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On the desk of Dr. Masad Barhoum, the new director of the Western Galilee Hospital-Nahariya, sits a document in an ornate frame from the Civil Service Commission and the Ministry of Health. "According to our findings, Dr. Barhoum does not have sufficient professional knowledge, understanding or experience to run a hospital on the scale of Nahariya hospital," reads the text.

This is the decision that was reached unanimously on March 19, 2007, by a public appointments committee that included the director general of the Health Ministry, Prof. Avi Israeli. The committee concluded that all five physicians who applied for the post of director of the government hospital in Nahariya, one of the largest and most important medical centers in northern Israel, were unsuitable for the job - including Barhoum.

However, another appointments committee, with new members, chosen four months later by the ministry and the Civil Service Commission, chose Barhoum for the job from among six applicants. The contradictory results of the two tenders sparked an outcry in the medical establishment, not least because of the involvement of top ministry officials in the decision-making.

Barhoum assumed his duties in mid-September. He told Haaretz that he keeps the framed letter from the first committee on his desk deliberately: It helps to remind him to apply himself to the task and succeed, if only to prove the committee was wrong about him.

Dr. Barhoum is the first Arab director of a government hospital since the establishment of the state. Since taking up his post, he has received congratulatory messages from the heads of many Arab villages in the North, who see his appointment as an important step forward for Arabs in the public health sector. According to Barhoum, being the first Arab in this position makes him even more committed to doing well, in order to prove the importance of installing Israeli Arabs in key positions in the system. By the same token, he keeps warning himself that if he fails, it could harm the prospects of other Israeli Arabs.

The hospital in Nahariya, situated seven kilometers from the Lebanese border, serves nearly half a million residents of the Western Galilee, as well as Israeli soldiers and UN personnel. It has 600 hospital beds, and its emergency room treats an average of 120,000 patients a year, about half of them from Arab villages in the area. Of those who seek emergency care, about half are hospitalized. Over the past year, the hospital delivered 6,500 babies, and performed 13,000 operations.

Barhoum, 47, was born in Shfaram. During his childhood, the family moved back and forth between that town and Haifa. They returned to Haifa in 1973, when he was in eighth grade. His father worked for a construction company, while his mother raised him and his three sisters. His parents were born in Mandatory Palestine, and he has distant relatives in Jordan and Lebanon.

Barhoum says he is "an Israeli, an Arab and a Christian - in that order. I was born in this country and I'm proud to live here. Not that I deny my Arab nationality: In the broad category of Arab nationality, I belong to the subcategory of Christians."

But some Israeli Arabs also define themselves as Palestinians.

Barhoum: "I feel more Israeli than Palestinian. I can't say things that I don't feel. My Arabness is a combination of Arab and Palestinian. I feel Israeli in every respect. I have a certain connection to the Palestinians, but I was born and raised in Israel, so my ties to Israel are closer."

During the Yom Kippur War, Barhoum was in ninth grade, in a class for Arabs at Haifa's Alef Municipal high school. Although he ended the year with very high marks, "I couldn't stand the emotional pressure of being an Arab in an Israeli school while a war was going on," he says. "It was like they were blaming us for the war. There was hatred and bad feeling. I didn't feel comfortable there."

He has not forgotten the racist comments of some of the teachers. For example, the Jewish teacher who told them: "Without the Jews you wouldn't have refrigerators in your houses." Or the one who walked into the classroom at the height of the war, saw that the floor was dirty, and said: "So it's true what they say about you being dirty Arabs." Not a single student protested, and until today Barhoum is angry with himself for not telling her that her remarks were racist. "At home I grew up in an atmosphere of tolerance, peace and love. I couldn't stay in a place like that." He transferred to the Arab Orthodox high school in Haifa.

That said, he also notes that he has never again encountered such taunts or discriminatory remarks - not at the faculty of medicine at the Technion - Israel Institute of Technology, not during his internship at Rambam Medical Center in Haifa, and not while working as a doctor at the Clalit health maintenance organization. Barhoum refuses to discuss the issue of discrimination or prejudice against Israel's Arab citizens.

Studying medicine, he says, was the fulfillment of a childhood dream. After graduation, he began his internship in internal medicine at Rambam, but switched to family medicine three years later. At the time, his wife, Dr. Marie Nofi-Barhoum, was doing her internship in pediatrics at Hillel Yaffe Medical Center, in Hadera. Today she is a resident in pediatric endocrinology at Afula's Ha'emek Hospital.

After completing his residency in family medicine, Barhoum worked as a family doctor at Kibbutz Ramat Hashofet (where he lived with his family for several years) and supervised home hospitalizations in the Haifa region and the Western Galilee for Clalit. Because the job in Nahariya requires him to live near the hospital, the Barhoums moved to Kibbutz Kabri. Barhoum's three daughters continue to study at a Christian school, St. Joseph's, in Nazareth.

From November 1999 until his current appointment, Barhoum was the medical director of the Italian Sisters of the Holy Family Hospital in Nazareth, one of three hospitals run by the mission. The 120-bed hospital was established 125 years ago by an order of Catholic nuns based in Rome that operates dozens of hospitals in Italy and Europe. Today the hospital in Nazareth is owned by an order in Milan, and the Milan soccer club has donated 750,000 euros toward the construction of a new neonatal intensive care unit.

