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Mission to Haiti

Dr. Joshua Hyman, a hero of Haiti

One of the UJA-NNJ “Heroes of Haiti,” Dr. Joshua Hyman is not new to volunteering his medical services for earthquake victims. As associate director of the Children for China Pediatrics Foundation, he said, he travels to China every year to “provide surgical services to Chinese orphans.” There he treats congenital and post-traumatic deformities in children, but last year he “also took care of about half dozen children who were injured in the [2009 China] earthquake.”

When he learned of the devastation due to the earthquake in Haiti, Hyman quickly arranged his trip, arriving on Jan. 18 for 10 marathon days of surgery and medical treatment of young quake victims. As a pediatric orthopedic surgeon, his skills were particularly essential as he and other team members addressed the needs of children whose limbs were crushed in the rubble of collapsed buildings.

Hyman described how he joined up with other medical professionals of the Florida based Project Medishare facility at the Port-au-Prince airfield, where “four big wedding tents” held operating and other treatment facilities for the victims. During his stay he found the Israeli field hospital personnel very helpful. In order to maximize the use of medical expertise of the Medishare and Israeli physicians, “there was a fair amount of trading of patients” with the Israelis, said Hyman. “I brought patients to the Israeli facility, and brought back patients that they couldn’t manage.”

Hyman encountered challenging cases. “One patient, a 10-year-old girl, had a terrible crush injury to her arm,” said Hyman. “I spent a great deal of time trying to save the arm, and brought her to the Israelis to try to get a plastic surgeon, but they couldn’t help her.” He did manage to get the youngster transferred to a Florida hospital where she could get the needed services. Each day he spent most of his time operating on victims, but Hyman also concerned himself with finding facilities for follow-up treatment of his patients. Hyman succeeded in transferring numerous patients to the U.S.N. Comfort as well as to Florida hospitals for continued treatment.

Hyman found inspiration in “the spirit of the Haitian people who suffered tremendously — physically, spiritually — who lost their homes and businesses, yet in camps and in the hospitals they wanted to help each other.” Many Haitians volunteered as translators, or helped with equipment and patient transfers, said Hyman.

Hyman is associate professor of orthopaedic surgery at Columbia University College of Physicians and Surgeons and director of Pediatric Orthopaedic Fellowship at Morgan Stanley Children’s Hospital of NewYork-Presbyterian. He has lived most of his life in Englewood, where he and his wife are raising their 13-year-old twins, who will celebrate their bar and bat mitzvahs in Israel shortly, and two younger daughters who were adopted from China.

Regarding his Haiti experience, Hyman said, “My wife was completely supportive and my kids just wanted to make sure that I would be safe. They were pleased that their father was involved in trying to help.”

“I’m fortunate that I have the training to do this work,” said Hyman, who plans to return to Haiti to organize rehabilitative care and to help amputees acquire the prostheses they so desperately need. He is also planning a trip to China in the fall to continue his medical volunteer work there.

“The need for additional support in Haiti is tremendous and it will be ongoing,” concluded Hyman. “A tragedy as great as this, very, very close to home, will have to stay in the minds of people in the U.S.”

 
 

Mission to Haiti

The needs persist

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Dr. Howard Zucker examins one of the children in the orphanage. COURTESY DR. ZUCKER

Dr. Howard Zucker of Cliffside Park recently returned from a week in Haiti, where he used his skills as anesthesiologist and pediatrician to bring sorely needed services to earthquake victims. “It’s very sad,” he said. “It’s amazing how one event could impact every single person you cross paths with.” The Jan. 12 earthquake was estimated to have killed over 200,000, injured hundreds of thousands of others, and left a million people homeless. The magnitude 7 quake destroyed or hopelessly damaged hundreds of thousands of residences and commercial buildings.

Zucker did not join the rescue efforts immediately after the disaster; he understood that weeks and months later there would still be enormous need for medical assistance. “The situation is still difficult,” he said. “In a couple of months the need will still be there. It’s important that people recognize that the needs persist.”

Zucker, who has M.D., J.D. and L.L.M. degrees, has a résumé that could describe the accomplishments of several busy professionals. Graduating high school at 15, college at 19, and George Washington University Medical School at age 22, Zucker has worked at Yale University School of Medicine, MIT, and the National Institutes of Health, and ran the pediatric intensive care unit at Columbia University College of Physicians and Surgeons. He served in the U.S. government under Secretary of Health and Human Services Tommy Thompson and worked for the World Health Organization, in charge of health technology and pharmaceuticals. Last spring he led a study group on global health diplomacy at Harvard Kennedy School. He is currently senior advisor in the Division of Global Health and Human Rights at Massachusetts General Hospital. He has combined his medical and legal training to develop and improve health policy and the quality of health care in the U.S. and worldwide.

During his week of volunteering in Haiti, Zucker spent most of his time at Sacre Coeur Hospital in Milot, about 70 miles north of Port-au-Prince, where many victims had been airlifted. The 73-bed facility became one of the busiest hospitals in Haiti after the quake because it did not sustain damage, and also had a system in place for rehabilitation and recovery of patients.

