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PEP – Treatment in fear of exposure to HIV

The following is a translation and edit of an article on www.aidsisrael.org.il. For more information see the full article [Hebrew] by clicking here

PEP

PEP – Treatment given in cases of fear of exposure to the HIV virus. Your condom is torn during sexual intercourse; Are you afraid of being exposed to HIV? There are some things that everyone needs to know:

What is PEP?

POST 

EXPOSURE 

PROPHYLAXISpreventive treatment 

PEP is a treatment given after exposure to HIV and its goal is to minimize the risk of infection.

Is  PEP  a new invention?

For years, PEP has been used to prevent HIV infection in cases of high-risk exposure. For example, if a medical staff member is exposed to a contagious fluid (for example, stabbed from a syringe containing HIV positive blood), he or she is offered the preventive treatment that should significantly reduce the chances of contracting the virus. This treatment is also offered in hospitals to victims of sexual assault or to partners of HIV positive people if the condom is broken. PEP is actually a drug that is taken for 28 days and is based on the combined drug therapy that people living with HIV take throughout their lives.

In what situations should I consider PEP ?

If one of the following conditions occurs:

1. Almost certain exposure to the virus, for example, you are HIV negative and in a relationship with someone who is positive. Although you are always careful about protected sex – something happens and the condom breaks at the time of penetration.

2. Possible exposure to the virus, such as having unprotected sex with a partner whose HIV status is unknown, and a condom rupture during penetration.

3. Having unprotected sex that involves penetration with a partner whose HIV status is unknown or known to be positive.

Some clear cases in which treatment is recommended: 

  1. A needle stabbing from a person living with HIV (mainly occupational exposure).
  2. People who have been penetrated without a condom by a person living with HIV and whose therapeutic status is unknown.  
  3. Victims of sexual assault. (If a call to the ER is made up to 72 hours).

How do you get and who decides on it?

If you are concerned about HIV, contact the emergency room of one of the listed hospitals below as soon as possible (and no later than 72 hours after exposure). Treatment can be requested 24 hours a day, 7 days a week.

Where can I get the treatment?

In each of the following seven emergency rooms (24 hours a day, 7 days a week):

  • Soroka, Beer Sheva
  • Kaplan, Rehovot
  • Hadassah Ein Karem, Jerusalem
  • Sheba, Tel Hashomer
  • Ichilov, Tel Aviv
  • Meir, Kfar Saba
  • Rambam Medical Center, Haifa

Remember: the treatment is not given to anyone who wants it, and the decision is made by the doctor in the emergency room.  The doctor will decide whether or not to prescribe the treatment, only after consulting an infectious disease specialist or an HIV doctor from the hospital’s AIDS center, since this is a treatment with rare but life-threatening side effects, the doctor will try to see if the risk of infection in your case justifies the chances The doctor will ask you some questions related to your sex habits and the last time you have unprotected sex.

Can I go directly to the emergency room or need a referral?

A visit to the hospital must be paid by a fee, unless there is a commitment from the health fund (hitchayvut/Form 17), or in cases defined in advance by the Ministry of Health and in the regulations of the health funds. HIV prevention is not one of these cases, so in order to be exempt from a screening visit, you must have a hitchayvut. How do you do this? One way is to visit a family doctor and ask for a referral to the ER. It may be a cumbersome way of scheduling or trying to get into a doctor without a queue because of an emergency, and time is pressing. The simplest and fastest way would be to call the HMO call center and ask to speak to the nurses’ center. If the nurse at the center approves the need for an emergency appointment, the telephone call is recorded on the computer and is considered according to the fund’s regulations as a liability of the fund for all intents and purposes. In some cases the nurse may require you to visit your GP. In such a situation, you must clarify the urgency of the matter and insist on receiving a referral from the call center.

In any case, remember: Arriving at the ER without a commitment from a doctor or a nurses’ center will cost you NIS 715, even if the visit is medically justified.

What happens to a caller when he arrives at the ER?

