The medical system is broken after all

I have often bragged about how great the medical system here is in Israel. There’s no problem with people not being able to get insurance and care is on a very high level. For regular doctor visits, I’ve never had to wait more than a day or two for an appointment, and there are drop in hours every morning at the clinic where my physician works.

All that efficiency was for routine care, however. When you need to see a specialist, that’s when trouble sets in. And, recently, we’ve run quite afoul of the system.

My daughter, Merav, fell over the summer and hurt her knee. Her family doctor thought it was an inflammation and sent her for physical therapy. But the first appointment she could get through Maccabi, our HMO, wasn’t for two months. And going privately is upwards of $100 a session, so not a good long-term option.

Over the course of the waiting for physical therapy, her knee grew steadily worse. She went back to her family doctor who, this time, gave her a referral to an orthopedist. She got in there pretty quickly – only two weeks this time – and he sent her for a bone scan which determined that she had a torn meniscus which needed surgery.

But first she had to go back to the orthopedist to get a referral to a knee specialist. Problem: he was busy and Merav’s knee was really hurting now and also preventing her from participating in activities at her mechina (see my previous post on what that is).

The next available appointment with a knee specialist at Hadassah Hospital (which works tightly with our HMO): another two months. So we called around and found an appointment sooner at a different hospital. They needed a bunch of paperwork from the HMO, which can only be done by fax (hey – medical institutions: ever hear of the Internet?)

But we did it and arrived at Sha’arei Tzedek Hospital for an 8:20 AM appointment. We figured it was one of the first of the day so we should be out pretty quickly. But the knee doctor wasn’t there yet. “I don’t know why they book these appointments so early,” the secretary said with unsurprisingly Israeli brusqueness. “They always do their rounds at this time.”

But after an hour of waiting, I was getting concerned so I braved the secretary’s scorn and asked again. Turns out that the doctor was called into emergency surgery. They were waiting for a replacement. It would have been nice if they had told us (especially since now the waiting room was now quite full). When would the replacement arrive? No one had any idea.


Train construction ahead

The fast train tunnel under construction

When our kids were young, we had a videotape they used to love called “Road Construction Ahead” which was all about, well, road construction. It featured hard hats, tractors and lots of concrete.

The truth is, I loved it too – I’m a nut when it comes to anything in the stages of being built – highways, bridges, airports. So, when the annual Jerusalem-area “Houses from Within” event featured a tour of one of the tunnels currently being dug out for the fast train line from Jerusalem to Tel Aviv, there was no question I’d be there.

Houses from Within began in 2007 with the aim of allowing Jerusalemites to peek inside beautiful houses that would normally be for the enjoyment of their owners only. The two-day event has expanded to include more than 100 homes as well public facilities (you can tour City Hall or the Jewish Agency), educational institutions (check out Beit Avi Chai or the Mormon Center on the Mount of Olives), museums, churches, hotels (a boutique inn in Ein Kerem, the half built Palace Hotel) and now, apparently, train tunnels (that fits the description of “within” though they’re not exactly a house).

The fast train, which will zip between Israel’s two largest cities in an astounding 28 minutes (compare that with the current train which clocks in at nearly two hours), has been an engineering challenge to say the least, and includes five tunnels in total. We were allowed entrance to Tunnel 3A, the second to last tunnel on the way into Jerusalem.

9-11 Memorial outside Jerusalem

The tunnel is located adjacent to a little known monument memorializing the 9/11 attacks in New York, perched on a hill in the middle of nowhere (the murky directions towards the site called for us to go “straight at the T Junction”).

Once inside the construction fence, we walked into one of two 820-meter long tunnels. The ground was still rough (the rails won’t be laid until much later) and the makeshift fluorescent lights on either side reminded me of a Dr. Who episode that scared the dickens out of me when I was ten.

There are two tunnels to handle trains going in each direction. Why not save money and bore only a single tunnel? Two tunnels make it safer in case of a disaster and would allow the trains to keep running, our engineer and tour guide Sagi told us. While he explained that he was referring to a fire, living in Israel, it was hard not to think about the possibility of a terror attack as well.

Another Israeli aspect to the tour: the Houses from Within program stated that only 20 people would be let into the tunnels at a time, and they’d have to wear hard hats and reflective vests. But Sagi took about 50 of us in and there were two similarly sized groups already inside. No helmets, vests or waivers in case a boulder fell on someone’s head (none did).

Near the end of the tour, one of the participants asked whether the fast train’s construction (due to be completed in 2017) would be finished before the still-delayed Jerusalem light rail is fully functional. “Without a doubt,” Sagi quipped.

