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,

ALN

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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.

Live: Parlor Meeting with a Candidate for Head of Our Regional Council

Here's democracy in action.  

I'm sitting in my neighbor's living room, and about 30 additional neighbors have joined us here to meet with Moshe Dadon, a candidate for our local Regional Council (mo'etza).  Unlike the major cities, where voting took place a few weeks ago, our area goes to the polls in January to choose its new Regional Council members.

Moshe grew up in the area (Moshav Luzit) and has served as the Regional Council secretary for the past four years, so he knows the system from the inside.  He described growing up among the chicken coops, and seeing the agriculture lifestyle fall by the wayside as the years went by. The area's needs now are completely different; he noted that much of the moshav property formerly used for agriculture is now factories.

Moshe describes himself as "very green - not in terms of money, but the environment" (It wasn't clear what he means by this, as some of his later statements indicated that he has a poor understanding of certain environmental issues).  He understands that many people are flocking to the moshav expansions for the quality of life, and are not agriculturally minded. He realizes that municipality taxes have been rising, but are not nearly at Jerusalem levels, and that all the local illegal building is only hurting all the citizens because they cannot benefit from improvements if local tax money is not being put back into the system.  

Moshe pledges the following:

1.  Taxes collected locally, stay local.  All tax monies collected for the moshav expansions (of which there are many) will go directly back into moshav coffers.

2.  Sliding scale taxation.  Everyone should pay arnona, including residential buildings, local businesses, quarries and other industrial properties, according to their ability.  Anyone who qualified for a discount will receive one accordingly.  The Arab sector, which has been neglected until now, will also receive the amount entitled by law.  

3.  Financial independence.  The general dependence on the system for financial support is unjustified and has to be changed.  Every community can then become independent and make its own decisions according to its needs.

4.  Infrastructure.  By law, 5% of tax money collected by the Regional Council is designated for internal development;  that means 12 million shekels has to be distributed every year to the local municipal governments, for use as they see fit.

5.  Primary Education.   The local educational system should be run locally, by a professional with a doctorate in education.  Most of the local population is religious, and any new local school would have to be religious and include all the children in the surrounding local moshavim.   Until now, our religious school system has not provided a good education, period, and many families send their kids to a different school district.  

6.  Secondary Education.  High schools in the area have been closing, but the local population is growing and we'll need to develop a series of local high schools here in the area. Competition is good for education, as it is for everything else.  By law, only the head of the Regional Council is entitled to choose where kids go to school.  At this time we have 4000 high school students, and the system doesn't have room for new students, even if it were a good system and people were willing to send their kids.

7.  Transportation to School.  For now, funding from other budgets, such as the building budget, to fund school buses for local kids.  There is no governmentally funded option for transportation for high school-age pupils.   Children need to go to good schools, locally, such that there won't be a need for transportation.  School buses are a temporary measure until we have good schools in the area.  Pupils can't succeed if they spend hours on buses, and there's no equal opportunities for all citizens until we have quality local schools for everyone.  We don't have time to wait.

When it was pointed out that building all these schools will take time, he didn't have a clear answer, except to improve the existing schools.  One neighbor offered a temporary solution of not having kids for the next few years, which got a few laughs but underlined the seriousness of the issue.  Moshe grew up in the system, continued to be involved in the local education system after his high school graduation, and sends his kids to the local schools, so he is aware, from the inside, of just how bad it is.

When asked about the decision making powers of the local municipality versus the Council regarding expansion issues, he spoke in favor of allowing the municipal council to receive tax monies and make most local decisions.  Regarding division of properties, especially public and moshav properties, he cited a local example of a town within the region that wanted to build a swimming pool with public develop monies, and the Regional Council refused to grant permission.   

A participant described one local conflict regarding the use and upkeep of moshav property, an issue which has put residents of our Moshav extension at odds with the decision-makers of the moshav's municipal council, with no legal redress... As this neighborbor pointed out, this type of conflict usually stays on a minor and limited level, but the same problems tend to repeat themselves, and our current expansion has only brought the issue to the fore.  Moshe did not provide a clear answer regarding this issue.

Regarding the protection of nature conservancies, Moshe supports expanding into parts of those ares for the benefit of the local populations.  He cited the building of a new school as one example.

Moshe has pledged to bring educated, reliable and honest workers into the Regional Council, and here he was asked regarding the type of people he would, indeed, bring with him.  (It has been said that our local government has become bulky and corrupt over the years, and I can testify to the number and quality of shiny cars in the parking lot).  

Moshe responded by pointing out that there is one person in the regional government overseeing all 180 local kindergartens in the region, with a similar situation for the primary schools...  "No one person is a workhorse."  A neighbor responded with cynicism, that the only department in the council that returns phone calls is the Collection Department.  Generally, those present at the meeting did not express satisfaction with the so-called reforms he claims to have made until now.

Moshe referred to a total rearrangement of the governing system, especially the educational system, and that in his view this includes, among other things, encouraging older workers to retire, and having others transfer to departments where they are needed.  "If one doctor is no good, do you blame all the doctors?"

He continued to refer to poor air quality, although he offered no clear solutions.  Prior to this, he claimed not to understand the connection between electricity and the quality of the environment.   Regarding a specific road in the area which has been declared unsafe and whose legal status has remained unclear for years (the road remains open but the police sometimes distributes tickets to those who travel on it), he offered no clear answer, except to point out that the Regional Council has been trying to resolve the issue.

Moshe's closing statement (summary):  We have the opportunity to develop the area, to give everyone an opportunity and quality of life.  The problem is not as other candidates will tell you, that this or that individual bureaucrat is responsible.  The money is the issue.  If we want to develop the area, our money has to go to the right places;  quality education for everyone, and local development.

* * * * *

On Wednesday, another candidate will be coming to impress us.... stay tuned.

Keep the balance,

ALN