Don't call him doctor

A Bnei Brak rabbi has made his life's mission helping people find the medical help they need.

By JUDY SIEGEL-ITZKOVICH
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Thousands of people would give their right arms for the privilege I had: a 90-minute, face-to-face meeting in a Jerusalem hotel lobby with Rabbi Avraham Elimelech Firer. My aim was to interview this incredibly busy man, who on that average day had already devoted a few potentially lifesaving minutes each to 40 people in his Bnei Brak office and 80 or 90 more over a computerized phone system. They want and need him not because he dispenses rabbinical blessings for good health, happiness or material success. Firer an autodidact who studied solely in Belz hassidic yeshivot and never formally learned English or the sciences is a kind of matchmaker. He does not bring together prospective marriage partners, but deftly and competently matches sick people with the best hospitals, physicians and treatments available for their conditions, either in Israel or, in rare cases, abroad. His free, objective medical referral service is the capstone of Ezra Le'Marpeh, the voluntary organization he founded in 1979, which also lends $4 million in medical equipment, holds videoconferences with medical experts giving second opinions, visits the sick, provides home care for children with cancer, solicits blood donations and runs a rehabilitation center for victims of stroke and other disorders. It offers its free services to Jews and non-Jews, secular and observant anyone in need. The accomplishments of the organization, its unpaid founder and director, its few salaried workers and hundreds of volunteers are documented in the Hebrew-language, photo-filled book by journalist Menachem Michelson, 24 Hours with Ezra Le'Marpeh. President Moshe Katsav wrote the laudatory foreword to the 160-page volume. "Rabbi Firer makes an incredible contribution to Israeli patients who fall between the cracks of the medical establishment," testifies Prof. Yehoshua Shemer, Maccabi Health Services' chief and a former Health Ministry director-general. "His referral service makes him a one-man show, a public institution on his own." "He's a very precious person who does holy work and helps many people get the good treatment they need," adds Dr. Yitzhak Berlovich, the ministry deputy director-general in charge of its medical branch. "I know many people have been helped by his incredible ability and his connections. Nothing in the medical establishment can replace him." "We doctors are still not communicative enough with patients, although we are better than before," says Prof. Jonathan Halevy, director-general of Jerusalem's Shaare Zedek Medical Center. "Unlike the US, Israel is not open enough on how much experience individual doctors have, how many operations they have done and done well in a specific field, when and why they failed, and if they had been sued for negligence," proffers Halevy. "He is a self-educated genius in the field of medicine who can quote medical journal articles verbatim," continues Halevy. "It is rare to have such a combination of genius and motivation to help others. There are commercial firms that offer medical treatment referrals for money, but they are not necessarily objective, as they may get money from doctors and institutions for their referrals. There was a vacuum that we didn't even realize existed until he filled it. Today, hospitals compete for his recommendation. Senior doctors immediately answer the rabbi's phone calls, respect him and even try to court him, but when he rates them, it is objective and not connected to flattery." It's a near-impossible challenge to find someone who has something negative to say about Firer. The Israeli establishment and medical and academic institutions apparently agree with the praise, as Firer has received honorary doctorates from the Weizmann Institute of Science and Bar-Ilan University, and the Ot Hanagid Award from Shaare Zedek. At the Ot Hanagid ceremony, Firer said he was unsure whether he should accept the award, since he did not want to give the public the impression that he was showing a preference for a particular hospital. "Shaare Zedek is a leader in the fields in which it specializes, but that wasn't what, in the end, persuaded me to accept the award," he said at the ceremony. "It was Shaare Zedek's emphasis on establishing a human connection between doctors and patients. I wanted to demonstrate how much I identified with this approach." In 1997, he was the recipient of the country's highest civilian honor, the Israel Prize, for his life's work. Although Firer, his wife Feige (Tzipora) and their 10 children (ages 12 to 27) live modestly, the rabbi unhesitatingly donated the NIS 50,000 check that accompanied the prize to Ezra Le'Marpeh in Bnei Brak. SITTING IN a quiet corner of the hotel lobby with his devoted assistant, Avishai Bagad, the 50-year-old Firer is dressed in his ever-present hassidic uniform a large black kippa on his head, tieless white shirt covered with wool ritual fringes and a black vest, a long black coat, black trousers whose edges are stuck into shin-high black socks, and laceless black shoes. Tall, thin and bearded, with his sidecurls tightly twirled around his ears, Firer sips tea and speaks softly but authoritatively as Bagad handles a stream of incoming cellular phone calls. A married man, he never looks directly into my eyes; his gaze falls somewhere beyond my shoulder, even though he peers directly through his glasses to my husband, sitting next to me, who came along to hear what Firer had to say. But he is candid and answers every question. A medical and health system maven myself, I covertly test his expertise during the interview by dropping medical acronyms, names of treatments, senior physicians and medical journals. He is clearly very familiar with all of them. His spoken and