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Hadassah's Helping Hand

A Friday Story
Prof. Shlomo Mor-Yosef

We at Hadassah have always understood that illness and disease cross borders without regard for international demarcations - and that man-made and natural disasters unfortunately leave people in need of rapid medical expertise. We mean it when we say that "medicine knows no borders" and are quick to offer our help to people and countries near and far.

Just a few weeks ago, three Hadassah physicians flew to Cyprus to help treat the people injured in the explosion at a naval base that killed 13 people. Prof. Bertie Freund, former head of the Department of Surgery at Hadassah-Mt. Scopus and Senior Plastic Surgeon Dr. Neta Adler went to the main hospital in Limassol to see a patient while Dr. Guy Rosenthal, a neurosurgeon, went to see a patient in Nicosia. A few days later, the most seriously injured Cypriot solder was airlifted to Hadassah where he underwent surgery. He is now in our Surgical Intensive Care Unit where a multidisciplinary team is helping him recover from his wounds.

About a week before, we treated a patient from closer to home, Bar'aa, a 29-year-old woman from the Palestinian Authority. Helping our neighbors is not an unusual occurrence here. However, her situation required a great deal more than medical attention.

During cardiac surgery in a Palestinian hospital, an important artery that supplies blood to her small intestine was damaged. Her husband, Eiad, contacted Dr. Gidon Almogy, Director of Hadassah's Surgical Center B, and begged to have his wife moved to our Medical Center. Dr. Almogy turned to Dr. Yuval Bloch, Assistant to the Director of Hadassah Ein-Kerem, who took charge of the project. With the help of Dalia Bassa, Coordinator of Health and Welfare for the Israeli Civil Administration, they arranged for Bar'aa's transfer from a Palestinian hospital. Ms. Bassa and the Civil Administration work with the Palestinian Authority to attend to the needs of the civilian population in the West Bank - and this young woman was most assuredly in need.

Bar'aa, Eiad and Dr. Gidon Almogy

Our surgeons managed to save a portion of her small intestine, but she will still requires Total Parenteral Nutrition (TPN) for the rest of her life. TPN is a way of supplying all the body's nutritional needs by dripping a nutrient solution directly into a vein.

When she had recovered sufficiently, Bar'aa was transferred to a local Palestinian hospital with a day's supply of the nutrient, a letter to her doctors describing the treatment she had received and follow up instructions. A short time later, when she returned to our Intensive Care Unit with a severe infection, we learned that the doctors she saw and the Palestinian hospital where she was treated had no familiarity with TPN. They didn't know how to administer the solution and that it has to be kept sterile, so when the original supply ran out, her doctors simply refilled the TPN plastic bag with other nutrients.

To complicate the situation, there was no supplier to provide her with ongoing replacements - her only source of nourishment. As the situation unfolded, it was clear to us that without actively intervening, Bar'aa would die.

Dr. Yuval Bloch again asked Ms. Bassa for help, this time to facilitate contact with the Palestinian Authority. We used our own network as well, asking our staff members to reach out to their colleagues in the Palestinian Health Authority to plead for permission for the doctors to come to Hadassah and be trained in the procedure. After an intense diplomatic dialogue, the Palestinian Health Authority sent two senior physicians, two nurses and two staff members to Hadassah to learn how to handle the treatment.

Dr. Hashem Rawhi, an expert in TPN, is a Palestinian physician who completed his entire medical training and specialty in Anesthesiology and Intensive Care at Hadassah under the auspices of funding from the Karl Kahane Foundation of Switzerland. He and Rivka Shouval, M.Sc., Director of the Division of Pharmacy, took on the task of teaching the Palestinian medical team about TPN, while Bar'aa continued to remain hospitalized and treated.

After learning the subject from Pharmacy Director Shouval and Dr. Rawhi - and another month of preparation, Bar'aa's Palestinian team - and her husband - received "how to" training on Bar'aa herself. Meanwhile Ms. Bassa convinced Teva Pharmaceuticals to supply the TPN solution - and the Israeli government to guarantee payment for the solution. In much better condition, but still requiring a lifetime

of care, Bar'aa, Eiad and the team returned home together.

"It was a real triumph for our patient and for other people in the Palestinian Authority who surely need this treatment and this help," Dr. Bloch says. "Everyone had the same goal and everyone worked together to achieve it. In the process, we developed strong professional relationships and made some good friends."

Quite by chance, Eiad, Bar'aa and Dalia Bassa were all at Hadassah-Ein Kerem last week at the same time. Ms. Bassa to address a group of visitors - Eiad and Bar'aa to attend to some medical needs. When Ms. Bassa and Eiad accidentally met in the lobby, she invited him to tell his story to our foreign friends. "I am always happy to speak about Hadassah," he said, explaining that his connection to our Medical Center goes back to his childhood when his mother had heart surgery at Hadassah. "Ask me any time," he said, "and I will gladly tell Bar'aa's Hadassah story and mine."

Pictured on right are Eiad, Bar'aa, Dalia Bassa and the Teva representative

****

The triumph for this patient and for the people in the Palestinian Authority is truly a triumph for Hadassah and Israel. With all that it entailed, we were victorious in the battle to save Bar'aa. When I heard about how our entire staff responded, I was impressed but not surprised. They behaved exactly as I would have expected, because they feel as I do.

Eiad's earlier connection - and Bar'aa's experience reinforced what I already believe and know - that for Hadassah the phrase "medicine knows no borders" is more than a slogan. It is inculcated in everyone who works at the Medical Center as it has been from our earliest days. It is who we are and what we do - for the people of our city and country, for people nearby and far away.

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