Hospitals in Israel’s Periphery: In Need of Intensive Care

Patients are squeezed eight to a room, cancer care is minimal and delivery rooms are primitive. But change is on the way.

Wheeling a patient down a corridor in Haemek Medical Center.
Rami Shllush

Sometimes the little things tell the whole story.

Israelis from well-off central Israel, seeing baby delivery rooms in Haemek Medical Center in Afula, go into spasms. Where are the spacious rooms, the cutting-edge birthing aids, the Jacuzzi? Or, walls?

The delivery “rooms” in Afula are, like in a throwback to the 1940s, one long room in which “units” are separated by thin dividers. Every murmur, let alone every shriek, is audible to all the rest.

And that’s an improvement – the delivery beds used to be separated by curtains, says Orna Blondheim, Haemek manager. She proudly notes that despite the austere conditions, the hospital boasts the highest customer satisfaction of all the Clalit hospitals.

That’s just one example of eye-popping gaps between conditions at hospitals in central Israel and elsewhere in the country. Haemek still has rooms with eight beds and one toilet for all; today’s construction standard for hospitals is two patients per room.

Israel’s northern district has 1.4 million residents (half of whom are associated with Haemek, and half are Arab). It also has the fewest number of doctors per capita in the country, and relatively few beds. The situation in the southern district is worse.

The Health Ministry is well aware of the gaps – it publishes spreadsheets from time to time that show them. So does a stroll through Haemek.

However, within months, Haemek is due to inaugurate a new building, erected at a cost of $70 million for construction and equipment – with cutting-edge delivery rooms (real ones). The rooms will house two patients each: Blondheim hopes she can reduce crowding at Haemek to three per room.

In three years, too, Haemek plans to erect a cancer center, featuring joint research with the Technion Israel Institute of Technology, at a cost of $50 million and designed by reknowned architect Ron Arad. It will even have its own pharmacy and quality of life center.

This is huge news for the people of northern Israel. The north is the area with the country’s highest cancer rates, and the region has exactly one radiation therapy center. However, succor will be coming sooner: the Ziv Medical Center (formerly known as the Rebecca Sieff Hospital) in Safed should be opening a radiation therapy clinic, too, in a matter of months. One reason it delayed so long is the glacial pace at which donations to help fund it were raised.

Haemek has no radiation therapy clinic, though it serves half a million people in the first circle and many more who come in for unique services it provides, including child dialysis and surgery, says Blondheim.

Rambam for radiation

So cancer patients in the north treated at Haemek have to get radiation elsewhere, traveling daily (over weeks) to Rambam in Haifa or Beilinson in Petah Tikva. Sick and frightened, some have to travel hundreds of kilometers from home, every day, taking public transportation – and that’s once they start treatment. The radiation centers are overloaded, it can take a month to begin therapy once the recommendation is made.

“In fact the wait can be so long that sometimes doctors tell patients they’re better off having a major operation in order to avoid radiation,” Blondheim says.

“It’s hard for people to cope with such long trips, over weeks and weeks, to get radiation exactly at the time they feel so sick, not to mention the economic and family implications. It can paralyze, practically destroy the family. At the end of the day, the rate of malignant disease in the north isn’t lower, in some cases it’s even higher, but people here get less radiation.”

And that’s once the disease is diagnosed. People in northern Israel have a problem with belated diagnosis, partly because compared with the center, they are poorer, less educated and less aware of scanning tests precisely for the sake of early cancer diagnosis, Blondheim says.

“The fact that Haemek has no oncological ward means that cancer patients are put in internal medicine wards instead of special departments that can treat the disease. Since the population here is poorer, dependence on public medicine is higher. The patients depend on us and we have less beds and less doctors for them [per capita],” she adds.

Not only doesn’t Haemek have radiation machines. It is horribly short of advanced scanners. It doesn’t even have a permanent MRI, just a mobile one. Getting a PET CT scan, which is pretty standard for cancer patients elsewhere, requires the patient to haul himself to Rambam in Haifa or Beilinson in Petach Tikvah. Even the state comptroller wrote passionately about inequality in medical care, in his 2014 report.

Donations are key to the problem, and the cancer center Haemek building found a daddy in the form of Gazit Globe Chairman Chaim Katzman, who decided, shortly after the premature death of his pediatrician wife Shulamit to make a big donation in her memory.

It was unusually that he chose to put $25 million in the periphery, in building the cancer center at mid-size Haemek, rather than in one of the giant Israeli hospitals in the center. (His condition was that Clalit match his donation.)

Not even 50 years old, Shulamit Katzman died of colon cancer, two years after her diagnosis. The experience was horrendous and he developed the idea of building a cancer treatment center that would be humane, compassionate – helping people through the experience, Katzman says.

Donors may not realize how dependent the Israeli peripheral clinics are on philanthropy, Blondheim thinks, and anyway, “Donating in metropolitan Tel Aviv, or Jerusalem or the Technion and so on is more attractive. It’s a lot harder to raise money in an area that isn’t sexy.”

Stiffed by the state

And given that donors usually demand matching, the upshot is that hospitals in the periphery are also stiffed by the government – “It doesn’t put a shekel in here,” Blondheim says.

He wanted to memorialize his wife in Israel: Katzman says simply that he looked for the place that needed help the most.

“The north has three less beds per capita than the center life expectancy is shorter,” he adds. His conversations with Dr. Blondheim sealed the deal.

The center, expected to take three years to build, could be a game changer not only for Haemek but for Afula and the region, Katzman says.

There’s good reason he chose a name architect like Ron Arad, a man capable of building unique things that become attractions in and of themselves. Katzman believes the new center’s potential is no less than the Guggenheim Museum in Bilbao, a city scorned by its own residents as an armpit, until Frank Gehry’s design turned it into a tourist attraction.

“That Guggenheim changed the fate of the whole city,” Katzman says. “So, it was important to me that beyond being a hospital that provides a solution, it be an architectural gem we even reached the level of what patients lying in bed can see, and how the hallways will look.” There will be art, too, to distract patients and their relatives. “It’s a net gain.”

The Clalit healthcare organization, which owns Haemek, did match Katzman’s $25 million – which however means other projects will suffer, points out Eli Defes, CEO of Clalit. Some renovations planned for 2017 will be deferred; some equipment scheduled for procurement won’t get bought for another two or three years. He chose projects that could suffer deferral – and a cancer center is sorely needed. “I guess this is a commitment for life,” he says.

Katzman plans to be deeply involved personally, including in decisions made with the architect Arad. “You don’t built a thing like this for five years, but for 500, so it takes planning. For instance, we will build 60 chemotherapy stations but if chemotherapy is phased out in the future, they can be discarded and other things can be done.”

Katzman and his donation is a moving story, but they beg thoughts about how dependent the Israeli healthcare system is on philanthropy – even for crucial life-saving offerings like radiation therapy. Also, building one center (and even adding the one at Ziv) won’t close the gaps between the center and periphery.

Also, government is fickle. A government committee was formed to plan how to upgrade medical services in the north. Shortly after it filed the Plan for Expanding Healthcare Services in the North, at a total investment of about 10 billion shekels, the blueprint was put on ice.