Hospital that heals division

Amid the ever-deepening separation of Israeli and Palestinian life, the Hadassah stands out - a clinic run by a Jewish organisation that is sworn to save lives regardless of the patient's religion.

(Quique Kierszenbaum)

If this were any family, there would be nothing remarkable about the way six-year-old Adham Takatka gently tickles the palms of his baby brother Mohammed before, unprompted, planting a kiss on one of his cheeks. But the bond between these two brothers will always be special. It isn't everyone who can say his first achievement as a new-born infant was to save someone's life, but Mohammed will certainly be able to make that unusual boast when he grows up.

Today, Adham happily rides his fairy cycle round the family's living room in the West Bank village of Marah Ma'ala. Eight months ago, he was lying in hospital in dire need of a bone marrow transplant. Samples had been taken from his siblings and five other relatives; none produced the match needed to save their firstborn's life. "My nerves collapsed," recalls his father, Ahmad. "This is a deadly disease. If there was no transplant he was going to die."

There seemed to be only one hope left, a one in four chance that the unborn infant his mother Warda was carrying would have the matching marrow. That he did is why his oldest brother is alive today. But if Adham wouldn't have made it without Mohammed, he certainly wouldn't have made it without the Hadassah Hospital's paediatric haematology-oncology department either. Adham arrived at the Hadassah after a deeply dispiriting year of his parents trailing him round hospitals in the West Bank and Arab East Jerusalem, with symptoms that included a pronounced yellowing of the white of his eyes, and of his urine. The dismal round ended with his father being told first, that his son probably had cancer and second, that there was no hope of being treated at a Palestinian hospital.

"One doctor in Bethlehem told me Adham had two months to live," he says. "I was angry and frustrated. Even if it was true he shouldn't have said it."

By now, a desperate Mr Takatka approached the Peres Centre for Peace, whose Saving Children programme helps find places for seriously ill Palestinian children in Israeli hospitals. The centre paid the 45,000 shekels (£6,400) it cost to admit him for three days of diagnosis which established that Adham did not have cancer but rather aplastic anaemia, a rare and potentially fatal disorder in which the bone marrow fails to produce enough blood cells.

When he finally had a clear diagnosis, Mr Takatka said: "It was hard to describe the feeling. You have to be strong to deal with the problem. You have to be stronger than the problem."

Mr Takatka would need all his strength in the next seven months. But his relief at his son being in an Israeli hospital was not in doubt. "It was excellent," he says. " I felt like it was my own country. They say that they treat a Palestinian boy the same as they would the son of an Israeli minister and I think it's true. Almost every day I would ask questions of Dr Mickey [Michael Weintraub, the eminent, hands-on Jewish head of paediatric oncology at the Hadassah]. He understands some Arabic and when I said, 'I hope you don't mind me doing that', he said, 'I would hope all the parents of patients would ask questions like you do, Abu Adham [father of Adham a standard colloquial form of address among Arabs].' I did not feel that I was under occupation."

It is easy to understand what Mr Takatka is getting at. To walk round the brightly decorated children's oncology wards, and see Palestinian mothers in traditional headscarfs sitting alongside their ultra-Orthodox Israeli counterparts in the parents' room with its coffee machine and huge bay window overlooking the Jerusalem hills, is to feel you are in a conflict-free bubble.

Criss and Doody, the department's resident clinical clowns, both Israelis, move with equal tact and cheerfulness among the Palestinian and the Israeli children. Criss deftly encourages Adham to play with a balloon, flexing his arm in the way needed before the his regular blood test. "The only combat here is against illness," says Criss. "The most difficult ones to make laugh are the Orthodox Jews. But we're getting there."

One of the spin-offs of the past seven years has been the ever-deepening separation of Israeli from Palestinian life compared with the hopeful years after the Oslo accords. The West Bank's Palestinians are precluded from visiting Israel at all, other than those with permits such as the special Hadassah-issued one that Mr Takatka carries when he brings Adham for his twice weekly outpatient check-ups and which warns the military that "keeping him at the checkpoints will endanger his life".

In this context, the Hadassah, a distinctively Jewish – and indeed Zionist organisation – but whose mission statement includes a pledge to forge "links between patients of all nationalities, races and religion who come to its doors for healing", seems like another world.

"I don't pretend to run a co-existence camp here," says Michael Weintraub, "but I do say as a physician we have a common enemy here, disease, and you do need to have the co-existence to fight it."

By last summer, Adham was getting more ill, attacked by a virulent fungus infection that came close to killing him.'But when Warda Takatka came in to have her bone marrow tested in a final effort to find a match, her husband mentioned that his wife was pregnant and asked if that mattered. Suddenly, everyone seemed a little more hopeful. The medics immediately urged Mrs Takatka to have her baby in the Hadassah and come in a month before he was due.

