Post Trauma. This is how it feels/(NTL)
Half a year into the "Iron Swords" war. Since that morning on October 7, the mental health of a high percentage of Israelis has been getting worse. Recently, reports have been accumulating of a hundreds of percent increase in requests for mental health assistance and the long queues are getting longer in the mental health systems in Israel, which even before the war was working under heavy loads.
Dr. Shlomit Tzafrir, director of the Child and Adolescent Psychiatry Clinic, from the Safra Children's Hospital in Tel Hashomer, tells Walla! Health that from October 7, everyone mobilized to take care of children in hospitals, returned abductees, hotels and evacuation sites. Even doctors who were not experts in working on trauma issues , have become experts in the field out of necessity, but according to her this is a drop in the ocean. What about the future? If you ask her - the picture is completely pessimistic at the moment.
"I am now in a panic. It is clear to me that we are at the beginning of the beginning of the trauma wave," says Dr. Zafarir. "We are short of personnel, we are under increasing load along with crazy attrition of the teams, and if we continue in the same direction, the situation will not get better. The patients' files are moved on and the load is increasing. People are breaking down and leaving the public system. I must say that I feel now Like the child who holds his finger before the dam breaks, I'm not the only one who feels this way - it's a common experience for all of us."
The crisis is already here
Dr. Zafarir refers to the conditions of the doctors in the public system in Israel and claims that the Ministry of Health understands the great difficulty and tries to get into the thick of the beam, but it is too little and perhaps a little too late, because the crisis is already here. "If I see children patients today, and I don't have time to A conversation with the educational consultant, the principal, the parent or the psychologist, then it ultimately affects the child. We don't come to cut a coupon for the other's suffering, but I have to be honest with myself and say that many times I finish my work when things are still unresolved and remain in the air - and this is an ongoing experience that gets stronger and stronger."
Recently, a large conference was held at Sheba, which dealt with trauma care and anxiety among children. One of the goals of the conference was to make accessible to the medical, professional and research teams how to treat trauma in children, how to provide initial response and how to recognize the symptoms.
"A pediatrician from Sderot told me that every child who enters her clinic, regardless of the reason for which he came, has some psychiatric symptom"
"Aggravation in behavior, depression, social situation, distance, all of these are initial symptoms of trauma," says Dr. Zafarir. "The first line of pediatric medicine in Israel is the family doctors. They see them the most. Many family doctors came to us who only wanted to gain initial knowledge on the subject. We are always thinking about how we can help with remote care and give support and help when needed. We work from morning to night because it is important to us. In my opinion, we are in a serious national problem. The Ministry of Health knows, sees and understands, there is an understanding of the importance and they are in contact with us all the time, but the bottom line is that we do not have enough personnel for what is needed and what will still be needed."
She describes the difficulty of the family clinics in the south and their inability to respond. "She came to us A pediatrician at one of the health funds in Sderot who told us at the end of the conference that every child who enters her clinic, regardless of the reason for which he came, has some psychiatric symptom. She claimed that today's family doctors need a psychiatrist by their side, and according to her, they would fill their diaries because they are desperate for help on the matter."
Since October 7, Dr. Tzafir and all the doctors at Safra Hospital have treated thousands of children with various symptoms. Some of them were treated Already in the system and in the wards, and the events that happened only added weight to their mental state. Another part was added to the mental health care system, which is now collapsing.
"Are you from the army that abandoned us and did not come to help"?
"A 10-year-old boy asked his mother: "If they come into our house now, where should I hide? This is a question that the child takes very seriously because the answer to it saved many children from October 7th. In the past, we didn't think about such a thing at all, just understand that this is a child from the center of the country, not from the south, not from the north, and he doesn't live near any border. The child also did not come around the trauma, that was a marginal reason. "I see around me, almost every child who comes to the clinic now has some kind of aggravation or difficulty related to October 7," notes Dr. Zafarir.
