Big news!

Rather than my usual musings on Israel, this time I have some personal news.

On Friday I asked my girlfriend, Ayelet, to marry me, and she agreed!

I know that a lot of our friends and family in the UK haven’t yet had a chance to meet her, and I was wondering how to summarise her here in a couple of sentences. Of course I can’t, but I thought I’d string together a few facts just so that you have some image of her.

Ayelet is an Olah Chadasshah (new immigrant like me), who moved from New York to Israel a couple of years ago. She’s a wonderful, caring person; connected to her Judaism, her family and her new home. She speaks Hebrew, Chinese and we are working on teaching her English too!

She also very much enjoys exploring the countryside, and on Thursday we went camping in Wadi Tzin, next to Sde Boker in the desert. On Friday we did the 16km hike up Chod Ekev, with the difficult climb up the side of the valley. I’d forgotten quite how scary the slope could be (at least for someone with my fear of heights – see photos), but somehow we got to the top and enjoyed a spectacular view across the desert.

The climb to Chod Ekev

The top of the mountain

At the summit I asked her if she’d marry me, and to my joy she agreed!

I’m sorry that we didn’t get a chance to contact many of you immediately, but we were racing the sun to get off the mountains before dark and the Sabbath, and then spent the next two days in a gorgeous hotel called Beresheet overlooking Machtesh Ramon. It was one of these places that really pampers you, with massages and private swimming pools and fantastic food. They are also right on the edge of the desert, so wild ibexes jump the fence to drink from the pools and one of them came and ate our left over carrots and cucumbers from the hike, from our outstretched hands!

We’re now back in Tel Aviv. Life seems a bit of a daze but we are both very happy and very excited at the thought of the upcoming adventure of life together.

Why does it have to be like this?

I have a patient who is only 52 years old and will die in the next few hours. I spent most of the night doing everything I can to extend his life just enough for the family to get here.

At 11pm I spoke to his brother who said he can arrive by 2pm from Ramallah, but unfortunately, because of the situation at the Kalandia Checkpoint, may not be able to arrive sooner. He did however managed to contact the patient’s teenage son who was nearby and who I spoke to this morning.

I can’t even begin to imagine what this boy is going through, trying to deal with the fact that his father is dying, but he managed to put on a brave face talking to me.

When the boy realised how bad things were he asked if there was anything we could do to try to help his mother get to his fathers bedside before he died. The trouble was that she doesn't have a permit to get through the checkpoint.

After I went this them to Hospital Reception (me as a doctor being there may open some doors), we ended up having to just give the teenager a letter saying that his father is a patient at Hadassah and is dying. He now has to take that to various bureaucrats to get the permit. I hope and pray that someone helpful decides to rush it through, because my greatest fear is that while he is off doing this, his father will die alone.

It doesn't need to be like this.

There should be a number I can call for the officer at the checkpoint. A helpful army soldier should pick up the wife and drive her straight to us. Doors should part.

If not, then I'm not sure the son will ever forgive the occupiers, and I'm not sure how easily I could forgive us either.

Hadassah - most issues resolved, waiting on court decision regarding insurance before we can return to work

Most of the strike issues look like they may have been solved, but we are still not insured sufficiently to work safely. This is being discussed in the courts Wednesday, but after that is resolved, it looks like we may be back at work soon.

The end (of the strike) is in sight.

P.S. after that there is still 3 months of hard negotiations to resolve the problems of Hadassah. But at least we will be working normally.

Stop attacking Hadassah Management!

I have just read a seriously disingenuous article in Ynet about Hadassah. They are accusing the managers of continuing to take large salaries, and to support this claim, they quote figures for how much each manager "costs Hadassah" (allowing them to include pension contributions, Keren Hishtalmut, insurance costs etc.)

I know personally one of the managers well: Yoram Weiss used to be head of Anaesthesia before he was asked to take on the role of Medical Director when this crisis became really bad. He did this without any increase in salary (as noted in the paper but then ignored), and knowing that it is a tough and unpopular job. There is no way I would agree to be standing in his shoes right now - not for twice his salary.
I would also say that in his 3.5 years as head of Anaesthesia in Hadassah, he made the department into one of the best places to train in the country, earning the respect of all his Residents. I have no idea how this mess will end, but Yoram seems to be someone who at least has a chance of moving things in the right direction.

I have only seen Avigdor Kaplan (the Chief Exec) from afar, and have only heard him speak twice. However on both those occasions he impressed me with what appeared to be an honest aim to rescue Hadassah, and an inspirational dream of bringing us back to our position at the top of Israeli healthcare. He also came in during the peak of the crisis, also taking on a job that was certain to be unpopular and tough.

I know that we are on strike, but as the doctors' committee chairs said at the start - we are standing side-by-side with the management and asking for the government for support (not just a bailout. The current system of reimbursement for Israeli hospitals prevents almost any hospital from covering its costs).

So whoever thinks it's a smart idea to make these personal attacks on the people who have taken on the challenge of running Hadassah doesn't seem to have Hadassah's interests at heart. Nor those of the population of Jerusalem.

Hadassah - Chapter 11 Bankruptcy Protection

A quick Hadassah update:
Firstly we were told today that the Anglo-Saxon (ie English) term for the process we are in would be Chapter 11 bankruptcy protection.
The deal is that the court appointed executors can impose deals for 3 months on the workers, management and creditors.
After 3 months there are three possible outcomes:
1) everyone agrees to a deal to save Hadassah
2) the Chapter 11 is extended
3) full breakup or bankruptcy of Hadassah. Effectively all the staff lose our jobs and can be Re-employed if the new management chooses and with any terms they choose.

