Aliza Yaffe – Head nurse: Israel Cancer Association: interviewed by Amanda Bingley, 13 May 2005. Length of interview: 1 hour 20 minutes
In this interview Aliza Yaffe describes her work with the Israel Cancer Association, developing specialist nurse training and community home care:
‘When I came to the Israel Cancer Association I was working in a general hospital in Tel Aviv and I was teaching at nursing school and I already had experience of treating the patient with stoma but I didn’t have the formal education in stoma care. And later on I went to the United States to, in order to have specific education. And that was my job description. But stoma care is not the only thing that they should need, and not everybody has a stoma, so gradually we developed in the Israel Cancer Association some nursing services and some nursing education. I think it was kind of bolting things together. I went to the first Cancer Nursing Conference in London in 1978 when Mr Bob Tiffany from the Royal Marsden, he said, ‘We need an international conference.’ When I returned from there, I went to the General Director of the Israel Cancer Association, Miriam Boaz. She said, ‘OK, what do you think we need here?’ Then I said, “we need some education for nurses in cancer, nursing not only the general, the general nursing education that we get.” There were specific courses on midwifery - not like in England, the nurse study differently, but postgraduate courses, midwife courses. Then we said we need also something like that in cancer nursing, and that was the first step doing something different from stoma care, starting a course in cancer nursing.’140
Dr Nathan Cherny – Co-founder and director, Cancer Pain and Palliative Medicine Service, Sha’are Zedek Medical Centre, Jerusalem: interviewed by Amanda Bingley, 4 May 2005. Length of interview: 1 hour 19 minutes
Nathan Cherny describes his early interest in medicine and his eventual training as a physician. He explains that he was made powerfully aware of the needs of cancer patients and palliative care partly through his own experience of illness and partly through the impact of seeing two documentaries on St Christopher’s Hospice and another on the work of Elizabeth Kubler Ross, who he later met, and then caring for a young patient who was dying. These influences led to his training in medical oncology where he was struck by the lack of awareness in other oncologists of palliative care:
‘When I started my training in medical oncology one of the things that struck me was that the residents around the hospital really knew nothing about palliative care and this was a problem in terms of care round the wards and I approached the medical school to see if they would allow me to teach palliative care to the students on the internal medicine rotation and this is now 1988/89, and that was supported and I wrote part of the palliative care training programme for Monash University and I taught that through the rest of my fellowship in oncology and you know the preparatory work that went into preparing that material gave me a lot of background into palliative care and the clinical skills of palliative care and led me to the next decision point which was in seeking a fellowship, to seek out a fellowship in palliative care. I went to talk with Kathy Foley. So you can see there have been multiple steps along this way, and when people ask me who inspired me, no single person inspired me, there was the very brief exposure to the work of Elizabeth Kubler Ross and then these trigger experiences with patients as a young medical student. As I have gone along the path there are people who I’ve found wonderful inspirational people along the way, certainly Kathy Foley and Russell Portenoy were wonderful mentors to me when I was at the Memorial Sloan-Kettering Cancer Centre. While I was there I was exposed to a couple of other people who had a disproportionate impression on me to the amount of contact, one was Derek Doyle and the other one is Ned Casson. Kathy and Russell in particular created opportunities for me to develop professionally to develop an interest in policy beyond just service delivery.’
In 1993 he arrived in Israel at the invitation of the director of Sha’are Zedek to establish, with Professor Rafael Catane, the service at the centre, which has proved to be a highly successful unit. He notes that in the course of his work in palliative medicine he has instigated research into pain and symptom control and the relief of suffering at the end of life.
Jonathan Rudnick – Rabbi, spiritual counsellor, Cancer Pain and Palliative Medicine Service, Sha’are Zedek Medical Centre, Jerusalem: interviewed by Amanda Bingley, 4 May 2005. Length of interview: 35 minutes
Jonathan Rudnick talks about how spiritual counselling was initiated into the service and is currently being developed. He explains that his interest in bringing spiritual counselling into palliative care was supported by Nathan Cherny and other colleagues in the service. He speaks about his specialist training in the USA, and how the service is now supporting the course he is teaching for others to train in this work. He describes how successful the counselling is proving to be for patients, families and staff.
