According to the World Health Organization, 80% of blindness is preventable or treatable–but it remains a severe health concern across the globe, even in industrialized countries.
Now hope is on the horizon–especially if countries are willing to emulate Israel’s approach to eye health, says Prof. Michael Belkin of the Goldschleger Eye Research Institute at Tel Aviv University’s Sackler Faculty of Medicine and Sheba Medical Center in a new study published in the American Journal of Ophthalmology. In the last decade, rates of preventable blindness in Israel have been cut by more than half-from 33.8 cases of blindness per 100,000 residents in 1999 to 14.8 in 2010. This improvement, found across all four main causes of avoidable blindness-age-related deterioration, glaucoma, diabetes, and cataract–is unmatched anywhere else in the world, he says.
The secret is not only the innovative methods of treatment that were added to the Israeli medical system, but their universal availability and accessibility, as well as good patient compliance with treatment regimens, including the correct use of prescribed medications.
Israel also offers community-based programs, such as dedicated diabetes clinics, which promote early prevention and timely treatment for diabetes-related complications that can lead to blindness. Prof. Belkin notes that such programs save public and private health care money in the long term.
Advancing eye care
To evaluate the effectiveness of eye health care in Israel, Prof. Belkin and his fellow researchers Alon Skaat, Angela Chetrit and Ofra Kalter-Leibovici from TAU and Sheba, conducted a statistical study measuring rates of blindness in the Israeli population over twelve years. They discovered that Israel has emerged as a world leader in preventing avoidable blindness, reducing rates by over 56%. The rates of untreatable genetic causes of blindness remained steady over the same period.
Several solutions are employed by Israel, which approaches the problem of blindness from medical, public health, and cultural perspectives. For example, age-related macular degeneration, one of the leading causes of blindness in the industrialized world, is treated with a drug therapy originally approved for colon cancer tumors. By diluting the drug to create smaller doses for the eye–an idea that originated in the United States–it is possible to provide inexpensive therapy to thousands of patients.
From the public policy standpoint, Prof. Belkin notes that the decline in blindness due to cataracts is due to a change in health care policy rather than any technical advance. Since the 1990’s, patients have been able to choose their doctors privately for cataract surgery. This practically eliminated wait times for surgery and prevented the condition from growing worse over the long term.
Long term savings
Prof. Belkin believes that it’s possible for any country to adopt Israel’s strategies for reducing blindness. Although the initial costs can be daunting–such as the price of top-notch medications and setting up clinics–it’s a worthwhile investment. Treating blindness as it develops rather than preventing it from the start is much more expensive for the healthcare system in the long term. Diabetes clinics in Israel pay for themselves in about two years’ time, he says, factoring in their impact on preventing greater health concerns.
But even the most advanced and widely available treatments can’t be effective if patients are not examined by an ophthalmologist and don’t adhere to the treatment regimen. In Israel, an exceptionally high rate of adherence to these regimens is a major contributor to the prevention of blindness.
The Sheba Medical Center at Tel Hashomer in Israel was awarded on Friday the highest level of international accreditation as an “outstanding” clinical and academic institution. The accreditation was awarded to Sheba following a grueling three-year review process conducted by the American-based “Joint Commission International” (JCI), the world’s leading testing and standards institute for the healthcare profession.
The JCI evaluated over 1,600 parameters in reviewing the clinical treatment, safety standards, education protocols and scientific research activities of the medical center. The final JCI report contains 16 lengthy chapters, and was termed an “excellent” report by the JCI chief investigator and her team of five investigators.
Sheba Medical Center is the first Israeli hospital and one of the first in the world to receive JCI accreditation as an academic teaching center, in addition to being a clinical treatment center. The standards for such additional academic accreditation were introduced by the JCI only one year ago. This additional element involved investigation of human clinical trials at Sheba, as well as education protocols for medical interns, residents and medical personnel from around the world who train at Sheba.
The director of the hospital, Prof. Zeev Rotstein, expressed great satisfaction at the JCI announcement, and thanked the medical and administrative faculty of Sheba for its commitment to excellence and patient well-being.
“If you look for a light at the end of the tunnel, you’ll find it in Israeli hospitals,” Prof. Zeev Rotstein, the director of Sheba Medical Center at Tel Hashomer, once told me. “A bridge to peace is being built right before our eyes. Its foundations should no doubt run deeper and its columns be shored up. But the fact remains that hospital wards turn people who were just shy of death into lifelong ambassadors, ambassadors of coexistence.”
