White Elephant is a Life Saver

Occupying over four square blocks or an approximately 144,000-square-feet plot, seven stories high, the Central Tel Aviv Bus Station, frequently referred to as "Tel Aviv's White Elephant", was until very recently the largest bus station in the world. Bankrupt, dirty and poorly maintained, it sits, not in a central location but in the refugee-packed environs of South Tel Aviv. The Central Bus Station serves as the city's major transportation hub, but travelers hustle in and hustle out, hesitant to linger too long, and get sucked away into its confusing halls.

But, as a major redeeming factor, it also houses a health care facility devoted to providing care for the refugees and foreign workers who, having no health insurance, would otherwise be denied services.

Founded in 2008 by Dr. Michael Dor, former deputy director of the medical services division in the Ministry of Health, the refugee clinic was opened with funding from the government for the physical facility, but was manned entirely by volunteers. The clinic had little to nothing – four rooms, a few desks and chairs, and a stack of donated paper and pens. It could only be open when a doctor could come in for a couple of hours, meaning it was open at first for about ten hours per week. There were no computers, office materials, medical supplies or equipment; services and treatment depended solely on six volunteer doctors and donations.

Orel Ben-Ari, the clinic's current director, started at the clinic as one of the very first non-clinical volunteers in 2010. His job included sorting through the nearly 100 people, all sick or injured, waiting outside the clinic door to come in, and deciding who among them was in the most need of medical care. He could choose 15. The rest would have to come back when the clinic opened again later that week, and the process would start all over. He recalls, "Wow, it was sad. At that point, everyone was sick, injured and homeless, without food or clean clothes. And it was so hard to treat them. We had no blood tests, no medicine and no nurses to assist. The files were handwritten on paper. Only true emergency cases could be seen and the rest had to wait. When we would close in the evening, we would just cry." 

Eventually, attention to the clinic grew, improvements were made, and the clinic began to expand. More devoted volunteers began coming to help and more supplies were donated. Due to this, the Ministry of Health eventually assumed more responsibility and facilitated a critical partnership between the clinic and Terem, a private chain of urgent care clinics in Israel. Through this, the clinic now has an urgent care wing, equipped with a lab, X-ray and ultrasound machines, medical supplies and equipment, and full-time physicians and paramedics (1-2 per shift) funded by the Ministry of Health. Of course, the need for volunteer physicians in the different specialties remains as critical as ever. They see patients in a separate non-urgent care area of the facility, and they continue to serve on a weekly or bimonthly basis.

Today the clinic is open from 8:00am to 8:00pm and welcomes over 100 patients per day. In 2014, there were roughly 3,500 patient visits per month and over 32,000 for the year.

The volunteer physicians provide primary and chronic care and consist of GPs, pediatricians, gynecologists, a contraception specialist, a dermatologist, an infectious disease specialist, otolaryngologist, physiotherapist, endocrinologist, and others.

The clinic is likely the only refugee clinic in the world to provide extensive chronic care and follow-up treatment to patients with non-communicable, chronic diseases, such as asthma, diabetes, and hypertension.

The clinic relies on volunteers from all over the world to help work in reception and at the information desk, and to assist with other projects. Most of the volunteers in reception are young adults or students from the United States who are here on internship programs. Critical also are the 7 medical translators from Eritrea—all of whom have a background in healthcare and play a crucial role in bridging both lingual and cultural gaps between the patients and the healthcare providers.

The clinic has created a "public health department" that focuses efforts on providing health promotion and disease prevention information to the patients. They create culturally appropriate fliers, handouts, posters, workshops, lectures, and events on various topics, including the prevention of skin infections in the kindergartens, infant and child health and safety at home, asthma maintenance, diabetes, nutrition, HIV and STDs, and others.

Emphasizing disease prevention and health promotion is a critical initiative of the clinic that directly benefits the health and wellbeing of the community, while simultaneously saving money and resources for the clinic by keeping people healthy.

In general, emergency cases that come through with situations too severe for the clinic's urgent care wing will be sent to the ER at hospitals in the area. "We have wonderful relationships with hospitals, health organizations and aid agencies that allow us to collaborate to provide the best and most affordable care possible," says Jenna Berent, assistant director of the clinic.

Recently, the clinic was able to set up a system for "special cases," allowing patients who have complex medical cases and may be in need of expensive procedures, surgeries or treatment to be seen at the clinic by a physician from one of the local hospitals, who personally arranges for their continued care at the hospital.

During a recent visit, I had the occasion to observe the interactions between a client and the clinic personnel. A father had arrived with a nine year old daughter who had an ear infection. She had been seen by the doctor, and an appropriate prescription had been provided. How we underestimate cultural gaps! I watched as a patient volunteer, via a volunteer translator, explained to the father what a prescription was, how to approach the pharmacy, what to expect at the pharmacy and how ultimately the prescription had to be administered and finished, even if the symptoms disappeared earlier. It all seemed so obvious unless, as was the case, it was one's first encounter with western medicine.

As the encounter I was watching drew to an end, Jenna Berent, assistant director of the clinic and my hostess, excused herself, "They've been here quite a while – let me go expedite the paperwork."

Currently, the clinic is starting to expand its research department and to expand and document their achievements, and would welcome any medical researchers who would like to volunteer. In addition, despite some governmental funding, there is still a need for financial support to help pay for new equipment, projects and programs. And of course, any physicians or nurses licensed in Israel who are interested in helping out at the clinic would be much appreciated.

See also: "Clinic's Trials & Tribulations" by Lucille Cohen

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