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The Healer of Bnei Brak
Peter Hirschberg
Offering advice on the best specialists and the occasional incisive diagnosis, a Belz hasid with no medical training has won the trust of thousands of `patients' and the respect of top doctors
The 8-year-old girl had developed an illness that had the doctors flummoxed. Her hands were making involuntary movements. Holding a cup of juice without spilling had become a major feat. Her writing had degenerated into a scrawl.
Despairing, her mother turned for help to Rabbi Avraham Elimelech Firer. "Describe the symptoms," Firer told the tearful parent calmly over the phone from his Bnei Brak office. The rabbi listened carefully, thought for a moment, then gave an immediate diagnosis: "That sounds like chorea minor," he said confidently - a rare form of rheumatic fever.
The girl's parents contacted their doctor, who admitted the rabbi's over-the-phone diagnosis might well be accurate. But such cases, she confessed, were so rare she had never encountered any, and had no experience treating the disease.
Once again the rabbi, who has 10 children of his own, intervened, advising the parents to take the girl to Prof. Tzvi Spirer, the head of the pediatric department at Tel Aviv's Sheba Hospital. "Rabbi Firer phoned and told me it was chorea minor," recalls Spirer, who has seen only three cases of the disease in the last five years and who is now successfully treating the 8-year-old patient. "And it was. A classic case. It's simply astounding."
Spirer's incredulity stems not merely from the speed and accuracy of Firer's diagnosis, but from the fact that the ultra-Orthodox rabbi is not a doctor. Indeed, he has no medical training whatsoever. His only formal learning has been religious - in the heders and yeshivot of the Belz hasidic sect in Bnei Brak.
Yet the 42-year-old Firer has compiled a store of medical knowledge in fields like hematology, endocrinology and cardiology that some leading doctors describe as "stunning." He won't discuss how he accumulated his know-how. "I don't have books and I've never attended any formal course." But his aides say he learned by reading, working with doctors, asking questions, discussing cases. He reads X-rays, CT-scans, even MRIs.
Firer is up to date - sometimes more than the doctors - on latest treatments, versed in medical jargon and has such a well-developed data bank on the world's top specialists that doctors refer their patients to him for advice on which expert to see. He is not the only ultra-Orthodox medical intermediary around, but is considered in a league of his own - because of the breadth of his knowledge, and the fact that his reputation has spread far beyond the religious community.
The rabbi is also a world-class fixer, with a global network of contacts that enables him to fly patients abroad for emergency surgery, and bring specialists to Israel. He once had Ben-Gurion Airport opened on Yom Kippur. When an explosion ripped through an Israel Military Industries plant in Nof Yam four years ago, an uncommon antibiotic had to be rushed here for one of the blast victims. Firer was called in, made a few calls, and found a Belgian contact willing to drive into Holland, purchase the $7,000 drug, drive it to the airport and put it on a plane to Israel. It arrived in less than 12 hours.
But possibly Firer's most precious service to Israel's sick is that he has become a one-man medical union - the patients' representative and guardian in contacts with a powerful, imposing medical system. He offers guidance to the hordes - religious and secular, Arabs too - who descend on his office as to which specialist can best perform the surgery they require, who to see for a second opinion, where they should go to for treatment.
His "patients" include Knesset members, ministers, foreign heads of state, even doctors. And most extraordinary of all, Firer does all this free of charge.
It's early morning on a balmy winter's day at the Belz synagogue in Bnei Brak. A group of men linger in a corner, near a wooden table bearing a notice that reads: "The list is closed. Please don't wait. Thank you and sorry."
The "list" covers Firer's 20 five-minute morning slots, allotted on a first-come-first-served basis. Firer, who has been here since 7 for prayers, opens the "clinic" at 8:15. While his fellow Belzers pray all around him, he takes a seat at the table and peers through the glasses perched half-way down his nose at the test results of a man from Nes Tzionah. Patient No. 1, 49, here since 5:55, is seeking the rabbi's advice on treatment for a colon complaint.
Firer tells No. 8 on the list, a young ultra-Orthodox man, that his father-in-law's feeling of weakness has nothing to do with his recent bypass operation, and suggests a comprehensive checkup; "It surprises me that he's suggesting a balloon and not surgery," Firer remarks to No. 12, simultaneously fitting a plastic filter onto the tip of a Kent cigarette. "But then I haven't seen the X-rays." And he recommends a specialist to the last person on the list - a young man in a brown leather jacket - whose brother is still suffering with a shrapnel wound in the eye from September's West Bank gun battles.