A number of tests are performed at the ER. First, an HIV test that checks whether there has been past infection (and then any unnecessary preventive treatment). In addition, a blood count is performed and a liver and kidney function test is performed to determine a health condition that does not allow taking the treatment. In addition, in case of exposure to sexual relations, antibiotic treatment was provided to cover other sexually transmitted diseases (gonorrhea and chlamydia). At the end of the tests, and after the consultation of the emergency doctor with a physician aids are given in sorting out several doses of treatment for the next day or two. During the course of the treatment, the person is instructed to perform additional tests, the most important of which is, of course, HIV testing after three weeks of treatment. Which prevents, to ensure that no adhesion occurred.

What would they ask me in the emergency room? 

The questions that the doctor will ask you in the emergency room can be very personal and cause a feeling of discomfort. You will be asked to talk about the partner with unprotected sex, you will be asked about the sexual act, when was, what included what was your role in sex and whether there was ejaculation inside or outside. Remember that the doctor asks for all this information not to satisfy his curiosity but to make the right decision about your health. In any case, all the information you tell your doctor needs medical confidentiality so that you can be calm. The more accurate information you provide, the more appropriate a decision can be made by your doctor regarding the need for preventive care and its composition.

So take or not take?

Whether to take or not to take lies in the benefit of treatment versus its risks. Treatment is not easy in many cases and sometimes even life-threatening. Another important fact is that the side effects of the treatment may be difficult. Usually more severe than the side effects experienced by people living with HIV and taking the treatment for many years. For these reasons, complex therapeutic protocols have been written that weigh the risk of infection compared with the risk of side effects, according to which the AIDS doctors decide whether to give the treatment or not. 

When should I seek treatment?

The faster the better! The efficacy of the treatment depends on the time that has passed since the exposure: the closer the treatment is to the time of exposure, the more effective it is. If 72 hours have elapsed since the exposure, PEP will not be given in any case because treatment is no longer effective.

It has recently been shown that taking the treatment more than 48 hours after exposure reduces its effectiveness significantly, so in situations where PEP is recommended, this should be done as soon as possible !!!

Some things to know about  PEP :

– PEP is not a “day after” pill and is definitely not a substitute for condom use.

Treatment reduces the chances of HIV infection but is not 100% effective.

– Treatment must commence as soon as possible as of the date of exposure, and in any event not later than 72 hours from the moment the incident occurred.

– The treatment is not given to anyone who asks, and in any case, it is possible to receive it only in emergency rooms with the instruction of a specialist.

– Treatment is based on some of the combined drug therapy taken by people living with HIV.

Treatment has short- and long-term side effects. Sometimes these are serious phenomena. (And therefore, as noted, can not be given to any person who requests it and under the instruction of a specialist doctor only).

So now I know there is a PEP, why should I continue using the condom?

Well, simply because PEP is not a protective measure and it certainly is not a substitute for a condom. This is not a “day after” pill, but a complex drug treatment with side effects that can be determined by an emergency room doctor. In the case of PEP, the doctor will decide for you. They have the full professional authority to refuse you.

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Answers and Guidance

The Shira Pransky Project answers inquiries and provides guidance to those confused by the Israeli healthcare system via email, phone, or by appointment. Our staff includes professional healthcare advocate Aviva Yoselis, MPH, for situations requiring extended or continued guidance.

Contact us for answers, guidance, advice and information about navigating the Israeli healthcare system:

Email: Info@ShiraPranskyProject.org
Tel: +972 58 416 2777

Or send a message here:

Please Note:

Do not share confidential information over this form or in an initial email to The Shira Pransky Project. Information shared in correspondence or consultation with a representative of The Shira Pransky Project is not considered confidential unless initially specified and agreed upon by all parties.

The Shira Pransky Project does not give medical advice, diagnosis, or treatment. Rather, we are a source for information about accessing rights, benefits and support. Only recognized medical professionals are qualified to give medical advice, diagnosis, or treatment.  Always seek the advice of your physician or other qualified health provider with any questions regarding a medical condition.

The information provided by The Shira Pransky Project is general in nature and does not purport to be binding or authoritative. The information and assistance provided by The Shira Pransky Project does not serve as a substitute for obtaining medical, legal or other professional advice and the user assumes sole responsibility when relying on this information.

