It's so simple to be wise.  Just think of something stupid to say, and then don't say it.     Sam Levenson (1911-1980)

Wednesday, March 4, 2009

Scales are Tipped Down, Way Down, by the PA

Since beginning pediatric hospital work over a decade ago, I've shown a tendency to divide circumstances -- that is, reasons for hospitalization -- into two artificially neat categories:  Man-made, and G-d-made.  

Examples of the former include falls from upper-story windows, hot-water burns, and car "accidents."  The latter run a spectrum, from "less serious," (i.e. dangerous but curable) illnesses like RSV, Hanoch-Schlein and cellulitis, to acutely life-threatening maladies like Crohn's, SCID, CF, and acute myeloid leukemia.  

Believe it or not, in many ways I had a much harder time in Pediatric Surgical, working with kids injured as a result of the "man-made" stuff.  Why?  I was constantly troubled by the thought that most of the injuries there were preventable;  Falls resulting from unsupervised climbs along an unfenced roof edge or an unbarred third-story window.  Shabbat kettle burns?  See Prof K's posts, here and here, for more on that.  (Yes, I've referenced these before, and I'll probably keep doing it until the problem is no more).  Car-related injuries?   I won't start ranting here about street safety or seat belt use, but please pretend I did.

As for the G-d-made part -- we can't prevent that stuff.  It's just not our jurisdiction.  We can only try to cure it.  And if we cannot cure a child's illness, we can still try to help that child find comfort and meaning until the end.

But now we are stuck in a new situation, where life-threatening, G-d-made circumstances have been further complicated by man-made decisions.

I am, of course, referring to the February 1, 2009 decision of the Palestinian Authority to cease nearly all payments to Israeli hospitals, thereby cutting off hundreds of Palestinian children (and adults) with life-threatening illnesses from the medical care they need. 


Let's not turn this situation into another political discussion.  Because for me, and so many others, this is not a theoretical situation involving some unnamed, unknown enemy.  This is a new reality, where over fifty children, all of which I know personally on one level or another -- some for several years now -- have been given a death sentence by way of a governmental policy of collective medical neglect.

When I let myself think about it, or when circumstances force me to think about this new reality, sadness creeps in and hits me, literally, in the face.  Our department is half empty, which for us staff members could be viewed as a glass half-full, since we've been working at a slower pace these past few weeks and can take a few minutes to breathe now and then.

But then someone like A -- a beautiful, bright and sensitive teenage girl whom we have been treating for a leukemia for the past four months -- suddenly shows up in our department with a nearly lethal systemic infection because she no longer had a commitment from the PA to pay for her treatments.

What about all the others?  Some of them are in touch with us by phone, while others have been so difficult to contact, it's as if they have disappeared into thin air.   All are pleading desperately, crying at the desks of the PA bureaucrats who have the power to make a life-changing decision but choose not to.  These officials have claimed they will sponsor parallel treatment in an Egyptian, Jordanian, or even Europe -- anywhere but Israel -- but with very few exceptions, we've yet to encounter evidence that our patients are receiving any treatment whatsoever.   

Every once in awhile a rumor flits through the department -- that so-and-so has died of a deadly infection in some PA hospital somewhere.  So far these rumors have proven false, but it's only a matter of time before they are not.  Chemotherapy protocols are measured in days and hours.  A lost week is an acute risk;  a lost month, or even a fever, is a death sentence.  

If we could treat for free, we would.  But we can't, because the funding would come out of our department budget, such that within a month even one patient's treatment would empty the coffers and shut down the department.  A few of our staff have even dug into their pockets so that certain individual patients could have this one medical test or that course of life-saving antibiotics.  A few miniscule drops into a very deep bucket.

This past Monday we were all relieved to learn that A's family managed to confirm her East Jerusalem resident status, allowing us to continue the treatment that will, most likely, save her life.  This morning, the Palestinian Authority's Committee of Medical Exceptions purportedly met to review the list of children requesting funding in to continue treatment in Israeli hospitals for long-term, life-threatening illnesses.  

I can only hope that tomorrow morning, all of our lost patients will be knocking down our doors, PA funding commitments in hand.

Keep the balance,



While this situation has affected patients in hospitals throughout the country, for whatever reason most of the (limited) PR refers to Hadassah Hospital in Jerusalem.  See the NY Times piece here, and the JTA piece here.


rickismom said...

It is quite telling, the PA attitude.

About shabbas urns. Years ago the doctor at Maiyei Yeshua mentioned this, and I attached our urn to the wall. Yet most people don't.....a real time bomb. I will try and rectify some of the other points mentioned in your link.....

A Living Nadneyda said...

Good for you about the urn!

We will never be aware of the accidents we've prevented, but we will always regret the ones we didn't manage to prevent (חו"ש).

RivkA with a capital A said...

I have a few rants of my own that this post triggers... I won't go off and rant about any of them, but you can pretend I did. ;-)

therapydoc said...

This is what I call bi-nomial thinking. I'm always saying,

there are two kinds of people in this world.

i.e., People who make the yellow light, people who don't.

People who need 8 hours or more sleep, everyone else.

It's your totally inclusive measurement tool. You can't lose. Right everytime.

rickismom said...