Dr Amitai Oberman – medical director Milton and Lois Shiffman Home Hospice in the Valleys: interviewed by Amanda Bingley, 10 May 2005. Length of interview: 58 minutes
 Amitai Oberman describes how his interest in palliative medicine developed out of his work in geriatrics. He explains how after his training in internal medicine in 1996 he went to the United States to do a Fellowship in Geriatric Medicine at Harvard. After two years of clinical training and a year of research, he was increasingly fascinated by the USA approach to end of life issues and treatment, such as the advanced directives and patient autonomy. This led to a two months palliative care training in an inpatient hospital based hospice unit. On his return to Israel he continued, as a geriatrician, to be involved in palliative care, both in the nursing home system and in his work in internal medicine in one of the hospitals:
‘Mali [Szlaifer] approached me and said, “Would I like to come and help out, because she knew of my interest in setting up the home hospice unit?” Then I joined the Israeli Palliative Care Association and from there things began rolling very quickly and I became very involved, both on a local level setting up the services here, a lot of education, and on a national level meeting people, getting to know the system. Over the last few years we’ve been working in parallel lanes: one is the local hospice here and the other on a national level. I have to devote much of my time to the national level, setting up, getting to know people, bringing people together, setting up these big annual conferences, and also working on a regional level. When I went to work in Poria at the Geriatrics Department, originally there was an inpatient unit there which was a more skilled nursing facility, but I managed to get education for the nurses there, so until it was closed down a year ago all the terminally ill patients at Poria were moved over to my department; and we’ve got good staff over there. I’ve been involved with the EAPC from 2001 or so, we’ve had the poster, then I had some more posters, in The Hague I gave a lecture on palliative care and dementia. A lot of the work is devoted to the national level kind of stuff in order to promote palliative care on a national level. I’m very active in the Education Committee and the Health Services Committee, teach a lot, but also try to get involved as much as I can in doing true clinical care. In the kibbutz which I live in we had a couple of patients die at home. I wish I could have more time and devote more of my time to palliative care, which I don’t do enough. I could do more but these are the limits which I have.’141
Mali Szlaifer – Chair of IAPC and hospice director Milton and Lois Shiffman Home Hospice in the Valleys: interviewed by Amanda Bingley, 9 May 2005. Length of interview: 2 hrs 20 minutes
 Mali Szlaifer talks about the history of her involvement in the Israel Association for Palliative Care (IAPC) and her election as chair of the association. She describes her work in the largest of Israel’s health insurers Clalit Health Services, where as a trained nurse and regional nurse manager she organises the provision of nursing services for patients at home with chronic illness. She relates how in the course of this work she became acutely aware of the needs of patients at the end of life and decided in 1999 to set up a palliative home care service. Drawing on her considerable management experience she negotiated with Clalit to fund the service and called on another IAPC board member and local geriatrician Dr Amitai Oberman to join her in establishing the home hospice. She talks about her determination to create opportunities in developing her own and her colleagues’ knowledge and skills in palliative care through links with healthcare professionals in organisations in Israel and overseas. She describes her research and evaluation work in home care and her enthusiasm in developing the IAPC educational programmes.
Hospice Team Interviews
Ina and Jack Kay, Hadassah, Mt Scopus
Team interviewed by Amanda Bingley, 4 May 2005. Length of interview: 2 hours 7 minutes
Ruth Gassner – co-founder and director.
