Issue 1 PDF
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Issue 1 PDF
Hadassah haddasah health 2 haddasah health Hadassah Health is published by: P4 Welcome Hadassah UK 26 Enford Street London W1H 1DW P6 Editorial P8 News bites P10 Hadassah’s Chagall windows P12 Israel’s team in Haiti P14 Molecularly linked: The Jewish people P18 New research into dystonomia P20 Stem cells- Hadassah helps you see P22 Defeating cancer P24 Hadassah’s Paediatric intensive care unit Sub Editors: Tamar Mendelsohn, Sofie Blaugrund Design: Josh Saunders P26 A Revolution in Medical Care by James Artbuthnot MP Articles thanks to: Wendy Elliman, Judy Segal-Itzkavich, Ralph Dobrin, Caroyln Weiniger, James Arbuthnot M.P., Tamar Mendelsohn. P28 Care not creed Photos: Debbie Cooper, Avi Hayun, Yasmin Keats P32 An anaesthetist’s view at Hadassah With special thanks to: Marylou Grimberg P34 We’re Building the futureSarah Wetsman Davidson Tower T : 020 7723 1144 F : 020 7723 1222 E : [email protected] www.hadassahuk.org Registered Charity No 1040848 Editor in Chief: Prof Michael Baum Editorial Board: Prof Michael Baum, Lord Leslie Turnberg, Prof David Katz, Sir Ian Gainsford, Prof Victor Hoffbrand, Prof Stuart Stanton And to our Anonymous Sponsor Supporting the Hadassah Medical Organisation, Jerusalem 3 haddasah health I 4 haddasah health t gives me great pleasure to welcome you to the first issue of Hadassah UK’s magazine, Hadassah Health. As editor, I need to make clear the nature of my vision, shared by our trustees who are well represented on our editorial board. Firstly, Hadassah is not raising funds to support the equivalent of an Israeli NHS. If that was all we had in mind I might recommend you gave your charitable donations to Holby City NHS hospital trust. No, Hadassah is different, very special and close to my heart. We hope this magazine will help bond the Anglo-Jewish community and its many non-Jewish well wishers with the Hadassah Medical Organisation in Jerusalem. Hadassah Health will capture the imagination of both lay and medical readers by reporting on the medical achievements, scientific discoveries and general atmosphere that make Hadassah so special, and of such importance to the Middle East and the world at large. In addition, as a British publication, we focus on the achievements brought about by the money raised specifically by Hadassah UK and promote fund raising activities within the UK. We also aim to showcase Israeli medicine in Britain in order to support Anglo-Jewish doctors in their fight against an academic boycott of Israel. Welcome My most enduring memory of my last visit to Hadassah, Ein Kerem, is of my tour of the paediatric oncology unit that is housed in the amazing tower dedicated to children’s health. Professor Shlomo Mor-Yosef, HMO’s director general, was showing me around, when he introduced me to the chief nurse looking after the kids with leukaemia. Whilst standing in the glass atrium at the end of wing, with one of the best views over the seven hills of Jerusalem, she mentioned in passing that as all the children in her care were bald from the effects of chemotherapy, one could not distinguish their race, religion or ethnicity. Everyone in the mosaic of minority groups in Israel is at equal risk of developing childhood leukaemia and each has equal right to the best care available in the Middle East. Incidentally the chief nurse was an Israeli Arab; and I almost forgot to mention that the Paediatric Oncology Department is totally funded by the generous donations from the UK from the Dyna & Fala Weinstock Charitable Trust. I think that one vignette summarises our vision and the ethos of Hadassah UK and Hadassah Health. In this first edition of Hadassah Health you will find many similar stories both to warm your heart and stimulate your imagination. Hadassah UK exists to support the Hadassah Medical Organisation in Jerusalem with its work in healing, teaching, research and outreach. We raise funds, put on events and bring speakers from Hadassah to the UK such as Dr Shir Dar from the IDF Haiti rescue mission and other Hadassah doctors to speak about its breakthroughs in medical research, treatments and procedures. Hadassah UK publicises the hospital’s work to medical professionals, journalists, MPs and Peers and to the general public. Our Young Hadassah group and special interest committees have programmes of events to support their chosen projects within Hadassah. Please contact Mark Addleman at Hadassah UK if you are interested in helping us, visiting Hadassah or finding any other information on 020 7723 1144 or email [email protected] 5 haddasah health T Editorial 6 haddasah health his is not my first outing as an editor as I was, until recently editor-in-chief of the International Journal of Surgery. In that role I made the final decision on which papers were published and which were returned to sender with my insincere regrets. However the best part was not this prerogative, but the opportunity it provided for the occasional self -indulgence as expressed in my editorial columns and my on-line blog. I think it is obvious by now if you’ve read my welcome, where my prejudices lie. Apart from that I have a dark secret, and that is my passion for fine art. It was therefore obvious to me right from the start that the lead feature had to be related to those iconic stained glass windows by Chagall that fenestrate the synagogue of Hadassah at Ein Kerem. In many ways I prefer Chagall’s work with glass to those works on canvas or on paper. Even though his best oils create an impression of transmitted light I prefer being literally bathed in the colours of his windows. In what better way can you enjoy the early summer light in Jerusalem, than by its refraction through the cobalt blue and vermillion tones of Chagall’s masterpiece? The next feature, on the activity of the IDF and the Israeli medical teams in Haiti, was an obvious choice being both highly topical as well as being one of the best examples of showcasing Israeli doctors at work outside the boundaries of their hospitals and of Israel herself. My chest swelled with pride when Sky television showed the new baby boy named ‘Israel’ as a token of gratitude to the medical corps of the IDF. Incidentally he was delivered in Haiti by Hadassah Paediatrician, Dr Shir Dar. The next feature is another example of my self- indulgence in describing the molecular genealogy of the Jewish people as judged by the inheritance of the genetic malfunction that pre-disposes to breast and ovarian cancer. Many of our readers will come from families blighted by these diseases as is mine and it might yet be in our enlightened self-interest to donate to HMO to support their research in this area. We then present a series of delightful essays with human-interest stories that feature the staff and patients of the HMO. Finally to capture the interest of our medical readers there are accounts of some of the scientific research and new clinical services at Hadassah. Although much of this is rather esoteric, we have edited the text so that it should be of some interest to and understood by the intelligent lay reader. As that applies to all who have read so far, sit back and enjoy. When you reach the end papers you will learn just how easy it is to donate to Hadassah in Jerusalem via Hadassah UK. Professor Michael Baum WHO KNOWS, YOU OR YOUR LOVED ONES MAY YET HAVE NEED OF THEIR SERVICES SHOULD YOU FALL IN A WADI IN THE NEGEV AND NEED AIR LIFTING TO THE NEAREST A&E DEPARTMENT THAT JUST HAPPENS TO BE ON A HILL OVERLOOKING THE VILLAGE OF EIN KEREM. 