Chelm Comes to Israel

Once upon a time, in Eastern European Jewish folklore, there was a town called Chelm, whose inhabitants were all simpletons. They tried to capture the moon, which everyone knows is made of cheese, in a barrel, and could not figure out why there seemed to be less of it each night, even though the barrel was guarded and no thief could be discovered…

There are those who think Chelm is a delightful fantasy. It's quite real, I assure you, and alive and well in Israel. (After all, if, in the Ingathering of the Exiles, we have Jews from every corner of the globe, why not Chelm?)

I work for one of the Israeli sick funds—our version of an HMO—in the Women's Clinic. And here is what happens to that yearly Pap smear your gynecologist takes:

First of course, the doctor actually gets the necessary specimen, and, after labeling it and putting it in a little plastic or cardboard holder to protect it, gives it to his nurse or office secretary, along with a computer-printed or hand written sheet that is to be given to the laboratory along with the specimen. The nurse or secretary puts both into an envelope, sealing the envelope so the "hafnaya" (the lab form) and the smear itself won't become separated from one another. Then the envelopes are either picked up by a messenger who brings it to our clinic, or the patient does, or, if the smear has been done by one of our doctors, it is given to our secretaries. If the smear is done by a doctor in another clinic belonging to our HMO, then the secretaries there deal with it, but since we are the central clinic, we get the most to process, roughly about 350-400 per month. Not infrequently, especially if the smear is taken by a doctor a long way from our central branch, it can be a week or more before it gets to us.

The medical secretary of the kupah then rips open the envelope, generates what is known as "hithayvut"—authorization (a woman gets one Pap smear a year for free, otherwise she has to pay NIS 25 per smear)—and puts the specimen, the hafnaya, and the hithayvut into ANOTHER envelope, sealing it so nothing goes astray, as before.

Then the medical secretary brings the accumulated envelopes to one of the nurses in the clinic. This is an innovation decreed by the kupah Poohbahs in Tel Aviv two years ago, supposedly for "medico-legal" reasons, but they remain completely obscure as there is no nursing input whatsoever. We merely copy, on our extremely slow and antiquated computers (doctors have Windows XP and Pentium 4 computers; we work on DOS and, if lucky, have Windows 98 and Pentium 2) what the medical secretary put onto the hithayvut page. So if there's any mistake, we just pass it right along. I won't bore you with the number of steps required for this exercise in absurdity* but between opening the envelope (usually not only sealed but stapled several times, which makes opening it without tearing the forms inside a bit tricky), paste a bar code on the hafnaya, write the patient's name (already on the specimen, remember) and ID number on another bar-coded sticker to put on the specimen container itself, and on the outside of yet another envelope, which is sealed with the two forms and specimen inside. This is tossed into a box, which waits about 3 days for another messenger who will take it to the lab. We tell patients that it will take about a month for the smear to be processed, but two weeks go by before it even gets to the lab.

So far, about four, maybe more, persons have handled the smear in its little box. Three envelopes, at least, have been used. Someone ought to do time-motion studies on this little "routine" test. It usually takes the secretaries about 5 minutes to do their thing, and anywhere between 3 and 7 minutes for the nurse—who of course is expected to take care of numerous other duties at the same time, such as antenatal followup for about 40 women a day, fetal monitors, teaching women in our high-risk clinic how to cope with their gestational diabetes and women in fertility treatment how to inject themselves, and give advice on the phone when patients call up with questions. I worked out, once, that it takes one nurse about one hour of each day just to cope with this---well, what can I call it? Exclusively secretarial task. It is a total waste of valuable nursing time, and the patient's smear results are delayed for no good reason. All doctors with the kupah are connected by computer; there is no reason, really, why the smear cannot be completely processed, including its financial authorization, at its point of origin and sent directly to the lab (which is not in Jerusalem, btw) by messenger. The current messenger makes rounds of numerous other clinics to collect specimens on a daily basis, and by next year, when the entire laboratory of the kupah nationwide is relocated to a central site, the messenger service will have to be extended anyway.

It is just stupid. For this I went to nursing school for 4 years. To put bar codes on lab specimens and to unstaple envelopes. Bah humbug.

*Well, if you must know the computer steps involved, they are as follows:
Main menu → sub menu → patient's ID # → code for Pap smear → doctor's name or code # → note if patient teaching done (y/n) → write in "Pap sent to lab" → note whether this is a work accident (y/n) → then press, in sequence: F10, F3, 3, F6, F7, fill in password, type of exam (code), Dr's ID code, date, bar code number. Press Enter three times then F12.

