Talking to: Hadas Ziv, 55, lives in Tel Aviv; director of public outreach for Physicians for Human Rights Israel and head of the group’s ethics committee. Where: A café in Tel Aviv. When: Monday, 10 A.M.
People expect that doctors will not be racists, but this of course isn’t a realistic expectation. You deal with the issue day to day: How much racism is there in the Israeli health system?
Doctors have a sweeping tendency to believe in the ethos that they don’t give the status or ethnic origin of their patients any weight. But racism is inherent in the health-care system. I hear a large number of doctors, men and women, who describe themselves as an island of sanity in a turbulent country, who take pride in the way they treat Palestinians or asylum seekers, but who are completely blind to their problematic attitude to patients here and now.
You have to understand, the problem isn’t that once there were missing Yemenite children, the issue is that today there are Ethiopians, Palestinians and refugees. The issue isn’t that once upon a time they related to childbearing in a racist way, the issue is that today too, in many hospitals in Israel, they segregate new mothers. Why do they segregate mothers [of different backgrounds] in the maternity ward, but in the internal medicine wards they don’t ask anyone if they mind if their roommate is an Arab?
Because the hospital has a financial interest. It receives money for each woman who gives birth there, and it needs to draw a clientele.
True, and that’s the real danger. Because when racism is economically worthwhile, when it’s possible to profit from it, it becomes deeply rooted in the system. If I were to request not to have to share a room with another woman who gave birth, who’s richer than me, because she would receive a lot of expensive presents, they’d think I was crazy. But if I say I don’t want to be with an Arab, because she has “a huge number of visitors,” that’s legitimate.
This segregation is embedded deep down in the historical roots of medicine itself. It was always believed that one minority or another was biologically different, to justify racism or discrimination; it was even considered pure science.
These categories of populations still reverberate in medicine, though today the racism is different. It’s more social, institutionalized.
And this racism too, at least in Israel, has a long history. The fundamental reason is the fusion of medicine and politics.
True. Why do we even have four health maintenance organizations? It’s political. Leumit was established by the Revisionists [right-wing Zionists]. Clalit [established by the Labor movement] was called the Clalit Health Fund of the Hebrew Workers in Israel. The Jewish Yishuv [the pre-independence community] established an independent health system whose very basis was separation.
And its founding fathers also belonged to a certain ethnic origin and class, and they were also affiliated politically.
The founders were people who came from Europe, who received a European medical education. With great enthusiasm they cooperated with the discrimination, because many of them also came from the eugenics culture and they had all sorts of ideas about genetics and the Jewish body. The politics was there from the very beginning — the health funds themselves and their connections to political organizations.
It was an integral part of the project of the building of the Yishuv, and so it was natural for the medical staffs to be involved in absorbing new immigrants and “educating” them. They believed they were doing the new olim a favor, and when immigrants would express opposition, it surprised and angered them. Why is it so hard for Ashkenazim to admit they caused damage to the Mizrahim? Think about the statements by Dr. Giora Yoseftal that were exposed in the television documentary “The Ancestral Sin” [in Hebrew, “Salah, Po Zeh Eretz Yisrael”]. He said that the immigrants from North Africa were worthless and inferior, and that they would degrade society here.
He said out loud what everyone thought back then. And by the way, from my personal experience as a North African, it’s what many think today too.
So it’s impossible to address what’s happening today without looking at the historical connection. They ask me, why should we deal with the [issue of the] missing Yemenite children; after all, it happened so many years ago. Why? Because things haven’t changed.
Today it seems shocking to us that Prof. Sheba [Haim Sheba, early Israeli medical administrator] said, ‘it’s not possible to explain to them what vaccines are,” but this attitude repeated itself in the affair of the blood donations from Ethiopians [in the 1990s]. When Dr. Yosef Meir said back in the day, in response to Ben-Gurion’s childbearing prize [given in the state’s early years to women who bore 10 children or more], that what’s important isn’t the seventh child of the Mizrahim but the second child of the “intelligentsia” — how is this different than injecting Ethiopian women with Depo Provera? [The long-term contraceptive given to Ethiopian women at transit camps before they came to Israel in the 1980s and ‘90s; in some cases it was a condition for immigrating.]
Why was it so urgent for us to limit reproduction among this group? The establishment refuses to examine itself. When we and the nonprofit Amram Association requested information about the Yemenite children, we didn’t threaten anyone with a lawsuit, we only asked for information, and they [the medical establishment] ignored us. They weren’t willing to admit there was a systemic failure here.
I wonder how realistic this expectation is.