7 haddasah health 8 haddasah health ‘Hadassah’s Golden Eagle’ Revolutionary technique saves father of ten Hadassah’s stroke unit is using a revolutionary new technique to save the lives of stroke victims. A corkscrew device called a MERCI clot retriever is being used to prevent the permanent loss of brain function among stroke victims. The device is introduced through the femoral artery to reverse blood clots, re-establishing blood flow to the brain and preventing neurological damage. Moshe, a 64-year-old father of ten recently underwent the procedure following a massive stroke. A two-hour operation by the director of Hadassah’s Endovascular Neurosurgery and Invasive Neuroradiology Unit, Professor José Cohen, and his stroke team successfully removed the 4cm clot, allowing Moshe to regain full neurological function. Improving health in Abu Gosh Twenty-five volunteers graduating from Hadassah’s health promotion trainer’s course. The Head of the Abu Gosh Council attended the graduation ceremony and warmly congratulated the women on their involvement and achievements. At the graduation ceremony, youngsters from Abu Gosh performed the Arabic Debka dance. A second group of volunteers from the Arab village of Abu Gosh has completed Hadassah’s 80-hour training course to become health promoters in their home village. The Project for the Promotion of Women’s Health is an outgrowth of Hadassah’s vision to create partnerships with different communities. The initiative, with funding from the L’Oreal Foundation, operates under the auspices of our Patricia and Russell Fleischman Women’s Health Centre. At their graduation ceremony, volunteers said that the programme had helped change their lives, empowering, educating them and helping them to bring about improvements in their communities. Immuron and Hadasit: working together Hadasit, Hadassah’s technology transfer arm, is the largest clinical research centre in Israel, and has a global reputation for excellent medical and scientific research. With a 20% stake it is now the largest shareholder in Immuron, a biopharmaceutical company. Professor Yaron Ilan of Hadassah will serve as Immuron’s medical director. Dr Einat Zisman, CEO of Hadasit, believes the “combined efforts of Hadassah’s IP and Immuron capabilities can yield a new approach to address serious diseases and metabolic syndromes.” Making matches Before Hadassah launched its bone marrow campaign in October 2008, 200 people from the Arab community had enrolled in the 60,000-person database. To emphasise the importance of its bone marrow registry, Hadassah then set about distributing an Arab-language brochure, organising workshops, lectures and drives to recruit people in three hospitals in Nazareth, at the Hebrew University-Hadassah Medical School, in Arab towns around Israel and in the Palestinian Authority. Dr Amal Bishara, head of the project, says there are now 2,920 Arab donors in the registry, and some have already been good matches for patients. with a history of marrying among themselves to have a particular type of retinal disease. Identifying the causative genes is a “significant step forward”, according to Dr Eyal Banin, head of Hadassah’s Centre for Retinal and Macular Degeneration. “These patients and families now have a home and an address to which to turn. That address is Hadassah.” Israel’s first medical tissue bank One of Hadassah’s senior pathologists, Karen Meir, has helped to establish Israel’s first medical tissue bank. The goal, Dr Meir explains, “is to preserve and store tissue from malignant tumours so we can study them and come up with predictive tests and markers.” This, in turn, will help in the development of specific, tailor-made therapies. Now in its start-up phase, the bank is targeting patients with malignancies of the breast, lung, pancreas, and colon. Dr Meir says that Israel’s unique demographics are of invaluable use in this field. “In a small geographical space we have an amazing mix of genetic populations, in both the Jewish and the Arab communities. For the purpose of molecular comparisons, this is a treasure trove.” Hadassah eyes it up Hadassah really treats everyone Hadassah has identified the genetic cause of a retinal disease which has plagued Israeli and Palestinian families for generations. The findings, published in the journal Archives of Ophthalmology, describe specific mutations in a gene which creates a wide range of retinal phenotypes. Using specific genetic methodology, the Hadassah team was able to identify a single mutation that caused six families from the same village Hadassah’s Ophthalmology Department has successfully treated a golden eagle. The bird had already lost one eye due to an injury, and had been diagnosed with cataract in the other. Having been approached by the managers of the Jerusalem Biblical Zoo, Hadassah agreed to help. Dr Michael Halpert (first on the left) performed the operation and saved the eagle’s sight. From Esti Katz who looks after patients and their relatives at Hadassah Working in Hadassah hospital, has provided me with many powerful and emotional experiences, but after some years, I thought I had become “immune”. Years of Intifada and other heart-tearing experiences had convinced me that I had seen everything. Well, I had not, not until today. Earlier today I was asked to speak with a young man. His name, Eliad Sharoni, didn’t mean anything to me. He told me that he was visiting his 43-year-old sister, Yifat, in the oncology department. “My sister has only a few days left – maybe even hours – before she dies,” he said, trying not to cry. “I have come especially from Italy to be with her, and spent last night massaging her for hours to try to ease her pain. This morning I went to have a cup of coffee and I saw a piano in the main lobby of the hospital. I am a pianist and my sister has never heard me play. I’d like to bring her in a wheelchair and play for her.” I said yes, of course, and he started crying, telling me that this was his last chance to compensate for not spending time with her before. For the next 30 minutes I was a witness to one of the most powerful and moving concerts I have ever heard. Eliad, who turned out to be a great pianist, was crying as he played, while his sister, who was too weak to speak or move, was sitting in a wheelchair in front of him, listening. Only her shiny black eyes could tell what was happening inside her. Their mother stood behind her, holding her hand throughout the entire concert. As the music played, people gathered around looking at the surreal scene. It was very difficult to comprehend what we were watching. It was as if everything stood still. And then it ended. Eliad hugged his sister, told her how much he loved her, took her back to the department, the maintenance people locked the piano and life went on again. 9 haddasah health 11 haddasah health 10 Hadassah is home not only to medical excellence, but artistic excellence too. Twelve stained glass windows by Marc Chagall adorn the Hadassah Hospital Synagogue in Jerusalem. “This is my modest gift to the Jewish people who have always dreamt of biblical love, friendship and of peace among all peoples. This is my gift to that people which lived here thousands of years ago among the other Semitic people.” Marc Chagall February 6th 1962 The eldest of nine children, Chagall the roof” recurs frequently, often hovering within another scene. Strong colours portray the world with a dreamlike simplicity, and the fusion of fantasy and religion gives his work a joyous quality. While Chagall’s work was influenced by contemporary French painting, his style remains independent of any one school of art. During the first world war, Chagall lived in Russia, and in 1917, endorsing the revolution, he was appointed Commissar for Fine Arts in Vitebsk and then director of the newly established Free Academy of Art. But the Bolshevik authorities frowned upon Chagall’s style of art as too modern, “All the time I was working,” he said, “I felt my father and my mother were looking over my shoulder, and behind them were Jews, millions of other vanished Jews of yesterday and a thousand years ago.” The Bible was Chagall’s main inspiration, particularly Genesis 49, where Jacob blesses his 12 sons, and Deuteronomy 33, where Moses blesses the Twelve Tribes. The dominant colours used in each window are inspired by those blessings as well as by the description of the breastplate of the High Priest in Exodus 28:15, which were described as gold, blue, purple THE TWELVE WINDOWS OF HADASSAH was born in 1887 in Vitebsk, Byelorussia (Belarus today), to a poor Hassidic family. At the age of 20, despite his father’s disapproval, Chagall pursued his interest in art and went to St Petersburg to study with the Russian painter Leon Bakst. Influenced by contemporary Russian painting, Chagall’s distinctive, child-like style, often centring on images from his childhood, began to emerge. Chagall then spent four years living in Paris, absorbing the works of the leading cubist, surrealist, and