Indeed, in the corridors of Israeli hospitals, almost on a daily basis and away from the media, human stories are woven. Stories that can only be found there–on the fine line between life and death, where all preconceived notions, prejudice and hatred are set aside. Here are a few of the tales that have unfolded since the beginning of this month at Israeli hospitals.
At the Rambam Medical Center in Haifa, 32-year-old Muhammad Aqrat from Haifa and 57-year-old David Ben-Yair from the nearby suburbs lay side by side. Muhammad’s wife donated a kidney to Ben-Yair, and in return for the noble act that saved his life, Ben-Yair’s son donated a kidney to Muhammad.
In the medical world, this is called a crossover transplantation. When the blood types of the patients in need of a transplant do not match those of family members willing to donate an organ, doctors search a database shared between all the hospitals. In the case of Aqrat and Ben-Yair, it was discovered that their relatives matched each other, and a cross kidney transplant was possible. When doctors suggested the procedure to Aqrat and Ben-Yair, they both agreed with no hesitation.
“Destiny brought us together. We bonded in body and spirit,” Ben-Yair said after the operation. An excited Aqrat added, “We’re now inseparable. Truly like a family.”
Sarit and Avi Naor, an ultra-Orthodox couple from Ramleh, lost their three-year-old, Noam, when he fell out of the window at home and was pronounced brain-dead at Sheba Medical Center. In Israel, organ donation among the ultra-Orthodox is not common. Yet the parents were told that donating their son’s kidney would save a 10-year-old Palestinian who had been on dialysis for seven years. They, too, didn’t hesitate a second.
“It doesn’t matter where he comes from and who he is,” they explained. “We would like to help others, for they are human beings.”
The third story took place at Soroka Hospital in Beer Sheba, where 38-year-old Efrat Cohen from the town of Kiryat Malachi passed away as a result of a cerebral hemorrhage. Her husband, Benny, and their three children decided to donate her organs. The person given new life thanks to Cohen’s kidney is Malika Jama’in from Hura, a small Bedouin town in the Negev. Malika had been suffering from terminal renal insufficiency for ten years. Efrat’s husband arrived with the children to see Malika Jama’in bid farewell to the dialysis machine that had been her companion for so many years and go back to normalcy.
“Efrat’s death caught us unprepared. To this day, we still can’t process this. We took the first step to donate her organs, almost with no second thoughts. Those who knew Efrat know how charming, kindhearted and giving she was,” Benny said with great emotion. “I’m sure that that’s what she would have wanted us to do.”
In the photo distributed by Soroka Hospital, Roni, the deceased’s daughter, is seen sitting close to kidney transplantee Malika Jamai’n. There’s no need to gild that lily.
Let’s go back to Rotstein. At the end of December 2008, in the midst of Operation Cast Lead, the director of Sheba Medical Center addressed a fundraiser in Switzerland, saying:
“The state of Israel, my homeland, and the Sheba Medical Center, my home, are topping the headlines at this time. In the past three days, Israel has been striking Hamas objectives in Gaza, as a result of which it has unintentionally inflicted great suffering to many Palestinians. It was only this morning that Sheba Medical Center took in Israeli citizens from the south of the country who had been hit by Hamas missiles, as well as Palestinians from the Gaza Strip who had been wounded in the fighting. Among them was a terrorist…we also took in dozens of Palestinian children from Gaza suffering from cardiac diseases and cancer.”
Rotstein concluded his address with, “Our medical center is an island of sanity in a turbulent sea of violence and hopelessness. We give Israelis, Palestinians and the entire region hope.”
Rotstein is correct. In a region where demonization, racism and hatred dominate the scene, it seems that the bonds created in the hospital wards between the people walking the fine line of life and death are indeed the light at the end of the tunnel.
Shlomi Eldar is a contributing writer for Al-Monitor’s Israel Pulse. For the past two decades, he has covered the Palestinian Authority and especially the Gaza Strip for Israel’s Channels 1 and 10, reporting on the emergence of Hamas. In 2007, he was awarded the Sokolov Prize, Israel’s most important media award, for this work.
New research suggests that recovering stoke patients who use video games as a therapeutic exercise are more physically capable – making more bodily movements – as opposed to those who are given traditional motor therapy.
Conducted by Dr. Rebbie Rand, an occupational therapist of Tel Aviv University’s Stanley Steyer School of Health Professions at the Sackler Faculty of Medicine, in conjunction with a team from Sheba Medical Center, and funded by the Marie Curie International Reintegration Grant, the research has emphasizes the importance of goal-directed movement as a means to repair speech, movement, and overall functionality.