Then go back to the beginning and do it all over again with the next specimen. Assuming the computer doesn't crash, which it often does.

The Congested Oracle Speaks

Between sneezes and coughs, the following bits and bobs have occurred to me. If anything sounds bizarre, blame it on fever...

I never promised you a rose garden...
Reading a message posted on one of my Israel lists, it occurs to me that it is much tougher to make aliyah than back in the late 70s, when I did. The poster writes that she is unable to find many items she is used to, such as particular brands of toothpaste and decaffeinated tea, and the children's favorite all-natural, unsweetened, low cholesterol candies, and many other essential items of civilization like Ziploc bags. My heart bleeds.

Food nostalgia is indeed the last part of one's previous life to relinquish, and it can be painful and long. My poor Dad, z"l, used to shlep cheddar cheese, Hebrew National hot dogs, and maple syrup in his suitcases whenever he visited. Now we have both an indigenous cheese called "cheddar", and you can get the real imported item as well, there are beef frankfurters which are a fair replica (lower fat, though) to the American kind, and at least 4 different brands of maple syrup, (including the real thing), not counting the low-calorie variety.

When I arrived in Israel there were almost no imported food "luxury" items. You could drink Elite instant coffee (called by Israelis "Nes", which means "miracle" and is also a contraction of the word "Nescafe", a generic term for instant coffee), or Cafe Hag (instant decaffeinated coffee and about as tasty as its name suggests), or "botz"--which is Turkish ground coffee which settles to the bottom of the glass (not cup) in a thick mud (that's what "botz" means) after boiling water has been poured on it. "Nes" isn't really coffee, to my mind, rather a coffee-flavored beverage. In coffee houses one could get an "hafuch" or "upside down" coffee which was an espresso with hot, foaming milk poured on top. At home, or in the army (where I understand the custom originated) this could be simulated with "Nes" by putting a teaspoon of water into a cup with the coffee powder and sugar and whipping the mixture into a thick paste before adding the hot water, creating a foam on top. Many a newcomer didn't understand what the early morning sound of a teaspoon beating against the side of a cup was at first.

Now, while we haven't gone to Starbucks extremes (Starbucks did not succeed in Israel; its coffees were too American) we can buy both American and European instant coffees in our supermarkets, decaffeinated in a variety of forms, not to mention espresso and filter blends and all the paraphenalia that goes with it. So much choice!

Too much choice. When I came to Israel, you knew, as you did with so many other aspects of Israeli life, that you were making radical change. A "care package" from the folks back in the Old Country (often still referred to as "home") had coffee and tuna fish in it. As with tokens for public telephones, that is now completely obsolete.

But what I have noticed, over the past thirty years is that those who have the strongest yearnings for certain foods from the US, and who go to the greatest extremes to get them, either bringing giant quantities in their lifts or constantly begging travelers to bring them packages from America when they come, have the toughest time being "absorbed" into Israel. The writer of the post describing all the things she packed into her lift and is trying to work out how to get more when they run out is making a major mistake.

Fixing the Fat
Our local Discovery Channel has been running a series of programs by the BBC Horizon folks about obesity and what has been discovered about it. Lots of investigations into what triggers appetite and how to suppress it, as in leptin production, or non-production, in fat mice, or various kinds of gastric bypass operations, or the checkered history of drugs to suppress appetite.

But none seem to address my obesity problem: I eat when I'm not hungry. For three years I went to Overeaters Anonymous and listened to people relate their struggles with binge eating, but I don't binge. Frankly, I don't know what it means to be hungry, most of the time. I just like to eat. And a nurse--especially in a unit like a delivery room--learns very early to eat whenever it is possible because it may not be possible when you "ought" to eat. Food is definitely a great comfort to me, when I'm anxious or tired. But more than that, I like the taste and texture of what I eat. It is a joy to contemplate a plate of macaroni and cheese, or a full British afternoon tea, or a Chinese banquet. I eat slowly, masticating well, enjoying the sensations. I don't overeat--one serving of spaghetti Bolognese is enough, I don't need a whole potful of pasta--but I look forward to when the clock says it's time for the next meal.

And now that I've got diabetes, this is aggravated. I must eat at specific times because of the medications I take. And since my carbohydrate intake must be strictly limited, of course, I am obsessed with carbohydrates and don't want anything else. Just thinking of dieting makes me so nervous I have go eat something to calm down. Which is why I am leaving this for the moment and going to the refrigerator...