Ruth talks about her long history with the hospice, as co-founder and director since the start in 1986. She trained in paediatric nursing specialising in paediatric oncology before she became involved in establishing the hospice. She describes how the renovation of the building and the setting up of the hospice was funded by American benefactors; the Kay family and then she had to find staff:
‘I started to recruit some staff, and I did it on my own intuition. I didn’t know what I want; I just knew that I wanted good people. What is good I don’t know - now I know, then I didn’t know. I made a few mistakes: I don’t think too many, but a few mistakes I made. Those that weren’t so good left, but very small number of people. Most of the staff which is working here in the hospice are people that started with me in ’86.’
She talks about how the team has developed ways to best support patients and families and relates some of the challenges they have faced in their work within the inpatient hospice and in the community.
Dr Daniel Azoulay - physician.
Daniel Azoulay describes his work at the hospice, the ethos of the care, and how he came to work there. He explains that he was practising general medicine in France and came to Israel to train in internal medicine. He began to work in geriatric medicine which started his interest in palliative care. Around 10 years ago he was asked to take the position as hospice physician in addition to his geriatric work at Mt Scopus hospital. He discusses his dedication to working in palliative care, his enthusiasm for teaching and training other health professionals and his involvement in seminars and conferences nationally and internationally.
Malka Yehezkel - social worker.
Malka explains that she has worked at the hospice for around 16 years, following community social work. She relates the story of her introduction to the hospice:
‘I was working in the community, I had a patient that I felt maybe should be in hospice and I asked the family and they were interested; her son was a doctor, and her daughter was a social worker. We got in touch. It was a good relationship with the patient … it was the first time I talked to someone about death and hospice - and I asked her what she thinks about it, and she said, ‘I feel I need it’. And then I talked to the family and I called Ruthie [Ruth Gassner] and the patient was hospitalised here. I came to visit once ...she was only here a few days; I came to visit only once. It was a time that I thought I need a change, a different kind of work in my profession, and it was the first convention of the hospice, three years after the hospice was opened, and you invited me to come. The first social worker, she said in front of everyone that the hospice is looking for a social worker to the home care, and I came to talk to her and I said I feel I want to be in the inpatient unit at the beginning, and that’s how it started.’
She talks about the importance of how the team support each other and how much she loves her work.
Judy Yoran - home care social worker.
Judy talks about her work in the home care and the family support offered by the service. She explains how the work changes and presents different challenges, which reflect the ways communities and cultural groups have had to change in the face of the conflict.
Helen Englesberg - home care nurse.
Helen talks about how she came to be one of the first nurses recruited to the hospice when it opened. She started nursing in London and was working in oncology before she was unexpectedly introduced to palliative care:
‘I’d met Cicely Saunders many years ago when I was in London. I went to the Royal Free Hospital to visit a friend, and I’m looking at the noticeboard, I was working in oncology, and I see [there was a] Cicely Saunders’ lecture; [I thought] that sounds interesting. I went to the lecture and I just fell in love with this whole idea. I said this is wonderful, this is what we need, this was in 1975, something like that. And then [Cicely Saunders] came to Israel and she came to Hadassah, she gave a lecture and I went to the lecture, and again I said this is wonderful and I was full of it all. And the years went by and I’m not in oncology any more, and I’m reading the Jerusalem Post one day and I suddenly see ‘Hadassah Medical Organisation ... opening a hospice ... contact Ruth Gassner’ so immediately I called Ruth Gassner. We arranged a meeting, she said ‘I’ll meet you, come to the hospice,’ and she told me how to get to here, and she met me at the door. The place was empty, there was no furniture, I think there were a few chairs in here, and we sat. I remember exactly, we sat over here on those brown chairs, just a few chairs. We sat together and we talked and I told Ruthie about my history, she told me her history and I think I was one of the first nurses probably to be employed here actually.’
Jerusalem Home Hospital
Team interviewed by Amanda Bingley, 3 May 2005.
Length of interview: 1 hour 9 minutes
Dr Jeremy Jacobs, geriatrician and medical director, Dr Ora Rosengarten, consultant in palliative medicine, Yonat Lamed, specialist oncology palliative nurse supervisor, Timna Zistling, head nurse.
