not to be read at the dinner table

Warning, I'm going to touch on both religion and politics. So polite company, this is not for you!

I've been asked a few times about the involvement of religion in the Israeli healthcare system. This is a topic that's difficult to confine to a blog post, and one that I'm by no means an expert in, but I'm happy to offer a few anecdotes.

Israel is a strange bird. Its a tremendously modern country that prides itself on being cutting-edge and technologically relevant, and especially in healthcare, practices tend towards the liberal side. The level of service we provide is not too disimilar from what I experienced in America. The doctors are up to date on the literature, we have all the technology you would expect in a major hospital, and the socialized system covers basic needs very nicely (prescriptions, diagnostic tests, necessary surgeries, checkups and prenatal care, and visits to specialists are all compensated).

But by nature of living in a country that holds some very large and deeply conservative communities (who wield significant political sway), we're confronted with religious issues on a daily basis.

Some examples:

-The abortion policy here is liberal to an extreme. Abortions are covered by health insurance if "medically indicated" (presence of birth defect such as Down Syndrome, cardiac defects, etc., risk to the health of the mother, unmarried mother (!))and can even be performed legally through the third trimester (although many doctors refuse to do this). I personally witnessed a mid-second trimester abortion that was performed for strictly social reasons, a teenage mother, and as liberal as I am that pushed the boundaries of my tolerance, for sure.

The hospital is very permissive (appropriately, I believe) of doctors who feel uncomfortable performing abortions for religious or personal reasons. However, doctors are required to provide prenatal counseling including genetic screening and to educate about birth control methods (which are covered by insurance).

On the flip side, many of our patients (and a percentage of physicians)are deeply conservative. The Bedouin population our hospital serves have a long history of consanguinity and a birth defects prevalence to prove it. They also tend to marry young and have as many children as possible. It's not uncommon for these patients to risk their lives, and that of their unborn child, by refusing c-sections or life-saving medical procedures because it is so important to them to preserve their fertility.

We also see quite a few patients who have refused any prenatal care or genetic testing, despite their significant risk factors, because they believe that their health is simply in god's hands. It's impossible for me to argue with their belief system, but it's difficult when complications do occur, they change their minds about healthcare, and arrive to the hospital expecting us to pick up the pieces (and to take responsibility for the outcome.)

- A small subset of the ultra-orthodox in Jerusalem have stopped vaccinating their children according to the order of their Rabbi (the health-is-in-the-hands-of-god-until-someone-actually-gets-sick argument). Within my six weeks of pediatrics, I saw four cases of measles, one of which resulted in major neurologic complications, and one which proved fatal. Again, I try to be respectful of their decision, but it's very difficult when I see children suffering for the choices of their parents. In addition, when these children come into the small emergency room with measles, they put all the immunocompromised children in the waiting room and the ward at risk.

-I completed my pediatrics rotation at a private religious hospital. This hospital remained open on Shabbat (Friday night and Saturday) BUT- no lab tests, no diagnostic imaging, and no writing. That's correct. The already understaffed ER is allowed only to provide immediately life-save services without the benefit of basic diagnostic information. In addition, they rely on volunteers to do any writing that needs to be done which slows down the already vastly backed up ER to such an extent that children with real emergency sometimes had to wait up to four hours to see a physician (who won't actually be able to diagnose or treat them fully).

In my mind, it would be better to simply close the ER and let the patients with emergencies go to a public ER where they can be treated appropriately. I volunteered one Friday evening and was so horrified I ended up leaving early. I have no problem with doctors choosing not to work on Shabbat or on closing the hospital entirely. But to provide half-healthcare in my mind is almost worse than providing nothing at all.

On the positive side, government run hospitals and clinics are fully functional through the holidays with one major exception that I wrote about in the fall.

So it's really a mixed bag here. The contrasts can be quite shocking. I don't see religion interfering too much in hospital policy. To the contrary, actually. But by the very nature of this country, it's still a daily issue, and a constant consideration.