The crisis in Haiti involves “individuals whose lives are completely upside down. Their lives are still upside down,” said Zucker. Even before the earthquake Haiti’s millions of impoverished people did not have access to modern medical services.

“Haiti is not that far from southern Florida, yet there’s such a difference in resources,” Zucker noted. “The situation was quite challenging before the earthquake. I want to figure out how to improve public health in Haiti.”

The doctor described some of the cases he faced. “There was a child with marked hydrocephaly — water on the brain. In the U.S. they would have put a shunt in long, long before the child was [in] as bad [shape]. We had a discussion about what to do.” When hydrocephaly is treated early in infants, most babies will recover with no long-term damage. But the Haitian child had no access to treatment and had already suffered serious brain damage.

“This was an ethical discussion that would never occur in the U.S. The decision was to send the kid to an orphanage and not do anything medically,” said Zucker. If they had intervened at that point there were no mechanisms to follow up on the severely disabled child.

Zucker was deeply touched by another case — that of a 3-month-old baby girl who had been buried in the rubble for four days. “It was unbelievable,” he said, “that you could survive buried under for so long.” All the family members apparently had been killed in the quake, leaving the little girl the lone survivor. “She’s doing pretty well,” he added. “There were other amazing stories of survival there as well.”

Another young patient inspired Zucker with her courage and optimism. “I saw a little girl sitting in the tent. She was cute — with braided hair, and a big smile on her face. She lost her leg, but still had the ability to get a smile,” he said. “This is something that kids in America should see. The [Haitian children] have the ability to find joy in many small things.”

Zucker and others have noted that Haitians suffer from a range of health problems. “Everybody has high blood pressure,” he said. “Either it’s the stress or some other factor or combination of factors. The chronic level of hypertension leads to a shorter life expectancy.”

Zucker also reported that “the people looked so much older than their years — more worn.”

“The poverty in the community — how do you fix all that? We did surgeries and procedures and you try to do what you can. But they need follow up.” He explained that as teams of medical volunteers left they passed the patients on to the next group of volunteers and hoped for the best.

Zucker’s tremendous record of achievement includes working on crises such as the anthrax attacks in the United States and developing the “Afghan Family Health Book” to improve public health literacy for millions of Afghanis.

But he is particularly proud of his work in the development of the Medical Reserve Corps. Zucker arrived in Washington, D.C., on September 4, 2001, as a White House Fellow — just a few days before the 9/11 attacks on the Pentagon and World Trade Center. Shortly after the attacks, Zucker proposed the Medical Reserve Corps, a program to bring doctors and nurses together in cooperative groups to help Americans in times of crisis. “Doctors and nurses in the same community don’t know each other,” he explained. “The program provides the opportunity for all the health professionals to work together.”

“The proposal was given to Secretary Thompson who sent it to President Bush, and he loved it,” said Zucker. The program started off with $10 million and 10 pilot programs involving 1,000 volunteers. “Now it has expanded to 900 programs with 200,000 American volunteers, in every state of the union. It’s a major program run out of the Surgeon General’s Office.”

Bergen County was among the first 10 program sites. Some examples of the joint projects include addressing diabetes and obesity in children and combating smoking in junior high school students.

Zucker speculated on how to address inequities in resources, poverty in developing nations, and responses to catastrophes. “I’ve spent a fair amount of time in the developing world,” he noted. “Is it the role of the public sector? The private sector? Wealthy nations? Just the U.S.? Things are changing. Now everyone feels an obligation.”

Zucker’s career includes decades of improving medical services all over the world. His work with the World Health Organization brought him to 70 countries. “My job with the WHO involved parts of the world where there are no resources at all,” he said. “Having traveled the whole world, you wonder how on one planet there can be such a discrepancy in resources.”

“I tend to be an optimist,” he added, “believing that if you want to push things forward you can.”

Although Zucker has been to 70 countries on his medical missions, Israel was not one of them. “There are many other areas where there was more need,” he said, noting that medical personnel from Israel joined volunteers from other countries helping the survivors in Haiti. Zucker was particularly impressed by reports about the Israeli field hospital in Port-au-Prince. “In the future if there were another disaster,” he said, “I would ask them if I could join their team.”

Zucker said that news coverage on the Internet and cable stations puts people more in touch with disasters and their aftermaths. “The only worry” about such widespread coverage, he added, “is that we don’t want people to get saturated and stop giving.”

 
 

Frisch team studies a tiny plant with a big impact

The science of sequencing: Decoding duckweed genes

Every living thing has a genetic blueprint, called a genome, that determines how the organism is structured and how it works. The genomes of plants and animals are made up of billions of chemical subunits called base pairs, strung together in a sequence unique to each creature. Base pairs are the letters of the genetic alphabet, arranged differently for each gene, like the chapters of a book.

The Human Genome Project has led to the decoding of more than 3 billion base pairs found in human beings. The genomes of other animals, plants, and microorganisms have also been decoded. But the Wolffia australiana (duckweed) genome is still largely unknown, hence the goal of this project is to sequence and analyze, gene by gene, the base pairs of the tiny plant. Some of those genes are similar to those found in other plants and animals and some are used by the plant for its unique functions.