Jeremy Jacobs leads the team discussion about the work of the Home Hospital and how the service is managed and organised. He describes the flexible approach they have developed in order to be able to care for patients with a range of complex illnesses. He explains some of the history of the service and how, because the service is run by the HMO Clalit, they have had pay to particular attention to balancing economics with providing good care for a large number of patients. Ora Rosengarten, Yonat Lamed and Timna Zistling describe some of the situations and challenges of bringing hospital type care into the home with a wide range of patients. They talk about the importance of helping to reduce the physical, mental and emotional suffering for people at the end of life and how they try to do everything needed for the patient; offering such a wide ranging home care service enables them to support many people to stay at home who would otherwise die in hospital. They sometimes have to deal with difficult ethical dilemmas but have proved the service to be both efficient and welcomed by patients and families.
Yonat Lamed explains:
‘I started to work here something like nine years ago and today it seems so different from since I started. You know, at the beginning when I called a doctor and I said, ‘Well maybe we do that,’ and he was shocked, I mean, ‘Who you are? A nurse?’ and today we just work together, it’s really a team and we advise each other and the doctors know that I know palliative care maybe more than many of them and they are willing to hear advice etc and we just work as a team. You do need an oncology nurse who is palliative care oriented, you know, to be able to do it.’
Dr Ora Rosengarten confirms the importance of the commitment of those dedicated to palliative care:
‘If you look at the doctors, really it’s something that’s very special, I think; like we have a surgeon in the service that’s giving palliative care today: I think you can take a lot of oncologists who could learn from him how to deal with patients with their last days of life, really. They’re really dedicated and devoted, they’re devoted, it’s more than dedicated, they’re devoted.’
Nancy Caroline Hospice of the Upper Galilee (HUG)
Team interviewed by Amanda Bingley, 9 May 2005. Length: 2 hrs 3 minutes
Dr Jim Shalom - medical director.
Jim Shalom talks about his involvement in palliative care and he also relates the story of Nancy Caroline, in whose memory the hospice is named; she was an influential physician in palliative care before her untimely death in December 2002:
‘Nancy grew up in Boston, USA and from a very young age she knew that she wanted to be a physician, studying at Harvard. She got involved early on in her career in emergency medicine, and set up an educational programme for paramedics and wrote a handbook called Emergency care in the streets. The paramedic programme became nationwide and then was basically exported, certainly Israel uses paramedics and Canada uses [them] and other places. She came to Israel and started working with the Israeli Red Cross, which is called Magen David Adom, as the medical director, and found out that they were corrupt. Eventually some of the people were exposed and had to resign and she left and settled in Metula, Upper Galilee, and she continued to do emergency care. At some point a physician friend of hers had terminal cancer, she was working during the last month and she found herself helpless not being able to help him. And that sort of caused her to change: she declared that she would never let that happen again, and she started going down to Tel Hashomer which is one of Israel’s big hospitals and studied oncology for 4 years. Then she met Alex Waller, (head of the Tel Hashomer Hospice) and started studying; going down to the hospice there. She got very interested and learnt the subject well and she co-wrote a textbook of palliative of care with Alex Waller, based on their experience.
Then she decided to set up a hospice and that’s where I met her. She tried to persuade me that the Upper Galilee needed a hospice. I said, ‘Nancy, you know, I’ve worked in palliative care in semi-rural Canada, and when I came here I was surprised at how antiquated things were; their hesitation about using opiates, the idea of not treating people at home or, if they’re treated in hospital all the very basic stuff, but that’s just the way it is here. Because when I was working that’s not only how the hospital practised but the families, that’s what they expected: ‘They’re gonna give my father narcotics! I mean, he’ll become addicted to it.’ He’s gonna die in three days.
So I said [to Nancy], ‘You don’t have to persuade me, I just don’t think that you’ll be able to get through the red tape.’ Well she did and she set things up and she had this way of getting people to agree with her. You could argue with her but it didn’t help because she always had the arguments to justify. But when I took over as the administrator it was a little bit intimidating and she didn’t interfere at all, nothing, absolutely nothing. There was a period of about, I took over in October 2001 and she died December 2002 - never once did she have a word of criticism. She was just helpful and supportive in any way that she could be. And then we took care of her.’
