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Tuesday, July 22, 2014

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Canadian OT changing lives in Israel

Tags: Israel
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Hadassah Fortinsky, centre, with backpack, and a group of Reuth staff on a trip.

Inspired by her patients, Torontonian Hadassah Fortinsky is helping push occupational therapy into a leading role in Israel’s modern health-care system. When she began working at Reuth Medical & Rehabilitation Center in Tel Aviv 15 years ago, she was the only occupational therapist on staff. “Now, we’re up to 20 occupational therapists,” she says.

The role of occupational therapy (OT) is far broader than most people know, especially in the busy life of this rehabilitative and chronic-care hospital in Tel Aviv, where Fortinsky is assistant manager of occupational therapy. From 25 beds in 1961, Reuth has grown to a 350-bed modern facility; about 70 per cent of patients live in the hospital permanently.

When she arrived at Reuth, as the sole OT, there wasn’t much focus on rehabilitation. “It wasn’t an exciting place to work,” she says. “Over time, [following] guidelines from the Ministry of Health in Israel… we grew a huge department.”

At Reuth, patients are grouped by age, rather than by diagnosis, as in many other facilities. On any given day, an OT may help stroke and cardiac or lung patients, car accident victims, post-surgical patients, severely disabled children and individuals with multiple sclerosis, ALS and other degenerative neurological conditions.

Often, they focus on regaining abilities and independence so patients can return to daily life. But even when that’s not possible, OTs work to ensure quality of life. “We’ll work with the recreational therapist to find… leisure activities, handiwork, games, access to computers, sports or current events groups, depending on their ability to understand.”

OTs also help adapt technology to physical abilities, whether patients can sit up and use a mouse and keyboard or simply use head or eye motions to indicate a yes/no response.

Discovering those responses requires a long-term assessment that may surprise doctors and family members.  “It takes a lot of education and teamwork for families and staff to understand that this person can communicate at some level, and what those movements may mean.”

“We work with the family and with the patient to increase their level of response, so there can be some sort of meaningful communication.”

One common factor in patients’ lives is the shock they are in when they first meet Fortinsky or one of her colleagues, she says. Especially younger patients often tell her, “You don’t understand, a week ago, I was fine.” Then, they broke a hip, had a car accident or a stroke, and suddenly, they’re struggling to return to tasks that were simple just a week before:  walking, eating, doing up buttons.

When Fortinsky came to Israel, she didn’t need to requalify. Today, olim must take a standardized exam before they can work here. Now a member of the Board of Occupational Therapists, Fortinsky translates the national OT exam to make it accessible for English-speaking olim.

“Anybody who studied in North America can definitely pass the local exam; the material is very, very similar, if not identical.” With enough Hebrew, it’s easy to start working in the field.  “The scope of practice is very similar.  If you were doing certain things in North America, it’s easy to do the same things here.”

With the Hebrew she learned at Eitz Chaim Day Schools and the Anne and Max Tanenbaum Community Hebrew Academy of Toronto, Fortinsky was well prepared to hit the ground running at Reuth. “The background that I had culturally, Jewishly, language-wise, and OT-wise, I was able to manage very, very well here.”

However, there are cultural differences in OT practice, especially in the area of documentation and paperwork.  “There’s more in North America than there is here, to our benefit.” There’s still documentation in Israel, just not as much. “Here, it’s a reasonable and professional amount.”

More than just an employee, she calls herself a “huge fan of Reuth,” which she says is “very, very warm… you feel like the patients are really the focus of the organization.  The pyramid is not steep; it’s a very responsive organization.”

Working there, she says, is well worth the 45-minute daily commute – long by Israeli standards – to her home in Raanana, where she volunteers with her synagogue’s youth department, and helps brides navigate the Israeli marriage process. Marathons are another hobby; she ran the Tel Aviv marathon in March.

She regularly attends Israeli OT conferences, where she has watched the field expand and progress, particularly in the area of technology. “In the past five years, there are at least two new schools that have opened to study OT.”  The Israeli Ministry of Health now insists on OTs in all its facilities, and there are “tons of job openings.”

As for staying in the profession as long as she has, “it’s not easy but I draw inspiration from my patients, especially the older adults who come in following an injury or stroke. They tell me, ‘I was able to get around until now; I’m 80… I can handle this as well.’ That gives me the motivation to come back here and say, ‘if they’re willing to try, I’m willing to try.’”

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