Clinic's Trials & Tribulations

I watch as the young Eritrean woman in her mid-20s, sitting in a Tel Aviv clinic, listens to the pros and cons of her options for birth control. Although flickers of apprehension cross her face like tiny ripples reflecting minuscule movements beneath the surface of a placid lake, she appears composed and attentive – despite an almost three hour wait after arriving much too early.

The advice is being carefully and clearly delivered, in English, with the help of a model visual aid, by a doctor who has made aliyah from Britain.

Forming a triangle with the doctor and patient is a new, volunteer translator who is gently and conscientiously doing his utmost to decipher it all in Tigrinya for the patient.

She readies herself to take the permission form away and, after considering the potential side effects that have been explained to her, may return when she has signed it and paid a reduced fee.

Apparently, she did return a little later, acted on the advice and had her coil (IUD) fitted by the doctor. She was one of five women similarly treated in a session full of 10 minute slots during that Wednesday morning. On Monday morning there had been seven takers.

"Most of the women return on the same day as they don't want to take another day off work", explains Dr Braunold.

The clinic's fame has spread far so that its patients, mostly Eritreans and Sudanese, readily locate it through word of mouth or turn up with companions.

Dr Gillian Braunold occupies a corner room. She is the dedicated volunteer doctor who runs the contraception clinic two long mornings a week at this public clinic. Experienced and efficient, she nevertheless exhibits a deep and heartfelt concern for her patients – a difficult combination by anyone's count.

Dealing with her patients is a culturally sensitive matter, she explains. For example, she does not ask if the women she sees are married, instead asking if they are with the same partner, as this is relevant to the risk of infection.

Dr. Braunold also explained to me the social and cultural problems associated with the use of the "three month" birth control injection, Depo-Provera. "In affluent countries, patients are advised to come back for a repeat prescription after three months, but the preventative effect only lasts 85 days maximum.

"My patients are not told to return in 12 weeks in case they run overtime or no appointments are available for a few days," she reveals. "Instead they are told 10 to 11 weeks which allows me an extra 13 days to play with." 

"The Depo-Provera injection is seen as stigmatized in Israel," Dr Braunold says, "because it is used for those of low socio-economic levels. It is simply not offered to Israeli women but is actually a very good method."

Dr Braunold sees 70% of all the women who attend the clinic. Last year she fitted 20% of them with coils. That represents 112 IUDs. It is not always a comfortable procedure for the patient, but, for the past two years, she has run a successful, recorded trial of fitting them to music.

Her patients are mainly Eritrean although there are some Kenyans, Nigerians, and West Africans including some from the Ivory Coast. Generally, she does not see Sudanese as those who attend the general clinic are single men whereas the Eritreans seem to be family groups.

Eritreans, she was pleased to note, have not been subjected to FMG (Female Genital Mutilation) otherwise she would not be able to fit the coils. However, Sudanese, Somalis, Ethiopians and Egyptians often have this procedure which produces a "chastity belt of skin". She had expected to see more FMG cases but has only come across two in her two years at the clinic.

Most of the women attending her clinic are aged from 20 to 35 and have various choices.

Patients wanting an IUCD usually have to have a pregnancy test and wait a week unless they are certain there is no chance and sign the consent form.

The IUCDs used by the clinic last for five years and are passed to the user at cost plus a small visit cost.

Not offered is the subcutaneous, implanted rod known as Implanon as it offers little extra benefit and is much more expensive than other methods, says the doctor.

The pill is one of the choices available and is suitable for committed patients, but the doctor and patient have to acknowledge that chaotic and difficult lifestyles and illiteracy in the packet language can make the pill a challenging method.

Do they get teenagers? Those they do see have come to Israel as children during the Eritrean immigration of 2007-12 as part of families who have arrived from Africa and have been seen as children in the general clinic.

Anyone aged 17 or under needs to be accompanied by an adult for any treatment. Here teenagers do not present seeking terminations.

The clinic has become increasingly busy and Gillian is delighted to have drawn in a UK trained and retired practice nurse, Rosalind Knight. Rosalind, the mother of a friend of Dr Braunold, was working as a volunteer at the Ramat Hanadiv gardens in Zichron Yaakov, where Dr Braunold also lives. However, she was delighted to get back into the medical field and works one day a week, advises on contraception and gives the injections under a doctor's supervision. Another Zichron volunteer is South African olah, Dr Ilana Davis.

Sitting in with us as I interview Dr Braunold is Jenna Berent, the efficient and attractive 26-year-old assistant director. She became a volunteer in 2013 "almost immediately" after her arrival in Israel from Rochester, New York, and has continued to work here every afternoon. "I wanted to work in the field of volunteers and health," she says.

Dr Braunold is a strong, determined woman and is continuing to ensure that her medical knowledge and many skills are put to good use for the benefit of society in Israel.

Between observing Dr Braunold with a patient and interviewing her I am shunted off by the clinic's energetic Director.

Orel Ben Ari, speaks with an almost palpable fervor: "I take a patient's special case such as a vital heart operation and search the internet. I choose a suitable doctor and call him and ask him to treat the patient free of charge. If I cannot help him from here, the man dies. Even if I have to ring ten doctors until one says "Yes" it is a great success.

I can understand why. His youthful looks lead me to place him in his early 20s whilst he is actually a decade older. Yet that fervor for the clinic and its patients demands that he be taken seriously – very seriously indeed.

He is a young man with a mission and definitely firing on all cylinders – rattling off information at me in a mixture of Hebrew and English. Ben Ari is keen to tell me about the history of the clinic and how it operates.

After working with children, Ben Ari joined as a volunteer in reception in 2010 when the operation was very small in another part of the bus station. He is proud that every room now has a computer and a telephone.

"The clinic is like a big, friendly 'family'," he beams, turning serious. "Contrary to the popular image, the patients are not narcotics, homeless and thieves. They are not! They do not come here.

"They are nice, polite people in a difficult situation. Most live in this area and nowadays, unlike in 2012, no one lives in (the nearby) Lewinsky Park or in shelters."

Baya, a health care assistant who is a trained nurse, can take blood and acts as a translator, runs the medical side of the clinic with Ben Ari.

The dedication the clinic inspires in its volunteers is remarkable too. There are more than 100 volunteers working there plus 15 employees who started as volunteers including seven from Eritrea.

This means that the languages spoken include Tigrinya, Arabic, Hebrew and English.

I come away with the feeling that it is Ben Ari's fervor that holds this operation together – the keystone without whom this remarkable clinic would all fall apart.

Here to help . . . public clinic staff in Reception

See also:

"White Elephant is a Life Saver" by Morton Leibowitz

Public Clinic Terem TLV https://www.facebook.com/public.clinictlv?fref=ts.