Yael Bleich – specialist oncology nurse.
Yael Bleich describes how she became involved in this work at HUG 9 years ago:
'I met Nancy Caroline at 1996. I first went on the oncology nursing course, a postgraduate course for one year. Then Nancy invited me to meet her and to see if I would work with her. She was the hospice [at that time], she did everything there; doctor, nursing, secretary, driver. She treated about, say, five, six patients at a time. I started to work with her and it was only two days a week, but more and more I left everything else and I did this work. Between all this more and more families and physicians and nurses, started to ask us come to see the patient: and it grew and grew, and one more doctor came, Dr Marianne, and then one more nurse, another American doctor, and then Nanny got sick and Dr Shalom started work. Now we are about 10 or 11 people.'
Yael discusses the way the team works to resolve pain relief and symptom control in collaboration with the oncology department, always with the aim to connect sensitively to a patient’s individual needs. Where appropriate, Yael will bring in the expertise of the team art and music therapists (Leila and Adira) to support a person’s journey at the end of life.
Dr Eyal Goldberger – physician and homeopath.
Eyal Goldberger describes how his interest developed in homeopathy and palliative care:
After I finished my internship, I was interested in oncology and especially as a student I was always seeing the old patients, if nobody wanted to see them myself, I was not afraid of the real people. So when we had the opportunity to do the one year course included two or three months in the department that you are interested in, so I went to the hospice in Tel Hashomer for one month and then after the course for a one year I was mainly in charge of the home hospice, but also working in the department. They asked what was a young doctor at the beginning of his career doing with people at the end of their career? But it was a very, very important experience for me. Then I did an officer course as a medical doctor with the army, and then the Gulf War began. Afterwards I went to England to study homeopathy at the Royal Homeopathic Hospital. Even in the army I was interested in complementary medicine. For almost ten years I left the palliative field and was doing mainly homeopathy, teaching and working here [in a hospital]. Then my father-in-law had cancer: at the end of his life I arranged for him to go to Tel Hashomer, and I spent the last two weeks of his life with him there. I met people that I knew ten years ago. I said, ‘When I go back I must check what’s happening in palliative medicine in the north.’ A week later I had a message on my answering machine from Niva - she’s the psychologist - that I should call her urgently connected to Hospice of the Upper Galilee, which I never heard before. I said what a coincidence. So since then ... and then I was in a kind of a turning point, I had to decide to start a new job in somewhere else or I was ... and I was ready to go into it. I heard of Nancy just through the emergency part, I read her book in the Army, I was teaching paramedics in the Army. I began to work, it didn’t take me long to get, to go back to things, even though ten years away, and I started to work. Very quickly it became the main thing that I am doing so basically I am, I got, cut down my homeopathy but in this last two years I had to see how homeopathy is going in the world, I attend lot of seminars here in Israel, so it was a good time to do some kind of change. I enjoy the work. At first I was not religious and going to homeopathy from orthodox medicine, I also, through a long process of spiritual searching which were all over many other fields so I became religious here. And here, when I work, everything that I did in the past, it was as if it is connected, it’s all going to the same - the orthodox medicine, homeopathy, the spiritual part, a new age movement that I was in - all the things that I am doing, there’s a lot of field to develop. So, basically, there’s not enough time, but I have a few plans for research I think with the oncology, things to combine homeopathy with. I have many ideas but not the time to check it right now. I enjoy very much seeing the patient in their home, not in a clinic, see where they live and how they thought, and the team is a very, very excellent... I think the potential is very big for things in the future in many fields.’
Yaniv Ben-Shoshan – social worker and family therapist.