reading English is very good, even though he never learned a word of it in the yeshiva; his knowledge of medical terminology is astounding, and he is a master at Internet searches of medical journals. Firer also has an encyclopedic database of names and medical information in his head. "I never intended to go into this," he says. "I never dreamed it would grow to such proportions. Neither I nor my parents or siblings suffered from an illness that inspired me." His father was a melamed (teacher of religious subjects) born in Galicia. Avraham Elimelech was born in Bnei Brak, the fifth of nine children. He married Feige, a kindergarten teacher, when he as 21 and studied in a kollel (yeshiva for married men), with the burden of supporting the family falling on her. He used his logical, sponge-like intellect for analyzing the Talmud, never taking anything for granted and always viewing a problem from all angles. He later adapted this method to his medical referral work. When he was 17, a relative of his contracted a disease that resulted in serious complications. A yeshiva student with absolutely no background in medicine or the sciences, he decided to delve into the matter because the doctor who was treating the man seemed to evince a lack of confidence. Firer, showing some hutzpa for a teenage hassid, asked the doctor if he objected to his coming over and listening to an explanation of the illness. The open-hearted doctor invited him over to his apartment at Tel Hashomer and patiently explained the situation and possible treatments in a 90-minute conversation, during which the young Firer took copious notes. He then went to a public library to study the matter and communicated his findings to the family. The patient recovered, and Firer thought that was the end of his little escapade. But when he encountered a patient who needed a portable ventilator available freely in the US but not in Israel, he made calls, collected money, purchased it and started a medical-device loan society. Gradually it expanded to Ezra Le'Marpeh's major proportions. Simultaneously, Firer began to amass his store of medical knowledge like a detective, collecting facts by reading technical material and consulting with incredulous and sometimes dismissive doctors. "When they asked me who I was, I said I was there on behalf of the family, so they could tell me what they would otherwise tell them," he recalled. On those rare occasions when one is not supposed to study Torah or Talmud, Firer read popular science magazines about electronics, radio frequencies and even how television works even though he doesn't have one at home. Firer's grasp of medical terminology, medical conditions including the most rare and his English improved so much that eventually he was able to swim in them quite naturally. He even reads x-rays on a light box in his office, as well as CT and MRI scans and catheterization films on his computer screen. But the rabbi doesn't regret not having formally studied medicine. "There are enough doctors around," he says. Firer says he has no favorite medical subject. "I don't do it because I have personal interest in a medical field," he insists, "but because the information can help and be lifesaving. But there are some intellectual things, such as bioinformatics and DNA chips," he says, that provide some intellectual indeed talmudic stimulation. "Most of these things are theoretical and not yet of practical use to patients." He often astounds medical specialists. When doctors scratched their heads over the case of an eight-year-old girl who suddenly developed involuntary hand movements that made it difficult for her even to hold a cup or write her name, Firer reached the conclusion that she suffered from chorea minor, a form of rheumatic fever so rare that even the head of Sheba Medical Center's pediatric department has seen only three cases in five years. The rabbi called the senior pediatrician, who examined her, confirmed the rabbi's diagnosis and treated her successfully. One pediatric ophthalmologist in California was flabbergasted: "Rabbi Firer called me and told me there was a five-week-old baby girl who needed an urgent cornea transplant. I didn't know him, but he 'ordered' me to treat her, and I did." She made a full recovery. A radiologist at Beth Israel Hospital in the US invited Firer for a half-hour talk. "I gave him a copy of a major book I wrote that is very technical. I realized this man knows more about my field than almost any doctor I ever met. Rabbi Firer phoned me a few months later and, by the way, pointed out three mistakes in the book!" He is also a virtuoso in logistics. When a condition is so uncommon that Israeli physicians have too little experience treating it to ensure a positive outcome, Firer contacts his wide reservoir of Jewish and non-Jewish contacts abroad. "Some of them I have met on overseas trips, and others I reached by phone or through my Israeli connections," he explains. Although Ezra Le'Marpeh lacks the funds to send patients with rare conditions abroad, on special occasions they do use "frequent flier" points donated to them by habitual travelers. In a flash, Firer uses his contacts to arrange for visas and passports for foreign travel, air ambulances, transport to medical centers and home hospitality for family members in the homes of volunteers. He has also brought world-class surgeons to Israel when a patient urgently needs an operation but cannot safely be moved. He was responsible for bringing world-renowned Yugoslavian neurosurgeon Dr. Vinko Dolenc to Israel about a decade ago, arousing some anger among local neurosurgeons who worried about their reputations and livelihoods and unsuccessfully tried to prevent the Health Ministry from giving him a temporary license. While two decades ago there were major lacunae in the expertise of Israeli surgeons and other doctors regarding some conditions (such as