Whether that turns out to be the case, I’ll be the first in line to book my ticket. And when we pass through Tunnel 3A, I’ll be able to tell my grandchildren I was there.


Toilets here and there

Fortunately in Israel, we have nicer bathrooms than this one in Nepal

Abby Leichman has written one of the most off-beat and yet voyeuristically engaging Top Ten Lists I’ve read in a while on Israel21c. It’s a compilation of the best public toilets in Jerusalem. Now, while such a grouping is necessarily gender subjective at best (after all, Abby couldn’t visit the men’s side of her chosen bathrooms), it still represents an alternative eye into Israeli society.

I have to admit that moving to Israel has brought up my own fascination with public facilities. On the one hand, it’s the often-lacking comparison with the luxury of North America. I remember a month back, when my mother came to visit Israel for the first time, she was decidedly less than enamored of the old school gas station toilets (the ones out back, around the side of the station, not the newer “lavish” facilities inside the mini-mart).

Still, she has nothing to complain about. A few years ago, I was driving with the family from San Diego to Los Angeles at 3:00 AM to catch an early morning flight from LAX back to Israel. We needed to use the restroom, so we stopped at a gas station. “Sorry, it’s out of order,” the not particularly interested clerk mumbled. We got back on the highway but the next station we pulled into also had a toilet that mysteriously was “being cleaned” (there were no cleaning supplies nearby). After the same thing happened another couple of times, I got the message and found a bush in back of a Denny’s (which apparently wasn’t one of the 24-7 restaurants I remember from my youth). Bottom line: I’ll take stinky Israel over non-available America any day.

An outdoor bathroom in the Serengeti

It’s also hard not to appreciate the lowly Israeli facility after traveling in the third world. Most Israeli toilets flush; they usually have seats (other than a few in the Old City, squatters are a rarity in Israel); any bad smells tend more to the urine spectrum (don’t even think about the other side!); and these days you can even find toilet paper and soap.

Here’s one more praise for the Israeli restroom: very frequently, the walls for your stall go all the way to the floor, so that you’re actually in your own separate room. Nearly uniformly (and especially at hotels and airports), North American public toilets have short knee-length dividers between stalls so that you are forced to see your neighbor’s shiny shoes wiggling around (not to mention the uncomfortable audio feedback).

So, thanks Abby, for bringing to light the unseen heroes of the Israeli toilet. If you want to go even deeper into the bowels of the public facilities, visit the user-generated toilet site, which has literally thousands of photos of the fabled stand up facility from all over the world (I particularly liked the one from the Mir Space Station).


Sunk costs on the road to Tel Aviv

Traffic along the Ayalon Highway

The evening was intended to be a gala celebration of the partnership between Tel Aviv and Los Angeles. 400 Angelenos, in Israel on a Federation mission, along with another several hundred local Anglos of Angeleno-descent, filled the Smolarz Hall on the Tel Aviv University campus. There was a program planned with glamorous entertainment: opera, performance art, modern dance and drumming, all emcee’d by the aging master of kitsch Haim Topol who, without any coaching, it was rumored would be belting out “Sunrise Sunset” in full Tevye voice.

My wife Jody, who grew up from Los Angeles, scored us a pair of tickets. It sounded like a worthwhile way to spend a few hours. But the traffic gods deemed otherwise.

The event had a 5:00 PM starting time, which is already pushing it, throwing commuters into the worst of the Tel Aviv rush hour. But our back up started even earlier: just getting out of Jerusalem took us close to an hour.

But sometimes, long rides can be serendipitous. At about 40 minutes into the ride, the radio program we were listening to began a discussion on “The Upside of Quitting.” The host’s talking point was that, when evaluating a situation – whether it’s a job, a marriage, or in our case the traffic – there are both “sunk costs” and “opportunity costs,” and both play a big role in when and whether to call it quits.

A quick economics lesson: “sunk costs” are the time, money, and more intangible commitments we’ve made to a particular project that keep us from wanting to abandon it…even if we know in our hearts it’s not the right thing. “Opportunity costs” are those things you could be doing with your time if you weren’t sinking it into the wrong activity.

I have experience with both – in 2001, for example, I took a job at a large hi-tech company. My position was esoteric and brand new; only the CEO really knew what was expected of me. He quit two days after I started. I intuitively knew I should too, but I had already accepted the job, turned down other offers, received a company car. Mentally I was “sunk.” As expected, without my patron, the job became a never-ending hell and I wound up, entirely through my fault, losing almost three years in “opportunity costs.”

Jody and I turned to each other as we listened to the program. We had sunk costs now of just under an hour. We had another hour (at least) until we got to Tel Aviv, plus a similar amount of time back. Was now the time to quit?

