Hava Gadassi at Royal Children's Hospital with one of her patients, Santiago, and his mom, Carolina.
Photo: The Royal Children’s Hospital Foundation, Melbourne
To spearhead a paradigm shift in Israeli pediatric care, Hadassah Medical Center Pediatrician Dr. Hava Gadassi trained for two and a half years at the Center for Community Child Health at the Royal Children's Hospital in Melbourne, Australia.
Our goal, explains Dr. Gadassi, is to establish a Center for Community Child Health in Israel, based on the Australian model. The initial plan for this national project is to create a Child Health Center at Hadassah, which will provide clinical services for common childhood developmental and behavioral problems, as well as be an academic center for training pediatricians and conducting research. Hadassah has already opened two new clinics: one dealing with bed-wetting and soiling; another, addressing excessive crying and sleeping problems in babies.
The Center also plans to raise awareness among families and professionals who work with children about the importance of early identification and treatment of developmental and behavioral problems. Eventually, the Center will branch out to other parts of Israel and become a core part of community clinics.
Entitled the Goshen Project (named after the Tel Aviv restaurant where it was conceived in 2010), this initiative was propelled forward by Hadassah Australia President Ron Finkel and Internationally Renowned Australian Community Child Health Specialist Prof. Frank Oberklaid of Royal Children's Hospital. At that formative gathering in Tel Aviv,
there was wide participation from Israel's leading pediatricians. These included leaders of hospital pediatric departments and pediatric associations, veteran pediatricians from various Israeli cities, representatives of Israel's health funds, and leaders of organization involved in child health care issues.
Goshen's primary intent, relates Dr. Gadassi, is to place more focus on childhood developmental and behavioral problems; to identify them early and address them—to ensure that children in need receive the right interventions.
During her fellowship, funded by Hadassah Australia under the tutelage of Prof. Frank Oberklaid, Founding Director and head of the Royal Children's Center for Community Child Health, Dr. Gadassi participated on multidisciplinary teams and gained clinical experience in managing common developmental and behavioral problems in infancy and childhood. In addition, she was exposed to current research projects and community work in the field of community child health.
"The whole concept of community child health in Australia is different from the one in Israel," Dr. Gadassi says. In Australia, she explains, children are first seen by a family physician and the pediatricians are secondary consultants. In Israel, in contrast, pediatricians are the primary caregivers, so the focus of their work is different.
Dr. Hava Gadassi with Prof. Oberklaid
Developmental and behavioral problems make up almost 50 percent of an Australian pediatrician's practice, Dr. Gadassi notes; in Israel, these issues are not typically dealt with in primary care community clinics. Instead, children are referred mainly to secondary or tertiary specialized centers or their problems are not dealt with at all by the available medical services.
Because of this disparity in paradigms, a pediatrician's training is different in Australia.
Behavioral and developmental issues are a core part of their curriculum. In Israel, most of a pediatrician's training is hospital-based and these issues are given little attention, leaving the new pediatrician with few tools to address them within the local community.
Currently, Dr. Gadassi relates, she and her team are working on a continuing education course for pediatricians that will cover common developmental and behavioral problems in infancy and early childhood. It is slated to begin enrolling pediatricians for October 2013.
A major component of Goshen's long-range plan is to forge connections with existing community facilities so that satellite childhood developmental clinics can be part of the amalgam of services communities provide.
The idea, comments Mr. Finkel, "is to take the pediatricians from a hospital-based practice out into the community, before a child is brought in to the pediatrician with a specific disease; to embed a pediatrician in the community." A pediatrician who is trained in comprehensive community child health, for example, would go out into the community and hold workshops for parents to raise their consciousness about whether their children need to be seen by behavioral/developmental specialists.
Furthering the collaboration between Hadassah and Australia in the field of pediatrics is the Memorandum of Understanding that was signed in the early part of this year between Hadassah and the Murdoch Children's Research Institute, the leading Australian research center in children's diseases.
"As this collaboration grows," comments Prof. Oberklaid, "there will be a two-way exchange of intellectual property and ideas between areas of research at Hadassah and at MCRI." The Goshen Project will be a key part of this collaboration.
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