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Preparing for Aliyah With Complex Medical Concerns

Aviva Yoselis, Healthcare Advocate for The Shira Pransky Project, shares the following steps to preparing for Aliyah with complex medical concerns:

Medications

Collate a list of all your medications and try to ascertain if they are included in the Healthcare basket (see here). Use this list as a general guide. Some medications are available in Israel but not included in the basic health care basket – meaning patients need to pay for the medication out of pocket, which can be costly. It is also possible to get exceptions made for coverage of medication when it is not included in the basket, however there is a process involved.

Bring a three month supply of your medication or whatever your health plan allows for. This allows you make appointments with relevant specialists to have any prescriptions filled.

Medical Summaries

Medical summaries or tests you can obtain from your treating Doctors back ‘home’ – they may be beneficial to your new treating Dr who has not been treating you for several years. These will not assist you in applying for Bituach Leumi.

For example, if you have been diagnosed with Thyroid disease it is often helpful for doctors here to have records of what your previous medications have been and a summary of your condition.  This includes any diagnosis you have had since childhood it will assist your Dr to have summaries. The same is true of educational testing for both children and adults. You will still need to complete additional testing here in Israel but it is often helpful to come with a ready ‘paper-trail’.

Bring records of immunizations for children and adults alike, if available.

Insurance

Check any private insurance policies which you have purchased outside of Israel. It is advisable to check with your insurance broker if there is any level of international coverage  for medications, long term care, etc.

Once you become a citizen you are immediately covered on the national health insurance, however it is advisable to purchase traveler’s insurance for the first week of living here just in case.

Final Note

A good family Dr. is the key to accessing the Health care system here as they are your first port of call, in illness. Review their part in navigating the Kupah, and seek out valuable recommendations before you arrive.

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Therapy Through the Kupat Cholim

As of July 2015, the responsibility for providing mental health services to the public was transferred from the Ministry of Health to the Kupot Cholim. For the average Kupah member (in non-acute and non-critical situations) this means figuring out how to receive therapy, possibly preceded by a psychological assessment or diagnosis.

For all mental health services you should start with your primary care doctor for referral. Once you find out where you need to go, check with the Kupah secretary or information service to see if you will need a Hitchayvut

Outpatient Clinics

There are therapists available in outpatient clinics of general and psychiatric hospitals, or community clinics run by, (or by agreement with), the Kupat Cholim. These options are the cheapest (ranging from free to around 32 shekels, once per quarter), and you may be able to find one close to home. On the other hand, it may take a lot of time to get started, and your flexibility in choosing the right therapist for you may be limited.

Independent Therapist

The way that many people consider ideal, is choosing an independent therapist. This option is more expensive (around 55 shekels for the first visit and 132 for each subsequent session), and still does not mean unlimited choice. The Kupah has a listing of independent therapists from which to choose (links below). The listing will include location and may also include the languages in which the therapist will work. You can contact these therapists directly until you find the right one and make an appointment.  At the Kupah, you will have to pay the co-payment and get a Hitchayvut to bring to the therapists’ office.

Useful Links:

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Payment and Choice in the Kupah [Basics Review]

As I read through Leumit’s Passport to Healthcare in Israel brochure from 2010 (available for download here) I thought it was a good opportunity to highlight some points that they felt were essential information about what a Kupat Cholim has to offer its clientele. I will not be referring to anything unique to Leumit, so members of Meuhedet, Maccabi and Clalit can also follow along to learn or recall just what you are entitled to receive, and what options you have in the Israeli public health system.

You Do Not Pay The Kupah for the Basic Basket

We’ve summarized the Basket of Health Services here, but these points bear repeating:

  • The Kupot Cholim provide the government’s package of basic healthcare services, which include: doctor visits, laboratory services, imaging, hospitalization, rehabilitation, paramedical (speech, occupational and other therapies), prescriptions and medical equipment.
  • You do not pay your Kupat Cholim for this insurance coverage (except for co-pays). The basic coverage is automatic when you sign up as a member to any kupat cholim. The funding comes out of your payments to Bituach Leumi (National Insurance Institute), not the kupot.