Dr. Rand explains that interactive game consoles insist that players move around continuously throughout virtual games. In her study, the results of which were recently presented at the 9th International Conference on Disability, Virtual Reality and Associated Technologies, Rand learned that game-players perform twice the amount of arm movements during each session compared to patients in traditional therapy. She also notes that each movement is also ‘goal-directed,’ whereas traditional therapy aims to simply exercise bodily movements.
Dr. Rand suggests that this discovery can have positive benefits for the process of brain plasticity – mental changes that occur in patients who have suffered from brain damage caused by stroke, and mandatory for the brain’s recovery. Simply by moving deliberately to accomplish a specific goal results in certain cognitive benefits.
To put her theory to the test, Dr. Rand organized two groups of 20 participants each: a traditional therapy group, given traditional rehabilitation exercises, and a video-games group, that used Xbox Kinect, Sony Playstation and Nintendo Wii throughout sessions. After three months, though both groups showed physical improvements, the video games group continued to improve grip strength for the next three months, while the traditional group did not.
Plus, she notes, since video games are often enjoyable, patients will be more susceptible to continue treatment. Her study confirms that 92 percent of participants playing video games enjoy their therapeutic exercises, opposed to only 72 percent of those given traditional therapeutic exercises.
The social environment brought on through video games is also beneficial for morale, and gives a boost for certain patients having a tough time integrating back into society. Video games through therapy are really just more fun, Dr. Rand Notes, and most importantly, it offers patients a way to establish meaningful relationships with one another.
Sparked by a Los Angeles Times article [below], a 19-year-old Haitian girl, Sounlove, who lost her father and both legs in the devastating earthquake, traveled with her sister to Israel, where she received two new prosthetic legs and eight weeks of critical rehabilitation at Israel’s National Center for Rehabilitation at Sheba Medical Center.
This initiative was started by Friends of Sheba Medical Center’s Executive Director, Jack Saltzberg. All costs of Sounlove’s travel and rehabilitation ($50,000) was paid through the generosity of Friends of Sheba donors.
Sounlove’s difficult journey has just begun as she would like to complete high school and study in college. However, there are many further medical expenses facing Sounlove, and she can use your support. Please help. All donations will go toward Sounlove’s future medical and educational needs.
Watch this incredibly powerful story that aired on Israel’s leading news station, Channel 2!
Haitian double amputee returns from Israel with new legs
After Sounlove Zamor lost her limbs in last year’s quake, an L.A. group arranged for her to get prosthetics. She’s grateful to be walking well, but in her impoverished homeland, she feels there is nowhere to go.
March 20, 2011 By Ken Ellingwood, Los Angeles Times
Reporting from Port-au-Prince, Haiti—She can climb stairs and hike blocks to a bus stop. The beat-up wheelchair is gone.
Sounlove Zamor, who lost both legs below the knee in Haiti’s earthquake, is walking again.
The young woman, who had been caught in a collapsed house, was fitted with prosthetic legs in Israel after benefactors read about her in The Times. Now she’s back in Haiti and walking on new legs, as called for in the script.
But in Haiti, endings are seldom TV tidy.
For Zamor, now 20, home has meant heartache. Her father died in last year’s earthquake, and her mother can’t look at her without sobbing in sadness. Like most impoverished Haitians, Zamor and four grown sisters lack jobs, and see few prospects amid the quake-ripped landscape.
The Zamor sisters share the home of an aunt who lives in Canada and sends money for food. Although the house isn’t theirs, it’s shelter in a city where hundreds of thousands of people are stuck in squalid tent camps.
Zamor pines for the strangers in Israel who taught her words of Hebrew and how to balance on her new limbs, which start at the knee and end in white running shoes.
“I was praying from the day I got there that I wouldn’t come back to Haiti,” Zamor said, tending a pot of rice and beans over an outdoor charcoal fire.
At Sheba Medical Center near Tel Aviv, Zamor learned to jump rope, practiced walking with a plastic basin perched on her head, got steadier on her limbs. In the end, she begged to stay, but that wasn’t possible.
Haiti is a brutal place for those who can’t walk, with few services for the disabled and wheelchair access a remote afterthought. Zamor’s life will be much different with legs, even prosthetic ones.
Zamor, grateful, knows this. “I can really walk,” she said.
But where; that’s the problem. She’s at a loss so far. “I have to have somewhere to go,” she said. “And there’s nothing.”