For the Waksman Student Scholars Program, Rutgers scientists have taken DNA from the plant and used special enzymes to connect it to DNA from bacterial cells. The hybrid DNA can be carried by bacteria, which can be grown in large amounts. The bacteria are grown on petri dishes, and the colonies carrying plant DNA are called clones.

These clones are provided to the WSSP high schools for further study. The Frisch School’s science department chair, Mindy Furman, and her students began to study the clones by making many copies of the duckweed DNA inserts using PCR (a procedure commonly used in forensic labs to make millions of copies of DNA). The students measured the plant DNA pieces with gel electrophoresis. Any clones found to have a big enough piece of duckweed DNA are sent back to Rutgers for decoding the genetic letters, that is, DNA sequencing.

“You insert your DNA into a well and you run electrical current through it and it pulls down the DNA,” explained Jennifer Ledner of Paramus. “We compare it to a ladder of identified DNA fragments, where you know the size. If it’s too small you won’t be able to learn anything from it.”

“We deal with the actual base pairs of the DNA,” said Ben Sultan of West Orange. “My clone had an insert of 790 base pairs. It’s interesting that we are studying the building blocks of the duckweed.”

At Rutgers, DNA sequencing is performed to read the genetic alphabet of each student’s clones. Since plants and animals can have billions of genetic letters, the information is catalogued, organized, and processed using computer programs. The genetic sequences, in the form of graphs called waveforms, are sent back to the students for further study.

DNA base pairs are strung together in each gene like letters in a language. And like most languages there are also punctuation marks, which can be found in the genetic narrative. When the students receive the sequence data for the clones, they can use a computer program called DSAP (DNA Sequence Analysis Program) to find these punctuation marks, showing the beginnings and ends of the genes. They can also use computer analysis to determine what the proteins, produced by genetic instruction, might look like.

In addition, students will compare the sequence of their clones to other genetic sequences in a vast database, maintained by the National Center for Biotechnology Information, or NCBI. According to NCBI’s website, the database contains the genetic sequences from more than 800 organisms, including plants, animals, and microorganisms, from bees and bacteria to zebrafish. Using very powerful computer programs they will be able to answer questions such as: “Is your sequence similar to sequences found in any other organism?” and “What is the function of your gene?”

Hannah Lebovics and Ariana Schanzer, both 16-year-olds from Englewood, accompanied Furman to the WSSP training institute in July.

“We sequenced four clones each and analyzed what proteins they code for, how it can improve our knowledge and understanding of duckweed, and how it can help us,” said Hannah.

“We had noncoding regions and we had coding regions,” said Ariana, referring to types of DNA they studied. “A seemingly negative result [that did not match the database] … could mean you found a new gene,” she added. The students working on this project could discover duckweed genes that look and act like genes found in other plants and animals, or genes that were novel, i.e., brand-new discoveries.

One example of a gene the two girls studied in the summer workshop was one that works in mitochondria, the cell structures found in all plants and animals that provide energy for the cell. “We found proteins that were also found in humans and other organisms, that were important for mitochondrial transport and removal of copper,” Ariana reported.

“It’s a necessity for all living organisms, so it should be important,” she concluded.

Ariana, Hannah, and their classmates are now studying a new set of clones, a process that can take months from start to finish. They are patiently pursuing the project, step-by-step, hoping to contribute to the understanding of the duckweed genome and how it can be used to help humankind.

 
 

Frisch team studies a tiny plant with a big impact

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Studying a tiny plant, the duckweed, are, sitting, Rachel Reichner and Eric Tepper; standing, Katie Fishbein and Ben Sultan. Aaron Keigher

A recent report by The National Academies, the nation’s top advisory group on science and technology, found that the U.S. ranks 48th out of 133 developed and developing nations in the quality of math and science instruction. Last month a New York Times editorial reacting to the report stated that “too often, science curriculums are grinding and unimaginative.” However, a new nontraditional “Science Research Course” offered by the Frisch School in Paramus appears to be anything but a grind. Through a grant funded by the National Science Foundation and G.E. Healthcare, Frisch has been able to offer “The Waksman Students Scholars Program: HiGene: A Genome Sequencing Project” as a new elective course for its juniors.

“The program is exquisitely creative,” said Mindy Furman, chair of the science department, who teaches the course. “The goal is to develop a passion for science in students and ultimately to help encourage them to pursue careers in science. It’s an opportunity to do authentic hands-on research with publication, on a topic that’s very timely, all in the school day.”

The project involves the analysis of genes from a tiny plant, Wolffia australiana, the duckweed. The seemingly insignificant organism has been recently recognized as having many potential uses.

Frisch 11th-graders, ages 15 and 16, who are taking the class, explained the importance of the tiny plant. “Duckweed produces more ethanol than corn. So we could make alternate fuel sources without using up food,” explained Rachel Reichner of Spring Valley, N.Y. It is estimated that nearly one third of the U.S. corn crop is converted into ethanol-based fuels.

“Duckweed grows more quickly than corn,” added Aaron Dardik of Livingston, highlighting another advantage of the special little plant.