But we didn’t. We were too far committed. And the “opportunity” was too intangible (another night of catching up on emails?)

We arrived in Tel Aviv two and a quarter hours after we set out. We missed the reception (and what looked on the other participants’ plates to have been some very yummy food) and got the cheap seats for the show. Haim Topol seemed to be running on autopilot, exuding the enthusiasm of peasant who’d delivered way too much milk. The opera singers were proficient (and sexy, as seems to be the requirement for 21st century classical performers), but neither Jody nor I like opera much. The drumming, which included synchronized banging on steel drums with flaming baton sticks, was excellent, however.

In his introductory words to the event, Tel Aviv mayor Ron Huldai lauded the partnership between his city and Los Angeles. It was logical that the two cities were twinned, he said. Both have an emphasis on the entertainment industry; there are stellar beaches; and probably about as many Israelis in both cities. But the biggest commonality? The traffic, he quipped.

With sunk costs like those, who needs opportunities?


Art in Umm el-Fahem

Ammar Younis has an exhibit at the Umm el-Fahem Art Gallery

We visited one of Israel’s most unusual museums last week. The Umm el-Fahem Art Gallery, in the Israeli Arab town of the same name, is a small gem, way off the usual museum track, and absolutely worth the visit if you’re traveling between Tel Aviv and the Sea of Galilee…and even if you’re not.

The Gallery houses several rotating exhibitions and a permanent floor exploring the history of Umm el-Fahem and the greater Wadi Ara environs. The Gallery’s aim is to bring contemporary art of all types – not just from Arab and Palestinian artists – to an area that has been mostly devoid of museums of this kind.

To wit, the current exhibitions include a series of striking portraits of men and women from Arab villages, adorned by jewels and beads glued on top of the paintings themselves, by artist Fatma Abu Rumi; impressionistic images of cityscapes from the Former Soviet Union by Nidal Gabarin, who left Israel to train in Russia; a collection of large framed photographs from Ammar Younis, all of which prominently feature donkeys in often amusing settings; and a playful exhibition of ceramic sculptures by Jewish artist Rafi Munz which adorn the Gallery’s rooftop, overlooking the sprawling town with its 50,000 inhabitants.

The Gallery’s biggest claim to fame, perhaps, was the 1999 exhibition of Yoko Ono’s “Open Window.”

We visited the Art Gallery with a group of 30 other Jerusalemites and were hosted by 55-year-old Said Abu-Shakra, the gallery’s founder and director who is an artist himself and a former policeman. He laid out his vision for the future of art in Umm el-Fahem.

The Art Gallery was founded in 1996 in a 100 square meter space. A few years ago, it moved to its current location with 1,500 meters on three floors. Abu-Shakra has commissioned plans that will expand the gallery again in a stunning architectural design that will hang over the Umm el-Fahem’s main street.

Local residents don’t tend to visit art galleries, Abu-Shakra told the group. So the design will force people to pass under the building, coming at least into proximity to the gallery. Abu-Shakra hopes that some of those transversing the town will eventually stop and visit the gallery itself.

“We knew the cultural situation in Umm el-Fahem and most of the Arab sector was close to zero,” Abu-Shakra said in an interview with Arieh O’Sullivan earlier this year. “But I’m not blaming anyone. I’m here to build.”

Abu-Shakra provided an example in an interview with Hadassah Magazine. He invited his neighbor Yousef, a gardener, to the opening, he explained. “The next day I saw him and said ‘Hey Yousef, why didn’t you come?’ And Yousef said: ‘I did come, with my two sons, but we stood in the door and looked in and when I saw all those fancy people inside with suits and ties, I looked at myself and said, this isn’t for me, and I went home.’ Yousef represents 80 percent of the people here. My challenge is how to reach these people and make them feel part of what we are doing.

Building won’t be cheap: the plan for the new museum, which has been allocated a 4-acre plot, requires a not insignificant $40 million to be realized. Abu-Shakra said he’s willing to build in phases.

An art gallery in Umm el-Fahem is all the more surprising given the town’s recent, violent history. In October 2000, three residents were killed by Israeli police during riots that swept through the Wadi Ara region. Then, in March 2009, members of the Israeli right marched through the town (under police protection), resulting in clashes in which 16 were wounded.

The Gallery receives some money from the Israeli Ministry of Culture, as well from donors abroad. It’s hard to raise money from the local population, Abu-Shakra said, which is struggling just to make ends meet amid severe poverty and unemployment. Some 40,000 visitors came in 2010. If Abu-Shakra has his way, that will increase dramatically.

If you like discovering the off-beat or lesser known attractions in Israel, now is the time to visit – before the Umm el-Fahem Art Gallery becomes the next big thing.