Why? I definitely would expect, and especially from doctors, whose work is based on understanding and learning from mistakes, that they would take this step. That’s exactly the issue. Many people have no problem saying about themselves that they’re racists. Doctors will never admit it. At the time, we held a hearing in the Knesset House Committee on the issue of segregating mothers after childbirth. The more they twisted, turned and tried to prove that it doesn’t exist, the more racist their statements became.
A gynecologist and midwife came with us [to the committee] and testified to the segregation they witnessed. They would say, “I was told there’s no ‘policy,’ but that there is ‘consideration of preference.’” What’s “preference” mean? Or Prof. Drorit Hochner [the head of obstetrics and gynecology at Hadassah University Hospital, Mount Scopus], who said “no Arab mother will lie in the hallway because the only remaining bed is next to a Jewish mother.” But when they asked her if she’d agree to a request from a mother who didn’t want to share a room with an Ethiopian woman, she said, “certainly.” That’s horrible.
And in what way can an external ethics committee that’s actually a part of Physicians for Human Rights contend with these cases? You don’t really have teeth.
In the specific case of separating mothers in maternity wards, we went all the way to the Knesset. We conduct seminars and lectures for medical staff and medical and nursing students, and I definitely see a lot of pennies dropping there. Many times our questions and stubbornness, as well as the letters and approach to the media, do lead to a change. Sometimes our intervention is enough to convince a doctor to act differently.
Of course, I don’t claim that the entire medical system is racist, but that it has racism in it. The system’s tendency of denying and even attacking those who complain about it lets racism continue to exist in its midst. Our aspiration is for the medical staffs to truly listen, to act to correct it.
How does racism manifest itself in Israeli health-care at the sytemic level, not just as statements and actions by specific doctors?
For example, it’s reflected in those who are allowed to join the national health insurance system. Migrant workers, young and healthy people whose fitness is examined in their countries of origin before they [are permitted to] come here, are allowed to insure themselves only if they purchase expensive private insurance. They have to pay out a lot of money, instead of being allowed to join the HMOs. Why are the HMOs only for Jews? Or take the clinic in the town of Omer [a well-off community in the Negev]. Do you think a Bedouin would dare go there to seek treatment? Never. There was a time when they would explain it by saying they were a “community clinic.” So [today], maybe no one would throw him out of there, but he’ll know very well he’s not wanted.
Can anyone imagine building a hospital next to [Israeli Arab cities] Rahat or Taibeh? How many well-baby clinics are there in East Jerusalem, and versus how many are in the western part? Why is it perfectly acceptable to us that the Bedouin community has clinics in trailers with a doctor who comes once a week, in the best case?
And of course, the mortality rates are higher among needier populations because of their economic situations and overall environment.
Among the ultra-Orthodox and Arab communities, there are monstrous rates of diabetes, relative to the size of the population. The health system tends to blame people for their lifestyle habits. But is the fact that Arabs smoke more their problem or ours? Do we worry enough about the level of awareness in that society? Do we address the link between diabetes and the constraints of poor nutrition? How much effort is made regarding birth defects in the ultra-Orthodox and Bedouin communities? If such rates of diabetes were discovered in Tel Aviv, you’d see a national program with huge investments. Even with drug use: Who uses expensive grass and who uses cheap Mr. Nice Guy [synthetic marijuana] and suffers much greater and deeper damage?
These are the end results of government policy. It’s not the health system’s fault.
True. From the moment there’s segregation in housing, and ghettos are created, from the moment there’s segregation in education and children are tracked, it’s clear where the resources will go. I’m not naïve. But the medical system stands at a crossroads from which it can influence policy, and it’s not doing so.
Racism is part of the method in every system. In the legal system, in which everyone is supposed to be equal, there’s no racism?
These are systems that go together. The legal system cleared the medical system from guilt in the matter of the missing Yemenite children for a reason. There was a reason the state comptroller’s report didn’t find the smoking gun in the Depo-Provera affair. These are two super-elite systems and it’s clear that an essential condition for eradicating racism in them is a change in their human component.
In other words, at their entry gates.
There is the interesting example of Cuba. The infant mortality rate there and the health system’s numbers overall are better than those of the United States, despite the insignificant monetary investment in relative terms. Why? Because when Fidel Castro rose to power, most of the doctors who were part of the elites and bourgeoisie left, and this sought-after club was forced to open its doors to other groups, too. This needs to happen here, too. The minute weaker groups enter the medical system, the entire system will change. The chances of a child from Rahat reaching medical school are infinitesimal compared to a child from Ramat Hasharon. Why? They say there are Arab doctors. Well, thank you very much. They too, most of them, come from the Arab elite.
And of course it’s not easy for them either. Israeli patients are racists too.
