Who doubts a child's heart?
The philanthropic organization Save a Child's Heart has treated thousands of Palestinian and African children. Now, officials are questioning the wisdom of its actions in these cash-strapped times.
Hospitals are great for teaching you how to wait. You wait to be examined, wait for a doctor, wait for a nurse, wait for an operation, wait for the result. At best, there is someone who waits with you. That way, both of you learn how to wait. In a corridor at Wolfson Medical Center, Holon, Hana Kolab sits and waits, outside the room in which children with serious heart conditions undergo echocardiograms. Her daughter, Reem, aged 2 years and 9 months, rests on her mom’s hip as Hana waits for her to fall asleep. Not just from being tired − though the toddler is undoubtedly weary, having left home early that morning. Her mother is waiting for the anesthetic her daughter was given to take effect. Only when the child’s limbs go limp under the influence of the drug will it be possible to take her in for an examination.
But that’s alright: Kolab is used to waiting. She and her daughter arrived this morning from the Gaza Strip via the Erez checkpoint, and that is no route for people who lack patience. Finally, the little girl falls asleep. The energetic echocardiogram technician, Yifat Brosh, arrives to check the girl, who is hanging like a rag doll on her mother. “Very good,” she says. “Go in.”
Kolab, her daughter and a friend of the family enter the room. The other parents and children in the corridor watch them with a mixture of curiosity and empathy. It’s Tuesday, the day physicians from a humanitarian project called Save a Child’s Heart devote to clinical examinations of children from the Palestinian territories who suffer from serious heart ailments. Some of the children who are keeping themselves busy quietly in the corridor have already had surgery and are here for a follow-up. Others, like Reem, are here for the first time, for diagnosis.
In the echocardiogram room, Kolab lays her tiny daughter on the examination table. At the technician’s instruction she removes the girl’s blouse. The technician starts the examination. The room is cold, and the mother places a hand on her daughter’s leg. She looks at the image that appears on the machine’s screen. The heart is constructed of four chambers: left ventricle and left atrium, right ventricle and right atrium. There is a hole between the ventricles of Reem’s heart. Also visible is a blockage in the middle of the right ventricle, which interferes with the blood flow. Reem is starting to move about on the bed. Brosh moves authoritatively to complete the examination before the little girl wakes up. She hands the diagnosis to Dr. Akiva Tamir, known as Aki, the hospital’s chief of pediatric cardiology.
As the effect of the anesthetic wears off, Dr. Tamir enlists his Arabic and explains to Ms. Kolab that the results of the examination are consistent with the diagnosis Reem received in Gaza. He tells her that surgery can be performed that same week, on Thursday. The worried mother nods approvingly. The family friend intervenes: Hana has a large family in nearby Jaffa, and they will be happy to host her until the operation, instead of her having to wait alone in the hospital. That is out of the question, Dr. Tamir tells him. The army gave Hana an entry permit to Israel that allows her to stay solely within the bounds of Wolfson. “But the house is so close,” the family friend implores. He promises that Kolab will not leave the house and will only remain within the family fold. “No way,” the doctor says firmly, though not without empathy. “If mothers who come with children for an operation will start to wander around outside the hospital, the whole project will be shut down,” he says. The family friend doesn’t relent. Dr. Tamir says, “If you want to make her a hafla [party], “do it here.” End of discussion.
Reem Kolab was admitted to Wolfson Medical Center thanks to Save a Child’s Heart, known as SACH. This year the organization is being given the Presidential Award for Volunteerism, in a ceremony to be held on September 4. It performs lifesaving heart surgery and medical monitoring for children from developing countries. It was founded by the late Dr. Ami Cohen in 1995, and its 70 members regularly devote a considerable part of their time to it, with no financial compensation. In 1996, the participating physicians performed 48 heart operations within the SACH framework. Last year, they operated on 250 children. All told, more than 2,900 children from around the world have benefited from the project, about half of them from the territories, Jordan and Iraq.
However, not everyone applauds this humanitarian effort, which strives to transcend the tangled political situation in the Middle East. Even though President Shimon Peres found SACH worthy of an award for its “special contribution to the good of the state and society in Israel,” the Health Ministry has a different take. It maintains that the Israeli health system is buckling under the load and cannot allow itself to subsidize a group of doctors with philanthropic tendencies.
