Under normal circumstances, it would sound like the product of an overactive scriptwriter’s mind, but this was the scene at Mayanei Hayeshua Medical Center in Bnei Brak last Monday: An Arab doctor entered the hospital’s coronavirus unit in full protective garb, holding a Torah scroll wrapped in a tallit (Jewish prayer shawl) for use by the patients there.
The Torah was from the hospital’s synagogue in this overwhelmingly ultra-Orthodox city, one of the country’s coronavirus hotspots. In a further irony (and before the Health Ministry rules were relaxed somewhat over the weekend to permit prayer out-of-doors by no more than 19 people), last week COVID-19 wards were the only places in Israel where prayer could be conducted in groups: The worshippers were already infected with the disease.
The physician who brought in the Torah, Dr. Abed Zahalka, has worked in the intensive care unit at Mayanei Hayeshua for many years. He is originally from the northern Arab town of Kafr Qara, but has more recently moved to Petah Tikva (like Bnei Brak, a suburb to the east of Tel Aviv). He says he feels at home not only at the hospital, but in Bnei Brak in general.
“I’m like a member of the household here for a large number of families in the city,” he said, adding that he also has a good understanding of Jewish religious practices after his long stint at the medical center.
A few minutes after the Torah arrived, patients were already excitedly using it in prayer, or to the extent that their condition enabled them to participate. The unit’s staff – a mix of secular, Orthodox and ultra-Orthodox (or Haredi) Jews, in addition to Arabs – were also moved by the scene. They gathered around an adjacent screen where they could see the worshippers and, although they were just meters away, watched from a sterile area completely sealed off from the patients.
The Torah “is giving them a sense of meaning and is making them stronger and helping their recovery,” said Michal Ben-Dov, who heads the hospital’s nursing department. “These are people who are used to praying every day,” she added, saying that it gives them strength amid the complex reality they are facing in isolation.
Zahalka was also moved by the arrival of the Torah. “I felt like I was making the connection even stronger, that I was a part of the place, of the people, of the tradition,” he said. “I am a person of faith, and I see a lot of people of faith here and a lot of Bnei Brak’s rabbis. I also think there’s a connection between faith and successful treatment,” he notes. “You see people who simply give up compared to people who were in very serious condition and are dealing amazingly with the disease and are recovering.”
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In recent weeks, Mayanei Hayeshua has become one of the country’s major coronavirus treatment centers. This small facility, known in Israel as a “private-public” hospital, is owned by a corporation that is supported by the Mayanei Hayeshua nonprofit organization. It was established through contributions to serve Bnei Brak’s residents and is financed from a number of sources – revenue from the country’s health maintenance organizations; income from the National Insurance Institute for the many mothers who deliver their babies there; contributions from Israel and abroad; and, in recent years, with several million shekels a year in government funding.
It has a rabbinical board in addition to its board of directors, and is geared to the needs of a population that is ultra-Orthodox and run in accordance with halakha (Jewish religious law).
The hospital is public in the sense that it has an emergency room and is committed to treating any patient regardless of financial considerations. It is also under the Health Ministry’s supervision when it comes to the quality of care and medical standards. But its private status also enables it to accept fee-paying patients (including patients whose insurance pays for treatment), in addition to its public sector patients.
Mayanei Hayeshua, which in normal times gets scant attention from the health care system, has found itself at the heart of the coronavirus pandemic. Bnei Brak is second only to Jerusalem in the number of coronavirus cases (and the capital has a vastly larger population). On the morning of our visit last week, there were 57 COVID-19 patients at the hospital, including 17 in serious condition and 11 on ventilators. Those are much larger figures than at the country’s major referral hospitals, such as Soroka in Be’er Sheva and Rambam in Haifa, and even more than at the nearby Sharon Hospital, which has been converted into a dedicated, 200-bed coronavirus facility.
‘This epidemic isn’t being managed’
Given that it’s on the frontline in the fight against the pandemic, it’s striking how quiet Mayanei Hayeshua is when you first enter. The hospital grounds, which are usually bustling, are nearly empty. Outside the medical center, there is a large tent that every patient must enter for screening purposes.
Those who are suspected of having the coronavirus are separated from “regular” patients on their way to the emergency room and are subjected to further examination. Patients who get tested for the coronavirus must wait in the tent for the four hours it takes for results to come back.
Whatever their department, all hospital staff must now wear full protective garb for their entire shift, after a number of employees had to go into quarantine after being exposed to COVID-19 patients. Mayanei Hayeshua has learned not to take chances.
When the hospital’s management recognized the magnitude of the situation, the surgery department in the new building was converted into a coronavirus department. Everything in the department looks brand-new – not what one might have expected at a small, crowded Bnei Brak hospital.
The surgery department was moved back into the old building, “because there are almost no operations,” explained Prof. Mordechai Ravid, the medical center’s director. Ravid, who declined to state his age, appears to have long been in the age category that would place him at danger from the coronavirus, and he acknowledges that he is in a “high-risk group.”
Among those who work with him, the virus has infected secretaries, nurses, doctors and other staff members. He is exposed to the virus “from morning to evening,” he said, but so far is still running things.