Obviously. We need to reach the situation where an Ethiopian or Arab doctor won’t be forced to erase his or her identity to enter the system. Take for example a case I know, of a doctor who said about an Arab who was injured in a demonstration: ‘What, now I need to save this terrorist?’ Do you think the Arab doctor standing next to him would dare to confront him? Or the Ethiopian midwife whom the mother in labor refuses to have touch her? Or with a patient who doesn’t agree to make do with an Arab doctor’s explanation and waits for the “real” doctor.
Let’s say a doctor didn’t want to take a blood donation from an English woman who came to Israel during the period of mad-cow disease. What would he have done? He would tell her. Why? Because he respects her as an intelligent and rational person. Why didn’t they tell that to the Ethiopians? Because they don’t trust them to understand.
I think that’s actually an example of suffocation by political correctness. It was “unpleasant,” so they chose a more complicated and expensive way out: Take their blood donations and throw them away.
And then when it was exposed in the media, there was a great uproar. Has something changed? No. It repeated with the Depo-Provera shots. When it happens time after time, it’s a sign this is a pattern. But doctors won’t admit they don’t relate to patients the same way.
Where does this attitude come from? It’s not just racism. These can also be judgmental, patronizing or basic human tendencies. An Arab doctor, for the sake of illustration, might give preferential treatment to an Arab patient. No one is free of it.
That’s what I said in the Knesset. It’s not possible to work in a bubble. The medical community isn’t an island of sanity and neutrality. It’s part of this place. It’s infected with the same things we’re all infected with. The war against racism is a matter of education; it’s mostly, before anything else, stopping with the pretense that medicine isn’t infected by it. It’s infected and then some.
What do you hear from the medical staffs in your lectures?
The issue of the Jewish women who are post-partum and demand segregation [in maternity wards] and apply incredible pressure comes up all the time. This doesn’t interest the doctors so it becomes a problem for the nurses, who have no choice but to agree and separate them. Many nurses have told me they’ve wanted to do the right thing but have no support.
But what’s the right thing? How do you even talk to such people? There’s no point at all in the nurses trying to educate them.
I can tell you about a certain hospital in Jerusalem where the nurses were instructed to continue with the segregation but not talk about it and not admit it. On the other hand, I have heard about another hospital in which the department head told someone: “You don’t want to be with an Arab in the room? No problem. Go out to the corridor.”
That’s leadership. Again, if it wasn’t worth it financially, if the sanctions were imposed on the hospital instead of compensating it, there would be no segregation. Economic interests and racism go hand in hand. The political climate has an influence too. For example, I hear a lot about Jews who refuse to be treated by Arab doctors. A mother who gave birth told a doctor that she wouldn’t agree to have him touch her while his people were killing Jews. A midwife at a hospital told another midwife: Here, you deliver the terrorist; I’ve already delivered enough of them today.
Do the medical staff express their difficulties to you?
I think it’s the medical staff that’s the difficulty. But yes, it’s hard for them, too. They tell me that even if they want to do things right, it has a price. If they extend a hospitalization for someone who’s needy, they might suffer for it. If they insist on not examining a prisoner who is in handcuffs or in the presence of a prison guard, they’re seen as troublemakers. We live in a very difficult society with a lot of minorities and communities, but we’re also a small country. It could have been possible to deal with this in an in-depth manner, system-wide.
The problem isn’t the racist doctors, the problem is that the system backs them up. Look, even I – the privileged Ashkenazi who contends with this system all the time – feel that my value drops when I speak emotionally, when I raise my voice. They expect me to write polite letters in the right jargon. And if I feel that way, how do people from weaker groups feel in the face of this system?
It’s sad that we could have held this same discussion anywhere in the world. Do you think an English doctor that sees a woman patient with a head covering acts differently? Or a white American who treats a black female patient? Where are you situated on this axis?
Our situation is better than the United States, I can tell you that with certainty. There are pockets of awareness there and all sorts of amazing projects and plans, but the racism in the medical system there is very deeply rooted. In Europe, until the current wave of immigration, there were countries whose situation was better concerning the attitude toward minorities and immigrants. In France and England there were excellent programs.
This apparently has changed.
Very much so. We’re in a very bad period, in which xenophobia feeds racism and economic interests feed racism. Where does the opposition to Barack Obama’s health reforms come from, if not this place of ‘why should they receive it’? The problem is from looking at racism only from the side of the victims – who is harmed by it, who is pushed out – and forget there’s another side: those who profit from it. We need to understand there’s a side that profits from racism, that most of us are on this side and in most cases our achievements and places in society are to a large extent due to the privileges we have. Only then will we understand what the interest is in preserving racism.