Nor is the controversy confined to the Israeli side alone. The Israeli physicians at Wolfson reiterate the mantra that “politics is outside the picture,” but it turns out that the Palestinians, too, have qualms about getting Israeli help, and about the cooperation this entails. The organization saves thousands of Palestinian children and also trains Palestinian physicians, at enormous expense. But the fledgling physicians themselves, however estimable they find the project, are prevented by forces greater than themselves from speaking well of SACH in public. It might be that, within the microcosm of the children’s ward at Wolfson, Israeli doctors joke in Arabic with Palestinian mothers, but it is also apparent that outside the hospital there are people who don’t find the joke very funny.
“I am very popular in Gaza,” Dr. Tamir says with a smile, when we speak between examinations. Dr. Tamir is SACH’s chief cardiologist and, as he puts it, “I am often told that if I come to Gaza I will get a royal welcome.” Turning more serious, he notes that there are “many problems” concerning the SACH clinic for Palestinian children: “The first problem was when rockets were fired into Israel. Do we go on accepting children from Gaza? Our decision, made at the beginning of the second intifada, was that yes, we go on receiving children from Gaza, even when missiles fly.”
But before he is suspected of being an ardent leftist, Tamir counters: “Not without agonizing. We are all Israelis, Zionists, and we love our country and our nation very much. But what we are doing is a humanitarian act. We are trying to divorce it from the conflict as much as possible. If someone hurts my children, does that mean I have to hurt his children? I am not sure. As a physician, the Hippocratic oath and my conscience oblige me to treat children regardless of anything else. I treat them as a doctor and as a human being.”
But given the unstable condition of the Israeli health system, is Wolfson supposed to go on subsidizing the organization’s activity as it does? “I think that Israel gains a great deal of respect from this project, and many doors are opened because of it,” Dr. Tamir responds. “I am just a simple doctor who treats children’s heart conditions. But I was received by the health ministers of Moldova, Zanzibar, Ethiopia − and suddenly Israel’s beautiful side shines through. I think this investment in public relations is perhaps one of the best Israel can make, if there is in fact any investment involved.”
Dr. Sion Houri, the director of the pediatric intensive care unit at Wolfson, is one of the project’s founding fathers. He seems able to talk about SACH in every language a potential donor might speak. And with great charm. A slightly black humor helps him deal with the wrenching situations he encounters. As he speaks, he occasionally fixes his gaze on you to see whether he has managed to unsettle you just a little.
We are on a tour of the intensive care unit. It’s a small, cramped room. At first glance it looks as though mothers are standing next to empty beds. Only when we draw closer is it possible to see that on each bed lies a small being, bandaged and suffering, his or her body punctured by thin plastic tubes. Dr. Houri, who is Tunisian by birth, exchanges a few words in Arabic with the worried mothers. A few days later, when we see them in the department at the recovery stage, they smile at him and Houri says, “I don’t think there is another Israeli man who has the privilege of having so many Palestinian women smile at him every morning.”
Later, in a minuscule office, Dr. Houri explains why it is impossible to claim that the organization’s activity consumes resources that could otherwise be diverted to Israeli children. “Less than one percent of the world’s children are born with heart defects, and even fewer than that in Israel,” he says. “This is something you see in prenatal scans and, with us [Israelis], if the child looks like anything less than Albert Einstein in the womb, it could lead to an abortion.” This was not always the case, he says. “In 1984, when I started my residency, I still saw Israeli children dying from heart defects, but no longer. At present, for every Israeli child who needs surgery, there are at least two physicians quarreling over who will do the operation. I am exaggerating a little, but overall we have solved the problem from this point of view. However, it still exists elsewhere in the world. There are estimated to be about five million people in the world who are waiting for heart surgery.”
Does he expect the public to empathize with the fact that senior physicians at Wolfson are devoting great energy to treating the Palestinian population, which is perceived as threatening and hostile to Israel? Houri has no doubts. “As a physician you treat every child, and it makes no difference whether he is green, red, or whatever. The only color we don’t like is blue, because if a child is blue it’s an indication that he is not getting enough oxygen. Every other color is fine. We have treated Chinese, Korean, Moldovan, Russian, African children, Palestinians who support Hamas, Palestinians who support no one, Christian Palestinians, Jews of all types, religious and not religious, it makes no difference. That is why I am a pediatrician: because I believe that the ability to devote oneself to the patient so absolutely is made possible because my patient is a child, and I have no problem.”
