As Israel battles the coronavirus pandemic, its health care system has emerged as its first and foremost line of defense, thrusting medical teams to the front line.
Ensuring adequate care for the growing number of seriously ill COVID-19 patients has proven a challenge. Thousands of doctors and nurses have been exposed to the virus, and healthcare officials have warned that the strain placed on medical teams, who have essentially been working around the clock since the pandemic hit Israel in mid-March, was rapidly approaching critical mass.
The Health Ministry has already ordered all hospitals to increase the capacity of their corona wards, and now, hundreds of interns and residents will move on from their challenging studies straight into the battle waged against the relentless pandemic.
‘A huge responsibility’
Dr. Roni Postan-Koren, 28, graduated from the Faculty of Medicine at the Hebrew University of Jerusalem not long ago and is set to begin her internship at Barzilai Medical Center in Ashkelon. She is married to Eldad and has twin girls who are six months old.
“Today I have a better understanding of the responsibility on my shoulders,” she told Israel Hayom, “Six years ago, I started medical school at the Hebrew University in Jerusalem — a girl dreaming to be a doctor and change lives. Soon I will start an internship and will fulfill my dream, and be there for strangers at the most significant times of their lives.”
Despite the excitement, Postan-Koren knows it will be challenging.
“I see the problems of the health care system,” she said. “Unfortunately, for this I was not trained. On the first day in an inpatient ward, I met a patient with heart failure and quickly understood that the hospital has its own problems. I remember myself, a new student, horrified at the possibility that I would be okay with it one day. Happily, I’m not okay with it yet.”
Her intern year, which will train her to be a practicing doctor, will begin in less than two months. It may start earlier, due to the need for more medical personnel.
“Instead of going through the different wards and learning about different types of medicine, my friends and I will spend most of our final training year in coronavirus wards, we’ll get responsibilities never given to interns before,” she said, adding that these are “responsibilities usually reserved for the more experienced among us. The hour is upon us to make changes in how things were done till now, but we won’t have to man the lines, the residents with proper training will.
“Residents, who during the normal routine before the pandemic, collapsed under the pressure of round-the-clock shifts without sleep. We need more residents to help us win the battle. I am proud to take part in the battle against the pandemic that is changing the world as we know it, and I understand the weight of responsibility given to me. I would also like to know, wholeheartedly, that we won’t need another pandemic in order to fix our broken health care system.”
‘Here to serve everyone’
Dr. Adiv Alias, 30, graduated from medical school in Hungary and is now beginning his E.R. residency at the Rabin Medical Center in Petach Tikvah.
“In my new role in the E.R. we meet all elements of the healthcare system without filters,” he said. “It’s the first place that people with a problem enter; it’s the ‘door’ of the hospital and healthcare system. You treat all types of medical problems, and therefore there’s a lot of fear and a lot of excitement. It’s a new stage in life. In medicine, you always see new things during your career; for example, the coronavirus, which no one knew about eight months ago.”
He says he knows the new job will force him to deal with the system’s problems: “We see in emergency medicine, in the E.R., the frustration and nerves of patients and those who accompany them. Unfortunately, there are many negative feelings towards the doctors and staff. At the end of the day, I understand the frustration, and we try to deal with the pressures, but it mustn’t be directed at the medical staff.”
Alias notes that “especially now, when the health care system is facing a major crisis, we need to set aside more resources and hire more staff. I hope we’ll be joined by more doctors and that the burden on the wards will lessen so we can give more effective treatment. Doctors must work in more normal conditions, including a reduction in the long hours per shift.”
Along with the excitement, he also fears contracting the virus at work: “Sometimes there is fear that a patient who comes to the E.R. with a certain problem may have the virus, so we protect ourselves with the appropriate equipment. It’s true that in this case there is a great risk, but there’s nothing to do, it’s part of the job and part of the risk. There’s that fear, but it fills a very small place, because the treatment of the patients is at the top of the list.”
Finally, he has a message: “We’re here to serve the population; it doesn’t matter from what sector.”
Virtual graduation ceremony
After graduating from the Azrieli Faculty of Medicine of Bar-Ilan University, Dr. Oriyan Naaman Yeganeh, 30, began her residency in pediatric surgery in the Galilee Medical Center in Nahariyah.
“I never imagined that my medical school graduation ceremony would be in front of the computer, on Zoom,” she said. “We took the Hippocratic oath by ourselves in front of our immediate families. Even though the current reality dictates social distancing, the alternative ceremony was emotional.”
Her internship year was spent at the Galilee Medical Center, and today she is a pediatric surgical resident. “I am exposed every day to many trauma cases among children who tend to get injured more often at this time, with the school system and other frameworks shuttered,” she notes, adding that in her view, the medical profession “holds the opportunity and ability to help anyone. This is especially true these days when battling the coronavirus pandemic that affects all of us.”
She speaks of the difficulty and complexity of this time: “I often have the opportunity to operate on children who carry the virus. The big challenge is to create a sense of security and good communication between us and the children who fear the unknown when they enter the operating room. Especially when we wear PPE, which can frighten them even more.”
Naaman Yeganeh added, “We try to create a comfortable and relaxing atmosphere by using things like stickers and drawings on masks that we wear. That’s how we make them forget for a moment the fear and new reality that we are forced to deal with now.”
‘Lessons for life’
Professor Karl Skorecki, dean of the Azrieli Faculty of Medicine of Bar-Ilan University told Israel Hayom that the student residents are being “thrown into the deep end” earlier than usual, but “of course, with appropriate training and direction. So, I’m not worried,” he said. “There won’t be a generation of less experienced doctors. Maybe the opposite. It’s difficult because we need more resources, but I see interns and residents we thought would be run down quickly — and they aren’t.
“Until now, when a medical student entered a ward, he would see an experienced senior doctor filled with self-confidence. This doctor, of course, knows what a heart attack is, or asthma, and so on. He would look at this senior doctor as an authority. Today, the coronavirus is a disease that the most senior or experienced doctor in the world has never known or seen. In other words, the senior doctor doesn’t have more knowledge on how to treat corona.”
According to Skorecki, “There is uncertainty and lack of knowledge that may cause fear, because there’s no way to know how to make the best decision; there’s no playbook and no one who has already seen something similar.”
He notes another change: “Every intern or resident knows they need to care first for their patients; they took an oath on this. Now, with corona, they also need to worry about themselves and their family and make sure they don’t bring the virus home.”
This year is special for the Bar-Ilan medical school: with 109 students, it has seen its largest graduating class since the faculty was founded.
“The doctors who graduated this year are more prepared than ever before; they have clinical experience, due to the circumstances, in a much earlier stage than expected,” Skorecki said.
In his view, medical school lasts for one’s professional lifetime.
“The pandemic only strengthened that, and we learned a lesson in humility and modesty. Students worked with senior doctors, who are also learning themselves how to deal with a new pandemic spreading around the world.
“There are difficult challenges in medical school. It’s not good to learn the theoretical part online, but it’s possible,” he said. “The challenging part is the practical one—taking a student and teaching him how to conduct a physical test when he needs to protect himself.
“In my view, the biggest concern is chronic existing conditions, which don’t get enough attention,” Skorecki noted. “The whole issue of balancing diabetes, follow-up tests for cancer and community medicine—people are scared of coming in, or the team that is supposed to treat them has been quarantined. We mustn’t forget the usual sicknesses that the population suffers from, and this is not necessarily getting the attention it needs.” JN
This article first appeared in Israel Hayom.