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Uri Ilan on saving lives in Israel’s Nepali field hospital

Dr. Uri Ilan treats Nepalese children during the IDF field hospital’s deployment to Kathmandu after a devastating earthquake in 2015

Dr. Uri Ilan, 38, is a man who wears different hats. On the one hand, he’s an attending physician in the department of pediatric hematology-oncology at Hadassah University Hospital in Jerusalem. On the other, he’s the human resource manager for the IDF’s military field hospital, which was deployed to Nepal following the catastrophic earthquake there in 2015. He was in Toronto recently to address the World Association of Disaster and Emergency Medicine (WADEM) conference.

Tell me about your role with the IDF’s military field hospital.

I wear two hats. One is as a human resource officer, responsible for all human resources – who will join, who will come for the drills. The other hat is as a pediatrician. We’ve built the unit from a small unit, to become a level three hospital, the best field hospital in the world.

How many of these field hospitals does the IDF have?

Just one.

If there’s a war on the Golan and in Gaza, where would you be located?

Israel is very small, so we use helicopters to take patients straight away to major hospitals. I’m not sure having a field hospital in a war is really beneficial. It’s made out of tents and it’s real easy to bomb.

Now we are working on a plan of building the hospital underground in fixed places, like a shopping mall. We’re trying that this year.

‘In Israel, we fight with each other. When we go abroad, we’re brothers’

If Israel is so small and you can helicopter people to hospitals, why does Israel need a field hospital?

Because sometimes in Israel, we have very small, peripheral hospitals, like in Tzfat (Safed), or Tiberias, or Eilat. If something happens there, and there’s a major air strike or terror attack and you need help over there, we can build our hospital in the city and make the little hospital bigger.

Has your field hospital been deployed in actual conflict situations in Israel?

No. Luckily.

In 2010, the field hospital was deployed independently, as a field hospital with all the disciplines of a hospital, in Haiti.

And then, in 2015, in Nepal, we were an independent hospital.

What distinguishes a level three field hospital from other field hospitals?

We have most of the medical disciplines. We have ear, nose, throat doctors, surgeons, we have gynaecology, obstetrics, we’ve got pediatrics. We’ve got everything a hospital would have, except neurosurgery.

We have 12 beds in the intensive care units. We can operate in three different operating rooms at the same time. We have 80 beds of hospitalization. It’s a very big support for the peripheral hospitals in Israel.

You were in Kathmandu. What was that experience like for you?

On a personal level, it was life changing to see how people live in Kathmandu, how they behave after such a disaster.

As a doctor, it was life changing. I usually work in Hadassah, where I have all the backup I need. I have CT and MRI machines. I can have everything. Someone can be operated on in a second.

When you’re in Nepal, you have only your eyes, your ears, your brain and your hands. No special tests to do, in order to diagnose people. Really simple, pure medicine.

You do what you know. And it works. I enjoyed that medicine more than I enjoyed anything.

I understand a lot of Israelis travel to Nepal after their military service. Did you run into many of them?

Israel is a very unique culture. In Israel, we fight with each other. When we go abroad, we’re brothers.

Two days after we built the hospital, a lot of Israelis came. We had medics from the army who were traveling after their service and they came to help us. It was amazing to see.

What kind of injuries did you have to treat while you were there?

We had quite a lot of situations. Most of the people were orthopaedic – broken bones.

Some had head injuries. In our case, we had a very rare disease of a child that we tried to treat, called HUS, Hemolytic-uremic syndrome.

It had nothing to do with the earthquake, but the Nepalese military hospital tried to treat him and they brought him to our tent. We treated him for two days. We actually had an Israeli consultant on the phone. I was talking to the head of the paediatric intensive care unit in Hadassah and the other doctor was consulting the head of the nephrology department in Shaare Zedek and we collaborated, all the brains together, in order to solve the problem. We started doing a dialysis in the stomach in the tent. We were doing things that in Israel takes a big amount of resources.

What happened to the child?

We had an ethical issue about it. We thought that his prognosis was very bad and should we just let him go? We needed the operating room to treat someone else. We needed the ICU bed. He took a lot (of) resources. He needed one doctor and one nurse with him all the time. So we decided we’d do our best for him and meanwhile we’ll search for a place that could host him in the hospital in Kathmandu.

After we found a place, we moved him, but unfortunately, he died three days later. But we did everything we could do.

Were there some medical successes in Nepal?

There was a nine-year-old girl they found in the woods in a distant village, three days after the earthquake.

We found out she had a blunt trauma to the head. We found out she had a neurological problem, a weakness on her left side. We wanted to do a CT scan, but the hospital in Nepal said, ‘we don’t work at night, you have to wait for the morning.’

It was crazy. We couldn’t understand how can you do medicine like that.

They did a head CT in the morning and we found out she had bleeding in the head.

We did a craniotomy. They let the blood come out. She was hospitalized for our full deployment over there. We tried to help her recover.

One of the travelers came to our hospital and asked, ‘do you need any help?’

She was a physiotherapist and she (worked) with this kid every day for two weeks and then she recovered. She could walk. She could do everything of a normal kid. We revived this girl. If it was only the Nepalese system, she would be dead.

There is a humanitarian aspect to sending a hospital abroad. Is there also a political benefit for Israel?

I’m sure there is a political point of view, PR for Israel. I think it’s good. It’s beneficial to both sides, a win-win situation.

How does Israel’s field hospital compare to other emergency units sent to disaster zones?

In my presentation, I have a slide of a UN report. There were 365 medical personnel in Nepal. One hundred and twenty-two were Israelis. Canada had four people. Germany had seven.

I think the main point is that we do it quickly, more than anyone else in the world. We pack our stuff and go.

Are there lessons from Nepal that can be applied back in Israel?

When you go to Nepal, you have to collaborate with those doctors who you’ve been competitive with in Israel. For me, it was a lesson to learn how they solve problems, how they see things.

We’re at a medical conference trying to learn how to respond to disasters. Sometimes doctors fly to the other side of the world to learn about something very small, but you never go to the other department in your hospital to see how they solve problems. And sometimes when you go to other hospitals or wards to learn from them, you don’t have to fly to the other side of the world to learn new things. That’s a lesson I learned.

This interview has been edited and condensed for style and clarity.

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