Thursday has arrived. The nurses in intensive care prepare Reem for the operation. Hana sits alone on a bench in the corridor and waits. She is indrawn. I look at her. I would like to say something to her, but the nerve-racking waiting seems to have placed her outside normal space and time, in a land to which I don’t have access. I leave the corridor and speak to Dr. Lior Sasson, who is about to operate on Reem.
Dr. Sasson is the head of the hospital’s cardiothoracic surgery department and SACH’s lead surgeon. His colleagues praise him to the skies (“He can mend the wings of a butterfly,” Houri says of him). Sasson tells me about the operation. His matter-of-factness does not detract from his charisma. “In the operating room,” he says, “we will place the child on the table, cover her, wash the area, open the chest cavity and then reach the heart. We will attach the heart to a heart-lung machine. While we are working on the heart and stopping its activity, the machine takes over the role of the heart and the lungs, and preserves life. Once we connect her to the heart-lung machine, we will stop the heart.
“We will administer a solution that contains potassium and you will see the pulses on the ECG [electrocardiogram] gradually disappearing. When you look at the heart, you will see that it is very gradually slowing down, until it stops completely. After it has stopped completely, I open it, close the hole in it, stop streaming in the potassium solution and redo the process in reverse. We will close the heart, reactivate it and then take her off the heart-lung machine. Dr. Tamir will do an echo, to see that everything is alright at the end of the operation. That, more or less, is what is supposed to happen, and I hope that everything will go smoothly. I estimate that it will take somewhere between two and three hours.”
Before our conversation, I saw Dr. Sasson exchange a few words with Hana, who sat pale and tense outside intensive care. I ask him what he sees when he looks at these mothers. “I tend to believe that every child like this whom we operate on is a seed of peace, or an ambassador of peace. A mother like her knows exactly what we did for her child, and if she knows what we did for her child, then her sons know and her husband knows and the neighbor knows and the whole street knows. There are already more than 2,000 of these children. So I am more inclined to think that these are people who will advance the peace process and not go in the direction of war.”
Where is his Arabic from? “My parents are from Iraq, so I heard the language as a child. I know enough Arabic to chat with them a little.” A few days later, as her daughter continues to recover, Hana will tell me with a smile that with the bit of Arabic the doctors think they know, and the bit of Hebrew she thinks she knows, they somehow manage to communicate.
It’s cold in the operating room. A cordial nurse has given me sterile green pants and a shirt to wear instead of my regular clothes. I wear a sterile white cap on my head that gathers my hair. The shoes, too, are covered. A mask covers my nose and mouth.
I remind myself that I am just an observer. It is not my life that is on the line. And I promise to try to be heroic. But open-heart surgery is as scary as it is incredible. Reem lies on the operating table, even smaller than she looked earlier. Iodine has been daubed on her chest and above her is a kind of nylon sheet. An opening has been cut into the middle of the chest and now I see, together with the physicians, her little heart, open and pumping before our eyes. Doing publicly what is supposed to be done under the protective covering of the chest. The physicians joke with one another, just like they do in TV hospital dramas.
There is a positive atmosphere. Reem’s heart looks the way they expected it to based on the preliminary tests. The operation proceeds. It is clear to me that from many points of view, the moment a sick child finally lies on the operating table is, in fact, a wonderful one. But in our daily reality, spent in a constant flight from every reminder of our mortality, the view of Reem’s gaping chest and her heart, now slowly winding down, reacting to the potassium solution, is like a view from the mouth of a volcano into the heart of the earth.
A few hours after the operation, I received a text message informing me that all was well and Reem was recovering in intensive care. I prefer to wait until Reem is moved to the ward for further recovery, so I use the remaining days to get to know the other side of SACH’s activity better. Although half the children are from the territories, a great many children arrive from Third World countries, and currently especially from Africa. The defects that are found in African children are not only congenital, Houri tells me, but also acquired − rheumatic fever, for example − and of a kind no longer seen in the West.
