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Passionate About Research

Diary of A Director General
By Prof. Ehud Kokia
Director General, Hadassah Medical Organization
The revolving doors at the end of the floors on the lower levels of Hadassah-Ein Kerem that connect the hospital and the Faculty of Medicine are constantly in motion. I am pleased to be one of those that uses the revolving door, and that after only two months, I am among the doctors and scientists who hurry back and forth between the two institutions as if they were one entity. In many ways they are, physically and intellectually. Hadassah doctors teach at the Medical and Dental Schools and faculty members collaborate with colleagues in the hospital. The connection on Mt. Scopus is not quite as close, about a five minute walk between Hadassah and the Hebrew University campus there, yet the connection is the same. The connection is research, award-winning research.

A conversation with one of our young doctors brought this home to me in a very vivid way. While his research is unique, how he went about it is the norm at Hadassah. Dr. Yehuda Ginosar is the Director of the Mother and Child Anesthesia Center in the Department of Anesthesiology and Critical Care Medicine. Initially we spoke about our mutual specialty, obstetrics and gynecology, about the unique challenges involved in simultaneously caring for the mother and the baby. Hadassah has the only anesthesia unit in Israel that specifically addresses both the individual and intertwined needs of the mother and fetus throughout pregnancy and delivery, and the needs of a child undergoing surgery.

Dr. Ginosar moved to Israel shortly after finishing medical school in England. When he decided to specialize in anesthesiology, he chose Hadassah. “Hadassah had the best training program in those days and still does,” he says. He completed his residency and continued his career, ever aware that research was part of the Hadassah mandate for clinical and academic excellence. At the time, he confesses, “I was more interested in teaching and patient care but I knew that research was a must if I was going to have a career at Hadassah.”

“These days,” he says, “I am passionate about research. My passion is generated by the environment I’m working in. Nowhere in Israel is there such an intimate relationship between basic science, clinical science and clinical medicine.”

His patients actually pointed the way to his initial and continuing research projects. It all began while treating a pregnant woman with pre-eclampsia, a fairly common but quite dangerous condition that threatens the life of the unborn baby and the mother. After administering an epidural to relieve her pain, he noted improvement in the baby’s condition.

He and Prof. Uriel Elchalal of the Department of  Obstetrics and Gynecology, wanted to apply for a HWZOA Women’s Health Research Award to fund an investigation into this phenomenon. First, they had to find a partner on the other side of the revolving door; a stipulation Hadassah made to strengthen the bond between science and its clinical application. They teamed up with Prof. Amnon Hoffman at the Hebrew University School of Pharmacy. The resulting project received HWZOA Women’s Health Research Award funding and also a large grant from the International Anesthesia Research Society.

Using ultrasound, they demonstrated that for women with pre-eclampsia, continuous epidurals throughout pregnancy improve the blood flow to the baby, allowing it to grow better and delaying the need for an interventional delivery. Once their study was published they felt they needed to examine neonatal outcomes, which require a much larger study and collaboration with other medical centers. When this proved unfeasible, they began looking for animal models to study.

At the time, Dr. Ginosar was on a clinical sabbatical at King's College Hospital in London. By chance, he heard about Rinat Abramovitch, PhD, a brilliant scientist in Hadassah’s Goldyne Savad Institute for Gene Therapy. Her focus was on using MRI as a tool for the study of vascular remodeling. He cut short his sabbatical and returned to Hadassah to pursue his research.

They used MRI , which he calls “a real cool tool,” to look at the blood flow to the placenta and to the different fetal organs, examined the changes that occurred and especially how the fetal brain maintained its blood supply at the expense of other fetal organs. As their research progressed, they looked at this brain-sparing phenomenon in animals that had been asphyxiated for long periods throughout pregnancy.

The presentation of their data at this year's Annual Meeting of the International Anesthesia Research Society earned them the award for best basic science research poster presentation. Their abstract was considered the best from among the 540 submitted.

“We need to conduct more research to determine whether this test can help us determine when to deliver the baby,” Dr. Ginosar says. He is now planning for a larger study on the effects of anesthetic drugs on the fetus and getting ready to go to Taiwan to learn how to give spinals to mice, much smaller subjects than pregnant women.

“My research has gone in several directions, from the clinical question to the research project to the lab and back to the patients,” he says. “This is truly translational medicine, trying to "translate" basic research into real therapies for real patients. Nowhere in the world could you slide so painlessly from clinical medicine to clinical research to laboratory research and back to the patient, with the involvement of such a broad group of professional disciplines. “

‘Passionate’ is the word Dr. Ginosar uses about his research, but his passion encompasses the all of Hadassah. “In anesthesiology, especially in academics, Hadassah is out in front. The Hadassah system makes these things happen. Hadassah demands research and demands that research be done properly. The revolving door linking the hospital and the Faculty of Medicine improves research. It brings scientists to the hospital for clinically relevant questions and clinical models; and it brings our physicians to the Faulty of Medicine to take advantage of their research models and expertise. They have the basic science experience, we have the clinical experience, but we share the same curiosity.”

His passion extends to all aspects of his work. This year he competed in the Jerusalem Marathon to raise money for equipment for the Mother and Child Anesthesia Center. “I’m planning to run again next year,” he says. “We still need more equipment to non-invasively assess cardiac output.”

As a sabra, a native Israeli, I am always curious about why people move to Israel, so I asked. “Zionism,” he said simply, explaining what brought him from London to Jerusalem, from King’s College Hospital to Hadassah.

Another answer can be found in two pictures on the wall of his office. One is a picture of his great grandfather who left Poland, went to Vienna to study medicine and then moved to England. The other is a letter from Theodor Herzl thanking his great grandfather for the treatment he received when he came to London for the Fourth Zionist Congress in 1900 and took sick. “Herzl asked for a Jewish, Zionist, Viennese-trained physician. My great grandfather had the extraordinary privilege of treating him. Moving to Israel is the great privilege of our generation,” Yehuda Ginosar says. “In many ways, working in Hadassah is a fulfillment of Herzl’s vision.” Dr. Ginosar’s ancestors would be justifiably proud of him, as are we.

We are proud that Hadassah can attract exceptional physicians whose commitment to their research matches their commitment to their patients. We are proud of their dedication, their passion and their accomplishments, which continue to enhance Hadassah’s reputation. Most of all we are proud of our mandate that encourages them to link the laboratory with the patient. As Dr. Ginosar said several times “Hadassah is the hero of this story.”

Yours,

Ehud

Prof. Ehud Kokia
Director General

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