Miriam, Emek medical teams learn from each other

PROVIDENCE — A medical team from The Miriam Hospital spent two weeks in May at Emek Medical Center in Afula, sharing their professional expertise and learning from their Israeli counterparts.

The Miriam funds the exchange program to honor the hospital’s Jewish roots. It was established several years ago through the initiative of Jeffrey Brier, chairman of the board at the hospital.

Dr. Otto Liebmann, director of emergency ultrasound at Miriam, taught an emergency room ultrasound course at Emek.

“They have a different patient population, both Israeli and Arab,” said Dr. Liebmann, “but patients are sick in the same way. It’s not that different from my usual practice.”

Emek serves the diverse population of the Galilee and Jezreel Valley, comprised of Jews, Muslims, Christians, Bedouins and Druse. The area is also home to many Ethiopian immigrants. It is a stone’s throw from Jenin and the West Bank.

Dr. Liebmann, who came to Rhode Island seven months ago, said there are numerous applications for ultrasound usage in emergency rooms, and taught doctors procedures for ultrasound guided nerve blocks, and using the technology in the medical diagnosis of gallstones, or congestive heart failure, to name just two. “They are very eager to learn,” he said. He called ultrasound the “stethoscope of the future.”

Emek is the designated trauma center in the north for “MCEs” (mass casualty events).

The trauma patients Dr. Liebmann saw were mostly from auto accidents, which is a serious problem in Israel, he said. “Have you been there?” he asks. “Do you see how people drive?”

Dr. Ken Sperber, a family practitioner with Hillside Family Medicine in Pawtucket, spent time at a variety of clinics, “from a tiny two-room clinic in a small village called K’far Hittim (“Village of Wheat”) to a city clinic in Tiberias and other moderate-sized clinics in towns such as Migdal Haemek (Tower of the Emek [valley], so named for the presence of a large water tower) and Ramat Yishai (The heights of Jesse).”

He said some characteristics of primary care differed from physicians’ practices here. “First, because this is an HMO model, all Israelis are enrolled in one of four HMOs. Emek Medical Center, and therefore each of the clinics I visited, is affiliated with the largest one – Clalit (from a word connoting “community”). Each patient receives his/her primary care from a Clalit primary care clinic and each one is on a common medical informatics network which allows for easy assembly of population as well as individual patient-based data.”

He noted the difference in reimbursement models. “No money changes hands in Israel. Physicians are not in the position of needing to collect co-pays, co-insurances, deductibles or any of countless other fees that we must collect here, nor do they need to deal with the uncomfortable situation of patients who are not able to pay their fees. This seemed to me to remove a barrier between the patient and the physician.”

Miriam nursing administrator, Karen Joost, and staff nurse, Christina DaCosta, were there to share best practices and priorities specific to cardiac, vascular, and perinatal care. Emek’s neo-natal intensive care unit is an example of the center’s motto: “Coexistence Through Medicine;” 50 percent of the newborns treated are Jewish and the other half are Arab, including infants from neighboring Jenin. Consistently on the rise are the numbers of pre-term births among the Russian and Ethiopian immigrant population.

Joost said Emek is preparing for an International Joint Commission accreditation review in September. She said one difference she noted is that at Miriam “we have more technology at our fingertips.” The nurses left with plans for joint educational and research projects.

DaCosta noted the security and safety measures that were in place at the hospital. “They are really good at it, and it’s something we can learn from them,” she said. She also found it interesting that there was a unit designated just for military patients.

The exchange program, aside from the professional aspects, was designed to introduce participants to the social, cultural and historical realities of Israel, and vice versa. The Miriam visitors stayed at Kibbutz Yizreel, which was an unusual and very friendly experience for these first-time visitors. Dr. Liebmann said its factory Meitronics manufactures robotic pool cleaning equipment and has provided the kibbutz with a solid financial mainstay. It also has a commercial and ornamental koi fish farm.

DaCosta said it was a memorable visit because it came during Memorial Day and Independence Day celebrations in Israel. “I could feel and sense the national pride when the country stopped to observe two minutes of silence on Memorial Day.”

“As a practicing Jew, I have a strong connection to Israel, so this was an opportunity to spend time there, learn about and experience Israeli medicine from an inside perspective. [I learned] about The Miriam Hospital’s “sister” institution in Israel as well as to tour Israel and visit friends and family,” said Dr. Sperber.