The African children arrive in groups. Those up to the age of 5 arrive with their mothers. Those older than 5 are considered, owing to budgetary constraints, to be old enough to travel alone. They arrive with other children, accompanied by a nurse. While awaiting surgery, and afterward, during recovery, they live in the SACH’s children’s home. This wonderful new structure, built with donors’ funds, was completed a few months ago. The children’s home is a short way from the hospital. Volunteers drive the children for treatment, play with them during the long days of waiting and help with ongoing maintenance.
The treatment of children from the Third World is not just confined to operations at Wolfson, but is part of an overall project aimed at improving pediatric heart surgery in those countries. As part of that effort, a delegation of physicians from SACH visits each of the countries involved once a year. They examine local children to decide whether they can be operated on, and the visit is also used to monitor the rehabilitation process of children on whom they operated in the past.
Dr. Alona Raucher, a senior pediatric cardiologist, has been making an annual trip to Angola for many years. Indeed, on some occasions she constitutes half the delegation. Beautiful and vivacious, Dr. Raucher occasionally bursts into infectious laughter that breaks the flow of her speech. I can only imagine the relief anxious parents must feel when they learn that she will be treating their child.
The delegation usually conducts a packed five-day visit. Dr. Raucher, who arrives with a mobile echo machine, talks about the effort to examine as many children as possible in the time available. “As far as I am concerned, I would be happy to see as many children as I can, from eight in the morning until ten at night. Before we arrive, the local radio announces the days on which we will receive children for an examination. All the hospital’s outpatient clinics are closed for us, and as soon as we open the doors they all rush in.
“It’s a chaotic scene,” she continues, “lots of screaming. Also hugs and kisses, because among these children are some we operated on. And if some of them arrived in Israel without their parents, when we get to Angola the parents introduce themselves. It is all very moving, because they heard from the children about the team that treated them. So the morning starts with hugs and kisses, it’s very emotional.”
At the end of the delegation’s visit, the physicians decide which children can be treated and how urgently they need surgery. From this stage, the children will start to arrive in Israel in those small groups. It’s a long journey, and the drama does not end with the flight.
In fact, in many senses, the flight, difficult as it is, is only the beginning. Dr. Raucher: “A child arrives, sick and hurting. He is jabbed with needles and stuck with patches and dressed in hospital pajamas. There are a million strange faces, machines, and things are scary to him. He is frightened. He doesn’t understand the language, he doesn’t like the food, these are not the faces he is used to seeing. The kids are terrified both physically and mentally, undergoing a terrible experience. We try to make things as easy as we can for them, within the limitations of the language. But a hug is a hug and a caress is a caress. It’s no coincidence that they come and hug us when we visit Angola a year later.”
Another element in the effort to offer a total solution to the needs of the children with heart conditions in developing countries involves training physicians, nurses, anesthetists and others from those countries. They spend long periods at Wolfson: from two months (for a nurse) to a year (for a surgeon), and return to their native land with precious medical knowledge. In an internal courtyard, I am sitting on a bench under a tree that is doing its best to create shade and talking to Dr. Godwin Godfrey, a pediatric cardiac surgeon in training. At the conclusion of his long-term stay under SACH’s auspices, he will become the first pediatric cardiologist in Tanzania.
Dr. Godfrey, 32, is married and the father of a 1-year-old boy. He has been at Wolfson for the past three and a half years and goes home once a year. There are currently two hospitals in Tanzania where heart surgery is performed, Godfrey says. But there are very few operations and all of them are on adults. “In Tanzania,” he explains, “we have something like between 300,000 and 400,000 children with heart ailments who need surgery. And we have no pediatric heart surgeons in the country. About 100 children a year are flown to India for surgery, the most inexpensive option, with government funding. But there is a very long waiting list.”
Dr. Godfrey will return to Tanzania in another year and a half. But despite the vast amount of knowledge he accumulated here, his ambitions remain modest. “In Israel, one surgeon can handle hundreds of cases a year,” he says. “I don’t think we can reach that number. The problem lies in the supply of disposable medical equipment. Most of the time you might be able to operate on five or ten patients, and then there is no money left to buy new equipment, so you have to wait two months until the supply is renewed. And then you handle a few more cases. If I can get to at least 50 operations a year, that will be a very good start.”