“If you were to create food from duckweed,” said Teaneck resident Eliora Wolf, “it would be used for animal feed. And the animals can provide food for humans. And if you give this product to animals instead of corn, then you can use the corn for humans instead.” The plant reportedly has up to six times as much starch as corn, is higher in protein than soybeans, and serves as an important food source for waterfowl. In some Asian countries it is consumed by humans.

Duckweed “also cleans up ponds and lakes and takes out toxic metals,” added Rachel.

Ariana Schanzer expanded on that point. “Bioremediation involves cleaning up toxins from the environment. They are using [duckweed] in several countries, such as Bangladesh, to clean up water.” The plants absorb nitrogen and phosphates as well as metals.

“There are 50 schools involved in the project, mostly in New Jersey,” said Furman. “Rutgers provides all the equipment on loan, and all supplies” needed for the project. The list includes thousands of dollars worth of equipment and materials that would typically be found in advanced college and graduate level research labs, such as Pipetmen, microcentrifuges, thermocycler, gel boxes, restriction enzymes, and primers for PCR.

“I learned about the program through a parent,” said Furman, who added that Frisch is the only yeshiva among the 50 participating schools. Furman spent three weeks at Rutgers University this summer training for the project. Two Frisch students, Ariana Schanzer and Hannah Lebovics, both from Englewood, accompanied her to the summer workshop, learning the complex procedures.

The website of the Waksman Students Scholars Program for 2010-2011 explains that “students in the project will isolate and sequence genes from Wolffia australiana. The sequences of these genes has never been determined before and this information will be deposited in the international sequence databases for the students and other scientists to use.” In other words, the high school students who participate in the program will discover new information about the genes of this unique plant, and will share their discoveries by publishing them online.

Andrew Vershon, a professor at Rutgers’ Waksman Institute, developed and runs the project. Described by Furman as “an amazing guy,” he says that his vision is to provide students an entrée into the world of science research at an early age. Furman explained that Vershon and his team developed the approach used in this study, including detailed instructions and manuals designed to provide guidance to the teachers and students who are new to such high-tech computer-based research.

“Rutgers has constructed a cDNA library,” said Furman, referring to a collection of bacterial colonies that carry genes of the organism. For the project, Rutgers scientists provide bacterial plates that have colonies of cells carrying specific duckweed genes (see sidebar). Each bacterial colony, known as a clone, is a cluster of cells that grew from one parent cell.

“The goal is that each student should analyze four clones,” said Furman. “We practiced for a week how to use the Pipetman,” she said, noting that students have learned techniques needed to measure and transfer the tiny volumes of material used in molecular biology research. Students were also introduced to methods for growing bacteria as well as extracting DNA from the cells.

The DNA is tested through a procedure called PCR, to measure the size of the duckweed gene in each clone. If the duckweed DNA fragment is large enough, then the bacteria from the clone are grown in a test tube and prepared for sequencing. That sample is sent back to Rutgers where it is decoded to reveal the genetic code for the duckweed genes.

“Dr. Vershon developed an amazing computer program, [the] DSAP, DNA Sequence Analysis Program,” said Furman. “It takes the kids step by step through how to analyze the sequence.”

“It’s user-friendly,” said Eliora. “The professors at Rutgers check everything we do. When we finish the analysis of the protein we can submit it to the database of the NCBI — the databases of all different kinds of organisms. Any scientist can access it.”

The DSAP program links to the National Center for Biotechnology Information (NCBI), which maintains a massive database of known DNA sequence information. “The students ‘mine’ the database for the same [or similar] DNA sequences,” said Furman. “The program converts the sequence to the amino acid sequence and compares it to known amino acid sequences.” In this way it may be possible to determine what the gene actually does in the plant.

“We ask whether it is ubiquitous or novel to duckweed. We send that information back to Rutgers and [scientists at] Rutgers check it,” said Furman. “We are online with Rutgers at every point. We upload all the data. We post everything on Google Docs and it is checked by the Rutgers people.

“Then we submit it to the NCBI where it gets published on the web,” Furman said. “We get national recognition.”

Next summer, students will be able to present reports on the genes they have analyzed at a symposium at Rutgers.

The biggest challenge, reported Furman, is that the students have to complete the laboratory work in four 43-minute periods each week. Some of the procedures need longer periods of time for completion. “How to stop a protocol and put it in the fridge where it won’t get messed up … from a research standpoint that’s been a challenge,” she said.

The project combines sophisticated biology research with high-powered computer technology. Furman acknowledged the contributions of Rabbi Tzvi Pittinsky, director of education technology at Frisch, who has helped to implement the computer-based aspects of the project. The new Frisch facility, with state of the art science and computer labs, has been a tremendous factor in the success of the project, she said.

Eleven students chose the course as an elective. “These kids are the pioneers,” said Furman. “They signed up for the course not knowing what they were getting into.”

“It sounded like an extremely interesting course,” said Jesse Silverman of Teaneck. “We are doing a lot of the things we learned about in ninth grade, but at a college level and with college-level equipment. I thought it was really cool that so much science research is being done on computer databases rather than the lab.”