Next stop is the office, in a rundown complex which also serves as home base for the Ezra L'Marpeh nonprofit medical organization he set up 18 years ago. The organization loans out medical equipment, while its largely ultra-Orthodox staffers serve as the rabbi's foot soldiers.
After a series of phone calls to physicians to discuss specific cases, Firer heads off to Sheba Hospital - for his daily rounds. His first stop is the pediatric department, where he politely questions a doctor about a newborn's weight problems. Now Firer is striding toward Pediatric Surgery, his ankle-length black coat flowing behind him like a cape. He jokes with the deputy head of the department, then gives the Ezra L'Marpeh telephone number to the ward physiotherapist who has a shortage of walkers for children. In the elevator up to Neurology, he chats to the head of the General Intensive Care ward about the lack of beds. In Dermatology, the department head interrupts a staff meeting and steps out into the corridor to reassure Firer about a patient.
Later that day, at Ichilov Hospital, Firer engages in a 50-minute closed-door consultation with the head of a new unit for movement disorders, and then, at Asaf Harofeh Hospital, the head of Pediatric Surgery takes him into his office to show him a video of a defect in the upper larynx of a child the rabbi is asking after. "The parents felt the doctor wasn't taking the right course of action and so they came to me," says Firer. "But he is - 100 percent. There's no need to operate. I'll tell them."
With their time at a premium, why are leading specialists so generous with a man who might be seen as an intruder? Is it the physicians' fascination with someone self-taught, a respect for Firer's devotion to his patients, or the oddity of a hasid, his head shaven, pe'ot entwined tightly around his ears, tzitzit sticking out from underneath his vest, knocking on their door to discuss a rare disease?
"I respect and like him and I appreciate his experience and wisdom," says a senior Sheba specialist. "If he had studied medicine he would have been a genius."
"He talks like a professional," adds former health minister Ephraim Sneh, himself a doctor. "He's a big tzadik."
"Every once in a while he bites off a little more than he can chew," says Prof. Tzvi Rappaport, head of Neurosurgery at Petah Tikvah's Beilinson Hospital. "But that's unusual. He understands his limitations."
"Some doctors don't like the fact that he is rating them," says Beilinson's Dr. Silvio Pitlik. "But he serves as an important control mechanism for the medical system."
And the doctors all have their own Firer tales. A Pitlik favorite starts about two years ago, when a middle-aged woman underwent surgery to remove a growth in her pancreas that was secreting insulin and causing her to black out. The surgery failed, largely because of the difficulty of locating growths in the pancreas. When the woman came to him earlier this year, Pitlik consulted the endocrinologists but "they didn't give me satisfactory advice."
Facing a long, complicated operation where the pancreas is removed piece by piece until the growth is extricated, the woman consulted Firer. He did not disappoint, soon informing Pitlik of a special procedure performed at the National Institutes of Health in Maryland to pinpoint the growth. The woman was dispatched to the clinic, and the growth located and removed. "Not only was Firer familiar with the procedure," Pitlik enthuses, "but he knew who performed it at NIH, and that person knew him."
But the doctors' praise tells only part of the story. Firer has clout: The power to channel the thousands of people who consult him to specific specialists, to take them away from one physician and send them to another. Doctors' reputations and livelihoods are at issue. "The medical establishment is extremely powerful," says Bar-Ilan University sociologist Menachem Friedman, "but it has come up against a counterforce... someone whom the consumer believes has his interests at heart, has access to the doctors, speaks their language and whom the doctors are dependent on. It's power versus power."
His rounds over, Firer is picked up by a driver - a childhood friend - for a visit to a young Tel Aviv doctor who has cancer and whom he referred to a clinic in the U.S. for treatment.
In the car, Firer is glued to his mobile phone - speaking English, Yiddish, but mainly Hebrew. He's arranging a flight back to the U.S. for the leading pediatric cardiologist Roger Mee, who, thanks to Firer, has just performed complicated surgery on a baby with a heart defect at Jerusalem's Hadassah Ein Kerem Hospital. After two failed operations, the family approached Firer, and the rabbi tracked Mee down in Italy, flew him to Israel, and organized for his surgical instruments to be flown out simultaneously from the U.S.
While the Hadassah cardiologists readily agreed to Mee's intervention, local surgeons have not always been that magnanimous. Three years ago, when Firer helped to bring world-renowned Yugoslavian neurosurgeon Dr. Vinko Dolenc to Israel, local neurosurgeons, livid that this would rob them of patients and dent their reputations, rallied in an unsuccessful effort to bar the specialist from operating.