fauvist painters. It was during this period that Chagall painted some of his most famous paintings of the Jewish shtetl (village), and developed the features that became recognizable trademarks of his art; the “fiddler on and in 1922 he left Russia. Chagall settled in France the following year. He lived there permanently except for the years 1941 to 1948 when he fled to the United States. Chagall’s horror over the Nazi rise to power is expressed in works depicting Jewish martyrs and refugees. The 12 Hadassah Windows To fully understand the significance of the Windows, they must be viewed against Chagall’s deep sense of identification with the whole of Jewish history, its tragedies and victories, as well as his own personal background in the shtetl of Vitebsk, where he was born and raised. and scarlet, and contained 12 distinct gems. Each gem was dedicated to a tribe with the tribe’s name engraved on it. According to the Bible, each of the tribes had its own flag and emblem, as cited in Numbers: 2, 2: “The sons of Israel shall encamp, each by his flag, with the emblems of their fathers’ house.” The background of the flag was said to be based on the colour of the corresponding gem on the breastplate. The tribal emblems were based mainly on the texts of Jacob’s blessings of his sons (Genesis 49) and Moses’ blessings of the tribes (Deuteronomy 33). Example: The Window of Judah Jacob’s blessing, Genesis 49 “You, O Judah, Your brother shall praise; Your hand shall be on the nape of your foes; Your father’s sons shall bow low to you. Judah is a young lion; On prey, my son, have you grown. He crouches, lies down like a lion, Like the King of Beasts – who dare rouse him? The sceptre shall not depart from Judah, Nor the ruler’s staff from between his feet; So that tribute shall come to him And the homage of peoples be his. He tethers his donkey to a vine, his ass-foal to a choicest vine; He washes his garments in wine, His robe in the blood of grapes. His eyes are darker than wine And his teeth are whiter than milk. Moses’s blessing, Deuteronomy 33 And this He said of Judah: Hear O LORD, the voice of Judah, And restore him to his people. Though his own hands strive for him, Help him against his foes. Midrash Rabbah Bamidbar 2 His gem was red garnet (NOFEKH), his flag was sky-blue, with a lion on it. The red background of the window refers undoubtedly to the wine image in Jacob’s blessing. But it also may be connected to the royal purple garment. The significance of the crown in the top is obvious. So is the lion at the bottom. The hands remind us of the verse “Though his own hands strive for him”, and “Your hand shall be on the nape of your foes”. Simultaneously, the two hands are raised in the manner of the priestly blessing. Behind the lion there is the city of Jerusalem. Chagall signed this Window in Hebrew. haddasah health 13 haddasah health 12 ISRAEL’s team in HAITI N ews of the devastating earthquake that hit the Haitian capital of Port-auPrince in January traveled quickly right across the globe. Within two days more than 20 countries had sent military personnel to help. Within a fortnight the world’s nations had pledged some $1 billion in emergency aid. In just under eight hours Israel had assembled a medical team to build a field hospital amid the destruction and chaos. Armed with supplies and equipment, the Israel Defence Forces (IDF) delegation, which included 220 army and medical personnel, set up the largest field hospital in Haiti to provide immediate disaster relief. The hospital was the most advanced medical facility in the area, with intensive care units and operating rooms, as well as over 40 doctors, specialists and volunteers. In the media The BBC and Sky News were quick to highlight Israel’s rescue operations in Haiti. CNN praised Israel’s doctors and nurses for mounting a swift and sophisticated response to the earthquake. ABC News described the Israeli hospital’s emergency unit as “legendary”, reporting that it was cause for the Americans to “rethink their entire emergency response”. Israeli rescuers worked tirelessly to locate survivors trapped in the ruins of buildings. They investigated reports of voices heard from inside the wreckage, with one of the Israeli search and rescue teams freeing 69-year-old France Gilles. “We told him we were from Israel and he asked if we were mocking him,” one member of the delegation recalled. At another site Israelis spoke with a man trapped under rubble, apparently the only survivor after a building had collapsed. After several hours of excavation rescuers provided him with fluids intravenously, and freed him within a few hours. “We’ve had to drill through a concrete girder, as he is trapped between pipes and planking,” said Liron Shapira, deputy commander of the Israeli delegation. “We removed most of the piping and managed to attach intravenous drips to his torso.” Zaka teams (Disaster Victim Identification units), representing Israel, also worked tirelessly, saving the lives of eight people as well as recovering the bodies of several victims. During the searches, teams from Nicaragua, Russia, and Venezuela located two girls who had been trapped in a collapsed building for more than five days. The girls were evacuated to the Israeli hospital, where they were treated. The first girl to be rescued had serious injuries, and CNN Reporter Chris Lawrence brought her in his truck to the hospital where she received life-saving treatment. The second girl was in much better condition, with only minor injuries. By the end of January the confirmed death toll from the earthquake had exceeded 150,000 in the Port-au-Prince area alone. The Israeli field hospital had treated some 970 patients, performed 300 surgeries and delivered 16 babies. Hadassah’s Dr Shir Dar delivered the first healthy baby in the Israeli field hospital delivery ward. Naming the child “Israel” to show gratitude to the doctor and his team, the mother was extremely quiet. “It wasn’t even clear initially that she was in labour,” Dr Dar explained. Childbirth in impoverished Haiti doesn’t normally take place in hospitals. “It is very exciting,” Dar added. “It offers some small balance to the things that are happening. Life is stronger, after all, and a woman will give birth even if the ground is shaking. This is what maintains the human race. This country has a very high infant mortality rate, and we delivered this healthy baby.” The following is from Hadassah’s Dr Taras Shirov, an anaesthesiologist and orthopedic surgeon, who has been working in Haiti, running back and forth between the anaesthesia machines and the operating table. “We arrived and built the field hospital from scratch in a football stadium. There was no local infrastructure such as running water or washrooms. We worked for 36 hours non-stop, operating on more than 70 people (not counting endless small treatments and procedures for which there are no records). People can now have showers under running water, instead of using three large bottles of water per person. “The numbers of injured and sick people are overwhelming and it seems as if no change is around the corner. Ameri- can physicians and nurses help in the Israeli hospital, and an American nurse who has been living in Haiti for years serves as a translator because language differences is a major problem. Imagine a situation where a physician or a nurse tries to take vital signs from patients and cannot communicate with them. Most of the ER work is done at night; operations are carried out during the day. The weather has been favorable so far although it’s very hot and humid. The only air conditioner is in the operating room, and they use regular ventilators.” Hadassah nails it When the hospital ran out of screws for external reinforcement structures for limb fractures, Hadassah’s Reuven Gelfond, a nurse from Mt Scopus, stepped in. He found a local factory where he had them create the necessary screws out of regular nails. Israel mounts rescue effort following Haiti’s devastating earthquake haddasah health 15 haddasah health 14 Molecularly THE JEWISH PEOPLE by Professor Michael Baum M y son-in-law is a “Cohen” and I am proud that my daughter has married into this princely and scholarly lineage. My son-inlaw’s father is Rabbi Dr Jeffrey Cohen and through the oral tradition