As camels walked along Jerusalem’s road heading towards Jaffa on January 27, 1902, Dr. Moshe Wallach, a 36-year-old Jewish physician who had immigrated from Germany to the Land of Israel 12 years before, opened a modest new 20-bed hospital – with an outpatient clinic and pharmacy. The institution was named Shaare Zedek (“Gates of Righteousness”) Hospital, taken from a verse in Psalms.
The majestic stone building was a 20-minute donkey ride away from Jerusalem’s Old City, where most of the patients lived. Wallach, who was strictly observant and devoted to his patients but never married, bought several cows and build a shed behind the hospital to provide milk for babies and toddlers who were patients. Introducing “modern” medicine to the poor and disease-plagued city, he spoke only German or Yiddish and not Hebrew, which he regarded solely as the language of Torah study and prayer.
Desperately needing a head nurse, Wallach traveled to Germany 14 years after the opening and brought to Jerusalem the 32-year-old Selma Mayer, a tiny woman with a bun of hair on her head who also never married but lived in the hospital for the next 68 years, until her death at the age of 100. Called “Schwester” (Nurse) Selma, she was Wallach’s right-hand person in the running of the hospital.
“Jerusalem has a thousand faces – and each one of us has his own Jerusalem,” said Yitzhak Rabin, who was prime minister of Israel many years later. “My Jerusalem is Dr. Moshe Wallach of Germany, the doctor of the sick of Israel and Jerusalem, who built Shaare Zedek hospital and had his home in its courtyard so as to be close to his patients day and night. I was born in his hospital. I am a Jerusalemite.”
Today, Shaare Zedek Medical Center (SZMC) no longer exists on Jaffa Road at the Western entrance to Israel’s capital. It moved in 1979 to a 11.5-acre (47,000 square-meter) site between the neighborhoods of Bayit Vegan in the south and Ramat Beit HaKerem in the north and east of Mount Herzl.
The huge medical center –one of only 23 public general hospitals and one of just seven tertiary (advanced) medical centers in Israel – along with its Bikur Cholim branch in the town center, now has 1,000 beds and offers the most cutting-edge inpatient and outpatient services, research and medical teaching facilities available anywhere in the world. And it is constantly expanding, with a huge oncology and radiotherapy center being constructed in a recently dug hole next to the main buildings.
And amazingly, there have been only three other permanent directors-general of the hospital since Wallach retired at the age of 80. The others were Dr. Falk Schleshinger (whose grandson Prof. Yechiel Schlesinger is now head of the hospital’s pediatric branch) and New York-born Prof. David Maeir, who pushed for the construction of the new campus. All four of them have been Orthodox Jews in the spirit of the original founders.
The fourth director-general is Prof. Jonathan Halevy, who after 31 years in his post is now voluntarily retiring at the age of 71 and been named SZMC’s president; he will continue to raise money on behalf of the medical center, teach medical students, help plan its future, see patients in its liver clinic (as a gastroenterologist and liver specialist) and provide guidance to his successor, Dr. Ofer Merin.
Merin –13 years younger than Halevy who is modern Orthodox and whose brother Micha is Ashkenazi Chief Rabbi of Petah Tikva – is a trained cardiac and trauma surgeon who been at SZMC for 28 years. Handpicked by his predecessor and approved by the hospital’s board of directors despite the fact that he is not Orthodox, Merin was the hospital’s deputy director-general and has earned renown abroad as commander of the Israel Defense Forces military field hospital.
As a colonel in the IDF reserves, he has taken part and saved lives in numerous mass-casualty events abroad, including in Haiti after the 2010 earthquake, Japan following the tsunami in 2011, the Philippines after the typhoon in 2013 and Nepal after the 2015 earthquake. He also took part in the treatment of Syrian victims from that country’s civil war.
A soft-spoken physician and administrator, Merin knows that it will be a challenge to fill Halevy’s very large shoes. Charismatic and regarded as one of the best medical center administrators – and certainly the longest-serving hospital directors – in the country, Halevy has been appointed four times as chairman of the state committee that decided what medical technologies will be added to the annual basket of health services. He has also been chairman of the Israel Transplant Center, teaches students at the Hebrew University-Hadassah Medical School, headed the body that set up a new medical faculty in the city of Safed, and was recently named chairman of the board of Jerusalem’s David Yellin Teachers College.