Jeremy Appelbaum of Suffern, N.Y., appreciated the hands-on biology, as well as the computer analysis. “I particularly liked seeing how gels run to see how long the DNA is,” he said. “In the computer analysis you have to take apart each bit and piece to see what it does. We want to find part of the genome and find what it does. We don’t know enough about it; that’s why we’re doing the project.”

Kate Fishbein of Livingston is interested in becoming a research scientist or a doctor. “As a high school student who wants a career in science, I thought this would be a project that is relevant to the world.”

Eric Tepper of Teaneck communicated his responses by texting. “I’m interested in possibly pursuing a career in science,” he wrote. “It is a good hands-on introduction to what I may see in the future. The program is educational and interesting, yet fun at the same time.”

“It’s a great opportunity that at this age we can contribute to the science world,” said Ben Sultan of West Orange. “We’re not just learning, but also contributing.”

 
 

Confessions and warnings

A ‘toolbox’ for dealing with sexual abuse

A new book, “Breaking the Silence: Sexual Abuse in the Jewish Community” (Ktav), addresses the disturbing, complex, and mostly hidden issue of child abuse in Orthodox Jewish communities.

In the Jewish community, “there’s a sense of secrecy, a sense of shame, as it contradicts the values of the community,” said Dr. David Pelcovitz, the book’s co-editor with David Mandel.

In the Orthodox community, said Pelcovitz, “there’s a tremendous emphasis on respecting authority. Kids may not want to disclose. And there is difficulty in handing in one of your own.”

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David Pelcovitz

After practicing psychology for more than two decades, in 2004 Pelcovitz became special assistant to Yeshiva University’s President Richard Joel, as well as professor of psychology and education at YU’s Azrieli Graduate School. There he teaches psychology, psychosocial issues in the Jewish Community, and pastoral psychology courses that are required for rabbinic students. “In the yeshivish world, people are more likely to go to the rabbi,” said Pelcovitz. “Many rabbis tell me they spend about 50 percent of their time doing pastoral work. They need to know how to intervene in an informed way.”

An expert on trauma, child abuse, and parenting, Pelcovitz worked with Ohel Children’s Home and Family Services for many years, where he got to know Mandel, the chief executive officer of Ohel.

“We were looking for a resource that parents, educators, and therapists could go to in terms of prevention and if something already happened,” said Pelcovitz. “Before the book I had done a fair amount of speaking to parents on how to talk to their kids about abuse.”

“Dr. Pelcovitz has trained rabbis for Project S.A.R.A.H. over many years,” said Esther East, director of Jewish Family Services of the Jewish Federation of Greated Clifton/Passaic. “His professional credentials and his [understanding of the Jewish community] are wonderful resources for us.”

“In Israel there is some research,” said Pelcovitz. “[Sexual abuse] is not clearly overrepresented in one segment of the population vs. another.

“However, he added, “in a more insular community there is more difficulty talking about sexually related issues.” In addition, “the more to the right you get, the more difficult it is to deal with secular authority.”

This is true outside the Jewish community as well, he noted. “Private school teachers have a harder time reporting [abuse] than public school teachers,” Pelcovitz said. “If the abuser is a member of your own social class, then it’s harder to see and it’s harder to act on.”

The book is “designed to be a toolbox for various members of the community — how to deal with it in a culturally sensitive, yet informed way,” said Pelcovitz. “In a general context, the book should raise awareness of the problem, help people realize that this is something that can be dealt with, and that there are practical approaches to prevention. And hopefully, in the rare cases of abuse, provide mechanisms for intervention.”

The book is divided into four sections: “The Voice of Abuse” documents experiences of men and women who were abused as children. The chapters emphasize that children who were abused are survivors, rather than victims. A chapter by Gavriel Fagin, a social worker at Ohel, addresses questions such as “Is there anything anyone could have told you that would have prepared you to avoid being abused?”

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The second section, “Prevention and Intervention Programs,” addresses what can be done at the parent, school, and community level to prevent abuse. Dr. Susan Schulman’s chapter, “Unwanted Touch: A Preventive Approach for Parents,” describes the issue as it relates to preschoolers, children ages 6 to 11, and adolescents. “The abuser is usually a familiar adult,” notes Schulman, a pediatrician. She presents graphic descriptions of cases involving child abuse. “I am uncomfortable writing about the actual abuse, and I am sure that you will be uncomfortable reading about it,” she writes, “but the children who went through these experiences deserve to have you know exactly what happened.”

The third section, “Halachic and Legal Perspectives — Insights and Misconceptions,” provides an overview of how Jewish law views and handles abuse. Ohel Rabbi Dovid Cohen, Rabbi Mark Dratch, founder of JSafe (Jewish Institute Supporting an Abuse Free Environment), and Adam Lancer, a lawyer who serves as general counsel for Ohel, grapple with the issue of the investigation of abuse and the reporting of abusers to secular authorities. “The book says unequivocally — very clearly —that if there’s a suspected abuse, the law is that one has to report it,” said Pelcovitz.