You Do Pay for Supplementary Health Insurance (Shaban)

Kupat Cholim Level 1 Level 2
Clalit Mushlam Zahav Mushlam Platinum
Maccabi Gold Sheli
Meuhedet Adif
Leumit Kessef Zahav

 

Your monthly fees to the kupah are for additional policies that add benefits on top of the basic basket entitlements. Since you are paying extra for additional coverage, you should be familiar with the added benefits and how to use them. Some supplemental benefits:

  • Private doctors, or private medical procedures at hospitals or other facilities. These options can be limited in the expense covered, the number of times used in a year, or to whom or where you can go. Explore the arrangements directly with your kupah to find out how to exercise these private options, or get reimbursements. 
  • Additional or expanded categories of services, such as genetic testing, dental treatment discounts, orthopedic products and travel vaccinations.
  • Extending coverage on treatments included in the basic basket, such as additional paramedical treatments in child development services.
  • Some surgery, transplant or treatment abroad options.
  • Additional pre- and post-natal services and tests, such as fertility treatments, genetic testing, scans, private obstetrician, preparation classes and convalescence.
  • Additional pediatric services, such as testing for learning disabilities and bedwetting treatments.
  • Discounts on drugs not included in the basic basket.
  • More preventative care.
  • Expansion of mental health coverage.
  • Discounted alternative medicine options.

Your Kupah Has Doctor and Facility Choices Without Going Private

  • Your Kupah has a directory of physicians that are considered “within the kupah”. This directory is on the kupah website (in Hebrew) and is accessible through the 24-hour hotline representative, or your local branch secretary. Occasionally you may even be able to get a print version that looks like a small phone book.

  • You can use this directory to find a primary care physician, the center of your galaxy in the Kupah system, and to find specialists. 

  • Many primary care physicians can see you on the same day you call, or the next. 

  • Specialists can have longer wait times, but if you find multiple options from the kupah directory, you can “shop” for the best appointment.

  • Finding a facility or clinic that is not “within the Kupah” is still an option even without using your private appointment supplemental benefits, especially if the Kupah does not have a good alternative (within a reasonable time and distance). Request a hitchayvut from the kupah, and see what happens.

Further Reading

Videos: Using Your Kupat Cholim Online

This page contains videos from two out of the four national health funds about how to use their online resources, such as scheduling appointments and finding services. Even if you are a member of one of the other kupot cholim similar tools are usually available for all.

The original videos are in Hebrew and we have added English subtitles, so please make sure that you have the captions enabled. The online tools from each kupat cholim are only available via their Hebrew websites or apps, but we hope that with familiarity and courage you will consider taking advantage of these useful tools!

(We have also added another useful English produced independently by a Maccabi Clinic.)

Booking a Doctor’s Appointment Online – Without a Password (Maccabi)

Booking an Appointment from your Cellphone – Without a Password (Maccabi)

Ordering Prescriptions Online (Maccabi)

How To Request Prescriptions From Your Doctor Online (Maccabi)

Update Personal Details Online (Clalit)

Send Requests to Your Clinic (Clalit)

Finding Your Lab Results Online (Clalit)

Check your Kupah Entitlements Online (Clalit)

Weekly Healthcare Guidance at AACI Jerusalem

guidance signpost

 

Are you confused about your healthcare benefits? Your rights? How it all works? Do you need guidance on a your options, making decisions, or even just where to go? 

AACI’s Shira Pransky Project provides free 15 minute consultations and guidance to individuals with issues in the Israeli healthcare system every week at the AACI Max & Gianna Glassman Family Center in Jerusalem. Our experienced healthcare advocate, Aviva Yoselis, MPH, has over a decade of experience as a professional healthcare advocate, researcher and guide to navigating the Israeli healthcare system.

Guidance services that require more time are available.

Office hours: Mondays from 10 am to 2 pm.

To schedule in advance: Email info@ShiraPranskyProject.org or call 02-566-1181 during regular office hours.

Walk-in consultations will be taken as availability allows.