What would Dr. Wallach and Schwester Selma say if they were alive and could walk through SZMC’s campus? “They would be amazed by the size and the technology, with which they would of course be unfamiliar,” Halevy said in an exclusive interview with the English-speaking press at Breaking Israel News. “But they would immediately recognize the compassion for which Shaare Zedek’s staff then was, and now is, well known.”
Halevy constantly says that when he chooses new hospital department heads and other senior physicians and nurses, he selects them as much for their compassion for human beings as for their professional expertise. “Being sympathetic is to encourage and provide comfort. Compassionate empathy is to go under the patient’s skin and feel what he feels.”
When MESSER, Israel’s Medical Simulation Center near Tel Aviv was opened by Prof. Amitai Ziv, Halevy sent all his departments there to learn, while being filmed, how to apologize to patients for errors, how to console bereaved families and more. “Now this is done in all Israeli hospitals,” Halevy said.
He was very emotional when he recalled sending auxiliary workers to MESSER, which uses actors to serve as patients and relatives. “They do work that practical nurses used to do, washing patients, moving them from bed to hospital trolley. One of them was asked to do a simulation of dealing with the family of an elderly patient who died of cancer and prepare the “body” for the morgue. The maintenance man patted the shocked “son” on his back and said: ‘We are here to help if you need us. We will be here so you can say goodbye to your father. My father too died of cancer, when he was 54. I know what you are going through!’ That is empathy!”
At his farewell lecture attended by hundreds of senior SZMC personnel (the auditorium overflowed so much that it was broadcast on closed-circuit TV to several additional halls), Halevy noted that medical centers have four purposes: “They treat diseases and save lives; relieve physical and medical suffering; teach the next generation of medical professionals; and contribute to medical research. We at SZMC do all this.”
Halevy was barely 40 and a promising gastroenterologist and head of an internal medicine department at Beilinson Hospital (now the Rabin Medical Center-Beilinson Campus) in Petah Tikva, not far from Tel Aviv where he was born, when SZMC philanthropist Ludwig Jesselson offered him the job and Prof. Haim Doron, head of Clalit Health Services, encouraged him.
The hospital then had only 300 beds and was lacking many of the vital facilities that existed in the much larger and better Hadassah University Medical Center in Jerusalem’s Ein Kerem. “Most Israelis outside Jerusalem had never heard of it,” Halevy recalls. He himself had never been there until his sister Vardina gave birth to a son in its obstetrics department. “When I agreed, I didn’t think I would be here for so long. I didn’t have plans. Being in medical administration can wear people down. I thought I might go back to treating patients and medical teaching elsewhere.”
But he fell in love with Jerusalem and devoted himself to the hospital. His wife, Adina, a psychotherapist who had once worked in the old Shaare Zedek building, is long used to him leaving home before dawn and arriving via the hospital’s emergency room at 6 a.m. to see how many patients have arrived and how they are treated.
He remains in the building or going to meetings and events elsewhere until around 8 p.m. and then home, reading and answering emails until later, getting only about five or five-and-a-half hours of sleep a night. For over 25 years, besides serving as director-general, he headed one of the hospital’s internal medicine departments so as to keep active in clinical medicine.
A family portrait shows Adina and Jonathan proudly surrounded by five children (two are physicians), 17 grandchildren and two great-granddaughters.
When Halevy arrives, the first person to arrive in his office is Shoham Ruvio, like Wallach’s Schwester Selma his right-hand person and indefatigable spokeswoman since he joined the hospital. “I wouldn’t have been able to do 50% of what I have done here without Shoham,” smiled Halevy, who named a reception hall in her honor.
As SZMC depends on donations to build infrastructure rather than state-owned and other public hospitals that have ongoing financial support, he has gone abroad for a week every six weeks or so to meet with potential donors and persuade them to finance equipment, medical units or whole buildings.
How did he decide what departments and units to add to the hospital? “So many basic services were missing when I came. In 1988, we had to send patients to little Bikur Cholim for basic tests on their ears. There were no oncology, ear-nose-and-throat, cardiothoracic surgery and other departments when I came. Our only consideration was what the residents of the Jerusalem area needed, not prestige or having what Hadassah had just to compete,” said Halevy, who has opened 26 new departments in the last 31 years. Half of the top physicians began their careers at SZMC.
