A sick person is just a person. Money, status – nothing matters. Sickness is the great equalizer, says nurse Siham Shibli at the cardiac catheterization unit of Hadassah Hospital in Ein Kerem.
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Israel’s public healthcare system is a model of genuine commonality between Arabs and Jews. It could well be a model for other areas of life, according to a recent report published by Irac, Israeli religion action center, which asked why medicine differs from all other areas of life, regarding egalitarianism between Jews and Arabs, who in other respects lead very separate lives.
Of all government jobs, Arabs fulfill 6.8%; in the government healthcare system, they fill 12.4% of jobs; in nursing studies (including geriatric), 42% of students are Arab; pharmaceuticals has become identified with the Arab community – 38% of druggists are Arab; at the Superpharm drugstore chain, 62% of the pharmacists are Arabs. And in medicine itself, the proportion of Arabs is roughly akin to their proportion in the population. In 2015, 16% of all medical students were Arab; at the Technion medical school, Arabs were 38% of students and at Ben-Gurion University of the Negev, 31%.
There are several reasons why medicine is an accessible profession for Arabs, one being the constant demand for doctors. Also, once you’re in, you’re in for life, points out Fadi Mahmid, while in technology, you’re considered old before your stubble turns gray. Also, medicine is a prestigious profession.
Another reason Arabs choose it is that the healthcare system gives the opportunity to find employment beyond the confines of Arab society, to become part of the Jewish society, which is often out of bounds. Sanabel Lafi points out that as a nurse, she can treat everybody, but Israeli society would find it harder to accept her as a teacher in a Jewish school.
In Arab society, becoming a doctor is a trend and it’s an open profession, without a smidgen of security issues, says Dr. Hany Daoud, chairman of the pharmacists’ association in the north.
“Somebody who studies electrical engineering or electronics, and wants to work in some institution that handles security matters, will have a problem finding work. Here, doctors have no such problem. They are accepted with open arms,” he says.
What’s the secret of the healthcare system? How do Arabs and Jews work side by side, including during wartime, without friction? One of the unwritten rules, according to Irac, is that politics is out of bounds, to the point of taboo. Burning issues of the day won’t be the topic of discussion over an operating table.
“The instructions are simple. We are here, treating patients and saving lives, whoever comes – a soldier, civilian, or terrorist. Everybody is busy saving lives, period,” says Prof. Rafi Beyar, director general of Rambam Medical Center in Haifa. “We very clearly do not encourage political discussions at the hospital. This is not the place,” he says. “I cannot control water cooler talk. As long as a couple of people are just exchanging opinions it’s a free country. But in principle, as a system, we do not allow it to affect behavior and treatment of patients.”
No politics in the OR
Dr. Masad Barhoum, director general of Western Galilee Hospital in Nahariya, does not allow expression of political opinions by employees. He gives the example of a worker who posted on Facebook, “Israeli soldiers are slaughtering children in Gaza.” Such things are unacceptable in the workplace, he says.
“During Operation Cast Lead, one of the doctors wrote something, I told her, I don’t care about your political opinions. Nobody does. You are a civil servant. I expect you to be a doctor and a human being with compassion. Do not have the pretension of being a judge. If you don’t delete that, you’re going into war with me. She deleted it and works here to this day.”
Another principle is that the system is shared, egalitarian, and promotion is based on seniority and experience – and everybody is treated equally, doctors and patients. Barriers fall. “It isn’t that the Jew is the boss and the Arab is the cleaner,” says Dr. Osnat Levtzion-Korach, director of Hadassah Hospital, Mount Scopus.
Hani Hindan, oncological pediatric nurse at Hadassah, agrees that the sense of equality is the reason for the good relations between Arabs and Jews at the hospital. The nurses are equal in salary, dignity, conditions and everything else. That’s not the case outside, she says.
Doctors contend with life and death on a daily basis. They fight together to preserve life, says Bashara Basharat, director of the Scottish Hospital in Nazareth.
The common enemy: Death and disease
That lofty common goal brings Arabs and Jews together in the profession. “Maybe I’m a little nave, but I want to believe there is a special solidarity connected with the world of medicine,” says Prof. Rafi Walden of Sheba Hospital, Tel Hashomer. “We’re together in the same camp, with a common enemy before our eyes – death and disease.”
Dr. Suheir Assady of the Rambam nephrology department suggests that the dimensions of the problems they see put other things into proportion.
Happily, these relationships not only break stereotypes, they can extend beyond work. Sanabel Lafi of Ein Karem tells that her best study friend is an ex-army officer who first came to lessons in uniform, with his gun, yet they’d take breaks together, go out to eat together.
“I did my seminar with somebody with a yarmulke,” she says. “I enjoyed being with him. I also wanted to learn from them. If we stuck only with Arabs, we wouldn’t learn from each other.”
Crucially, the report states, the Arab doctors and nurses do not feel their cultural origin hinders promotion. They do not see a glass ceiling. “Personally, what I wanted, I achieved,” says Prof. Ahmed Eid, head of the general surgery department at Hadassah Mt. Scopus. Obviously the system is a competitive one, he adds, but he doesn’t feel that the “system” tries to trip anybody up.
Dr. Rania Okby, the first female Bedouin doctor in Israel, says her being a Bedouin was less of a problem than her being a woman.
Still, this idyll only lasts as long as they’re in uniform, and on the job. Lafi, who was interviewed some months ago when Israeli-Palestinian tensions were high, says that at work, in uniform and with her name tag, she is accepted as a human being, and nobody thinks she’s up to no good just because she’s Arab.
“But when I finish work and walk in the street in ordinary clothing, I’m seen differently, and it’s hard,” she says.
“In the hospital I have some sort of authority. I can give something to people, help them. In the street they’re afraid of me. Next week I’m supposed to take a train and I don’t know what I’ll do. I thought to ride in my hospital uniform, or maybe to walk around carrying a sign, that I don’t mean to do anything bad to anybody.”