they can trace their lineage back to the Cohenim of the Temple in Jerusalem. We now know that this oral tradition has been scientifically confirmed by studying the Y chromosome of Cohenim. The Y chromosome is associated with the male sex and handed down through the generations from father to son. The Y chromosome of the Cohenim has certain characteristics that are common to all the Cohenim in the world, confirming the veracity of the oral tradition (figure 1). Perhaps more remarkable is the tradition that our ethnicity is handed down through the maternal line. Every cell in the human body has two sources of DNA. The major source is within the nucleus and this can be described as the blue print that codifies our personhood: the way we look, our height, the colour of our eyes and to a large extent our attitudes and intelligence. Hidden in the cytoplasm between the nucleus and the cell membrane, and only clearly seen on electron microscopy, are the mitochondria (figure 2). These tiny structures are vitally impor- tant in burning food to provide energy for cellular activity. The mitochondria are peculiar. Back in evolution they were once bacteria, living symbiotically in primitive cells. They still retain some of their own original DNA that codes for a few proteins that are essential for the organization of these “organelles”. (An organelle is a specialized subunit within a cell that has a specific function.) This mitochondrial DNA is now known to be entirely maternal in origin, handed down through the generations via the female line. So the mitochondrial DNA in the fertilized egg is all maternal. As is the case for the Y chromosome, mitochondrial Figure 1 Figure 2 DNA also differs in subtle detail, between individuals and through this it is possible to trace the origins and migration of peoples of different ethnicity from the first hominids who evolved from the apes in central Africa in the dark distant past. Once again genetic anthropology confirms that the majority of people who consider themselves Jewish are indeed Jewish as judged by their mitochondrial DNA. Subtle differences in this coding also allows us to trace the migration of the Jewish people over time and even suggests that our origins might indeed have arisen from four different matriarchal tribes. Sadly along the way the Jewish people have collected a number of deleterious mutations within their cellular DNA of the germ line that has also been passed on through the generations. These include the mutations that are associated with breast cancer, and those linked to Tay Sachs disease, which causes deterioration of mental and physical abilities. The origin of these mutations in time can be traced by considering the migration and dispersion of the Jewish people in haddasah health 17 haddasah health 16 ancient history. The story starts about 3000 years ago (figure 3). In 586BCE, after the Babylonian conquest and the fall of the First Temple, the major Jewish dispersion was to Mesopotamia; “by the rivers of Babylon, there we set down yea we wept when we remembered Zion” (Psalm 137). Some Jews migrated to Egypt and others north into Syria. Later many Jews drifted back to the land of Israel, but after the revolt against Persia, 359-338BCE, many migrated towards the Caspian Sea with gradual migrations through trading further north into Europe. The Jews who migrated to Mesopotamia enjoyed a long history, emerging ultimately as Iraqi Jews, most of whom were forced to leave after the Second World War. The next cataclysmic event in Jewish history was the sacking of the Second Temple by the Romans in 70CE. This event was celebrated by the Roman legions in the bas -relief seen on the arch of Titus in Rome, where the Temple menorah is seen carried on the shoulders of the triumphal Roman legionnaires. This is also celebrated by the coin that was struck embossed with the words Judea Capta (figure 4). At this point 80,000 Jewish slaves were shipped across to the Roman province of Hispania and settled in the region just south of Cordova. This colony ultimately gave rise to the Sephardic population. Some Jews remained behind in cities such as Jerusalem, Hebron and S’fad with descendents to this very day, whereas others continued their migration through Asia Minor into Eastern Europe (figure 5). Until the expulsion of the Jews from Portugal and Spain at the end of the 15th century, there was very little inter-marriage between the Sephardim and the Jews in Mesopotamia, Asia Minor and Europe. With these historical facts in mind it is then all the more interesting to look at the distribution of the BRCA 1 and BRCA 2 mutations amongst women from the different Jewish communities. These mutations occur in the genes that have an important role in DNA repair. This means that carriers of these mutant genes ac- cumulate sufficient DNA damage that can initiate malignant transformation of normal cells Amongst Jewish women within Israel and the diaspora, 1 in 40 women (2.5%) are affected. When you look at the individual mutations you see how the history of the Jewish people has been reflected, once again at the molecular level. First of all Sephardi women do not carry any of these mutations. Therefore the mutations that have been identified must have occurred after the fall of the Second Temple or amongst those families who remained in Mesopotamia or migrated north after the fall of the First Temple. There are three “Jewish” mutations. These can be roughly dated by analysis of mitochondrial DNA. The oldest mutation (185del AG) on the BRCA 1 gene occurs in 1% of both Ashkenazi and Iraqi Jews and is estimated to be between 2500 and 3000 years old. This therefore must have occurred by a founder germ line mutation in Mesopotamia shortly after the fall of the First Temple and also have been carried Figure 3 Figure 4 Figure 5 north amongst those Jews who ultimately contributed to the foundation of the Ashkenazi tribes. The second mutation (617del IT) is on the BRCA 2 gene. It is found in 1.4% of Ashkenazi Jews only, and is estimated to be about 700 years old. Long after the fall of the Second Temple, almost certainly the founder germ line mutation must have arisen from the Jews that had settled in Eastern Europe. The third mutation (5382ins C) is on the BRCA 1 gene. It occurs in 0.1% of the Jewish population and is said to reflect another tragic event in Jewish history. This mutation is also seen amongst high-risk non-Jewish women of Eastern European origin and is sometimes described as a “pogrom” mutation. In other words it is the consequence of pregnancies following rape. Both the Israeli and the British experience confirm that women carrying one of the BRCA 1 mutations have a nearly 80% chance of developing breast cancer by the time they are 80 years old. For those carrying the BRCA 2 mutations the risk is about 35%. These mutations are also associated with an increased risk of ovarian cancer and, curiously, prostate cancer amongst the male members of the family. Rarely, these mutations can be carried and express themselves as breast cancer in the male relatives of such at risk groups. Hadassah is undertaking cutting-edge research into understanding and managing these “Ashkenazi” breast cancers, which will benefit women all over the world. I hope this essay will remind potential donors that not only do we have emotional and cultural links to Jerusalem but our very molecular structure can trace its roots to the time of the Second Temple 2,000 years ago. haddasah health 19 haddasah health 18 H NEW RESEARCH ENDS A LIFE OF SUFFERING Treating dystonia with surgery developed for Parkinson’s disease adassah Hospital has a new treatment for dystonia sufferers that helps reverse their painful and debilitating disease By the time Talia Zusman had finished high school, the tremors in her legs that had begun when she was 12 years old had put her in a wheelchair. “My friends were going off to the army, and I was worrying about how to get upstairs,” she says. “I had an incurable disease. This was my reality. I accepted it.” says Dr. Israel. “Inherited or primary dystonia is, unfortunately, an Ashkenazic disease.” A year later, a healthy and active Zusman addressed the Hadassah convention in Los Angeles. She couldn’t attend in person as she was doing national service with children