“The expansion turned us from a small community hospital to a formidable tertiary hospital. We have almost all that the best medicine in the world can offer.” (It does not yet perform major organ transplants, however.) “People used to die waiting for cardiac catheterization or open-heart surgery because there was a queue at Hadassah.” SZMC’s cardiac center – today one of Israel’s most advanced, with prevention, treatment, surgical and rehabilitation services on one floor – opened in 1991.
The Hadassah Medical Organization has trained generations of Israeli doctors and nurses that today practice in hospitals around the country, Halevy said. “Numerous skilled senior physicians moved from Hadassah to SZMC,” he said, “not for higher salaries but because they regarded it as a chance to advance in their skills and responsibility. Many fewer made the opposite move from SZMC to Hadassah,” said Halevy.
When Halevy had the opportunity to hire Prof. Ari Zimran, a world-famous expert on Gaucher disease (a rare genetic disorder involving enlargement of the liver and spleen, anemia, abnormal bones, bruising, pain and arthritis), he asked him to set up a Gaucher clinic, which became the world’s largest referral center for the disorder – with more than 750 patients followed and about 350 patients treated successfully with enzyme replacement therapy.
SZMC’s obstetrics departments (including those at Bikur Cholim) deliver 22,000 babies a year – more than in any other hospital in the world. The midwives and nurses in the departments, and in the whole hospital, are known for their warmth and devotion to the patients. Its medical genetics institute headed by Prof. Ephrat Levy-Lahad performs preimplantation genetic diagnosis to distinguish healthy embryos from those suffering from serious genetic disorders. Over 1,000 healthy babies have been the result, freed from the specter of living with severe disabilities.
Its advanced Brain Center, chaired by Prof. Natan Bornstein, offers advanced neurological, neurosurgical and neuroradiological procedures including treatment of strokes and brain cancer. As millions of neurons die within minutes in stroke victims, people in the Jerusalem area, time is of the essence, and being so accessible saves lives and prevents disabilities.
The hospital opened an advanced and much-larger emergency department in 1994 that is busier even than Hadassah’s. Being close to the center of the city, it has treated most terrorist victims in the metropolitan area. “I am sorry that we didn’t expand it faster,” Halevy admitted. Contributions made it possible to buy and install the most advanced MRI, CT, catheterization and other technologies.
Detroit-born Dr. David Applebaum was the head of the emergency department in 2003 when he was murdered in a Palestinian suicide bomber at Jerusalem’s Café Hillel (just a moment away from where Halevy lives), along with Naava Appleaum, his 20-year-old daughter on the eve of her wedding.
When Halevy was alerted to the attack, he waited in vain for Dr. Applebaum – his close friend – to arrive. But the trauma doctor arrived lifeless. “It was the most traumatic day at Shaare Zedek in 31 years,” Halevy recalls with a shudder.
The most difficult times for Halevy are when a patient, even a very sick and elderly one, dies unexpectedly. “It may be that the death couldn’t be prevented, but it was a surprise. It is what I most dread. We investigate all cases so we can learn from them.”
Although Israel’s health system has been called by the OECD one of the most efficient in the world (with only 7.4% of its Gross Domestic Product spend on it) and the world’s “10th best,” it is fraught with problems. “We are ranked highly because of the high level of its doctors, nurses and other staffers. They work beyond the call of duty. The four health maintenance organizations in the community are accessible and function well. But public money for the hospital system and prevention are very lacking. If the health system’s share were raised to 9% of the GDP, we would be doing fine. As is, there is a serious shortage of hospital beds, physicians and nurses,” Halevy stated.
Health is never an issue in national elections, he continued. “Prime ministers and Knesset members don’t care. They don’t come to see hospitals. They prefer to post at anti-missile batteries than in crowded internal medicine departments. They get the best medical treatments and medications available. They don’t see the queues, the overcrowding, the patients lying on gurneys in internal medicine department corridors. And much too little is being done to cope with the ageing of the population.”
In another decade or so, medicine will be more advanced and different, Halevy said. “There will be more home care, more intensive care in hospitals, more telemedicine and digital medicine, more use of artificial intelligence [AI] and early warnings before chronic disease strikes. Treatments for cancer will be more advanced.” As for medical students, even more of them will be women. All doctors need more role models. They have to be exposed more to digital medicine and data mining. But the most important things doctors must have are empathy and compassion. A robot will never be able to replace them.”