Zamor said she is embarrassed to rejoin the club in which young women prance like fashion models, a popular pastime in Haiti. She bristles when strangers ask why she wears the sneakers instead of sandals, and fights a creeping dread that another quake is coming to end her for sure.
Zamor, who was in ninth grade when she got hurt, wants to go back to school and has dreams of becoming a lawyer or journalist. But she lacks money to pay for classes and books. The Los Angeles-based group that sponsored her rehabilitation, Friends of Sheba Medical Center, is gathering funds to help, said its executive director, Jack Saltzberg.
“My main goal in interacting with her is that she not take things for granted, and that she will learn that there will be only one person who can really help her, that is herself,” Saltzberg said in an e-mail exchange.
Under a skinny palm tree in Port-au-Prince, Zamor flipped through a pink-covered album of photos from her three-month stay in Israel. It’s a little book full of big smiles. She wore a donated black gown to her farewell party and looked elegant.
On a recent day, Zamor wore stretchy red-and-white sweatpants over the artificial legs, which don’t fit quite right because she has lost weight since she returned to Haiti. She pulls three layers of socks over the ends of her legs to fill them out.
Zamor eased up two flights of stairs, touching a wall for balance. She came back down successfully. Dancing, which has always given her special joy, must wait for another time.
There are days when tears burst through without warning, and Zamor wonders whether it might have been better if she had never left, never imagined a life far from this hard Haitian one.
Barely out of her teens, she is learning to pack dreams and despair in the same satchel.
“I feel grateful. I can visit my mother. That’s a good thing in my life,” Zamor said. The kettle bubbled. She considered. “But what comes after that?”?
For a Haitian amputee, life-changing aid is in sight
Across Haiti, a vast global relief effort continues for the 3 million people affected by the Jan. 12 quake. Those receiving the largesse are often the last to know what it all means.
July 24, 2010 By Ken Ellingwood
Reporting from Ganthier, Haiti – Sounlove Zamor was scrubbing laundry under an acacia tree when a stranger arrived to ask her about the good news.
The news was this: Foreign benefactors had arranged to fly Zamor, a 19-year-old student who lost both legs in Haiti’s earthquake, to a top-notch hospital in Israel to be fitted with prosthetic limbs and get rehabilitation for as long as four months, fully paid.
Zamor and her sister soon would fly to Tel Aviv. On the far side of the ocean, new legs awaited.
But here in the Haitian countryside, at the end of a dirt road that surrenders to a weedy footpath, Zamor was hearing for the first time the details of a journey that would change her life. Beneath a spray of tight braids, her round face betrayed neither surprise nor joy at word that the plan was coming true.
“They told me that when I was in the hospital, but I haven’t heard anything since then,” she said.
Across this broken, impoverished land thrums the machine of a vast global relief effort to provide water, tents, latrines, medical care and police protection to the 3 million Haitians affected by the Jan. 12 quake. Those on the receiving end of the largesse are often the last to know what it all means.
In Zamor’s case, the wheels of charity began turning after The Times featured her in a report in February about the plight of thousands of quake victims who had undergone amputations. The article generated a number of offers from readers wanting to help.
Among them was Jack Saltzberg, executive director of a Los Angeles-based foundation affiliated with Israel’s Sheba Medical Center. He thought the Israeli hospital, with a high-tech rehabilitation center and a long history of treating those gravely wounded in Middle East violence, was just the place to get Zamor walking again.
At the time, Zamor lay in a hospital to the north, where she had been taken after being pulled from the rubble. When the quake struck, Zamor was on the second floor of a house in Port-au-Prince, the capital, where she stayed part time with her father, the caretaker.
The building opened like jaws beneath her feet, she recalled, then closed just as suddenly, chewing off her left leg. They never found it.
Her right leg was mangled, her father was dead.
Doctors amputated the crushed leg, leaving Zamor a double amputee in a country where the disabled face monumental physical and social barriers. Both legs now end a little below the knee.
Before the earthquake, she was a vivacious young woman who liked kicking a soccer ball, dancing and practicing modeling struts with her friends. Now, the thought of dancing seemed a cruel joke.
Saltzberg relayed word to Zamor, through a Times translator, that the Israeli hospital would treat her and house her older sister, Baranatha, during her rehabilitation.
Over the next several months, staying in touch with Zamor from abroad would be a complicated task, conducted through intermediaries across barriers of language, distance and unreliable phone service.
“It’s been daunting,” Saltzberg said by telephone. “I was hoping to get her out in three weeks and it’s taken several months.”