The Chapter 11 was introduced when the hospital could no longer even buy good or basic medicines for her inpatients. Things were pretty desperate.

We are hoping to receive an advance on next months salary I'm the next few days (it is illegal to give us the second half of our January salaries under Chapter 11 terms). That won't be our full salary.
There are however some conditions we are demanding before we give up the strike. These include:
Adequate medical liability insurance cover.
Payment to the Palestinian doctors (they are paid separately and have done even worse than us)
Continued recruitment of trainees as needed.
Plus done other small points.

When the strike will end is still unclear

Hadassah Updates

After the suggestion of a friend (thanks Arieh), and as a chance to keep some of my non-FaceBook family up to date on what's going on, I thought I'd post some of my recent FB updates to this blog. They are probably shorter and less well thought out than I would normally feel proud to post, but things at Hadassah have been evolving rapidly, and maybe quality can be replaced by timeliness.

I've also tried to back-date them, so please look back over a few posts.

Hadassah - Tax and pensions money going missing

It turns out that my employer has been deducting my pension contributions, Keren Hishtalmut (a government matched saving scheme) and Income Tax (PAYE) from my salary each month...

...and then pocketing it instead of handing it to the Tax Office and Pension Company!!

I can hardly come up with words to describe what I think. This is the behaviour of big fraudsters like Maxwell and Meddof, not a public hospital!

Hadassah - No Medical Liability Insurance

The situation at Hadassah is going from bad to worse. 
As you may know, we have been running a "weekend service", of reduced staff and treating emergencies only, for the last week. 
A decision yesterday by the courts that freezes our debts may also leave us all uninsured against medical malpractice. We are waiting for final confirmation, but in that situation none of the doctors can continue working at all. (In Israel, unlike the UK, you don't have private MDU/MPS insurance - it's all through the work place).

In that case, I have no idea what happens to our several hundred in-patients

Hadassah in Crisis

It’s been a long time since I wrote anything, and in truth that was because life has trundled on, at a pleasant enough pace, with nothing hugely eventful to describe.

But today some strange things have been going on at Hadassah Hospital, so here goes:

Last night it emerged that the Finance Ministry has applied to the courts to put Hadassah into some sort of administration.

All Hadassah’s debts ($200m of them) will be cancelled. That’s the good news.

The bad news for us is that those debts include the salary they owe us for our work in January. In other words, we won’t be paid for this past month.

They also will enforce a 10% pay cut on all doctors, nurses and non-clinical staff. The pay cuts are likely to be even higher for doctors who do private work in the hospital.

As a result, the doctors committee declared a strike: from today we will reduce to weekend skeleton staffing levels, with operating theatres only doing emergency, cancer and obstetric surgery. Even that work is likely to be unpaid, with no guarantee that the “weekend” on-call team will ever see any salary for their time.

The impact on Jerusalem could be bad. There are three hospitals in West Jerusalem – Hadassah Ein Karem (the big teaching centre to the west), Sha’arei Tzedek (towards the centre) and Hadassah Mt Scopus (near East Jerusalem). Two of those are Hadassah owned and affected by the strike. That means that the only hospitals providing neurosurgery (including neurological major trauma), plastics and burns, liver transplants and whole bunch of other services, for the 1.2m inhabitants of Jerusalem plus significant amounts of the West Bank, are going to be effectively closed.

That’s the objective facts.

The question is how did we got to this situation?

Over the last few decades Hadassah has been haemorrhaging money, especially after negotiating a very bad deal with the HMOs for reimbursement. We just about survived due to the generosity of the Hadassah Women’s Organisation in the US. But after Madoff the HWO said they could no longer support our running costs and we started running up debts.

Last spring our Chief Exec resigned and a new guy called Avigdor Kaplan arrived. As far as I could see he acted decisively, proposing voluntary 5% cuts in salary for all employees to save the hospital, plus the loss of 200 jobs. The doctors committee reluctantly agreed; the nurses agreed to 2.5%, the workers committee (non-clinical) refused and went on strike. During that strike the picketed the hospital and even physically assaulted doctors who crossed the line to treat their patients.

It was clear there would be repercussions, and since then we have had several months were we were paid 80%, 50% and 50% of our salary on time, with the rest arriving later. But it always arrived.

No we are in a position where even that may not be happening.

In addition, Hadassah doctors had various forms of grant money held in hospital bank accounts. That includes research grants, personal grants awarded to Junior Doctors from the government, and funds from private practice. All those grants have recently been simply taken by the hospital into the central pot.

What about the future?

My fear is that the government will consider the things that make Hadassah great, to be non-affordable luxuries. Things like support for research, both financial and in terms of flexible working hours; good salaries (many doctors earned better than they would in purely government hospitals) etc.

These (especially the research) were also the reasons that I chose Hadassah over other hospitals.

Hadassah used to be known to be the best hospital in Israel by a mile. The heads of every anaesthesia department in the country were trained at Hadassah. That reputation has been slipping for close to a decade, and we now have very stiff competition from a number of places, but we felt that with determination we could regain/retain the top position.  However there is a real risk Hadassah may be stripped bare now, and become little more than a DGH.

That would be a shame for everyone.

For the moment we have been asked to remain loyal to Hadassah, and I will respect that request. I’m in the fortunate position of not having a family to support, and not having to worry about where my next meal will come from. But having said all that, when I moved to Israel, I came to the best place I could find to learn anaesthesia at the highest level Israel could offer, and perhaps contribute to medical research at that centre. If Hadassah ceases to be that place, a lot of us will start to wonder if our dreams can be fulfilled elsewhere.