repairing congenital heart defects as with transposition of the great arteries in infants), today there are few such cases. "Today, 99.9 percent of referrals are inside Israel. Routinely, I send patients to Israeli physicians. They go abroad for post-doctoral study and encounter rare conditions there. Medical school education has also improved," Firer says, "and the level of Israeli medicine is comparable to the best in the world and even better than in other advanced Western countries." When confronted with a patient who urgently needs experimental medications not available in Israel, he uses his network of personal connections to get them, once even having Ben-Gurion Airport opened on Yom Kippur to have a drug delivered. Like a religious doctor who deals in urgent matters, he answers his phone on Shabbat and Jewish festivals, because he knows it rings on holy days only in an emergency. "I will not have a Shabbes goy [non-Jew who performs such acts] do this for me," he says adamantly. THE Journal of Medical Ethics published an article in 2000 by Avinoam Shuper, Avraham Zeharia, Judy Balter-Seri, David Steier and Marc Mimouni of Schneider Children's Medical Center of Israel in Petah Tikva and Tel Aviv University, in which they studied and analyzed the involvement of rabbis in consulting with patients and their families on medical issues. Their study was performed to determine doctors' attitudes to rabbinical consultation by parents of sick children for purposes of basic medical decisionmaking. Processing responses to questionnaires, they found that between 63% and 77% of the pediatricians agreed to rabbinical consultation on medical decisions. But in cases of divergence from accepted medical practice and in emergencies, almost all stated they would take measures to resist the rabbi's advice. They concluded that Israeli doctors respect rabbis' suggestions in this field, but feel that to prevent their exaggerated involvement in medicine, "rules should be set to establish norms for rabbi-physician collaboration." Israeli rabbis are used less as chaplains for comfort or moral support when a patient is dying, but for helping patients and families make basic medical decisions in the acute care of emerging problems. The article noted that only rarely will a rabbi interpret test results or express an opinion about a specific treatment that has been recommended. The Schneider Medical Center researchers, however, specifically cited Firer as an exception. How does Firer support his family, if he takes no salary from Ezra Le'Marpeh, which depends almost totally on voluntary donations? "My wife works very hard and runs a mishpahton (family day care at home). I have also occasionally served on the boards of directors of companies that make medical equipment, but I don't really have time for that." He still finds time for his family and for Talmud study, but he admits he doesn't see his children as much as he would like. Firer knows that there are many prominent modern Orthodox physicians in Israel and abroad, but with few exceptions, the only haredi doctors are immigrants or those who were secular and became penitent Jews. "It's easier for yeshiva students abroad who want to go into medicine to study Talmud during the day and go to night school afterward. This is not an option in Israel," he says. But Firer thinks that haredi doctors would suffer unbearable conflicts in Israeli hospitals and other medical institutions. "Morally and halachicly, they would have to act in the best interest of their patients, but as employees they are also dictated to by the heads of their institutions." He is disturbed when presented with advertisements from haredi newspapers claiming that non-physicians have the supernatural power to "heal" diseases. "I am absolutely against these phenomena. People should go for medical treatment only by licensed medical practitioners," he declares, adding that doing otherwise and avoiding conventional medical care could complicate conditions and even prove fatal. He also denounces smoking, which he himself did "until about seven years ago, when I quit." Tobacco causes many needless deaths in Israel, including among haredi men. "But smoking is forbidden now inside yeshivot; it's better than it used to be, and smoking is looked down upon." Nevertheless, there is apparently not enough stigma to prevent haredi newspapers from regularly carrying lucrative cigarette ads. Asked what he thinks about the Health Ministry, Firer says he has personally known most health ministers over the past few decades. "There are a lot of political pressures, which causes waste. Every major hospital wants to have a cardiovascular surgery department or in-vitro fertilization unit as a matter of prestige, when in fact not so many are needed," he explains. As for the series of politicians who have headed the ministries, the rabbi says, "Dan Naveh [the current minister] and I are good friends. But I think he views the office as a springboard to 'higher' political office." The "best" health minister he has known was Shas MK Nissim Dahan, "who really wanted the job, took a fundamental interest in it and was really devoted." Amazingly, despite his use of computers as a search tool, Firer hasn't accumulated a computerized database of his medical contacts, specialists and expertise, and he hasn't trained anyone to eventually take over. "I know the information by heart, or I can easily obtain technical details such as addresses and phone numbers by searching the Internet or making a call," he says. As for preparing an eventual replacement or at least a substitute for him when he wants a respite from the endless calls for help, Firer says: "I feel enough responsibility when I have to decide things on my own. How would I be able to take responsibility for someone else? And in any case, before I came along people managed, and after me, they will manage." n Don't call him doctor