 

Pesach Cleaning Agents And Chemicals Safety Guidelines

pesach poison

In preparation for the Passover holiday, the Ministry of Health has shared the following safety rules for use of cleaning agents and chemicals prepared by Prof. Yedidia Bentur, of the Israel Poison Information Center at Rambam Medical Center and Orly Silvinger, of the Beterem Organization for Child Safety:

  • Cleaning agents are to be kept out of reach of children, in a high or locked place. Once the use is over, they must be returned to their place and the container closed, in order to prevent ingestion or inhalation of toxic and caustic agents.
  • It is advisable to purchase cleaning agents and drugs in packages that are difficult for children to open.
  • Do not mix cleaning agents, particularly acids and bleaches, these mixtures discharge toxic gases and may be dangerous in the case of inhalation.
  • Make sure to keep cleaning agents and drugs in their original package and keep the package shut. Do not store cleaning agents in drink bottles, even if the bottle states “Toxic” – toddlers cannot read.
  • Do not store cleaning agents near food products or drink cups.
  • Carefully reading the product’s directions before use, with special attention to warnings, may benefit both adults and children.
  • Drugs that are not in use or that have expired, cleaning agents and pesticides, paints and paint thinners that are not in use should be safely removed from the home without children having access to them.

In any case of exposure or suspected exposure to a toxic agent, seek medical assistance or contact the Israel Poison Information Center, Rambam Medical Center, telephone 04-7771900.

Click here for the full article on the Ministry of Health English website.

Accident Insurance and What to Do When a Child Gets Hurt

By Aviva Yoselis
Our strict contributed content guidelines ensure useful, informative and non-solicitous submitted content. Opinions expressed in this article are the author’s own.


Active Children Get Hurt

kid scraped kneeThe other day, I realized that there are actually people living in Israel who’ve never been to the Emergency Room, who’ve never had to take a bleeding child to the extended hours clinic to be stitched up, who’ve never looked at the chip in their child’s tooth after a fall from a slide and said, ‘yep, that tooth is gonna have to be fixed’. Now, before you stop reading in horror and say, my goodness what a negligent mother, let me just inform you that I have active boys. Three of them. Really active. And active girls who play with the active boys. We’ve been stitched, glued, x-rayed, bandaged…

So here are some important facts to know if your child, grandchild, niece, nephew or little neighbor gets hurt:

Accident Insurance for School Aged Children

Teeth

If a school age child (pre-K through 12th grade) has any type of tooth injury, chipped, knocked out, cracked,…treatment is covered by the school insurance, even if it didn’t happen on school property or during school hours. This means, that yes, the eight year old girl who was chasing her brother around the house, tripped, and cracked her two newly grown front teeth in half, can get full reconstruction of those teeth for free.

To go about this, you need to call the national insurance company (not connected to your kupah): 1-800-44-33-44 [in Hebrew only], give them your child’s information and they will call you back with a number and a list of eligible dental clinics. With that number and a letter from the school secretary saying your child is a student, you can make an appointment and go to one of the approved clinics.

Accident Injury

The insurance that you purchase at the beginning of each school year (mandatory~75 NIS), covers your school age child for all kinds of accidents (except for car and terrorist events-that’s through Bituach Leumi). If your child is hurt falling out of a tree, falling off a bike, injured on the playground, even if it didn’t happen on school property or during school hours, your child is eligible for insurance coverage. If they have a temporary disability, they may also receive coverage for that. Contact the secretary of the school for relevant phone numbers of the insurance.

Things to Remember

Head/facial wounds bleed, a lot

If the child comes in from the outside with blood running down their cheek, take a deep breath and wash the wound off first. Sometimes even small cuts look massive in the beginning.

If the injury looks deep, take the child to the nearest extended hours clinic of your kupah (not the ER unless it’s after midnight). Make sure you know where this clinic is before there’s an accident, so you don’t have to call around in the moment of panic. Put the number and address up on your fridge so it’s accessible. If there is an injury around the eye, or the cut is especially deep, know that the extended hours clinic or Terem may end up sending you to the ER to be stitched; you still need to go to the kupah clinic first, and then go to the ER with a referral, in order for the ER fee to be covered by the kupah.