“There are chapters for therapists to help them understand how to address these issues and the unique needs of the Orthodox community,” said Pelcovitz of the last section, “Psychological Analysis and Treatment of Victims and Offenders.” In one chapter, he writes about how victims should be treated. The long-term impact of childhood sexual abuse can be viewed as a type of post-traumatic stress disorder, manifesting many of the same symptoms of classic PTSD, writes Pelcovitz. Topics in that chapter include incest, stigmatization, and feelings of betrayal. Other chapters in that section, by social workers Barry Horowitz and Hillel Sternstein, deal with treating adolescent and adult offenders.

The final chapter, by Isaac Schechter, addresses how various parties in Jewish communities across the spectrum can help prevent sexual abuse. “Developmentally appropriate and culturally sensitive education to this issue is not a derision of the fundamental principle of tznius (modesty) but rather an affirmation of it,” writes Schechter, a psychologist who serves chasidic Jews in New York’s Rockland County.

“Anything that shines the light on what’s happening has to be a good thing,” said Pelcovitz. “There have been real improvements in the community. On the whole it’s painful, but it’s been necessary….

“I think that all parents should talk to their children about the issue, without frightening them. There is a doable, step-by-step approach that does not have to frighten them at all. It should be done as early as preschool,” he concluded. “Just as you talk about water safety, it’s important to talk about touch.”

 
 

Confessions and warnings

Project S.A.R.A.H. addresses domestic abuse

A young woman tells her mother, “I wouldn’t want a husband like you have…. Every time he comes home, we’re running away to hide in our rooms…. Do you like it when he pushes you around like that? I hate it! I’d rather stay out of his way so I don’t have to watch.”

This is a scene from “Confessions,” a video developed by Project S.A.R.A.H. (Stop Abusive Relationships at Home), to teach yeshiva high school girls about domestic abuse. “Most videos are not suitable for yeshivas to show,” said Teaneck resident Elke Stein, Director of the Domestic Violence and Sexual Assault Service of Project S.A.R.A.H. “We received a grant to develop videos that are religiously appropriate, to be used in these schools.”

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“The video project is pitching to a more [religiously] right-wing element in the community,” said Esther East, also of Teaneck, who is director of Jewish Family Services at the Jewish Federation of Greater Clifton/Passaic. “Single-sex schools need videos that speak to them — videos with only women in them, or only men in them.”

“The … videos for young people teach what to look for when they are dating,” said East. One called “The Warning,” is intended for women of 18 to 19 years old who are beginning to date, and portrays a young woman warning her friend about a suitor who is “just not a good guy … a control freak.” She describes an escalating abusive situation she experienced with that suitor and cautions her friend to “keep your eyes open and be careful.”

Another video, developed for young men, shows two brothers discussing a financially abusive girl who forces the boy to overspend on her. “There are emotional, psychological, and financial issues that go into a relationship,” said Stein.

Project S.A.R.A.H. will debut “Confessions” at its fifth annual breakfast on Sunday, March 27. The event will recognize eight physicians who have partnered with Project S.A.R.A.H., and will feature Dr. Susan Schulman, a contributing author in a new book, “Breaking the Silence: Sexual Abuse in the Jewish Community.” (The book, published by Ktav, was edited by David Mandel and David Pelcovitz; see related story.) Schulman, a Brooklyn pediatrician, was “one of the first to speak out against child sexual abuse in the Orthodox community,” said Stein.

The website describes the organization as having many partners and supporters. It is funded by the New Jersey Department of Law and Public Safety–Stop the Violence Against Women Grants Program, as well as the Passaic County Women’s Center, JFS of the Jewish Federation of Greater Clifton/Passaic, and private donors. Project S.A.R.A.H. also works in partnership with other JFSes to provide services in other parts of the state. The website further explains that Project S.A.R.A.H. serves Jewish families in New Jersey, seeking to “overcome the cultural, religious, and linguistic barriers that prevent victims from acknowledging the problems of domestic abuse and sexual assault.”

“There’s an enormous shift in the Jewish community, from being in denial that these problems existed in the Jewish community to really wanting to create a safer climate for families,” explained East. “People don’t have to live with abuse. Kids can keep themselves safer.”

Some of the support mechanisms for families provided by the agency include the Shalom Task Force hotline, opportunities for counseling, and the training of professionals in the community. “Abuse is a complex matter, with legal ramifications, financial issues,” said East, explaining that attorneys, physicians, and rabbis can all help families in crisis.

“We train rabbis so they can be as sophisticated as possible in understanding these issues in the congregation,” said East. “Rabbis are often the first point person who realizes there’s a problem in the family. The husband, the wife, or the school may reach out to the rabbi.”

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Elke Stein, director of the Domestic Violence and Sexual Assault Service of Project S.A.R.A.H., left, and Esther East, director of Jewish Family Services at the Jewish Federation of Greater Clifton/Passaic Josh Weinberg

“Whatever you do in these family systems in which there is violence or abuse, you have to be careful what you are doing. It can make the situation more explosive, more complicated,” she added. “We felt if we trained rabbis it would make them more effective.”