A New Treatment for Obsessive-Compulsives
I've been setting up my new computer, and in particular, reconstructing my iTunes music library. What a job! I currently have 78 GB of music, audiobooks, and radio drama and it suddenly dawned on me what a mechiah it would be for a sufferer from OCD. Endless reorganization of one's playlists. Changing "genre", "equalizer", moving names from "artist" to "composer", etc., etc. I think that, instead of psychotherapy or medication, just give an iPod to every obsessive-compulsive and let them spend the next 10 years or so sorting out their music libraries...

From Those Wonderful Folks Who Invented the Inquisition...

And now the Spaniards, who took the friendly step of forcing all Jews in Spain to convert in 1391, and then expelled them in 1492, have the answer to the Middle Eastern mess:

http://www.haaretz.com/hasen/spages/789009.html

It really is so simple that it is staring the world in the face: tell the Palestinians to renounce violence and recognize the legitimate right of Israel to exist. Then we can all get on with our lives, to our mutual benefit.

Trying to force Israel to cut its throat by yet more concessions only encourages those committed to Israel's destruction.

What part of "no" don't you understand, Moratinos?

Oh, For a Holocaust!

...of cellphones.

I HATE cellphones. I don't want everyone to know where I am, all the time. As a nurse, I am congenitally unable not to answer a ringing telephone (who knows what emergency is at the other end?) In the bath, on the toilet, sound asleep...

And the way other people behave with them is even worse. Back in the Seventies, when I came to Israel, it often took between 5 and 10 years to get a landline--Israel had barely completed its infrastructure when optical fiber technology came into existence, so the number of lines that could be carried on an old-fashioned cable, the only kind that had been laid, was far less than the demand for telephones--and when renting a flat, being able to advertise that you had a phone was a major selling point. Even though, by the time cellphones became available (at pretty exorbitant cost, initially), the Israeli equivalent of Ma Bell, Bezeq, had pretty much eliminated the waiting period, Israelis had become completely obsessive about telephones. The "security situation" of course plays a part--a car backfires and everyone who hears it begins telephoning all their loved ones to tell them they are OK. (And after every terrorist attack, one of the first things that happens is that the cellphone networks crash from the overload as people in opposite parts of the country begin calling everyone they know to find out that they're all right) It's not by chance that the only place with a higher degree of cellphone saturation is Hong Kong.

And Jews love to talk. And bargains. I have acquaintances who own phones belonging to each of the 4 networks and use them according to the current "special deal" for air time, etc. Bus drivers sell cards for the "pay-as-you go" type. It's bad enough that the buses themselves have exceptionally noisy motors and ventilating systems, and the drivers always seem to have the radio playing at full blast ("public service" so you don't miss a single newscast--another Israeli obsession) but everyone is shouting--and I do mean shouting, over the din--all the current details of their life (and the details of everyone else's) into the phone glued to their ears. Since about 85% of the population is right-handed, this means that in another decade or two we should begin to see a mass epidemic of left-sided hearing loss and maybe brain tumors. And now all the kids are vying with one another for the latest 3-G telephone, so that they can squint at the tiny screen to see their favorite singer's latest video clip or a nude photo of their boy/girlfriends. An optician's dream--an entire generation with eye strain and glasses.

We have long since outstripped the small annoyance of telephones ringing during movies, or in restaurants, or in class. Forget about honking at a pedestrian strolling across the street just in front of your car. He/she is undoubtedly entirely engrossed in a telephone conversation. But then, as you are probably trying to make a U-turn while trying to keep the telephone wedged between your ear and your shoulder (yes! I actually saw a driver do this the other day, totally unable to look right or left but both hands were on the wheel so I guess we have to give the driver some credit) There are, of course, laws preventing the use of a cellphone without a hands-off speaker in a car. As with most laws of this nature in this country, priority goes to trying to keep civilians from being blown up and it isn't enforced.

The Nazis burned books, and then people. There is a film clip, endlessly repeated (especially when there is a discussion of restricting civil rights in some area) of the bonfires they lit and books and "degenerate" art being tossed onto the flames. I think of that brief film segment often. Light the fire, boys, I'm coming with my cellphone, and any others I can grab! (Or maybe we should just lock the developers of the cellphone into a padded cell with speakers in every corner, endlessly broadcasting recorded conversations, such as the details of Uncle Max's hemorrhoid operation, or the color of Diana's diarrhea, or 24 ways to cook zucchini...or maybe just a loop tape of the 50 most popular ringtones...)