"There is no money in the doctor's cash register," says S., "and I'm always in pain. Always. From the NIS 1,000 a month I get from National Insurance, there is no money left for medicine. Nothing."

With these few words, spoken in the sing-song manner common to many Yemenite Israelis, 75-year-old S. sums up the reality of her life. In her golden years, after spending 57 years in Rosh Ha'ayin, raising seven children, many grandchildren and three great-grandchildren, she is forced, like other Yemenite immigrants who arrived with the establishment of Israel, to do without the drugs she needs.

The modest old age pension she and her husband receive does not allow her to pay bills, buy food and also afford their monthly drugs. But she seems to accept the verdict. She cannot stop the pain and her worn-out knee joints make walking difficult, and whenever she moves her right arm, it is clear her shoulder is also causing her pain.

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The drugs she cannot afford do not cost thousands of shekels a month. They are the most basic drugs in the health basket. They are routinely prescribed to people her age who suffer from high blood pressure, diabetes and joint problems. The figure she says she is short of is NIS 200 a month, the cost of her monthly insurance.

Depression and old age

"The doctor's empty cash register" refers to the medicine free-loan fund Prof. Michael Weingarten began three years ago at the old Rosh Ha'ayin clinic to help his patients.

59-year-old Weingarten is a specialist in family medicine from Tel Aviv University's Medical School. He has been treating S. ever since she arrived at the Rosh Ha'ayin HMO 27 years ago, several years after he immigrated from England. 12,000 human beings, nearly all old Yemenites and their families, are being treated at the clinic. Apart from serious health issues, many elderly suffer also from financial distress.

Weingarten treats 1,500 patients. "From age zero to old age," he says smiling. After nearly three decades in the same clinic, he knows quite a few of his patients on a personal level. The health problems of 70-year-old patient, D., have been treated by Weingarten for "at least 25 years," he says. D. also arrived in Israel with the major Yemenite wave of aliyah, a year after the country was established. D. arrived in Israel as a 13-year-old boy, and never acquired an education. The monthly pension that sustains him is lower than the minimum wage. "I don't have the money to buy all the drugs I need," he says, "so I do without many of the pills and suffer pain. There's nothing to do - such is life."

When D. is asked which health problem bothers him most, he answers: "Depression."

D: "All the bad things that happened to me in life I take very much to heart, and it makes me depressed. It's hard for a man my age to live without any money at all." Weingarten cuts into the conversation and coaxes his patient, "talk about your diabetes."

"Yes," says D., "I suffer from that as well. And now, when the doctor's till is all out and he cannot give me a discount, I have no money to buy the pills with and I feel bad."

D.'s poverty is translated into poor health. Weingarten turns the computer screen on and demonstrates how poverty causes diabetes to develop. During the last six months, the period of time in which the free-loan fund has been nearly dry, D.'s diabetes blood level has risen.

"Twice the acceptable high number that was stabilized before by drugs," explains Weingarten. He says that "a person in D.'s condition may suffer serious complications: an injury to the retina that can cause blindness, an injury to the kidneys that may necessitate dialysis and a kidney transplant, an injury to blood flow to the feet and arms that might pose a threat of gangrene and amputation, and a serious injury to the heart."

Weingarten says it is no coincidence that his two patients describe similar health issues. "Yemenites," he says, "suffer from three typical diseases. Diabetes, which is two and a half times more common in Yemenites than in the general population, is genetic. When the immigrants arrived in Israel and their diet changed, the genetic potential came into effect and diabetes broke out." He says that "this disease in Yemenite Israelis has the dimensions of an epidemic."

The emotional distress described by D., says Weingarten, "is also one of the common diseases suffered by Yemenites. Depression and schizophrenia are three times more common in this population than in the national average." Acute pains throughout the body, described by his elderly patients, come from "the skeletal, joint and bone ailments that are also unique to Yemenite Jews."

Deep financial distress

Weingarten's many years of clinical work among the Yemenites were also translated into a lengthy research. Some 14 years ago, he published the book, "The Yemenite Jews in Israel: Changing Culture and Changing Health."