Another program supported by Project S.A.R.A.H. is the Aleinu Safety Kid Program, which was originally developed by Jewish Family Services in Los Angeles. Project S.A.R.A.H.’s website explains, “The Safety Kid program is a comprehensive school program that teaches children in a fun and non-threatening way how to keep themselves safe from potential perpetrators.”

“They trained us to deliver the program; we are bringing that service into New Jersey,” said East. She reported that YBH of Passaic-Hillel has adopted the program. “We work with faculty, parents, and kids from kindergarten through third grade.” The program focuses on “primary prevention — teaching kids how to keep themselves safe,” she added. Yeshivat Noam of Paramus and Cheder Lubavitch of Morristown are scheduled to participate in the Aleinu program.

“There should be a safety net of different parts of the community that are trained and responsive to anyone who comes through the door,” East said. The doctors being recognized at the Project S.A.R.A.H. breakfast include pediatricians as well as obstetrician/gynecologists. “There are eight physicians who have accepted the opportunity for identifying themselves as partnering physicians. There are many others as well who work with us.”

“Pediatricians are vital community resources that can play a critical role in sexual abuse education and prevention.… [T]he pediatrician can create a ‘teachable moment’ to explain about privacy. This conversation can take place unobtrusively, with little emotional fanfare,” writes Dr. Isaac Schechter, a clinical psychologist in Rockland County in “Breaking the Silence.” He continues, “In a community where pediatricians as a group began implementing this practice … several situations of abuse were discovered and immediately addressed.”

Obstetrician/gynecologists also have a special relationship with their patients, which can provide opportunities to educate and advise women about domestic abuse and may serve as a front line to identify victims of abuse. “Physicians are an access point for people to help themselves,” said East.

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Rabbi Raffi Bilek, a licensed social worker and outreach coordinator for Project S.A.R.A.H., demonstrates how a puppet named Safety Kid is used in the organization’s Aleinu program to teach children about personal safety. Courtesy Project S.A.R.A.H.

Being recognized at the breakfast are Drs. Sema Bank, Ruth Borgen, Efrat Meier-Ginsberg, Wendy Hurst, Steven Schuss, Vickie Shulman, Lynn Sugarman, and David Wisotsky. They have raised awareness regarding domestic abuse by providing information for their patients. Some of them have participated in formal training on abuse, have arranged it for their staff, or are planning to do so.

“Their role is a very important one — to ask the questions if they have some concern about a patient,” said Stein.

The breakfast is scheduled for Sunday, March 27, from 9:30 to 11 a.m. at Cong. Bnai Yeshurun, Teaneck. There is no charge for the event. For information, go to www.projectsarah.org. RSVP to (973) 777-7638.

 
 

Moshe Tendler to address brain-stem death

_JStandardLocal
Published: 13 May 2011

“May God grant us the wisdom to determine His will in this frighteningly important area of Jewish law,” concludes a statement on the website of the Rabbinical Council of America. The issue under discussion is “Brain Stem Death and Jewish Law,” and the Jan. 7, 2011, statement was meant to serve as clarification of a more than 100-page controversial document on that topic released by the RCA’s Vaad Halacha (Council on Jewish Law) in 2010.

“The RCA showed nerve and verve on this issue and now they are wavering and recanting,” said Rabbi Lawrence Zierler of the recent RCA document, which articulated the opposition of some rabbis to using brain- stem death as a criterion for death. This has stirred great controversy in the ranks of the RCA, as well as in the greater Jewish community. The issue is compelling; in fact it is a matter of life and death, since those who have been declared dead by the criteria of brain-stem death can serve as organ donors, enabling the saving of many lives.

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Rabbi Moshe Tendler courtesy Yeshiva University

Zierler, who is rabbi at the Jewish Center of Teaneck, is deeply interested in this issue, in part because of his studies in bioethics at Case Western Reserve and a practicum he completed at University Hospital in Cleveland and the Cleveland Clinic. “I sat as an observer on the liver transplant team and had the opportunity to hear how pressing this whole issue is,” he said. Zierler, rabbinic consultant to the Hospice of New Jersey, serves on the ethics committee of Holy Name Hospital. “I know as a hospital chaplain that a brain-dead person is difficult to acknowledge. It’s very weighty, but there are ways to ascertain that a person is brain dead.”

Rabbi Dr. Moshe Tendler will address these issues at the JCT on Monday, May 16. “He’s my rebbe and my mentor in bioethics,” said Zierler of Tendler. Chair of the department of biology at Yeshiva University and rabbi of the Community Synagogue of Monsey, Tendler will lecture on “The Interface of Science and Halacha (Jewish Law),” with a focus on brain death as the determining factor in establishing death.

“I’m a devotee of Rabbi Tendler. This is a man with tremendous practical sensibilities, who makes difficult decisions in the trenches,” said Zierler. “Through Rabbi Tendler I have come to understand … that the power of permissibility is preferable.”

The Jewish Standard spoke by phone with Rabbi Tendler on the topic of Jewish law and brain-stem death.

J.S.: The RCA, which claims a membership of close to 1,000 Orthodox rabbis in 14 countries, represents differing views on the issue. Can you explain the controversy?

