Navigating the Israeli Healthcare System with Children During an Emergency

By: Ayala Laub Waltuch, Director of Programming & Organizational Development, Yad L'Olim

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Most parents know of the all too regular phone call from gan, telling you that someone has fever again, an ear infection again, a stomach virus again. Work is cut short, you pick up your sick kid, and make a doctor’s appointment for the next day. Nothing crazy, nothing urgent, just your run-of-the-mill using every last sick day for your toddler by March. Many of us also have experienced a different kind of phone call from gan. The one where they start by saying “everything is ok”, and you know everything is anything but ok. The one where your heart sinks, your stomach drops, and you keep reminding yourself not to panic, but all you can do is imagine the worst-case-scenario. The one where you arrive at gan, and it’s not just fever, not just an ear infection. You don’t know what it is, you’re not sure what to do, but you know you need help NOW.

I have the privilege of working for Yad l'Olim, and overseeing our Healthcare Division in memory of Shira Pransky z"l, so when I got the latter phone call from my son’s gan, I knew what steps to take. However, even someone with my level of experience still met some roadblocks when trying to get my son urgent care for a frightening & debilitating virus. Couple that with the stress and fear of dealing with a sick child, and I can’t even imagine how someone with a lesser understanding of the system would manage. To help you get through it if you need it, G-d forbid, here are some tips for navigating the Israeli healthcare system with children during an emergency:

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PLEASE NOTE: If experiencing a life-threatening emergency, do not hesitate to call an ambulance and go straight to the emergency room!

• Call Your Regular/Local Doctor’s Office: Ask if there’s a doctor there, let them know you’re on your way, or get a hafnaya (referral) for urgent care or miyun (the ER), depending on the urgency of the situation.
• Get to know your mazkira (secretary): This tip holds true all year round, in any situation, but is especially important in an emergency situation. A relationship with your branch secretary can be the difference between being seen immediately by an on call doctor, or waiting for hours.
• Bring all necessary ID/Papers (and a “Go Bag”): It’s hard to focus on technical things like this when dealing with an urgent situation, but take a deep breath, and gather all your teudot zehut (Israeli IDs), your cartis Kupat Cholim (Health Fund/Insurance card), and any other relevant medical documentation. This simple step can save you a lot of time and headache wherever you end up for care. Throw in some diapers, a change of clothes, a phone charger, and some food while you’re at it. This might be a while.
• Get a hafnaya (referral): Although there’s a long list of reasons you can go to the ER without one (and if you need to-- GO!), for many cases, going to the ER without a referral will land you an 800 NIS copay and/or a fight with the kupah after the fact for reimbursement. You can get a referral from your doctor or from the nurse’s hotline on the kupah’s moked (hotline). They can fax it to the treating ER, so you can even call on the way to the hospital.
• For Children Under 5: Try to get a referral straight to the ER: Most Urgent Care Clinics (Terem, HaTurim, etc), will be hesitant to make a final diagnosis for a young child (generally under the age of 5), and will often end up sending you to the ER anyway, even if the situation is under control, and a diagnosis seems clear. Since that’s often the case, if you can convince you referring doctor to send you straight to the ER, you may save yourself some time by cutting out the middleman.
• Review the referral with the doctor: Regardless of whether you’re being referred from the Kupah to urgent care, or from urgent care to the ER, make sure you review the referral with the referring doctor. Ask and insist that the instructions, needed tests, completed tests, level of urgency, and suspected diagnosis are clear on the referral. Otherwise, your child may be forced to repeat tests, do extra tests, or wait longer than they should for care.
• Use Protexia: This is a tough one for Olim, who often lack family & connections in a country that runs on family & connections. Sometimes, you really don’t have anyone. But if you can think of anyone… your neighbor’s third cousin’s sister in law is a nurse at Hospital x... reach out, make the connection. They’re often happy to help, or willing to connect you to the right people. This may help speed the process along or ensure better bedside manner, since after all, you’re “family”.
• Speak Up: If things are moving slowly, don’t be afraid to nudge the nurse. If you have a concern, say something. Don’t worry if your Hebrew isn’t perfect, don’t worry if you think they’ll think you’re annoying. Stand up for yourself and your child.
• Be Human, Ask for Help: Sometimes you’re waiting for what seems like too long, and you don’t feel your child is getting what he/she needs. You’ve been “Israeli”-- you’ve asserted yourself, raised your voice, shoved yourself into an office, and nothing is working. Now’s the time just to be human. Go over to someone-- a nurse, the branch manager, a secretary-- and tell them why you’re scared, and why you need help. When I was with my son in urgent care, things were stalled, and I felt my voice wasn’t being heard. I went up to the branch manager, looked her straight in the eye and said, “Listen, I know there’s a lot going on here, I know it’s not your fault, but I’m telling you, there’s something wrong with my child. I don’t know what it is, and I hope it’ll be ok, but I need to rule out that this isn’t serious. Please help me.” Within 2 minutes we were with a doctor.
• Phone a Friend: If you feel you’re Hebrew is not strong enough to assert yourself, or ask the necessary questions, try finding a friend who is more fluent to come with you to help.
• Ask the Right Questions: Knowledge is power. Ask the right questions to acquire the right knowledge. Some important questions might include:

• What test are you running?
• Why are you running this test?
• When can we expect a result?
• What diagnosis are you trying to make?
• What is your treatment plan or what are the treatment options?
• How long do you anticipate we will be hospitalized?
• What medications have you given? What medication should I give?
• Is there anything specific my child can not do when we get home, and for how long?
• Is there any long term follow up necessary?
• Trust Your Gut, Get a Second Opinion: Not all urgent care doctors are trained to deal with pediatrics, and not all of them have a lot of experience. For example, the on call family doctor insisted my son had growing pains. I knew this couldn’t be it. I asked to see another doctor or a specialist.
• Follow Up: Hospitals and Kupot Cholim do not actively share patient files or information. Therefore, it’s important to follow up with your child’s regular doctor or pediatrician. They’ll be able to add the diagnosis and summary to your child’s file, and watch for any related red flags in the future.
• Take a minute, have some perspective: This is easier said than done, and in no way is meant to belittle the incredibly stressful, scary, bureaucratic filled process, but sometimes, it helps to look at the bright side. We are fortunate to live in a country where all citizens & residents are entitled to healthcare, and that, albeit with a little pushing & shoving, we get what we need for free. Often when I am near tears dealing with the stress and chaos of Israeli healthcare, this thought helps me breathe a calm sigh of relief.

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If you’re struggling to navigate the Israeli healthcare system, we’re here to help!

Email: healthcare@yadlolim.org