Debra L. Beck

Borderless Medicine Where Borders Really Matter

“How do you know you’re safe on a call like that?” I asked.

Ilan gave a short laugh. “That’s a very good question.”

The question had been hanging in the air during the long ride to the hospital, but I didn’t dare ask it even though I was pretty sure the patient and his mother didn’t speak English. They didn’t even speak Hebrew.

We’d been called to attend to a 5-year-old boy with autism who’d suffered a seizure, after which he was not calming or recovering. On the way with lights and sirens, Ilan told me the call was in Abu Tor. “It’s a mixed neighborhood in Jerusalem,” he mentioned.

Ilan and Shmiel were my guides for the day on a Magen David Adom (MDA) Mobile Intensive Care Unit. Both are highly-trained paramedics with years of service under their belts. I was their “ride along” that day, a medical journalist who came to see and write about the workings of MDA.

After we drove deep into Abu Tor it appeared to me the only “mixed” part of Abu Tor was us, since we were the only Jews in sight. After missing our turn the first time, our driver, Shmiel, spotted a car with flashing hazard lights driven by a young Arab man who guided us deeper into the neighborhood to where the distraught boy was.

While the paramedics were likely thinking mostly about their young patient, in the back of my mind I wondered if callers here ever make fake 911 calls or ambush ambulance crews, because certainly, if this had been a trap, we’d be defenseless and in grave danger.

When we got to the bottom of a narrow, winding residential street, the crew jumped out of the ambulance, hands heavy with equipment, and followed the young Arab man into a small, tidy schoolhouse. Still no Jews in sight, and no students either, but there were about a dozen worried men and women standing around an even more worried-looking mother and a hysterically crying boy lying on the floor. The mother was a bit older and in traditional Arab dress, but most everyone else was dressed in Western clothing.

If these people had any strong feelings for or against having Jews in their neighborhood and school, they were not apparent. In fact, it seemed to me the reactions and attitudes expressed toward the MDA crew were much the same as every other call we took that day, as was the crew’s behavior towards them. It all just seemed pretty normal.

When we got to the classroom, Ilan and Shmiel did their stuff. Their leadership skills—on every call we took that day—were admirable.

First, Ilan cleared the room. The administrator, a young woman dressed casually in jeans and a sweater, said she’d stay and translate since the boy’s mother didn’t speak Hebrew.

The paramedics assessed the boy and asked the mother to pick him up and move away from the strangers to try again to comfort him. She did and he started to calm. After a bit more talking, it was decided that they’d take them to Shaarei Tzedek Hospital so he could be evaluated by a physician.

Shaarei Tzedek Medical Center is one of the biggest hospitals in Israel, serving over 600,000 patients a year. It also has a pediatric emergency department.

During the 40-minute drive in traffic, the boy, now feeling safer and less frazzled, fell asleep on his mother’s lap.

The paramedics discussed the case a bit afterward and noted that the boy probably didn’t strictly need to go to the hospital (and our ambulance needn’t have been tied up for nearly an hour taking him), but “the mother was worried and she wanted him checked,” Ilan said with a shrug.

Although he didn’t say as much, to me it seemed he preferred to err on the side of over-generous rather than risk appearing to this Arab-Israeli woman in any way dismissive or uncaring.

Later Ilan told me that MDA responds to calls in most areas in and around Jerusalem, except for a few that the police tell them not to enter without police escort. He said that they occasionally have rocks thrown at them as they drive through neighborhoods, but that there has never been a full out (life-threatening) attack on a crew. Sometimes, when things are particularly unsettled, the police will ask to have the patient meet the ambulance at the entrance of the neighborhood.

This was my first introduction to a unique form of borderless medicine, as practiced by Magen David Adom (MDA) in Israel.

MDA is the Israel’s national Emergency Medical Services (EMS), a non-governmental organization charged by the Israeli government with a host of responsibilities: they provide EMS to Jews, Arabs and Christians (as well as anyone else) in Israel and the areas of the West bank under Israeli civil control and also assist the IDF Medical Corps in wartime. They train all paramedics in the country, participate on International Red Cross relief missions globally, and run Israel’s National Blood Bank, which collects and provides not just the usual ABO blood types, but also rare bloods types, placental and umbilical cord blood (rich in stem cells), and mother’s milk.

Contrary to popular opinion, they are not funded by the government and operate only through the generosity of donors from overseas.

My two guides for the day were mature family men, extremely capable paramedics, and, in my eyes, representative of the expansiveness and generosity that will be needed for any lasting peace to be made in Israel.

With 20% of the country’s population within the green line being Arab, and the permanent status of the West Bank and the Arabs living there still unsettled, anything less than the willingness and courage these paramedics showed to help any and all residents will leave the country in an un-ending cycle of distrust and strife.

Abu Tor wasn’t our only call that crossed borders that day. I was similarly surprised to see an Arab woman doctor attending to a patient in the Israeli West Bank settlement of Maalei Adumim. Again, there seemed to be extra deference flowing around the room, rather than any hint of hostility or prejudice.

The thing is this: It’s easy to sit in North America and think you understand Israel and its issues. And it can feel hard to resist unwittingly absorbing the world’s condemnation of “Israeli aggression” and remember that Israel is first and foremost a country just hoping to defend itself against a sea of unfriendly neighbors.

But during my MDA shift, I saw a different side of things. With all the arguments and difficulties, with their real and legitimate need to protect and defend, Israel remains an am chesed: a nation of kindness. With individuals brave and committed enough to drive with lights flashing and sirens blazing into potential danger to help a child no matter of what faith.

The experience of riding along and crossing both physical and emotional borders to provide life-preserving healthcare for a day was full of surprises and helped this North American Jew reconsider what I think I know.

About the Author
Debra L. Beck is an award-winning medical journalist who lives in Toronto.
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