There was another hitch: Zamor didn’t have a passport. But her birth certificate and other documents survived at the family’s ramshackle compound here in Ganthier, a rural stretch of sugar cane fields and papaya trees an hour-and-a-half drive east of Port-au-Prince. Zamor has lived here with relatives in tents since March.
Israeli diplomats in Port-au-Prince and the neighboring Dominican Republic helped speed the passport application. When Zamor and an Israeli official went to Haiti’s passport office, she was able to skirt the line in her donated wheelchair.
Zamor was aware that the passport had been issued, but knew nothing about the planned departure until the visitor showed up to ask about the trip, which is scheduled for early August.
If she was weary of waiting, Zamor did not let on. She spoke with a matter-of-factness that was just shy of laconic. A soft smile peeked through now and then.
For four months, Zamor has slept in one of the donated tents next to her family’s quake-damaged concrete houses. The group spends lots of time watching the balky television they have set under the trees. The death of Zamor’s father meant the loss of the main breadwinner. Without the charity of neighbors, she said, “we would probably starve.”
When she needs to go somewhere, Zamor’s sisters steer her wheelchair over the bumpy terrain. The other day, she was debating whether to attend an annual party of her church-sponsored youth group. She wasn’t sure she could bear it.
“Last time I was around a lot of my friends,” she said, “I couldn’t stop crying.”
The farthest she has traveled before is Gonaives, the city up the coast from Port-au-Prince where she was hospitalized. Zamor can’t place Israel on a map but knows it’s mentioned a lot in the Bible. “They said it’s a godly place,” she said.
Zamor thinks about new legs, about snatching back a piece of the life she was supposed to have. She’d like to finish high school, find a career.
She imagines sashaying with her friends again. She worked the idea like a lozenge.
“Yes,” she said, as if assuring herself. “I would like that.”
Amputations push Haitians closer to the edge
A teen who was close to graduating from high school lost her father and both of her legs in the Haiti quake. For her and thousands like her, an already difficult life has become much bleaker.
February 17, 2010 By Mitchell Landsberg
Reporting from Gonaives, Haiti — She is 19 years old, with an angelic face and big, heavy-lidded eyes. A bright young woman close to graduating from high school, a rare accomplishment in Haiti.
As her sister runs a hand through her hair, Sounlove Zamour tells how the Jan. 12 earthquake split her family’s house in two, how it swallowed up her father, how it robbed her of her legs — both gone now, below the knee.
She manages a feeble smile.
Zamour belongs to a heartbreaking new class in Haiti: earthquake amputees. No one knows how many there are, although the number is clearly in the thousands…
It is hard to imagine a more difficult urban environment for a disabled person than Port-au-Prince, the country’s teeming capital. There are few, if any, wheelchair ramps. Even without the mounds of debris left by the earthquake, sidewalks and streets are full of obstacles: potholes, ditches, trash piles, street vendors. Only the grandest of multistory buildings ever had elevators…
The World Health Organization estimates that about 200,000 people were injured in the earthquake, and many of those injuries were disabling. Even fractures can leave a person crippled if not properly treated…
… the challenges are enormous, beginning with the sheer number of disabled people and the cost of treatment and rehabilitation.
After the quake, some patients were sent to hospitals in undamaged cities outside the capital. Four hours north of Port-au-Prince, in Gonaives, Dr. Marcel Chatelier said his staff performed 12 amputations among the patients they received, many with wounds that had festered for the better part of a week.
That was the case with Sounlove Zamour, the 19-year-old student.
She and her father were home when the quake hit. She remembers trying to run, but the floor split open and she tumbled to the ground as the house collapsed onto her. She was trapped for a full day before being rescued and taken to a hospital in Port-au-Prince. Her father, who provided her sole means of support, didn’t make it out alive.
One of her legs required immediate amputation, she said, but she was initially hopeful that the other could be saved. But at that first hospital, she said, the leg was bandaged without cleaning out the dirt in the wound. Four days after the quake, she was piled onto a bus to Gonaives because the Port-au-Prince hospital was too crowded.
By the time she arrived, her wounded leg was badly infected. It “smelled rotten” when the bandages were removed, she said. She was told it would have to be amputated too.
Now, she doesn’t know what the future will bring. “I have no father,” she said. “I’d like to continue my education, but I can’t.” With her father gone, she said, she can’t afford it.
A week later, she was still in the hospital. With groups like Handicap International focused for now on Port-au-Prince, she had received no offers of help and did not yet know when she might return to the capital and begin her life anew.
Times staff writer Scott Kraft in Port-au-Prince contributed to this report.