Opposition to Firer's methods escalated when the former Labor minister Ora Namir, with his behind-the-scenes aid, traveled to a Swiss clinic for Dolenc to remove a growth from her brain. "Firer isn't a great Zionist," says one physician dryly, referring to the cases the rabbi sends abroad. But Firer is scornful in response: "What would they (his Israeli critics) do if it were their child? What happens when it touches their pupik?" The Beja family from Jerusalem's Pisgat Ze'ev neighborhood owe the life of their 2-year-old son to Firer's refusal to accept what pediatric cardiologists here were telling him - that the boy had such a severe heart defect nothing could save him. After a cardiologist mentioned Firer's name to Merav Beja, she approached the rabbi - a little cautiously at first "because I am secular and I wasn't sure what to expect." Within 48 hours he had arranged an operation by one of the world's leading pediatric cardiologists in New York, passports for the family, visas from the U.S. Consulate even though it was closed for the weekend, an Ezra L'Marpeh ambulance to transport the baby to the plane, $100,000 of medical equipment on the plane to keep the baby alive, and a contact on the other side to meet the family, whip them through customs and straight to the hospital. "It was unbelievable," says Beja. "We didn't have to do a thing. Rabbi Firer would update us every day, explaining my son's medical condition. He even helped when it came to convincing the insurance company to cover part of the costs. I thank God and I thank the rabbi." A month later, back in Israel, Firer was the godfather at Lior Beja's circumcision.
Firer's interest in medicine emerged in his early 20s, when he accompanied a relative to the U.S. for treatment and was shocked by the communication gap between the doctor and the patient. When he returned, he began building up a "practice" - helping friends and relatives negotiate the often-impregnable medical bureaucracy. Today, he says, doctors communicate far better with their patients. Yet, he says, condescension still exists: "My impression is that in about 30 percent of cases the patient lacks confidence because the doctor hasn't explained things to them adequately." What gives the untrained Firer the audacious right to contradict doctors and refer their patients elsewhere? Ultimately, he says, it's the doctor who makes the decision. When he disagrees with a doctor, he says, "I always look for another one who agrees with my opinion. I don't have a license. If I am alone in my opinion, then I bow to them - even if I don't understand why. But I usually find a doctor who agrees. And I'm only talking about the top physicians, not lower-level ones." Firer admits he feels a rush of elation on solving particularly sticky medical conundrums, yet vehemently denies harboring a secret desire to be a certified physician. "There are enough doctors around already," he says - a trifle too quickly. Back at the office at 2:30 p.m., Firer takes his daily half-hour nap, then makes himself a cup of tea, puts a sugar cube in his mouth, takes a sip, and eases into his chair behind his paper-clogged desk to take telephone calls. On one wall is a white box for viewing X-rays. On the others, letters of gratitude - one from the president of Moldova - and certificates of recognition, including an honorary doctorate from Bar-Ilan University. A favorite memento is a Torah pointer in a glass case dated December 1987. "That is from a girl who had three failed operations in Israel. The surgeons said they would have to amputate her hand. I sent her to France and they saved it." While Firer talks to a caller on one line, five others are on hold. Most have faxed test results and doctors' opinions to the Ezra L'Marpeh offices, and staffers have scanned them into the computer so that, when they get through, Firer can call up the relevant information. "You have no choice but to do the operation," he tells one caller, now standing behind his chair and swaying like a yeshivah student. "You have to let them finish the checkup," he tells another. Except for a break of a few minutes for afternoon prayers, Firer takes calls non-stop till around six. A half-hour later, he begins lengthier personal consultations, with people who have made appointments a month and a half earlier. "He told me I can live without having the kidney removed," says a relieved middle-aged man. "And he said that I shouldn't go near the doctor who suggested taking it out." From 11 p.m., Firer takes three more hours of calls. Finally, at 2:00 in the morning, it's time to go home. His refusal to take a cent for his work makes life in the family's three-room apartment rather frugal. His wife's income from day-care she provides at home, along with national insurance benefits for large families and a small monthly stipend from the Belz institutions, hardly adds up to a lavish life style. And his 18-hour work-day leaves little time for his family. "It was very difficult for my wife at first," he says. "But she got used to it." Nowadays, when Rabbi Firer comes home early, she asks him if he's ill.
1997
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© The Jerusalem Report 1999-2000 |  |