at risk, and they needed her. Instead Zusman appeared via video to express her intense gratitude to the neurosurgeon and the medical centre that rid her of the symptoms of dystonia. “Zusman is one of 22 dystonia patients on whom we have performed deepbrain stimulation in the past six years,” says neurosurgeon Zvi Israel of the Hadassah Medical Organisation, who introduced the technique to Israel and has helped develop it. “Her affected elder brother waited to see the results of Talia’s surgery. Fourteen months later, he was in our operating room as well. Zusman and her brother Roi were completely cured. Deep-brain stimulation, the surgery that has turned life around for dystonia patients, was, in fact, developed for people with Parkinson’s disease. In the early 1990s, Israeli physiologist Hagai Bergman of the Hebrew University– Hadassah Medical School discovered a tiny area, deep in the brain, which is overactive in Parkinson’s sufferers. When he altered the electrical activity in this tissue, all overactivity was improved. Dystonia is a neurological disorder, a problem with the way the brain controls movement. Its victims suffer continuous muscle contractions, which cause uncontrolled twisting and repetitive movements, often with cramping and pain. In some patients, only a single muscle is affected. In others, the disease attacks groups of muscles in the arms, legs or neck, or it can affect the whole body. There are two main types: one results from birth-related or other physical trauma, infection, lack of oxygen or drug reaction. The other, which the Zusmans have, is genetic. “The fact that most of our dystonia patients have the genetic form is no coincidence,” The mutated gene implicated in dystonia is carried by 3 to 5 percent of Ashkenazic Jews, compared with less than 1 percent of the general population. The faulty gene, known as DYT1 and first mapped in 1989, probably results from a single mutation event in the Ashkenazic Jewish population in Lithuania about 350 years ago. Dr Israel learned the technique at the Oregon Health and Sciences University in Portland, USA. He brought the technique to Israel, where he built a deep-brain stimulation surgery program at Hadassah. As expertise in deep-brain stimulation for Parkinson’s grew worldwide, surgeons began wondering if the technique had broader applications. Zusman remembers lying on the operating-room table, listening to an iPod, with a stereotactic frame fitted around her head. Once her brain was scanned and the image combined with an earlier MRI to pinpoint the malfunctioning area, Dr. Israel got to work. He drilled a small hole through Zusman’s skull just above her hairline. He then inserted three inches of wire the thickness of a paper clip, four tiny electrodes at its end, and advanced it to the target. With one end of the silicon wire in place, he took the other, emerging from Zusman’s skull, placed it under her skin and trained it down the side of the head, neck and chest to her upper abdomen. There, he connected it to an electrical generator, a lightweight device the size of a small computer mouse, also implanted under the skin. “The electrodes immediately stun the overactive cells, and the patient is often dramatically better,” says Dr. Israel. “Within a week or two, however, the cells begin recovering, and it is time to program the generator. We place a hand-held electrical device on the patient’s skin over the generator and fine-tune the electrical pulses it delivers to the brain. Initially, we give only a small amount of stimulation, which must sometimes be increased.” The stimulation usually results in a complete reversal of symptoms. The technique is not able to cure patients suffering from Parkinson’s, but Hadassah is working to improve it. One way is by developing tools that ensure the electrodes are inserted in precisely the right area. The second important refinement is the degree of stimulation delivered to the malfunctioning brain area. Brain activity drops when a patient sleeps and rises when he or she goes running. If activity in the brain’s cortex can be recorded, it can be used to indicate how much stimulation should be given at different times and provide exactly the correct amount. People are looking to stem cell therapy as the next major advance in treating Parkinson’s. But until biologists can say: ‘Here are the stem cells!’ Dr Zvi believes deep-brain stimulation has a long way to go and much help to give patients with a range of difficult neurological disorders. Dr Zvi Israel’s work has been supported by our Hadassah UK’s Parkinson’s At The Hadassah (PATH) Committee. haddasah health 21 haddasah health 20 Hadassah researchers help you see R epresenting a significant step towards treating and preventing age-related macular degeneration, researchers from the Hadassah Medical Organisation in Jerusalem have produced findings that have since been published in the journal Cell Stem Cell. NEW HADASSAH RESEARCH USING HUMAN EMBRYONIC STEM CELLS Age-related macular degeneration causes major vision damage. It is the leading cause of blindness in adults over 50 in the western hemisphere, with 30 million afflicted around the world. A disease which causes millions of people worldwide to lose their sight, it damages the central area of the retina, the macula, which is responsible for the sharpness of vision and activities such as reading, driving or watching television. Researchers from the Hadassah Medical Organisation have transplanted pigment-containing visual cells derived from human embryonic stem cells, successfully preserving the structure and function of the specialised light-sensitive lining of the eye in an animal with macular degeneration. Professor Benjamin Reubinoff, Director of the Hadassah Human Embryonic Stem Cell Research Centre, and Dr Eyal Banin, Director of the Hadassah Centre for Retinal and Macular Degeneration, led the research team, creating unique laboratory conditions for deriving pigmental cells of the retina from human embryonic stem cells. They found that nicotinamide (vitamin B3, NIC) and Activin A, a stem cell maturation agent protein, turned human embryonic stem cells into pigmental retinal cells. When transplanted into the eye of a rat with macular degeneration caused by malfunctioning pigmental cells, they were able to delay deterioration of retinal structure and function. “Our findings are an important step towards the potential future use of human embryonic stem cells to replenish RPE in diseases that result in blindness,” Dr. Banin stated. Experimental transplantation of pigment cells in human patients is expected in two years. Professor Benjamin Reubinoff was featured on Fox News explaining how Hadassah’s manipulation of cells to model different diseases could help us understand how diseases evolve and how to correct the diseased state. Some Israeli scientists predict there may well be treatment for formerly untreatable diseases in as little as three years’ time. Human embryonic stem cells slow down MS Multiple sclerosis is the most common cause of neurological disabilities in young adults. It is an autoimmune inflammatory disease of the central nervous system in which the immune system attacks the insulation of neurons (myelin). As a result, the nervous system is damaged at a number of levels, leading to functional deficiencies in a number of neurological systems: sensory, motor, balance, sphincteral and vision. Following a long-term collaboration between Professor Tamir Ben Hur, Director of the Neurological Department and Professor Benjamin Reubinoff, new research has paved the way to further developments towards clinical application in MS patients. This research, as published in the scientific journal PL0S ONE, involves the transplantation of human embryonic stem cells into the brains of a mouse with MS, which slowed down significantly the clinical symptoms and pathological manifestations of the disease. They anticipate in the future, using embryonic stem cells, the inflammatory effects of MS may be reduced through repairing the damaged myelin in the brain. Cell Cure Neurosciences, a Hadasit Biotech Company which focuses on the development of human embryonic stem cells for transplantation therapy in neurological disorders, will further translate the results of the study to allow future