[Editor’s note: If the situation is truly urgent, and wasted time contributes to the danger, do not pause for preliminary concerns. Click here to read more about Medical Attention Any Time and in Emergencies.]

Possible concussions

If the child is unconscious or loses consciousness, feels dizzy or vomits after a falling injury, take the child to the ER immediately.


Aviva Yoselis, MPH, founder and director of Health Advize and Viva Research Institute, is an expert in the field of health research, health behavior modification and shared medical decision making. She has over 20 years of experience facilitating seminars and teaching classes on health behavior and health system navigation. Aviva is skilled in identifying key points in complex situations, and looking at a range of possible solutions. Feel free to download her free guide on navigating the Israel Health Care system at http://healthadvize.com/contact-us/.

Medical Attention Any Time and in Emergencies

Your Kupat Cholim is required to have options and procedures in place for you to receive medical attention within a reasonable time 24 hours a day. Your local clinic is  available daytime hours, and there are other options available during “off hours” that are subsidized by the kupat cholim. These other options include: urgent care centers, contracted private clinics and house-call companies. 

Click here for a description of alternative medical services during “off hours”.

What about the emergency room?

Even if you walk into the emergency room during off-hours you will still have to pay unless you have a referral or one of the conditions listed for exemption (see below). You should only go to the emergency room in a true emergency, not just because you need to see a doctor on short notice. 

Click here for a description and listing of exemptions from Emergency Room costs.

In contrast to the emergency room, other options are covered by the Kupat Cholim (with a co-pay) provided you use them at the correct time. If you have the time and presence of mind in your condition, you should call your kupat cholim’s 24-hour number for directions (listed below). The operator can tell you where there are urgent care centers or other clinics you can go to in the area, and you can find out the hours and cost for the house call option. If the best option is to go to an emergency room, the operator’s referral is enough to guarantee coverage by the kupat cholim.

Kupat Cholim’s 24-hour telephone information centers:

  • Clalit:          *2700
  • Maccabi:     *3555
  • Meuhedet:   *3833
  • Leumit:         1-700-507-507

 

But… Emergencies?!

Of course, if the situation is truly urgent, and wasted time contributes to the danger, then you should not pause for these preliminaries. If you need an emergency room, that is where you should go without delay. If you are hospitalized from there, or if your condition matches any of those listed for automatic exemption, all fees will be covered by the Kupat Cholim, and if not, you can establish that the visit was “medically justified” after the fact and receive at least partial coverage.

What if you need an ambulance?

It is also possible to face the expense of using an ambulance to get to the hospital, unless you are exempt. In this case too the gold standard for establishing that the ambulance evacuation was an emergency is if the patient was then hospitalized. Once again, one should not hesitate to call an ambulance when it is necessary, as an emergency situation should not be delayed. 

Click here for a description and listing of exemptions from ambulance evacuation costs.

So remember…

  • Your kupat cholim is responsible for providing medical attention at any time of day.
  • The emergency room can cost you plenty if you use it when it is not a true emergency.
  • An ambulance should not be considered a convenient form of transportation to the hospital if it is not necessary.
  • Do not hesitate to use emergency services in urgent situations!

 

Subsidized Addiction Rehabilitation at Retorno

The Retorno Jewish Center for Addictions is currently offering a special subsidy for their inpatient program.

Click here to see the full listing for Retorno in our Oranizations Directory.

Retorno offers private inpatient treatment for:

  • Alcohol addiction
  • Drug addiction
  • Gambling addiction
  • and other, concurrent addictions

The current subsidy is available until Purim, March 22, 2016, and allows the program to be offered as follows:

  • Free for Israeli Citizens in Hebrew. The program is paid for by Social Services (Misrad Herevacha). There is a small fee paid for by client, which is refunded by Bitach Leumi.
  • 12,000 NIS per month for Israeli Citizens in English.
  • $4,800 for non-Israelis in English. 

The programs are intended for Men ages 17.5 and up and for Girls or women ages 14 and up. There are separate divisions for men, women, and youth.

For more information call Shoshana at 052-436-9888 (Israel) or 718-285-9815 (US).

Click here for the program description and application on Retorno’s website.

