service), these people can still contribute. Today, more than 200 such volunteers perform important duties at the Rambam hospital in Haifa– 30 of them are Muslim & Christian Arabs

Visitors to Rambam are politely assisted by a soft-spoken young man with an easy smile. They have no idea of the long path that led Nizar Elkoury, 18, to volunteer at this hospital information desk, giving directions in perfect Hebrew.

Nizar was born in Lebanon. His father was a member of the South Lebanon Army (SLA), a Christian, Israeli-backed militia that fought the Hezbollah. When Israel withdrew from Lebanon in 2000, it granted asylum to the militiamen and their families. Given full citizenship and financial help, close to 1,000 of these families settled in Israel.

The Elkoury family has lived in Haifa since Nazir was eight. He has gone to Israeli schools, and says he has always been accepted and had friends. Hebrew posed no problem for Nazir, who mastered the language in three months. For his adopted country, Nazir expresses only gratitude, “I felt I had to do something for Israel,” he says. “I wanted to give back for the great favor we received.”

Nazir is one of 30 Sherut Leumi (National Service) minority volunteers at Rambam. Sherut Leumi offers 18-21 year olds who cannot or do not wish to serve in the army, an alternative to military service. Volunteers engage in dozens of “helping” projects. Although largely young Jewish women from religious backgrounds, Sherut Leumi volunteers also include men, and minority members. According to Rambam’s Director of Sherut Leumi, Shlomit Katzir, all qualified and motivated volunteers are welcome.

Lubna Kadry, 18, from the Arab Galilean village Nahaf also volunteers at Rambam through Sherut Leumi. Working for the children’s safety organization B’Terem, Lubna teaches children hospitalized at Rambam and their parents about safety in the home. “We work to turn homes into safe havens,” says Lubna.

According to Lubna, a disproportionate number of children from the Arab sector are injured in local and household accidents. “Homes and villages are often not safe, and parents are frequently not aware enough about these matters,” says Lubna, who says she is pleased to be helping her people in this way.

As with most volunteers, Lubna and Nazir feel they receive more than they give. “This position gives me skills for real life,” comments Lubna, who plans to be a doctor. Likewise, Nazir, who wants to be a nurse, appreciates the opportunity to view the world of medicine up close. At any rate, adds Nazir, “I believe that all of us should be connected not only to ourselves, but to our community at large.”

THE WORLD’S LARGEST UNDERGROUND HOSPITAL

Seven thousand cubic meters of concrete were poured this week to form the base of the world’s largest underground hospital. For 36 hours running, shifts of 70 workers and 80 cement mixers worked to lay the foundation of the emergency facility, which is designed to withstand conventional, chemical, and biological attacks

The night of Saturday October 9, 2010 marked the start of a crucial phase of construction at the Rambam Health Care Campus in Haifa, Israel. More than 70 workers at the site began to pour roughly 7,000 cubic meters of concrete, which will form the concrete base of Rambam’s protected emergency underground hospital – the largest facility of its type in the world – and underground parking lot. The pouring, which continued for more than 36 hours straight, involved 80 cement mixers that completed 1,000 rounds of mixing. To meet the deadline, four Haifa area concrete plants supplied materials around the clock.

According to Rambam Department of Engineering Director Aryeh Berkovitz, for two days following this effort, no concrete was poured in central to northern Israel. This is due to the fact that all related facilities, tools and personnel in the region were involved in the huge Rambam project.

RHCC Director Prof. Rafi Beyar commented, “This is a historic moment, not only for Rambam, but for the entire State of Israel. For a period of two years, we have coped with unexpected, difficult and weighty logistic problems regarding this construction. We overcame the obstacles, and with the help of our friends – donors and Ministry of Health officials – we are on the right path.”
This project is slated for completion by May 2012, at which time the three-floor parking lot will provide much-needed parking space for some 1,500 Rambam workers and visitors. In times of emergency, the lot can be transformed at short notice into a 2,000-bed hospital that is secure from conventional, chemical and biological weapons.
Not only underground, the emergency hospital will also sit eight meters below sea level. Designed to be self-sufficient, the hospital will be able to generate its own power and can store enough oxygen, drinking water and medical supplies for up to three days. Due to its special location, the facility’s construction has demanded unusual measures. Pumps have operated throughout construction – and will continue to the project’s end – 24 hours a day, moving millions of cubic meters of brackish groundwater to the sea, enabling the workers to carry out their mission.

The next major step in the Rambam complex construction – the concrete pouring for the foundation of the Ruth Rappaport Children’s Hospital – will begin on October 30, 2010. After that, work will begin on the new oncology and cardiology hospitals.

“Work is proceeding in a very ordered and professional manner,” says Aryeh Berkovitz, who reports that all construction is proceeding according to plan. Due to the project’s enormous scope and special nature, it has been making headlines. The recent cement pouring has received coverage on all major radio stations, TV channels and in the printed and online media throughout Israel.

Watch the foundation laying for the World’s Largest Underground Hospital on You Tube:
http://www.youtube.com/user/rambamhospital?feature=mhum#p/u/6/LzOXT7vzNIo

Yet another Rambam hospital success

In the western world, cataract operations are considered routine procedures. In Israel alone, some 40,000 such operations are performed yearly. Just a few hours’ flight from here, however, thousands of people suffer from cataracts and blindness. Two Rambam ophthalmologists, returned from a mission to Yaounde, capital of the Republic of Cameroon in Africa, where they restored vision to tens of patients, and instructed local medical teams performing the same procedures.