clinical application in MS patients. This research also demonstrated that human embryonic stem cells can improve the functioning of a rat with Parkinson’s disease. The stem cell therapy offers the first real possibility of curing Parkinson patients by replenishing their dying dopaminergic neurons. haddasah health 22 haddasah health 23 Malignant germ cell tumours This tumour arises when germ cells abnormally migrate during the embryonic period, travelling from the testes to the chest. They remain dormant for years, but eventually develop into a tumour. A two-and-a-half-year-old girl from Russia with an eye tumour, known as retinoblastoma, and a fourteenyear-old boy from Cyprus, have defeated the cancers that were threatening their lives thanks to Hadassah’s Dyna & Fala Weinstock Paediatric Haematology-Oncology Department. The department, which was kindly donated by a UK donor, is renowned for providing comprehensive and sophisticated medical treatment to children and adolescents with cancer and severe non-malignant haematological diseases. Referrals come from well beyond the borders of Israel and it is designed to serve the needs of paediatric and adolescent oncology patients as well as their families. This department together with “Linda’s Activity Centre” is located in the Mother and Child Centre at Hadassah Ein Kerem and this whole second floor was built as a result of donations raised from UK donors. The only comprehensive Paediatric Cancer Centre Jerusalem, it serves a large and heterogeneous population from diverse ethnic and psychosocial backgrounds who are treated by a multidisciplinary staff, using the most up-todate diagnostic and therapeutic tools. Further, it is actively involved in the teaching of medical students, paediatric residents and paediatric Haematology-Oncology fellows. The parents of the toddler with the eye tumour could not accept that their child would have to have both of her eyes surgically removed after physicians in Russia had informed them of this likelihood. After finding Professor Jacob Pe’er, director of Hadassah’s Department of Ophthalmology, and Dr Michael Weintraub, director of the Department of Paediatric Haematology-Oncology on the internet, the parents of the toddler contacted them. The parents and child flew to Hadassah, where tests and consultations began. Giving the parents a ray of hope, the Hadassah team explained that with chemotherapy, one of the child’s eyes could definitely be saved and possibly the vision in her second eye. “In cases of retinoblastoma,” Dr Weintraub explains, “we obviously do everything possible to control the tumour, which is our main concern. However, beyond the immediate medical need, we also try to avoid having to remove the eye, for obvious cosmetic reasons.” The fourteen-year-old boy from Cyprus was brought to Hadassah with an unusually large tumour on his chest. Unable to treat it successfully, physicians in his home country had all but given up hope. Offering another ray of hope, Hadassah’s Dr Weintraub and Thoracic Surgeon Dr El-Ami diagnosed the lesion as a malignant germ cell tumour. With surgery and chemotherapy, however, the boy recovered completely and returned to his normal life. DEFEAT CANCER An everyday story from Hadassah’s Paediatric Intensive Care Unit haddasah health 24 by Wendy Elliman Eli (not his real name) is scarcely aware of what went on. It’s his parents who carry the memories, and the thankfulness that they still have their four-and-a-half-year-old son. PICU medical staff, nonetheless, continued ventilating Eli as aggressively as they could without causing further damage, to protect his organs and brain. It began when Eli’s mother noticed swellings in the child’s neck and armpits. A visit to the doctor led to a specialist, a biopsy and the difficult news that the child had cancer of the lymphatic system, Burkitt’s lymphoma. But, they were reassured treatment results were generally very good, with 90 to 95 percent of children cured. Eli’s parents scarcely left him as the child hovered between life and death. But Eli himself knew nothing of what was going on. He was sedated and immobilized throughout the two weeks of intensive treatment he received in the PICU. As the days went on, the news began to improve. Eli was holding his own. The doctors were gradually able to reduce the ventilation pressure and the air bubbles and swellings beneath the child’s skin were absorbed. Eli began to look like himself again. They had just accustomed themselves to the routine of Hadassah’s Dyna & Fala Weinstock Paediatric HaematologyOncology Department, where Eli was given his chemotherapy, and to watching out for signs of infection or fever in Eli, when the child went suddenly and unexpectedly into multi-organ failure. This intense septic shock led to acute respiratory distress syndrome, a severe infection of the entire lungs. The child was rushed to Hadassah’s Paediatric Intensive Care Unit (PICU), where each complication lead to another. His respiratory distress syndrome required high-pressure ventilation at high oxygen concentrations to avoid damage to his brain and organs — but this, in turn, resulted in airleaks from the little boy’s trachea into the skin of his neck and head. Everywhere that air leaked, his skin ballooned outward, disfiguring his appearance in an alarming manner. Next came the process of weaning the young patient off sedation and, once he became conscious, assessing whether his brain had been damaged in the crisis. The whole unit rejoiced when he woke without any sign of neurological complications. In some ways, he was in better shape than his parents: the boy remembered nothing of the fraught period he had spent in the PICU, while his mother and father had to deal with disturbing memories. Finally well enough to be released from the PICU, Eli returned to the Dyna & Fala Weinstock Paediatric-Haematology Oncology Department; and then — two weeks later — he went home. Today, Eli’s lymphoma is in remission, his crisis in the PICU forgotten and everyone’s hopes are high that the disease has been defeated. haddasah health 25 haddasah health 27 haddasah health 26 A REVOLUTION IN MEDICAL CARE F ollowing his visit to the Hadassah Medical Centre in Jerusalem last year, the Rt Hon James Arbuthnot MP wrote a congratulatory article in the Conservative Friends of Israel magazine, highlighting in particular Hadassah’s humanitarian care, educational outreach, and trauma unit: Israel has long believed that medical care is a universal right that transcends ideology and borders. As a result, Israel has one of the best healthcare systems in the world. In Jerusalem, Hadassah Hospital, with its world class medical and research centre, is colour and creed blind with regard to caring for its patients. Today the hospital accommodates 1,100 patients and contains 130 departments and clinics in 22 buildings. During World War II, the staff of Hadassah Hospital played a significant role in helping Allied military forces throughout the Middle East. They offered weekly lectures and meetings to British medical personnel that acquainted them with regional medical issues including blood diseases, jaundice, dysentery and anaemia. Hadassah truly brought modern medicine to the Middle East, being the first to perform a successful heart transplant, establish a cancer care centre, and open a bone marrow transplantation unit. Rt Hon James Arbuthnot MP Parliamentary Chairman of Conservative Friends of Israel The hospital today is still a world leader with recovery success rates that exceed the United Kingdom. During my visit to Hadassah Hospital, statistics were supplied which compared recovery rates between UK and Israeli hospitals for those seriously injured. UK hospitals had an (alleged) 57% recovery rate compared with a more favourable 91.7% recovery rate for Hadassah itself. The dedicated trauma units that have been set up in Hadassah hospital go some way to explaining recovery success rates. The statistics provided to me compare the success of trauma units with that of accident and emergency departments. These trauma units, with expert teams, are geared to treating serious injuries and are proven to save more lives than normal accident and emergency rooms. The great thing about Hadassah hos- pital is that, fundamentally, it does not