*Subsidy does not include monthly expense account. 

Related:

Listing of organizations related to addiction on our Organizations Directory

Out-of-Balance

By Ilene Bloch-Levy

I used to view my life as a daily task in which I smoothly navigate between two vying planes. Then my father’s life intersected mine and I was so focused on giving that my life gelled into one.

On one plane, I have my ‘ill life’ which constitutes my ongoing battle with cancer. Replete with challenges it runs the gamut from medical to administrative. There are protocols that need to be continuously re-evaluated, weekly treatments, frequent blood tests, recurrent trips to the emergency room, and hospitalizations. There is endless paperwork, staying abreast of new medications, discussions with the hematologist, informational conferences.

On another, I have the life I love to live. This revolves around satisfyingly creative work, family, children, many grandchildren, and until recently, caring for my father.

Sometimes the planes are seamlessly balanced, other times, I am so out of balance, I feel I am falling off the precipice.

Last March my husband and I flew back to the States to help my 90-year old father pack and make aliyah.

For months my sister and I had been discussing the possibility of bringing my father to Israel. Until he was 90 years old, he worked full-time. But once the daily routine vanished, my father became restless. We felt that a change would be good, and since most of the grandchildren and all of the great-grandchildren were living in Israel, Israel seemed to offer an outstanding solution.

My father agreed. And, life began anew for him as he settled into an assisted living residence equidistant to the extended family. He took advantage of the diverse activities, discovered new interests and enjoyed frequent visits from family members.
I would visit twice-weekly on my way home from work, and on Fridays to wish him Shabbat Shalom.

I was amazed at how wonderfully he was adapting to being a new oleh, in a new city, in a new residence. I was equally amazed at how smoothly I was able to maintain the balance I had so carefully crafted since becoming ill four years ago. The situation seemed idyllic.

That is, until my father became ill and one hospitalization led to another. Now, instead of thrice-weekly visits to my father the visits were daily.

As my father’s health deteriorated, so did mine. And, as his life was thrown off balance, so was mine. So that by the time my father passed away in his hospital bed, I was in a hospital bed some 20 kilometers away.

We never fully realize how delicate that balance in life can be. As much as we would like to manage it, I learned that we cannot, nor should we want to. But, perhaps there is comfort in knowing that when one injects life with unbounded love and caring, one’s ‘ill life’ and the life one loves to live can seamlessly blend into one. As it should be.

Ilene Bloch-Levy was diagnosed with Multiple Myeloma in March 2012. She grew up in New York and made aliyah in 1986. She has 6 married children, and her husband has 3 married children. They both enormously enjoy a gaggle of grandchildren. A freelance copywriter, Ilene lives in the Shomron. According to her, “One of the joys of working in Israel is that Israelis get the important things in life; during my treatments and hospitalization, all of my clients patiently waited for me to return to work.”

[Editor’s note: We are grateful to Ilene for sharing some of her personal experiences with the SPP community, and are confident that her thoughts will help strengthen and enlighten the readers. Her views are her own and do not necessarily reflect the views of AACI’s Shira Pransky Project. If you would like to contribute to our blog with your own thoughts or experiences related to the Israeli healthcare system, let us know: info@shirapranskyproject.org.

Related

Medical Cannabis

סוכנות ישראלית ממשלתית לקנאביס רפואי

סוכנות ישראלית ממשלתית לקנאביס רפואי

“Cannabis is a substance that is defined as a “dangerous drug”. Medical Cannabis is not a medicine, it is not registered as a medicine, and its efficacy and safety when used for medical purposes has not yet been established. Nevertheless, there is evidence that cannabis could help patients suffering from certain medical conditions, and alleviate their suffering.”

Thus opens the homepage of the Medical Cannabis Unit of the Ministry of Health (MoH)  with as much clarity of purpose as can be mustered for the apparently loaded subject.

Over twenty thousand patients currently have permits for the use of medical cannabis in Israel, and over many years the means of supplying the substance to those in need have slowly progressed to the point where Israeli researchers, growers and distributors have gained international recognition as innovators. The evolution of policies is ongoing, with an expansion of availability seemingly around the corner. Still, the following is a summary of the current state of affairs, and will be updated when the MoH administration plans are fully implemented.