"They were worried that if she got stopped at a checkpoint they might lose the opportunity to take the marrow from the umbilical chord," Mr Takatka said. "They said, 'Pray to God it will work'. And I did, not just five times a day but more. And I read the Koran." The transplant was made from Mohammed's umbilical cord, then there was an agonising 15-day wait for engraftment, the flow of new stem cells to Adham's bone marrow. The first Mr Takatka knew of the outcome was when a social worker came to him with the papers to take to the Palestinian Authority for its share of the costs of the operation. He said: "I said, 'Did it match?' And she said, 'Yes'. And then I realised that they had known for two days that everything was OK, but they didn't tell me because they wanted to be 100 per cent sure. I was so happy."

Of three main concerns in the department where Adham Takatka was treated – paediatric cancer, blood disease which isn't connected to cancer, and bone marrow disease – it's the first that takes up most time. That's normal in advanced first world hospitals, as is the 80 per cent average recovery rate for afflicted children. What makes the Hadassah unique, however, is that it exists bang next door to a territory whose unquantifiedly much lower rates of recovery have more in common with the Third World.

"Without delegating blame, whether to God, the Palestinian Authority, or the government of Israel," says Dr Weintraub, "a short distance from where I practise successful oncology, there are perhaps 150 children diagnosed with cancer every year with very limited access to this kind of treatment."

Dr Weintraub estimates that of the 100 children he treats every year for cancer, the 100 for blood diseases, and the 20 needing bone marrow transplants, perhaps 10 per cent come from Arab East Jerusalem – where they are covered by medical insurance – and 15 per cent from the rest of the cccupied Palestinian territories. At any one time, there are some 20 in-patients and 30 outpatients in the hospital. Palestinian children from the West Bank are disporportionately represented – at about 25 per cent – among the in-patients because of the difficulties faced by parents bringing their children for regular outpatient treatment through the checkpoints.

What also inevitably restricts the numbers of West Bank Palestinians treated is cost, shared by the PA, the Peres Centre and the Hadassah itself. Bone marrow treatments, cost about £25,000, compared to £100,000 in the UK, mainly because of lower salary costs.

Mr Taktaka, who had to give up his job as a stone-cutter in a local quarry when he moved into the Hadassah with Adham, says he still had to borrow a total of £4,000 to make up a shortfall in the PA's contribution to the costs of the transplant – its price reduced by the Hadassah to £17,500 – and of Mohammed being born in the hospital. He sold the family jewellery and can't yet afford to pay in full the friendly taxi driver who takes him and Adham for the twice-weekly outpatient visits to the Hadassah. But he doesn't regret a single shekel. "It feels like a victory," he says.

In the much longer term, Dr Weintraub believes costly treatment in the Hadassah is "not a very good solution" and that Palestinian doctors need gradually to be trained to provide similar care in their own hospitals. As a first stage, the Hadassah has begun training doctors and nurses to make East Jerusalem's Augusta Victoria Hospital a paediatric oncology centre. "It's a slow process," he admits. "But this will work out in the end. It may take a few years."

It is, of course, as the primary hospital in Israel for those wounded in suicide attacks that the Hadassah has most often found itself in the headlines. Avi Rivkind, the steel blue-eyed, larger than life, square-jawed head of the department of general surgery and shock trauma unit, is in charge. It was also Dr Rivkind who led the surgical team that treated Prime Minister Ariel Sharon after his massive stroke in January 2006.

And famously insisted that the 18-year-old Israeli border policeman Shimon Ohana could be brought back to life when he had been pronounced dead on arrival at the Hadassah after being shot in the chest at the beginning of the intifada. This was also the man who saved the life of the senior Hamas militant Hassan Salemeh, by personally operating on him after he had been shot, seriously wounded and captured by Israeli forces in Hebron in 1996.

Dr Rivkind, who confesses to a desire to meet Salameh in prison 12 years later, adds: "Once they come here to the entrance to the hospital I have no problem to treat [Palestinians]. I know from our own history what is discrimination." And it was Dr Rivkind who was driving home just before 9pm on the evening of 6 March this year when he took a message on his pager that there had been a fatal incident at the Yeshiva Mercaz Harav in the Kyriat Moshe district of Jerusalem. Dr Rivkind immediately did a U-turn, slipped on the car roof the flashing red light he keeps for emergencies "paid for with my own money", connected his siren and headed back at speed to Hadassah Ein Kerem, phoning ER to tell the night staff: "I haven't a clue what but something's happened and there have been two deaths." (The death toll would turn out to be eight.)

Yet this kind of response is integral to the Hadassah's internationally outstanding performance as a level one trauma centre. Dr Rivkind is an impassioned champion of centres like this one which have the full range of facilities, including an operating theatre staffed 24/7, high-quality intensive care, specialist surgeons on call round the clock and, of course, a helicopter pad for medevac patients.

And he is an equally impassioned champion of "scoop and run", rather than "stay and play", the idea that paramedics should treat as many injuries as they can in the field. Instead, he says, the key is to get "the right patient to the right hospital in the right time. The faster you get there the better". For him, the attempts over two hours to treat Diana, Princess of Wales in the Pont D'Alma tunnel represent a classic failure of the "stay and play" doctrine.