It’s been a week since Hana Kolab crossed the Erez checkpoint with her sick daughter and arrived at Wolfson Medical Center. Now she is sitting at her daughter’s bedside in the children’s ward, watching as the toddler recovers. Ms. Kolab’s face is the personification of relief. She looks like a completely different person. We converse in Arabic, with the aid of the illuminating Fatma Sarsour, whose official title is liaison officer with the Palestinian children and families in the project, but who is considered its unofficial psychologist. Hana relates that Reem is the youngest child in the family, “number six.”
Hana also has three more daughters and two sons. The eldest daughter is 20, and the youngest ahead of Reem is a boy of 10. Reem’s older siblings love to play with the little one. They play in the family’s garden in the Al-Darj neighborhood of Gaza City, or sometimes in a small park outside. They pass a ball around, let her kick it and try to talk to her. Try, because Reem suffers from Down syndrome, which is often compounded by a heart defect.
“We saw the first signs that something was wrong when she was 6 months old,” Hana says. “She was very small. She did not grow enough. I took her for a regular checkup and the doctor found that she had a heart problem. He referred us to a cardiologist and we started to do echo-heart checks every three months. At first there was no need for more, but then last March we were referred to Schneider [Children’s Medical Center, Petah Tikva]. They told us she needed an urgent operation.”
I ask how she heard about SACH, and Hana admits she didn’t even know the exact name of the organization. All she knew was that she was being referred to a hospital in Israel. On the Tuesday on which she and Reem arrived at Wolfson, Hana and her husband, a furniture painter by trade, got up at 7 A.M., organized their daughter, packed a few clothes and set off for the Erez checkpoint, a half-hour from their home. They were driven by Hana’s brother-in-law. When she crossed into Israel, after 90 minutes of waiting and security checks, she didn’t even know that a driver would be waiting for her.
She was about to take a taxi with her own money when the driver found her, using a list he got from SACH, and explained that she was to go with him. That was the first time she heard about SACH. I ask Hana if she was afraid. “No,” she says, as she helps Reem open a packet of wafers. “I was not afraid. I just went along with it. The driver was Israeli and did not speak Arabic, but I had come for one purpose: to take care of my daughter and return home when she was healthy.”
A few minutes later she adds, “At the checkpoint I met many people from Gaza who come to Israel for medical treatment, here and at other hospitals. I am not the only one who came here. It is obvious that people come to Israel for medical treatment, regardless of the political conflict.”
We talk a little about the day of the operation. I mention that I saw her sitting outside ICU. “I was not afraid,” she repeats, and I wonder if she was really not afraid or whether she just doesn’t want to go back to those hours of mental strain. “On the one hand, it was the first time my daughter had an operation,” Hana says. “This is a girl who never even had an injection. So I was slightly sad and worried inside. But on the other hand, Reem’s condition was stable. She did not have any problems, the doctor reassured us. He said we had no reason to fear the operation. I understood that the hole she had in her heart was located at a place where it was possible to operate. It is not a difficult operation. The doctors in both Gaza and here reassured me. I knew that if the hole had been located in a different place, things would have been a little complicated. So, I was more or less calm.”
An additional calming element was her meeting with the other Palestinian mothers on the ward. On the first days after her arrival, Hana spoke with those back home twice a day, in the morning and the evening. But now, with the operation done and the return home approaching, she says the excitement there is growing. “I get calls from Gaza every minute. What’s happening? When are we coming back? Everyone is waiting to see Reem.”
Before parting, I ask whether during her stay here she found out anything about Israelis that was different from what she had imagined. Hana reflects on the question and replies, “No. The Israelis even eat the same things we do. Maybe the food is actually tastier at home,” she laughs, and then adds, “although honestly, it’s hard to know, because what I tasted was hospital food.”
We have done talking and I thank her for allowing me to follow her daughter’s operation. I wish them a full recovery. Then, with the interview over, I remember that I had another question. “What does ‘Reem’ mean?” I ask. “A reem is a gazelle,” Hana says, and looks lovingly at the little Bambi who is playing with a wafer in the hospital bed, still a bit woozy from the painkillers.