"When I was in the evacuee hotels, I heard a girl say to one of the soldiers: 'Are you from the army that abandoned us and didn't come to help'? It tore my heart. The massive investment in mental health should be now so that these children are not abandoned. All children should have received a response, or At least an initial assessment within two weeks, and not within a year, as is the case today," she says.
"It doesn't make sense that a child comes to us in acute distress in first grade, and he won't receive treatment before the middle of second grade"
But in the field, the queues for mental health clinics, at best, are almost six months and there are some who have to wait a year or more. "It doesn't make sense that a child comes to us in acute distress in first grade, and he won't receive treatment before the middle of second grade, just because of the long lines.
"Even before the war, the lines were crazy and now they're only getting worse. The wait for an appointment only gets longer as time goes by and the number of children a month who need treatment - only increases. There are many children waiting and we don't manage to see them. We treat very complex cases with very severe exposure to trauma and severe symptoms. What increased the trauma were the evacuations from the homes and the sights they saw in the evacuated hotels, the parents were not with the children, who experienced disconnection from their warm community and they were and still are much more vulnerable."
On the Ministry of Health: "Good intentions are not enough"
Dr. Zafarir also points to a certain desperation among the parents and claims that: "Parents do not always have the strength to provide an adequate response to the child and they suffer from burnout and fatigue. We will see the results of the war for years to come because many children do not come or cannot come to treatments and this will affect everyone. It's a bit reminiscent of the first days of the Corona virus, when everyone was at home with the kids and enjoying themselves. After a short while it became more oppressive until most of them broke down and gave all the kids screens. Here, too, the exhaustion and attrition occur among the parents, and I am very worried about what will happen in the future."
Dr. Zafarir claims that, alongside the reports of negotiations between the Treasury and the Ministry of Health, for the doctors, if the salary does not increase significantly, nothing has changed. "Those who leave the public system and go For the private market, feels that it is more professionally complete. He provides a better and more professional service because he does not have a large load. He also sees more of the family and children. We also don't want doctors who make a living all the time in a private clinic next to the public one that doesn't respond."
"There is a strong dissonance in my position. I can't take care of the many children who come for treatment and not see my children. My little boy is still in kindergarten, I have four children at home. It's unlikely. I know that everyone is proud of me because I do important things, but even I as a parent have my limits. In the situation where I had to leave the children and go to work on Shabbat because they returned kidnapped, it was understandable and there was no problem with it, but a mother will see them all her life only before going to bed because they need to make a living, it just won't last. Not with me and not with any other therapist. The distress is so great and the private market will always work. It is important for me to say, we need to improve the conditions for the community and the citizens of Israel, not only for the doctors, but mainly for the patients."
"A child who suffers from anxiety or depression that impairs his functioning and reduces his abilities - this is long-term damage. I know that this is a global problem after the corona virus, but we now have another chapter"
Tzafrir also refers to the NIS 1.4 billion addition to the budget for the mental health system in Israel and is satisfied that the token fell among the decision makers in the Ministry of Health: "There is an understanding of the situation as well as the need. There are many attempts to develop a solution for the short term as well as the long term. What will happen in the future and how much will it help? It is not clear . And how can we not touch on the issue of training? On the one hand, the system needs a lot of therapists, but we must maintain a high and professional level of care. I hope that they will also give a proper response to this. Good intentions are not enough."
"We are in a system that has already passed its peak. Back in Corona, we saw a deterioration in the children's mental state. I feel that we know how to help and improve while learning. There are also many people here who are willing to work hard and want to make it accessible as much as possible and help with treatments everywhere, even in the periphery and there are A lot of optimism.
"On the other hand, the latest budget does not address the needs of children's mental health. If many more standards for child psychiatry are opened starting this year, then there will be many more doctors who will complete internships. 350 psychiatrists who are now in the system is terribly few for children, to say that it will be enough? Definately not.
"A child who suffers from anxiety or depression that impairs his functioning and reduces his abilities - this is long-term damage. I know that this is a global problem after the corona virus, but we now have another episode. Recently, I hear about many more doctors who say enough is enough and go to the private system or easily find Work abroad and get along. It saddens me, we need to put the energy here and create a better public medical system."