Well-Baby Clinics Falling Victim to Changing Times

Finding one Tel Aviv proves a trying experience for reporter.

In a panic I ran into the Well Baby Clinic on Balfour Street in Tel Aviv, 15 minutes before closing time. At home, my eldest daughter, only a week old, was released two days ago from the hospital with a recommendation to see the nurse at the clinic within two days for a general checkup and measurements.

But since she came home with her mother, all the attempts to set up an appointment at the clinic failed. We managed to find on the Internet three telephone numbers of three different extensions at the clinic, but for two hours there was no answer at any of them.

Suddenly a preoccupied nurse answered, and she wanted to know which Well Baby Clinic the baby was assigned to. "Yes, you are assigned here," she said, and transferred the call to another nurse to schedule an appointment, but the call was cut off after a short wait. Two more hours, and another nurse answered: "You aren't assigned here, but to another clinic," she said after a short check.

After a not very peaceful night, the little one still had not been weighed, and I found myself rushing to the clinic in an attempt to determine how to get seen. Many parents were waiting at the entrance with baby carriages and babies, the treatment rooms were all closed. "Where is the reception?" I asked, and was laughed at in response. I left.

Nostalgia for a once-proud system

The health care system is very proud of the Well Baby Clinics, which are viewed by many ¬ maybe nostalgically ¬ as a successful government service by any measure. But old-fashioned methods and poor quality service, along with a rise in births and a bigger workload, have transformed the clinics recently from a service aiding and accompanying parents and their newborns into just a station for shots and measurements. The once proud system is on the brink of collapse, warn experts.

The idea behind the clinics goes back to the days of Napoleon in France. Here in Israel, the service goes back to Ottoman times and saved hundreds of thousands of children, said Ben-Gurion University medical historian Prof. Shifra Schwartz. The question today is whether the clinics can adapt themselves to the 21st century.

The number of births in Israel grew by over 20% over the past decade, but nurses were not added to the clinics.

There are 1,000 such clinics all over Israel, with 65% belonging to the Health Ministry, 20% to the health maintenance funds and 15% being run by the Jerusalem and Tel Aviv municipalities. The clinics are one of the few institutions in Israel where the periphery is not necessarily given the short end of the stick. For example, there are clinics in kibbutzim in the north with only 10 babies, while in Bnei Brak there are clinics that deal with 1,100 babies

"And what about the clinics in south Tel Aviv that also take care of babies of foreign workers and refugees without additional resources?" asks Moriah Ashkenazi, head of the public health nurses division of the Histadrut labor federation.

The Health Ministry said it has problems filling nurses' positions mainly in Bnei Brak, Jerusalem and in Bedouin towns in the south. But there are also reports of excessive loads in Tel Aviv clinics. The city has only 14 clinics with 50 nurses.

The nurses are supposed to give every baby 30 to 60 minutes on their first visit, and 15 to 30 minutes on subsequent check-ups. They have two main tasks to do in this time: Measurements and shots. Israeli babies have a 94% inoculation rate, one of the highest in the world. Most other tasks are left with little time: Diagnosing postpartum depression, nutrition advice and examining for signs of violence or abuse.

There are those who say it is not only the physical infrastructures of the clinics that are out of date, but the entire intellectual underpinnings of the program. Parents today need more help, especially with nutrition, said Schwartz. The clinics lack a multicultural approach and many are behind technologically, she said.

The Health Ministry is interested in strengthening the clinics, and is soon to introduce a new program to diagnose postpartum depression among mothers. The ministry is also aware of the increasing burden of the inoculations, including new ones that have been added in recent years. The ministry is also planning a pilot program to increase the availability of telephone consultations by nurses. The ministry said the problem is finding nurses, and not a lack of positions. Surveys show that mothers are satisfied with the services provided by the clinics and the nurses, said the ministry.

The Tel Aviv Municipality said it is acting to recruit more nurses, and is upgrading the computer and phone systems in the clinics to allow the nurses to concentrate on treating the children. The city is also examining opening two more clinics.