For Hana Kolab, the political implications of a journey from Gaza into Israel and surgery performed by Jewish-Israeli physicians at Wolfson pales in the face of the knowledge that her daughter has gained a new life. The Israeli doctors I spoke to also manage to put politics aside, as they continually insist. But not everyone can afford the luxury of a nonpolitical approach. When I put in a request to interview one of the Palestinian physicians who, like the African doctors, has enjoyed long-term training at Wolfson with SACH, problems start to crop up.
The first person I ask to interview is Dr. Rula Awwad, who, after spending three years at Wolfson in pediatric cardiology, now works in Bethlehem. The first thing I am told is that I must speak English when she answers the phone, because she is apprehensive that people will know she is talking to Israelis. After I try to reach her a few times with no success, people at SACH tell me I should drop the idea. Despite the major contribution of the training program to her professional competence, Dr. Awwad apparently does not want to link herself with the project − or with any Israeli institution, for that matter.
Next I try to contact Dr. Rima Nabulsi, who trained in neonatology (pediatric medicine concerned with newborns) at Wolfson and is currently with Rafidia Hospital, in Nablus. At first she agrees to an interview, but afterward doesn’t return my calls. It turns out the hospital in Nablus did not authorize her to give an interview. I consider trying to reach Dr. Othman Abu Salah, who specialized in pediatric intensive care at Wolfson, but I am advised by SACH that because he too works at Rafidia, there is no point trying to contact him.
I abandon the idea of talking to Palestinian physicians in Palestine. Instead, I request an interview with one of the Palestinians who is still in the SACH training program. At first it’s suggested that I speak to Dr. Wafiq Othman, who is in pediatric anesthesia at Wolfson and is a liaison with the Palestinian Authority. But at the last moment that interview is also aborted.
Here is SACH’s official response: “The Palestinian physicians who took part and are taking part in the training program of Save a Child’s Heart feel that their activity is contributing to the promotion of the ties between Palestinians and Israelis. However, given the sensitive situation, they do not feel it is their role to talk politics and prefer to concentrate on medicine.”
Unofficially, I am told they are fearful that by speaking on the record, they are liable to draw unnecessary attention to the project in the territories and thereby endanger its continuation.
The Palestinian authorities are not alone in having a problem with the project. The rumors circulating at Wolfson say that Deputy Health Minister Yaakov Litzman (United Torah Judaism) objects to the nonprofit organization’s activity. (Nominally, Prime Minister Benjamin Netanyahu is the health minister, though in practice it is Litzman.) I decided to see if this is really the case. At first, Yaakov Izak, Litzman’s personal assistant, assures me that Litzman is very interested in being interviewed and wants to answer my questions. But after a month of deferrals and evasions, I realize the subject is more sensitive than I thought. Litzman may be against SACH, but he also understands that this is a political breakwater on which he could run aground if he’s not careful.
At one point in our dialogue, Izak explains that they are unable to find a way to express Litzman’s opinion in a satisfactory manner. They even took legal advice on the subject, he says. And then, in one of his hurried conversations with me, he tries to play down the matter, suggesting that perhaps the deputy minister “does not need to express his view about the activity of every single organization.” But I insist that this is not just any nonprofit, but one that is operating under the auspices of significant decisions made by Wolfson Medical Center − an institution that enjoys state support and is under Litzman’s responsibility. “Yes, yes,” Izak agrees, and promises an answer by the end of the day. I do not hear from him again.
In desperation, I try to get Litzman’s response through the Health Ministry’s deputy director general for international relations, Yair Amikam. Amikam wants to see every question in advance, and afterward sends me this message: “Hi Amalia, I read your questions carefully. Some of them require a personal/principled reply, and I can understand if someone is not interested in replying to such questions (such as his opinion about the fact that the organization is being given an award).”
However, in the end my nagging pays off and I receive the official response of the deputy health minister to the activity of Save a Child’s Heart: “The policy of the Health Ministry is that Israel’s citizens take priority over any other population in the dispensing of medical services. Israel’s citizens have the right to all the medical services and they pay a health tax by law for this. The Health Ministry is entrusted with providing those services to them, ahead of anyone else, be they Eritreans, refugees or Palestinians.
