The “privilege” of being accepted to ER in time of real medical emergency is the only one legally guaranteed to persons of no civil status (according to the Patients’ Rights Law), and in reality, in most cases, the “infiltrator” will not manage to traverse beyond the bounds of the Emergency Room, into departments where he will receive more thorough treatment. That’s the reason why many of them turn to the Open Clinic, run by Physicians for Human Rights. However, the main notion impressed upon a volunteer at the Open Clinic, be him a doctor, a nurse, a translator, a front desk worker, or, as in my case, a medical student, is that the clinic cannot replace an entire health system.
Unfortunately, the patients who arrive at the clinic for treatment, frequently believing that it is a branch of the Ministry of Health, as a brief and frustrating survey I recently conducted shows, are often met by considerable helplessness and impotence. The great majority get lost somewhere (and usually early) along the procedure of seeing a general practitioner à seeing a specialist à examinations and tests à diagnosis à treatment à follow up, and therefore do not receive a full and complete treatment. This is the kind of treatment that the public health system has all the means to provide, but for some reason prefers to offer in varying measures to the various components making up Israeli society. Due to the high demand, about 30% of the people arriving at the clinic on any given day do not even manage to enter the clinic itself.
Because of the limited resources, most patients at the clinic who suffer from life-threatening illnesses do not get full medical treatment in accordance with western standards. This fact is especially frustrating since in many cases, the possibility to affect their prognosis, had they received such treatment earlier, is substantial. Furthermore, various researches have proven that the costs of providing preliminary treatment is significantly less than the cost of non-treatment, which leads to a deterioration in the patient’s condition that eventually necessitates expensive hospitalizations. In my work at the clinic I witness the results of the lack of treatment; I see the patients’ condition deteriorate from one visit to the next, up until the final breakdown. But then, suddenly, the public health system somehow opens its doors. Suddenly the clinic can send the patients to the Emergency Room, where they will be accepted with open arms and referred with exemplary efficiency to hospitalization in the Internal Ward, which will stand between them and the next world for the following week or month.
This brings up the following question: why does the health system choose to intervene precisely at this moment, when a man is about to die? Ivan Illich, an Austrian thinker and sociologist, offers one possible answer, terming the concept “medicalization of death” in his book Medical Nemesis. Illich argues, and I tend to agree, that modern Western society aspires to purify “dirty” forms of death and sterilize them by sequestering the responsibility for the dying person from his family and transferring it to the medical establishment. Whoever doesn’t die at home, peacefully and quietly in his sleep, will die in the Internal Ward or in ER. In this manner society manages to conceal the “ugly” process of the deterioration of the body.
Thus it is rather cynical that the state generally fails to fulfill its fundamental obligation – as it is expressed in the Refugee Status convention – and provide the refugees with equal access to welfare services (among them public health insurance) which are available to all the citizens of the state. But, to the small extent that the state does fulfill its obligation – as in the commitment, established in the Patients’ Rights Law, to offer treatment to every person arriving at the Emergency Room - it does so not for idealistic motives, out of humanitarian concern for a person who became a refugee, but in order to protect the refined sensitivities of the state’s citizens.
Yaniv Fenig, Student of Medicine
Translated from the Hebrew: Shir Alon