The mission was sponsored by MASHAV, the Center for International Cooperation of Israel’s foreign ministry. For two weeks, the doctors diagnosed and operated on patients with different eye ailments in the city’s main medical center, Centre H'ospitalier D'Essos. Some of the operations were performed using a phacoemulsifiaction machine, a device for cataract procedures that was brought specially from Israel for the mission. The Israeli doctors also supervised local teams in treating glaucoma patients by laser.

News of the Israeli doctors’ arrival drew patients seeking treatment and advice. Hospitals in Cameroon attend only to insured or paying patients and those without adequate means remain untreated. During their short stay, Drs. Berger and Socea conducted 55 cataract and glaucoma operations primarily for patients in need , ranging in age from five to over 80. Putting this in perspective, the local department carries out only 100 operations yearly.

The procedures were performed with help of the hospital’s staff, along with teams from other cities who arrived to take part in the operation and to learn from the Israeli doctors.

“One of the most moving cases involved a 15-year old boy,” recalls Dr. Berger. “At a young age, this boy had received treatment that left him with cataracts in both eyes and with reversible blindness. We operated on his eyes and he recovered his sight.” Another case involved an elderly man who had been blinded in both eyes as the result of traditional methods of cataract surgery . The RHCC doctors also succeeded in restoring his vision. “This is an ailment that can be treated effectively, ” says Dr. Berger. “Only the absence of proper diagnosis and treatment allows so many people to remain blind.”

The farewell ceremony for the Rambam doctors took place in the presence of Israel’s ambassador to Cameroon, the director and deputy-director of Cameroon’s social security program (CNPS) ,representatives of the Israel foreign ministry, hospital staff and treated patients.

The Department of Ophthalmology, under the direction of Prof. Benjamin Miller, has a tradition of assistance in Africa. “In Israel, medical care is taken for granted, but in Africa you feel you are helping people who live with great difficulties. The results are quick and exciting,” says Dr. Berger. “The operations and guidance we provided are a contribution of Israel to Cameroon. This is part of a long-term, successful Israeli initiative in developing countries, especially Africa.”

For a video presentation see http://www.youtube.com/user/rambamhospital#p/u/5/G0WOUM4azbE

Making Peace with the Pacemakers

From the Rambam hospital in my home town of Haifa comes another innovation to help those who have had pacemakers fitted as a consequence of their heart problems

New cutting-edge technology allows patients with pacemakers to safely undergo full MRI scans. In addition, this innovative device offers more functions than previous pacemakers. Lately, Rambam doctors implanted the device in the first Israeli patient

Rambam Health Care Campus (RHCC) doctors have implanted – in the first Israeli patient – a new improved pacemaker. This novel device, an updated version of the EnRythm MRI, is the first pacemaker developed that can be use safely during full body scans in Magnetic Resonance Imaging (MRI) machines. The device also offers more functions, particularly in the detection and treatment of arrythmias.

As part of a multi-national trial, the pacemaker was implanted in an Israeli patient by Dr Mahmud Suleiman, Dr Monder Boulos and Dr Yuval Goldschmidt of Rambam’s Cardiology Department.

While the first generation of the pacemaker, EnRythm MRI, implanted in a patient at Rambam last year, allowed for partial MRI scanning, the new device enables imaging of the entire body. EnRythm was developed by the company Medtronic, an international leader in medical technologies for chronic diseases that received the European CE Mark approval.

MRI has many advantages, including its unparalleled ability to discriminate between different soft tissues and the fact that it does not involve radiation. A sophisticated medical imaging device, MRI uses a powerful magnetic field to visualize the internal structure and function of the body for diagnostic purposes. To this point, patients with pacemakers could not undergo MRI testing since the device is sensitive to the MRI stimulus, which may cause life-threatening malfunctions.

It is estimated that some 50-75% of patients with heart implants worldwide will require MRI imaging tests during their lifetimes. In Europe alone, there are roughly two million patients with pacemakers who cannot undergo MRI imaging due to the high health risks involved.

"While the use of MRI testing has grown tremendously over the years and has become routine, it has also become a serious obstacle for heart implant patients due to incompatibility of the pacemaker with the powerful magnetic field of the imaging technology,” says Dr. Boulos. “The innovative pacemaker by Medtronic, allows heart implant patients to safely undergo MRI testing without risks to the functioning of the device"

“MRI is the best imaging modality available for neurology, rheumatology and orthopedics patients, since it has the best soft tissue characteristics,” says Dr. Ariel Roguin, head of Rambam’s Interventional Cardiology Laboratory, who wrote the European guidelines for this trial. “In the past, many patients who have pacemakers and neurology-related problems were denied this examination, which is crucial for accurate diagnosis. Now, with this new device, they can undergo the MRI procedure safely.”

Genes in kidney failure risk unlocked

Once again the Rambam Medical Center is at the forefront of discoveries that can solve chronic problems.

Chronic kidney disease affects millions in North America, with persons of African heritage being at a four-fold higher risk, and those of Hispanic heritage having a two-fold higher risk compared to the rest of the population.

Researchers in the USA working with the Rambam team recently announced that they've discovered a gene likely involved in the increased risk of kidney failure with those of African heritage.

Tremendous excitement has been growing in the scientific community worldwide, with an intense race to determine the genetic link responsible for the greatly increased risk many people of African heritage face for end-stage kidney disease and the need for dialysis or transplantation.

While much of the world has focused on the MYH9 gene, a team from the Rambam Medical Center and Technion in Haifa, Israel led by Toronto's own Dr. Karl Skorecki, has discovered that variations in a neighbouring gene, called APOL1, is much more likely to be involved.

Identifying the correct gene that puts people at risk for progressive kidney disease is necessary to understand the underlying reason for the increased risk, and to be able to find strategies to prevent or slow down kidney failure.