Yaniv Ben-Shoshan talks about how he became involved in palliative care and how this experience enriches his work at HUG:
‘When my daughter was six years old she was sick of cancer for one year, and received chemotherapy in Haifa Hospital. Ten years after, when I work with our hospice patients, I bring with me not only my experience of my work, but also the family, own family experience.’
He explains the importance of the way the team works, where each member is an integral part and can refer to the other in any way that best supports the patient and the family.
Negev Palliative Care Services, Beersheva
Professor Pesach Shvartzman: paediatric oncologist and head of division: interviewed with Dr Yoram Singer by Amanda Bingley, 5 May 2005. Length of interview: 45 minutes
Professor Pesach talks about his palliative medicine research work, specialising in paediatrics and his role in setting up the first hospice services in Beersheba. He is trained in family medicine and this led into his interest in palliative care:
‘When you look at palliative care and it’s actually very close to the way that family medicine works and actually I think if you look at the UK, a lot of GPs are involved in palliative care. It’s not just by chance, I think that the way of thinking, the way of looking at patients and not at diseases, the way of looking at the context of families, the way of not seeing the fact that you cannot cure everything as our own failure, but just as a fact that medicine cannot cure everything and just to recognise the fact that people die, and they will die. So I think that the way of thinking is not far off and actually I felt that probably it is actually pretty neglected in - not in the UK, but the UK is an exception I think - UK, Australia, Canada, the States, and probably that’s it, New Zealand maybe - but if you look at our country we have still a far way to go.’
He explains that he did some training in Canada with Balfour Mount at McGill University and conducts a research programme as part of his own work as a Professor in the Faculty of Medical Science at Ben-Gurion University of the Negev. He is also involved in training in paediatric palliative care.
Dr Yoram Singer, medical director: interviewed with Professor Pesach Shvartzman by Amanda Bingley, 5 May 2005. Length of interview: 45 minutes. Interviewed individually: 1 hour 10 minutes
 Yoram Singer describes his commitment to palliative medicine and his diverse experience in Africa, where he was involved in setting up effective community medicine projects; and in Israel as a community and family practitioner before he became involved in developing the service at Negev. He talks about how the service is organised and some of the extraordinary generosity of benefactors and the ways in which he has managed to raise the profile of palliative care by working sensitively with multi-cultural communities in remote parts of the country. He explains how his previous work has both enriched and inspired the ways he and his colleagues are developing the service:
Dr Alexander Waller - medical director: interviewed by Amanda Bingley, 8 May 2005
 Alex Waller discusses the ways in which Israel has developed a hospice and palliative care service that is on a par with Europe. He talks about the early history of Tel Hashomer and the importance of the hospice in starting to raise awareness of palliative care and in encouraging the education of health professionals.
He describes how Tel Hashomer influenced others, stimulating the opening of new hospices around the country. He explains his interest in education and the importance of exploring ways to improve the practice of palliative care, for example, the development of a multi-disciplinary hospice team that aims to address needs of the patient.
Dr Michaela Bercovitch - physician and researcher: interviewed by Amanda Bingley, 1 May 2005.
 Michaela Bercovitch describes how she joined the hospice in 1991 having arrived from Romania in 1987. She writes that from a background of great personal tragedy she was at first unsure that she could work in palliative medicine. However, during her work in the Rehabilitation Geriatric department at Chaim Sheba she completed a six month residency at Tel Hashomer Hospice and was subsequently inspired to take up a permanent post in the hospice as inpatient physician. She describes how much she learns about palliative care from the many patients she has cared for as a physician. She talks about how the hospice is organised and her role as researcher, physician and palliative care consultant in the department of gynae-oncology . She has seen the hospice through many changes, most recently the move to the new purpose built unit, and she talks about some the challenges they face as a unit and in the hospice movement. She writes about her involvement in developing and teaching palliative care training, and her work with the Israel Palliative Medical Society.
Tamie Goan, nurse, home care service: interviewed by Amanda Bingley, 1 May 2005
Tamie Goan explains how she became interested in palliative care when she was a dietician in a dialysis unit and went on to train in nursing, specialising in oncology nursing. She now organises the nursing in the home care service.