Hadassah's world-beating experience of trauma may have been brutally come by, in the worst of circumstances. "But if you are going to be wounded in a suicide attack, or in one of the formidably high number of serious accidents on Israeli roads, then the Hadassah is certainly the place to be. A crucial element is the constant availability of the key medics. On the night of the Mercaz Harav shooting last month, the whole department treated it as a matter of urgency. Everyone showed up, general surgeons, all the residents. Everybody. Show me anywhere else in Israel where that would happen. There were too many of us. I had to send some of them home."

One of the experienced doctors who remained that night to treat the victims of the shooting, boys from a right-wing national religious yeshiva, is anaesthetist and intensive-care specialist Rawhi Hashem. He is a Palestinian, who comes from Nablus, is married to a Palestinian teacher from East Jerusalem and has worked in the Hadassah for 10 years.

But just as for Dr Rivkind, "To me, a patient is a patient. It doesn't matter whether they come from [Jewish] West Jerusalem, [Arab] East Jerusalem or anywhere else. The treatment is the same." At 39, a member of what is still a small Palestinian minority (25 out of 500 Hadassah medics, the Ukraine-trainedDr Hashem faced stiff competition back in 1998 from 40 other West Bank doctors for one job here.

At that point, his main contact with Israelis had been when a year after the beginning of the first intifada in 1988, soldiers had come into the training centre where he was studying accountancy and taken his ID card from him. "They pointed to a wall covered with graffiti, all 50m of it and told me, 'clean the wall and we'll give you your ID back'. I cleaned the wall."

Since then, as he learnt Hebrew and "I started to be able to speak to people, the barriers started to disappear". On one occasion, he recalls, a Jewish patient protested at his presence in theatre as the anaesthetist. The Jewish ENT surgeon he was working with simply said: "Look, if my son was having an operation, Rawhi is the one I'd want as the anaesthetist."

Now he finds that a decade after arriving as a non-Hebrew- speaking young doctor: "I have lots of friends here. Things have changed 180 degrees."

Yet there is a paradox. Inside the Hadassah, Dr Hashem is highly respected. He has treated many victims of suicide bombings. He was one of the team responsible for Mr Sharon's intensive care in January 2006.

But outside the harmonious island of the Hadassah, he is hardly immune from the impact of the occupation. True, living in Jerusalem he is in some ways better off than many other Palestinian doctors, such as his paediatrician colleague, Dr Beda Abu Nimr, who is obliged to leave home in Bethlehem at 6am to get to work at 8.30am for what would be a 15-minute journey if he was allowed to drive, instead of queue on foot, through the Gilo checkpoint.

But Dr Hashem does not even have, as a native of the West Bank, the permanent ID which would allow him to work indefinitely in the Hadassah. Indeed, until last November, when he was finally granted a temporary permit after more than nine years of being entrusted with the lives of countless Jewish patients – including the then Prime Minister of Israel – he wasn't even allowed to drive a car in Jerusalem.

And there is a dilemma. Dr Hashem would clearly like to stay at the Hadassah because he likes his colleagues, he finds the work challenging and there are opportunities for research. He doesn't know whether he will get his permit, or whether the Hadassah will take him off nights, which, with three young children, he would certainly like. But his intensive care role at the Hadassah is rooted in team work and the same structure may not exist at a West Bank hospital. If he's unlucky, he may find himself working under a boss who owes his position more to political connections than clinical prowess. "I want to improve myself," he says. "If I took a job in Ramallah it might pay more but you know money isn't the only thing."

But at the same time, the clear purpose of recruiting Palestinian doctors was to send them back into their own hospitals to improve the standards of health care there. Stressing that his point is a general one, not about any individual Palestinian doctor, Dr Weintraub says that any doctor who advances his career in another country then stays there for good is a loss to his homeland.

"If a British or Israeli doctor goes to the US and stays there, we call it the brain drain," he says. "This is even truer if the doctor comes from Pakistan, say, or the Palestinian territories."

For serious professionals such as Dr Hashem it's a dilemma not easily resolved. What is clear, though, is that hospitals like the Hadassah are among the very few places left where mutual trust between Israeli and Palestinians can grow: patients for doctors; doctors for doctors. Ahmad Takatka recalls that one day an ambulance came to pick up Adham to bring him to the Hadassah. "He was crying and refusing to take any oxygen. An Israeli nurse blew up a balloon and drew a face for him, and he accepted the oxygen."

He adds without prompting: "I used to know Israel only through the bad side, the army, the checkpoints. Now I've seen Israel through the good side."

Dr Weintraub says: "For me, the bottom line is to treat, and we would do this even if the Palestinian patients went back hating all Israelis. But we have treated more than 100 Palestinian children [in this department], and if 500 members of their families have been exposed to a different kind of Israeli, who wants to help them and looks at them only as human beings, and they can be ambassadors of goodwill in some way, well then, that's a bonus."

The Hadassah hospital is represented in the UK by Hadassah Medical Relief Association UK, a registered charity, whose trustees include leading British medics. Its aim is to promote awareness and raise funds for Hadassah's work. Website www.hadassahuk.org