"The book," he says, "describes the ethnic group's history, and its cultural and genetic identity. The research follows the changes in their social life since immigration (1949-1951), the environmental, physical and nutritional changes they experienced when coming to Israel, and how it all affected their health. While in Yemen, the community suffered from infectious diseases and high infant mortality; in Israel, they developed the industrial world's diseases."

Weingarten was first exposed to the financial distress his elderly patients fell into three years ago, when he returned from Oxford University, where he was invited to work as a visiting professor for two years. "In old Rosh Ha'ayin," he says, "there's a community of 15,000 Yemenites, more than a third of the Magic Rug aliyah. A high percentage of them are elderly people from an extremely low economic echelon, and many of them are supported only by the National Insurance allowances."

Today the old section of Rosh Ha'ayin is surrounded by neighborhoods of a financially secure population. Weingarten explains that "this magnificent building has also affected the modest homes of veteran residents. Three years ago, the municipality taxes skyrocketed, but the allowances the old folks live off of remained the same."

Alongside the cost of living, explains Weingarten, "the participation fees in purchasing medicine have also risen." The decline in the quality of life is revealed by the fact that "many started asking me to cut down on basic drugs prescriptions, because they couldn't afford them. When I started following the situation at the clinic's pharmacy, I noticed that some of the patients were simply too embarrassed to approach the pharmacists with the prescription. They couldn't afford an expense of NIS 100-200 a month."

"Poor people are also usually sicker," says Weingarten. Therefore, in order to help his patients regularly obtain their necessary drugs, Weingarten decided to set up a non-profit organization to gather donations, NIS 3,000-4,000 a month, "to support the 30 to 40 patients in the greatest need."

Until two and a half years ago, he recounts, "I managed to more or less sustain the free-loan fund with random donations. Once, a retired colleague, a professor from the medical school, donated NIS 10,000 on the occasion of his 90th birthday. I gathered donations at my local synagogue in Petah Tikva. A drug company made a one-time donation of NIS 1,200, and local neighborhood activists and well-off residents in Rosh Ha'ayin have also joined in the effort."

When the free-loan fund's bank account at the Rosh Ha'ayin Bank Hapoalim branch reached the necessary NIS 3,000 a month, Weingarten sent his patients to the HMO's pharmacy. "When the pharmacists identified the person's name on the computer," he says, "they charged only half of the participation fee. The other half was deducted directly from the free-loan fund's bank account with a magnetic card kept by the pharmacists."

Restoring justice

In recent months, donations in the free-loan fund also started thinning. "It seems," says Weingarten, "that the combination of long work hours at the clinic, with the time I teach and conduct research at the university, makes me a terrible fundraiser."

As evidence he presents a thick binder documenting his appeals to various banks, drug companies and Israeli millionaires. "I asked all of them to make a contribution for the sake of the sick elderly in Rosh Ha'ayin, but no wealthy body or person replied with a positive answer."

Weingarten: "I have yet to find a way to gather a core of 40 donors, each donating via a standing bank order NIS 100 a month to sustain donation at the necessary minimal level."

It is rare to find a person with Weingarten's academic skills working as a family doctor at an HMO. Up until a year ago, he was head of the department of family medicine at Tel Aviv University, a position he held twice in the last ten years. He previously headed the medical department of behavioral science.

"I see this as the fulfillment of Zionism," he explains, "this was the reason I made aliyah in 1973, to treat patients in the periphery."

It is safe to assume that had he chosen to work at an HMO clinic in one of the more well-off neighborhoods in the center of the country, he would have been a wealthy man. That is the common path doctors - of lesser experience and knowledge - take. But for Weingarten, it is important "to restore some justice to an unjust society that neglects the weak."

Weingarten: "My mentor, Prof. Max Polliack, who was head of the family medicine department at Tel Aviv University before me, used to say: There are two kinds of citizens in our country, the giving kind and the receiving kind. I give thanks every day for the privilege of being on the giving side."