Sarah Rimer, social worker: interviewed by Amanda Bingley, 1 May 2005
Sarah Rimer joined the hospice as a part time social worker for the inpatient unit. She talks about her interest in palliative care and her commitment to work with patients and families.
Shulamith Werner - physiotherapist: interviewed by Amanda Bingley, 1 May 2005
Shulamith Werner, retired from her position as Head of the Physiotherapy School, Tel Aviv University, where she was also a lecturer in physiotherapy. She talks about her lifetime of experience as a physiotherapist and how she enjoys her part time work at the inpatient hospice. She describes her dedication in supporting patients at the end of life and the ways she can help to improve their quality of life.
Kiryat Tivon Home Hospice
Dr Ora Cibulski, sociologist and gerontologist, co-founder of the hospice and co-founder and retired chair of the Israel Association of Palliative Care: interviewed by Amanda Bingley, 12 May 2005. Length of interview: 1 hour 13 minutes
Ora Cibulski describes her involvement and motivation in setting up the home hospice at Tivon. She was born in the USA and had trained as a sociologist and became increasingly interested in gerontology. She was inspired to work in some way in palliative care following the experience of watching a close friend and also family members die from cancer and realising that there was no real support for them. Gathering other interested people; physicians, nurses, social workers she set out to establish the home care service in 1984 and also in 1993 to set up the Israel Association of Palliative Care, of which she was the first chair, retiring in 2002:
‘In order to build the organisation I went to the library, I looked for all the research on palliative care. By training I am a sociologist/anthropologist and then I went into gerontology and so today I call myself a gerontologist. OK? And I’m used to doing research because that’s what we do. There were four or five books altogether on hospice at the time, or anything to do with hospice: and there were journal articles. An important book for me described how these people wanted to introduce palliative care into their hospital in the United States. They made this wonderful plan to change the whole hospital and put palliative care in every department. They worked for a year but in the planning they had not included the people who were supposed to use the service, and they were completely ignored and thrown out of the departments. Well that told me something. It meant that everything we did, every step of the way, we had to explain to the people who would have to provide services and include in the planned provision. The initial reaction of local physicians, the Ministry of Health and the Ministry of Social Services was that we were slightly mad: palliative care was neither medicine nor social services. However we were very persuasive.
I’m always talking in the plural for the very simple reason that we were four or five people who did this work consistently. We added a young psychiatrist; we thought the psychiatrist would be for the patients, in the end he was actually for the team. Because for all of us this was something new, dealing with death, immediate death, how do we handle it? … I’m not a physician, I’m not a social worker, I’m not a nurse, and I’m not any of the direct disciplines of palliative care. I always was in the position of learning the material. What I would do is I’d learn it, and I’d and I’d ask the nurse or physician, ‘Would you say this was this way?’ and they would correct me, ‘Would you say this was that way?’ So it turned out that I could develop a general plan for developing training programs and palliative care services in Israel. I wasn’t being paid by anyone. OK? So that was my great advantage, that I could say exactly what I think and without anyone feeling attacked or competing or anything of that sort, and very long time ago I learned anything that had to do with a patient, I just put aside my ego.’
Dr Netta Bentur, sociologist, academic health research, Myers – JDC, Brookdale Institute, Jerusalem: interview by Amanda Bingley, 3 May 2005. Length of interview: 1 hour 4 minutes
Netta Bentur talks about her work in academic health research and how she has specialised in research in palliative care; mapping services and exploring patient and caregiver experiences of care, pain relief and symptom control. She co-authored a report on service provision in Israel in 2004, which included looking at different models and systems by which palliative care is provided.142
Miryam Morganstern, homeopath and trainee spiritual counsellor, Cancer Pain and Palliative Medicine Service, Sha’are Zedek Medical Centre, Jerusalem: interviewed by Amanda Bingley, 7 May 2005. Length of interview: 1 hour 10 minutes
Miryam Morganstern is currently training in spiritual counselling. She talks about her background in education and psychology, going on to train and for the last 13 years to practice as a professional homeopath. She discusses how important palliative care work is for her, and the extraordinary lessons in compassion she has learned in the course of her professional work as a homeopath emphasised in her current work as a trainee spiritual counsellor at Sha’are Zedek.