Barhoum says that when he took the job at the Nazareth hospital, it was in a state of financial and organizational collapse: "The infrastructure was terrible and the doctors were totally undisciplined. Some wouldn't show up for on-call duty in the wards, and some decided work was over at noon. The hospital was run by doctors who were not specialists in their respective fields, and there were times when junior doctors took over and told ambulances not to bring any more patients to the hospital."

He says the reforms he introduced in Nazareth triggered opposition from certain doctors, who found it hard to change their habits. A number of senior doctors were fired, although in some cases only after a lengthy legal battle. Others stayed on, but remained his sworn enemies. In collaboration with some of the top staffers, Barhoum managed to make improvements, including the establishment of an internal reporting and investigation system to probe cases of medical negligence or error ("so they won't sweep it all under the carpet"), working out better financial arrangements with the HMOs, and opening a new academic program for medical residents.

None of the above

In December 2006, Prof. Shaul Sasa, the director of the Nahariya hospital, retired, after 18 years in the post. According to a senior official in the medical establishment, Prof. Avi Israeli considered putting himself up as a candidate for the job. Other contenders were Dr. Yaakov Farbstein, long-time director of Poriya Hospital, in Tiberias; Dr. Sarit Avishai, former deputy director of Kaplan Hospital, in Rehovot, and today chief medical director of the Clalit HMO in the Jerusalem district; Dr. Barhoum, and three other senior physicians. Appointed to the tender committee were Prof. Israeli; Dr. Benny Davidson, director of Assaf Harofeh Hospital, in Tzrifin; and Prof. Anat Achiron, a neurologist from Sheba Medical Center in Tel Hashomer.

The committee met with all the candidates (apart from Poriya's Farbstein, who withdrew from the race at the last moment) and decided not to appoint any of them. In internal memos now made public for the first time, the committee wrote: "Nahariya is a major hospital in the North of the country, and unfortunately, we have not been convinced that any of the candidates fulfills the requirements for the job." The committee noted that Dr. Barhoum had just recently completed a master's degree in medical administration, and that the medical institution he had run until recently was only a small, 120-bed hospital.

As a consequence, the Health Ministry established a search committee, headed by Dr. Boaz Lev, assistant to the ministry's director general. Barhoum did not appear before the committee, and Haaretz learned that the panel had initially recommended that Dr. Amir Shachar, former director of Sheba Medical Center and deputy director of Meir Hospital in Kfar Saba, be considered for the job. After Dr. Shachar withdrew his candidacy, the search committee named Prof. Adi Karniel, a senior doctor at Rambam in Haifa, as a possibility. However, the committee also noted that if an Arab candidate received the same number of points as the candidate from Rambam, the Arab doctor was preferable, in keeping with the policy of affirmative action in government ministries.

The new tender committee included Prof. Jonathan Halevy, director of Jerusalem's Shaare Zedek Medical Center, Prof. Yehuda Baruch, director of the Abarbanel Mental Health Center in Bat Yam, and Dr. Tamar Shochat, the Health Ministry's district physician for Tel Aviv. In July, the committee voted unanimously for Barhoum, and affirmative action was not necessarily the clinching factor. "Compared to the other candidates, and also standing on his own, Dr. Barhoum demonstrated an impressive command of the facts. He radiates charisma and leadership ability. He has a congenial personality and a solid approach to hospital administration."

How is it that in July Barhoum was chosen to run the government hospital in Nahariya in July, four months after a tender committee that included the Health Ministry's director general found him unfit for the task? How could it be that a candidate who was not recommended by the ministry's search committee was elected in the end, rather than an applicant apparently viewed as more suitable?

Dr. Barhoum says that he submitted his candidacy for director of the Nahariya hospital because he felt that he had done all he could in Nazareth, and was "looking for a new challenge." "I don't know why the first committee rejected me, but I can tell you that when I appeared before the second one, I knew the hospital a lot better. I did my homework, the way anyone applying for a job would."

According to the Health Ministry, "Dr. Barhoum was properly selected in keeping with all the rules and regulations, and we wish him success in carrying out his duties. The Health Ministry and hospital staff will do whatever is necessary to assist him in this important mission."

Barhoum is committed to proving the first committee wrong and measuring up to expectations as the first Arab director of a government hospital. But he will face the difficult but ongoing challenges of operating a large hospital on the periphery that has serious problems recruiting senior physicians and reaching financial agreements with the HMOs, while grappling with a large deficit.

Apart from that, the new director will have to cope with a whole range of serious problems and major scandals that have enveloped the hospital in recent years, such as allegations, investigated by the police, that one of the hospital's leading doctors accepted bribes (something he denies), charges of misappropriation of funds and fictitious work reports submitted by senior employees, and Health Ministry disclosures of negligence and incompetence in the emergency treatment of gravely wounded patients.

According to a senior source in the medical establishment in the North, one of the challenges facing Barhoum is the need to build a reliable system of emergency room care in instances of severe trauma. Hospital employees recently complained to Haaretz that in the wake of administrative and budgetary decisions by the hospital's former management, the trauma center, which has all the equipment needed for treating patients with the most severe injuries, is closed at night. As a result, patients are brought to the regular ER, where care is not as quick and sophisticated, which lessens their chances for recovery. Barhoum explained that the trauma room was closed at night because the majority of severely injured patients do not arrive at such hours, and for those who do, the standard of medical care is not affected.

During a tour of the ER with Dr. Barhoum two weeks ago, one of the nurses started to complain that there were too few nurses on staff at night, making it hard to administer proper care. Barhoum immediately hushed her up. "There's a journalist on the premises," he reminded her.