let politics into the premises. Medical staff at the hospital have saved the lives of Palestinian suicide bombers and terrorists who were injured during the recent Intifada, as well tending to the medical needs of patients form the Mediterranean Basin, Europe, South America and the United States. Professor Shlomo Mor-Yosef, director general of Hadassah Medical Organisation stated “We consider it is our mission to serve as a bridge to peace by forging links between peoples of all nationalities, races and religions who come to our doors for healing.” Hadassah Hospital stands as a reminder to us all that, whatever the challenges, we must always strive to help those in need. Since 1994, when the Palestinian Authority assumed responsibility for the lives of Palestinians in the territo- ries, Israel has continued to pledge healthcare for those Palestinians who need it. In 2007, when Hamas seized control of the Gaza Strip through a violent coup, Israel increased permits to receive healthcare by 50% with more than 7,000 permits for Palestinian patients, and almost 8,000 permits for their escorts, to come into Israel to receive medical attention. The success of Hadassah Hospital exemplifies how Israel, despite the difficulties it faces, is determined to use its innovative medical technology to provide world class healthcare to Palestinians and Israelis alike. The openness of Israeli society and its ability to reach beyond the conflict in this way is truly something Israel can be proud of. “CARE NOT CREED” “CARE NOT CREED” “CARE NOT CREED” “CARE NOT CREED” haddasah health 29 haddasah health 28 A young Arab woman wearing a hijab dashed to catch the elevator. She was too late – the doors closed. But an elderly, bearded charedi man in the elevator, quickly pressed the button to re-open the doors. She nodded her thanks with a modest smile. Under normal circumstances in Israel this would have been a rare occurrence. But this was Jerusalem’s Hadassah Hospital. I was recovering from an operation when I witnessed the elevator scene. I was the donor in a kidney transplant for my daughter, whose renal system had collapsed. Throughout my eight-day stay at Hadassah, I kept seeing such scenes of spontaneous, cordial interaction between the different groups of people who make up the patient population. Race, religion and social status have far less significance in the corridors and wards of a hospital. Patients, no matter who they are, have a common denominator, which is anxiety, pain, discomfort and the need for patience. Patients wear ill-fitting hospital gowns. They share ward space and the attentions of the staff. They hear each other’s groans. It is all a great leveler. Jews and Arabs become fellow-patients; Jewish and Arab doctors and nurses become professional colleagues; racial differences, usually so loaded in this part of the world, are almost completely erased. As a Jew in a Jewish hospital, I found myself being treated by many Arab nurses and doctors, in addition to the Jewish staff. The surgeon in charge of the transplant was Professor Ahmed Eid (pictured). His Jewish colleagues cooperated fully under his expert and amiable direction. A similar situation exists in many other Israeli hospitals. Almost half of the patients in the ward seemed to be Arabs, coming from East Jerusalem as well as other Arab areas. In a neighbouring bed was an elderly Jew who on entering the ward informed me quietly that he did not like the fact that there were so many Arabs – staff and patients. “Surely they have their own hospitals,” he grumbled. He later told me that his daughter had been seriously wounded in a suicide bombing a few years before. A few minutes after he settled down in his bed, yet another patient was wheeled in – a groaning, middle-aged Arab, followed by a retinue of sons and a wife. The elderly Jew leaned towards me and pulled a face conspiratorially. The ward becomes a crowded place during visiting hours. I found that some of the Arab’s sons were sitting quite close to me. I began to chat with them, enjoying the opportunity to practise my shaky Arabic and soon we were chatting like old friends. After a while I quietly tried to introduce the Arab patient to the elderly guy in the bed next to mine. The Arab man nodded politely, but the old man promptly shut his eyes. Later a young nurse came in to measure his blood pressure and take his temperature. From her accent it was clear that she was an Arab. Grumpily, he allowed her to put a thermometer in his mouth. She was an incredibly sweet-looking person. Diminutive, chirpy, with a hint of naughtiness in her smile, she softly hummed an Arab song, while tending to the patients. “I hope you are feeling a little better,” she beamed at the old guy. He just stared at her. Next morning, nurses came into the ward to measure blood pres- haddasah health 31 haddasah health 30 sure and temperature and hand out medicine. Doctors came in with syringes to take blood samples. Patients got up to go to the bathroom. The old man and the Arab happened to get out of their beds at the same time and almost bumped into each other. “Good morning,” the Arab said in Hebrew with a deferential nod, “Boker Tov”. The old Jew looked at him coldly for a moment and then nodded and moved his hand to the Arab’s shoulder, almost touching it. Slowly, as though he was trying to remember the words, he said: “Sabbah el Ghir,” (‘Good morning’ in Arabic.) The two men would get onto more comradely terms during the next few days. Later, a portly, elderly man entered the ward, came to my bed and asked how I was feeling. He examined me, asked a few more questions, said he was pleased with my progress, gave some instructions to a nurse, quipped an amusing observation and walked out of the ward. After he left, I asked my Arab friend if he knew who the man was. He shook his head. I said, “That’s the doctor who did my transplant. That’s Professor Eid.” I added: “Professor Ahmed Eid.” The Arab got out of his bed and walked quickly to the exit of the ward to observe Professor Eid’s departing figure. Then he returned and stood by my bed. His face glowed with pride. He put his hands on my shoulders. “May you be healthy,” he repeated in Arabic a few times. “Thank you, Rafi. Thank you.” He was actually trembling with excitement. I realised that the mere presence of Professor Eid in a Jewish hospital had raised the Arab’s spirits and made him feel less of an outsider. I had become his friend – his Jewish friend in this Jewish hospital where he would get the best treatment possible, and he wanted to give thanks for everything. And so did I. While the central figures in contact with patients are doctors and nurses – a hospital can’t exist without a huge army of other specialists, such as radiologists, lab workers, physical therapists, pharmacists, dieticians, social workers, as well as kitchen, maintenance, laundry and cleaning staff. Those doing the menial jobs, as indeed in most Israeli hospitals, are mainly Arabs, or Russian or Ethiopian immigrants. One of the women who made the beds was a roly-poly Jewish, Moroccan-born, amazon-type nursing assistant with a ready smile. She would often share a joke with our daughter and her room-mate, who would frequently be an Arab woman. There was no difference in the genial amazon’s attitude. It is natural that the generations-old conflict between Jews and Arabs in the Middle East generates deep suspicion and hostility throughout the land. Tragically, so many events keep stoking these sentiments but in Israeli hospitals it’s as though there is an unwritten sign at the entrance: “Prejudice has no place in this hospital – here it’s a defunct disease!” by Ralph Dobrin Ralph Dobrin, writer, editor and publisher, originally from South Africa, has lived in Israel for over 50 years. Reproduced from Jewish Renaissance haddasah health 33 haddasah health 32 “S o why did you make aliyah?” It was the 15th time I had been asked this question since I started work one hour previously in the operating rooms in Hadassah Ein Kerem. Masked surgeons whom I had never met asked me seemingly unusual questions when introduced to their new British trainee anaesthetist: “Are you religious?” “Are you married?” A far cultural cry from the British surgeon’s: “Are you coming to the pub at the end of the operating