Dr Shlomith Perry, social worker, Beilinson Oncology Unit, Rabin Medical Centre, Tel Aviv, Head of the Psycho-Oncology Society, Israel: interviewed by Amanda Bingley, 1 May 2005. Length of interview: 55 minutes
Shlomith Perry talks about her supportive and palliative care work as a social worker with patients in the oncology unit. She completed her doctorate in genetic counselling for women with breast cancer and has a particular interest in work which addresses these kinds of ethical dilemmas for cancer patients, especially those patients who have a poor prognosis:
‘At the beginning, I thought that we should stop all the DNA testing. At the end, I’ve realized that people can manage it, and we have to be with them all the way and they can decide very good decisions, but the medical system has to be with them, not to make the tests and go back, but to be involved in the decision. So after I finished the Ph.D. we opened clinics for high-risk women, this was the fruit of my Ph.D. We opened [clinics] here in the hospital for follow-up.’
She explains that her work in palliative care is due to increase as the new Davidoff Centre opens and they plan to have a dedicated palliative care consultant and team. She is head of the psycho-oncology society in Israel and actively involved in developing support for children at the end of life and their bereaved parents, and also in encouraging psycho-social support and education for patients.
Professor Michael Silbermann, director of the Middle East Cancer Consortium (MECC): interviewed by Amanda Bingley at Haifa, Israel, 10 May 2005. Length of interview: 1 hour 3 minutes
Professor Silbermann talks about his role in developing the work of MECC and the original aims and objectives of the organisation to promote a standardised cancer registry in member countries in order to develop effective cancer control programmes. He describes how, since 2004, MECC has started to address the palliative care needs in member countries, funding health professionals to attend training seminars and setting up ‘train the trainer’ courses nationally and internationally. Professor Silbermann explains that he is a surgeon and served as the Chief Scientist for the Ministry of Health in Israel. He talks about his own increasing interest in palliative care, and his involvement at the Italian Hospital, Haifa who now have developed their palliative care services and run a hospital-based unit, where the patient is cared for physically and emotionally:
‘What impresses me most there is really the attitude of the staff - most of them are nursing sisters, nuns - to the patient; that is just amazing. I’m so impressed, you know, they sit with the patients on their own initiative, the patient doesn’t have to ring and ring and ‘please come and do ...’ - they come and they say ‘How are you doing? Can we do something for you?’ I mean, many of the cancer patients, many are lonely, so being alone and being a patient that is close to die, that’s a very, very unpleasant situation. So if somebody bothers to come and sit with you and puts his hand on you and asks ‘How are you feeling today? Can I do something for you?’ and this ... this is I think a big, big thing. And I was there and I visit there quite often, just to see what’s going on. And I think this will be one of the topics that we are going to really emphasise … and palliative care would eventually become one of the very most important issues that MECC will be involved in.’
Professor Abraham Steinberg, Centre for Medical Ethics, The Hebrew University-Hadassah Medical School, Jerusalem: interviewed by Amanda Bingley, 4 May 2005. Length of interview: 47 minutes
Rabbi Steinberg discusses his work in medical ethics as chair of the Steinberg Committee which debated the formulation of a law for the dying patient for which legislation was passed in late 2005. The law addresses end of life issues, including instituting statutory provision of palliative care, and legislation on euthanasia and assisted suicide. He describes the political, religious, medical and humanitarian aspects of the debate and concludes that the law must adhere to moral principles, and although this may not be perfect for everyone, for example those in extreme, intractable situations, the important point is that the law proves workable and acceptable for the greatest number of people. |
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