“We’re managing with the number of patients on respirators, and so far have only transferred one patient to Ichilov,” he said, referring to the major hospital in the center of Tel Aviv. “It happened in the second week, when we thought we would need an ECMO [heart-lung life-support machine] – and then they also complained, asking why we had transferred a patient.
But while he is happy with his hospital’s response, Ravid does have wider concerns. “This epidemic isn’t being managed,” he charged. “It’s clear that there should have been a central agency directing patients among the hospitals. There are patients who come here in a certain condition and their condition deteriorates. But there are also those who come when they were already in serious condition. There should have been a procedure in which a Magen David Adom [emergency medical service] paramedic who comes to the patient asks [a referral center] managing the event where to take the patient.”
In the absence of such coordination, Ravid said he resorts to his good relations with nearby large hospitals – Ichilov, Assaf Harofeh and Sheba – “and if we need help, we will be able to get it from them.”
When asked what has been learned about the disease, Ravid said “we are learning new things every day. Most of the seriously ill patients are up in years and are overweight [or] diabetic, and some also have respiratory diseases. Here and there, there are seriously ill young patients, but they are a minority.
“We have learned that the disease begins slowly, and after the symptoms have appeared, the second week is critical,” he explained. “That’s the time when we see what the tissue’s response is to the changes the virus makes to it – and that’s the stage that can be fatal. The air sacs in the lungs fill up with fluid and they need to be given respiration under pressure and sometimes also connected to an ECMO,” he said. “The bottom line is that there are a lot of questions and few answers.”
Zahalka, meanwhile, noted that “what’s surprising with this disease is the speed with which it progresses. There are people whose condition declines quickly and they become very seriously ill patients whose lives we need to save. It requires us to be aware of the smallest change in the patient.”
How does this manifest itself?
“It’s when you see a person, for example, who is speaking to you almost routinely, but his tests show a deterioration. I may tell this person, ‘We are about to put you on a ventilator because you have deteriorated significantly.’ And he answers: ‘How could that be? I’m breathing fine.’ But I see that the person is already breathing heavily, even though he isn’t yet feeling the respiratory distress he is about to experience. That’s the disease. It’s so fast that the patients don’t manage to realize it.”
The main problem at the moment, Ravid said, is not a shortage of ventilators but of manpower. “There have been a considerable number of cases of staff members who have been infected, and a large number who have gone into quarantine. At the moment, we have 30 staff members in quarantine,” he reported.
Staff members are now learning how to protect themselves better, while work procedures have also limited the potential for infection.
Giving birth with a mask
One of these procedures relates to one of the hospital’s most important wings: the maternity ward, which, like at other Israeli hospitals, is a major source of revenue. In the midst of the coronavirus pandemic, though, there has been a drop in the number of women coming to the hospital to give birth.
“For some reason, people think it’s dangerous to come here,” Ravid said, “but it’s not true. The only department where not a single doctor or nurse has been infected yet is maternity.”
The hospital has also created a separate maternity department for COVID-19 patients.
While this reporter was visiting the hospital, one maternity patient with the coronavirus who had already been released from the hospital called to thank the hospital’s staff. She was diagnosed with the virus a week before she delivered her baby, and came to the hospital in an ambulance that was equipped to transport coronavirus patients. She was referred directly to the separate maternity department for the birth of what was her fourth child.
“I was frightened when I arrived, alone in an ambulance, after they hadn’t even allowed my husband to come down to the street with me,” said the woman, who asked that her name not be published. “I was received by a midwife by the name of Danielle, who didn’t leave my side for the entire delivery. I had a mask and a clear shield on, and I was uncomfortable about infecting the staff. But they calmed me down and were amazing to me,” she added.
Following the delivery, her baby girl was taken to another room to avoid the risk of infection and the mother was transferred to the hospital’s regular coronavirus section. After leaving the hospital, the mother went into a quarantine space very near her own home in Bnei Brak. Until she has fully recovered from the virus, her husband will take care of their baby. “It’s not at all a simple thing, but we will get through it,” she said.
In the sterile area adjacent to the coronavirus department, there is a large staff monitoring the patients with cameras and computer screens. They go into the patients’ rooms when necessary to examine them and provide them with medical care – and then the staff members are protected from head to toe. They put on full protective gear before entering and on leaving. Everything except their protective goggles, which are reusable, is thrown away.
“Taking off the protective gear is dangerous,” said Marlen Taher, the nurse in charge in the coronavirus department. “Therefore, we are very careful here about how we take it off, and that it is supervised.”
Taher also spoke of the department’s successes. “We’ve already had a number of patients on ventilators who were weaned off them. Up to now, the people who have died here have been patients in very poor condition. From the staff’s perspective, we would never say that if a person is on a ventilator, that’s the end of the road.
“There is a 60-year-old man here now [who was] in very serious condition and had already taken leave of his family and was put on a ventilator, and it was very difficult for the staff to see how he deteriorated,” she recounted. However, she said, “The patient recovered, was weaned off the ventilator and probably will get his second negative coronavirus test [result] today and be transferred to a regular internal medicine department. That’s what gives us encouragement and strength.”