list?” I used to say that it was because of the weather. And of course it would be untrue to deny the pleasure of a long hot summer. Clearly I chose Hadassaheveryone I worked with in London knew the Hadassah Medical Organisation. Professor Cotev, the wonderful emeritus Head of Anaesthesia had promised me a job when I arrived. Slowly I learned my way around the building, the people and the questions. Then one day 10 years ago I found myself in the Labour ward, and have never left. A microcosm of Israeli life all in one ward; every day unexpected but thrilling as we witness new life born. How do you chat to someone in extreme agony who speaks only Arabic, Russian or Yiddish? But their pain speaks the same language and it is my job, my pleasure to make their labour a memory to be treasured not feared. The Hadassah hospitals combined witness 9,500 deliveries per year in the two sites. Women come from every walk of life and all over the country to bring their child into the world in Hadassah. As tertiary specialist care centre with a multidisciplinary team of obstetricians, anaesthetists, neonatolo- gists and nursing teams specialising in high risk deliveries, the task at hand is always challenging and rarely dull. my children’s school’s Remembrance Day ceremony for the fallen soldiers and terror victims. Last week the head chef of the Hadassah kitchens brought his lovely wife in to have their sixth “and final” baby! She spoke only Arabic, and he translated so that I could safely provide her with an epidural for labour. Before I came to work in Hadassah I knew many Muslims at university in Manchester, some were very close friends, but I never imagined I would have relations with Muslims in Israel. After all the news portrays them as far away, distant, different, separated. Where would we ever meet? Yet in Hadassah our paths cross daily as we live a special reality were all we want is the safe delivery of healthy children. Picture a school yard with hundreds of small gorgeous children hearing stories about soldiers who gave their lives for the State of Israel, remembering men and women who died. They light candles of remembrance and sing songs and recite poems written by the dead and those who loved them. As the siren sounds I lower my head and faces flash before my eyes. I get up every day, dress my four children as my husband makes their packed lunch. After kisses and hugs I drive from the centre of Israel where we made our home in a new modern city built on the ruins of a great old Hasmonean city. This beautiful daily journey on the winding main road that rises from the plains up towards Jerusalem never fails to impress. From Latrun to the Kastel, sites of fierce battles for the very heart of the new State of Israel, the way is lined with tank wreckage, as modern cars filled with young Israelis make a daily journey to work. How lucky I am to drive this special road up to the City of Zion every day, as opposed to the North Circular battle-ground I used to have to traverse in the UK. So 14 years after our aliyah which we made as a young idealistic couple, I reflect back on this question when I attend The boy from the bomb outside Bet Shmuel in Jerusalem who we treated in the Intensive Care Unit for over 60 days, following multiple surgeries who eventually succumbed to his injuries. The small boy I treated after a bus bomb, when we had no idea if his parents were alive to claim him, and the young Russian immigrant woman who we operated on all night, pumping blood from donors into her veins, but she could not be saved. I wipe tears from my eyes, and fleetingly wonder if I am doing the right thing that my children should be at this ceremony at being exposed so young to death. But this my home, I feel safe here even though it is frequently not a relaxing place to live, and my children share in every experience for better and for worse. So on a daily basis I share pleasures of new lives with a multitude of families from every walk of life. I experience people and cultures I would never otherwise meet and I am lucky enough to realise that the Middle East peace talked about all over the world is a daily reality for me as we get on with the business of healing. I hope that our whole country will be blessed some day with the same peace that today I see in the special cocoon in Hadassah. These are my hopes and joys as we raise a family in Israel. Carolyn Weiniger is Consultant Anaesthetist in the Department of Anaesthesia and Intensive Care Therapy, Hadassah University Medical Organisation. Reproduced from Jewish Renaissance VIEW FROM AN ANAESTHETIST CAROLYN WEINIGER haddasah health 35 haddasah health 34 The Sarah Wetsman Davidson Tower Since 2000 Hadassah has been working to improve its inpatient facilities. Occupancy rates currently exceed bed capacities and more space is needed to meet the new paradigm in patient care, including more privacy, adaptable function rooms, increased family involvement and patient comfort. To maintain Hadassah’s standards of excellence, a new physical plant was needed, both to support the established superior performance at every level and to continue to attract the best medical practitioners to work within a teaching oriented environment. Hadassah also had to ensure that the working environment continued to support and maintain its integrated research, which entails the involvement of everyone, from nurses to surgeons, and is fundamental to its “lab to bedside” research philosophy. For this reason the units on the site were moved to allow for the construction of a new integrated surgical tower unit. Consisting of 14 stories and 500 beds, 20 operating theatres and a 48-bed intensive care unit, the new high-tech tower is now being constructed on the Hadassah campus in Ein Kerem, Jerusalem, providing hope for both the patients and their families. Due to be completed in 2012, exactly 100 years since the founding of Hadassah, the stateof-the-art Sarah Wetsman Davidson Tower will be one of the most advanced medical centres in the world. A symbol of the future This complex will help Hadassah maintain its reputation as one of the best hospitals in the world. Patients will be offered therapy and nursing care in an all-encompassing environment. Magnificent healing gardens will be constructed to create an environment beneficial to patient recovery. The new tower complex will facilitate dedicated medical treatment; and encourage pioneering scientific research in everything from stem-cells to computer-generated surgery, which will be of global importance. Making the impossible possible The Sarah Wetsman Davidson Tower has developed well so far. This is thanks to our loyal supporters and their appreciation of the significance of this building for Hadassah, the Municipality of Jerusalem and for Israel. But we now need new donations to complete the project. This is what has always happened with Hadassah projects in the past, which start with the initiation of a revolutionary new idea, then are followed by repeated support in various ways. Hadassah has always been able to fulfil its ambitious forward-looking projects to bring the newest in medicine to all, thus creating possibilities where impossibilities previously lay. What can I do? With your help our vision of the future can be fulfilled. Would you like to link your name to Hadassah? You can do this: for £21,500 you can sponsor a treatment room, a standby duty room for doctors or a nurse’s room bearing your name; £3,000 will buy a Mezuzah for the new tower. Please help us to secure the future of medicine in the Hadassah Medical Organisation in Jerusalem. Hadassah UK would like to sponsor, with the help of your donations, a “UK Floor” in the Sarah Wetsman Davidson Tower. We are justifiably proud at Hadassah UK to have helped in almost every one of the 130 departments of Hadassah and to have the whole second floor of the Mother & Child Centre paid for solely by kind UK donors. One floor costs £6.25 million. We would like to pledge this sum towards the 2012 completion of the new Tower in Hadassah Medical Centre in Jerusalem. Please help! Every small donation brings us nearer to our goal. “From little acorns…..” To watch the progress of the construction LIVE on the Hadassah Medical Organisation webcam, go to: www.hadassah.org/TowerLivefeed.