“It is also clear that the Health Ministry is not against providing medical services to other populations, who are not from Israel, to the degree that this is possible and in such a way as not to be at the expense of Israel’s citizens,” it continues. “But in the case of a shortage of hospital beds, Israel’s citizens take precedence over everyone else. The project in question, which is important in its own right, has to be weighed according to these professional parameters by the Health Ministry in conjunction with Wolfson Medical Center.”
“There are areas in the Israeli health system that are truly ‘fully booked,’” says Dr. Yitzhak Berlovich, the director of Wolfson. “And there are areas that still have a growth potential that can be exploited. That was the springboard of the original initiative. When the late Dr. Ami Cohen initiated the project 16 or so years ago, he definitely spotted the potential ... All the medical staff is here, not because of SACH. They are here because of the needs of the State of Israel. But they are capable of treating more children than they are treating today, and the outlay is mainly what we call current expenses. You can think of it as overhead that is largely already paid for. Yes, SACH means we spend more on medicines, on disposables, etc., but the principal expense, of personnel, already exists, so the addition is relatively marginal. It might take the form of overtime or an extra shift, but that is not the major expense.”
When pressed, Berlovich, too, admits that the activities of SACH do extract something extra from the hospital. “As you saw for yourself, the conditions in the ward and in pediatric intensive care are not good. If the children brought in by SACH were not there, the physical conditions at the unit would be much better for the Israeli children who are hospitalized here. The occupancy rate of the pediatric surgery department, for example, is 150 percent − and of that, about 60 to 70 percent are SACH children.”
But Berlovich’s job does not consist of making easy decisions. “I do not ignore the fact that, at some point, the comfort of Israeli children is sacrificed for the benefit of these other children. The sacrifice is in the compromised conditions of the hospitalized children.
“You know,” he continues, “[Israeli] parents who come to the hospital walk around the department, see the conditions here, see who the children are and who their parents are, draw their own conclusions, turn around and go elsewhere. That is a loss both in terms of the hospital’s revenues and in terms of the excellent care they could receive.”
According to Berlovich, “There is no argument over the fact that we, as a hospital, are forgoing something here. Of course, we do not emphasize that, but we are definitely aware of it. We are not that blind and deaf. But decisions like this are not a black-and-white affair. We weighed all these considerations and still decided that we are continuing our very close connection with the organization. We view it as a type of mission, even though it’s not conventional to use words like that today.”
That mission is not as quixotic as it may sound. As I was told later by people in SACH, the organization is being courted by the top hospitals in the center of the country. But the people at SACH insist on staying at Wolfson, emphasizing that their commitment to the hospital stems from their understanding of the needs of the institution and of the surrounding population to receive proper conditions. As part of that commitment, SACH has undertaken to build a children’s hospital at Wolfson that will meet the needs of the Israeli population that comes to the hospital. It is determined to raise 100 percent of the funds needed for the project.
Before I take my leave, Berlovich emphasizes that he is empathetic not only toward the Israeli physicians but also to the Palestinians who have trained within the SACH framework but now decline to talk to the media. Like everyone behind SACH, Berlovich wants to speak sincerely but is concerned about harming the organization’s activity. Accordingly, he says in parting, “I would not want the Palestinians to stop sending children because of these tensions. Heaven forbid. On the contrary, I want them to understand. I understand them; I think that not talking to the Israeli media is a legitimate decision on their part, considering the propaganda campaign being waged between the two countries. One could supposedly say it doesn’t sound so great − ‘We are being so good to you and you don’t even want to thank us out loud’ − but truly I am not being in the least critical of anyone.”
It is sometimes thought that the only happy place in a hospital is the obstetrics ward. But each of the units where Save a Child’s Heart operates is ultimately a happy place. Maybe it’s because the cardiologists, surgeons and other members of the project team are actually like midwives. The children arrive when they are already on the other side, where death reigns. But thanks to trained, gentle hands, the physicians bring them back to the side of life.
On the ward, a sense of relief is seen on the faces of the mothers. The physicians radiate deep satisfaction and self-fulfillment. And the children who were operated on? Well, it’s hard to find them, because they’re running about somewhere, kicking a ball around.
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