Cannabis is Not in the Healthcare Basket

“The Ministry of Health wishes to remove obstacles to the supply of this drug to patients who could benefit from it medically and who wish to purchase it at their own expense.”

MoH website

This means that the MoH regulates who is allowed to use medical cannabis and who is allowed to supply it, but they are not obliged to provide it through the public healthcare system or cover its cost. Instead, permitted patients subscribe to a specific licensed supplier and pay a monthly fee. Currently this fee is NIS 380 per month, to which additional charges may be added for delivery, equipment, or other accompanying expenses.

One issue that has been recognized by patients and officials is the fact that the monthly fee bears no relationship to the prescribed amount of the drug that the patient receives. This may be changed in future policies, and there is always the possibility that eventually the committee in charge of the health basket will add cannabis to the list of medications that the government primarily finances for patients.

Another innovation that is planned by the MoH is to have the drug available from regular pharmacies instead of specially designated distributors, though this plan has not yet been implemented.

How to Receive a License

The request for a permit is an electronic form available on the MoH website that is filled out on the computer and then printed to be faxed or mailed to the Medical Cannabis Unit by a doctor specializing in the medical field of which the patient is afflicted. One notable exception The Ministry of Health has given oncologists in most of the major hospitals in the country the direct authority to issue medical cannabis licenses.

Currently, requests are not accepted from family doctors and general practitioners, though ministry officials have stated their plan to offer a short training course to any doctor in order to qualify for prescribing the drug. Theoretically, they will even be allowed to issue licenses directly, though this will not be clear until the plan is implemented.

The Recommending Doctor’s Responsibilities

The patient-doctor relationship plays a central role in the MoH’s approach to issuing licenses. The recommending doctor is specifically associated with the license that is issued and if the patient changes doctors the license will have to be updated. If there is any change of status of the patient under treatment, it is the responsibility of the doctor to update the Medical Cannabis Unit’s administration. The doctor must perform medical follow-ups with the patient every three months for the first year of treatment and every six months afterwards.

Recognized Conditions and Indications

The following conditions are currently recognized explicitly by the Ministry of Health as entitled to consideration for a license:

  • Oncology Patients
  • Chronic Pain
  • Crohn’s Disease
  • Ulcerative Colitis
  • HIV/AIDS
  • Multiple Sclerosis
  • Parkinson’s Disease
  • Tourette’s Syndrome
  • Terminally ill patients
  • Post-Traumatic Stress Disorder (PTSD)

In most cases patients are expected to have exhausted other conventional treatment options before they can receive a license. There are also other explicit indications for treatment for each condition.

All specialist doctors may make a recommendation for a medical cannabis license and either petition the indications committee of the Ministry of Health to add a new indication to the list or request individual exceptions for conditions not currently in the list that the doctor feels warrants the use of cannabis for the patient.

Further Resources

Ministry of Health:

Tikun Olam, Israel’s most prominent growing, research, and distribution organization:

Israeli Doctors Channel with Patients’ Rights Videos

Doctors Channel, is a YouTube channel providing informative videos on a wide variety of common diseases and medical conditions, information about patients’ rights in the Israeli medical system and other vital information, directly from the experts. 

Many of these videos are accompanied by English subtitles (click the English tab on the channel’s homepage for instructions if the subtitles don’t appear automatically), including the 2 we would like to highlight here. The entire YouTube channel can be a very useful resource for understanding many aspects of medical treatment and the approaches of Israeli practitioners, but we would like to point out the following videos for their focus on healthcare rights and navigation:

What to do if a prescription is not approved by the Kupat Cholim

Seeking your rights via the Society for Patients’ Rights in Israel

The videos are produced in coordination with the Society for Patients’ Rights in Israel and many Israel hospitals and medical centers. This is a non-profit initiative sponsored by the AbbVie biopharmaceutical company aimed at making important medical information more friendly and available to the public.

We hope that this initiative will continue to provide vital practical knowledge and, of course, remain committed to providing resources that are English accessible.