M.T.: For more than 30 years the RCA sent out health-care proxies recommending organ donations after brain death. Then they came out with a more than 100-page report that raised questions that were devastating, suggesting that brain death is not final and that some recover after brain death.

J.S.: Your late father-in-law, the renowned rabbinic authority Rabbi Moshe Feinstein, as well as the Chief Rabbinate of Israel, had come out in support of brain-stem death as a criterion for death. What led to this change of heart by the RCA?

M.T.: The Rabbanus Harashis [Chief Rabbinate of Israel] supported brain stem death as the only irrefutable indication of death. This was followed until two years ago, when under pressure of [Rabbi J. David] Bleich and [Rabbi Mordechai] Willig in the RCA, they tried to reverse it. They didn’t have the slightest idea of what brain-stem death means. There were attempts to obfuscate Rabbi Feinstein’s position. Rabbi Willig said that polio patients who were paralyzed and can’t breathe were brain-stem dead according to Rabbi Feinstein. He published that kind of nonsense. How could they make such errors? These are issues that touch upon intellectual integrity. The 100-page document is not a p’sak [rabbinic ruling], it’s just information.

J.S.: The document suggests that although they do not subscribe to the notion that brain stem death is death, they believe that it is permissible to get an organ from a non-Jew who is brain-stem dead.

M.T.: That’s already a blood libel. It [encourages] anti-Semitic reactions — “I am a non-Jew. Do you mean you can take my organs even though I am still alive?”

J.S.: The rabbis who oppose these principles are colleagues of yours at Yeshiva University. Those are strong criticisms of your colleagues. Is that a problem for you?

M.T.: They are colleagues… who are ignorant or are biased and allow themselves to say things without careful investigation. I’ve been criticized for using strong words. When dealing with pikuakh nefesh [saving lives], there is nothing wrong with using strong words if you think it will accomplish saving a life.

Lecture

What: Lecture by Rabbi Dr. Moshe Tendler on “The Interface of Science and Halacha (Jewish Law)” as part of the Seventy Sterling Community Lecture Series

Where: The Jewish Center of Teaneck

When: Monday, May 16, 8 p.m.

Cost: Free and open to the public.

Information: (201) 833-0515

J.S.: What is the status of the issue now?

M.T.: It’s back to where it was. The RCA retirees in Eretz Yisrael [Israel], and senior rabbanim [rabbis] in the RCA, want to make clear that they didn’t rule against brain death. They simply wanted to provide information for people to think about the topic. The overwhelming response of the RCA membership — hundreds of members — [was a reaction] against this document.

J.S.: What is the situation in Israel? The hospitals there are known to have sophisticated and highly successful organ transplant units.

M.T.: In Israel the Zionist Rabbanim support brain-stem death. The lungs and heart can only be taken from brain-stem dead people. Hadassah [Medical Center in Jerusalem] is known for heart transplantation, and Rambam Hospital [in Haifa] specializes in lung transplants. They have very successful innovations. In the U.S., if a hospital does not do at least nine transplants per month, the mortality rates go up. In Israel they don’t do nine transplants per year and their mortality rate is just as good.

J.S.: Are there any disadvantages to being Rabbi Moshe Feinstein’s son-in-law?

M.T.: They expect me to defend all his responsa. I only agreed to marry his daughter, but not to defend all his responsa, although he had a wonderful track record and was almost never wrong. He did his homework.

J.S.: Do you have any other comments for our readers?

M.T.: [I will be pleased to] have someone in the audience present the opposing view. It will permit me to clarify the issue. Generally the audience always contains someone who is committed to a position that interferes with intellectual integrity.

 
 
Editor's Notebook

Winning and sweet science

 

Jewish Standard sweeps the field

Newspaper racks up journalism awards

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From left, Warren Boroson, Rebecca Boroson, Josh Lipowsky, and Miryam Wahrman display their NJSPJ awards. photo by Israel Wahrman Winners Lois Goldrich, inset left, and Bram Boroson, inset right, were not at Sunday’s ceremony.

The Jewish Standard received seven awards, including four for first place, at the annual awards luncheon Sunday at the New Jersey Performing Arts Center in Newark of the New Jersey Society of Professional Journalists.

In the weekly newspaper division, a team of three — Rebecca Boroson, Lois Goldrich, and Josh Lipowsky — placed first in state for regional news for a mulitpart cover story “Sacred Space?” about the planned mosque near Ground Zero. (Boroson is the newspaper’s editor. Goldrich and Lipowsky, both former associate editors, continue to free-lance for the paper.)

The judges wrote, “This section explores one of the most sensitive topics of public discussion and news coverage of recent years through the thoughts and opinion of various people, including rabbis and other prominent Jews, Muslim leaders, and politicians. It lets those featured speak for themselves on the subject of whether a planned Muslim building should be erected near the 9/11 site, and the result is much food for thought on both sides of the issue. A real service to the readers.”

Lipowsky won second place in that category for “DeVries case spurs state to target driving while distracted.” He also won first place for a feature, “Hello, old friend: Death march survivors reunite after 65 years.” The judges comment was that the article “flowed seamlessly between the experiences of the men during the Holocaust, and today.”

Miryam Wahrman, the newspaper’s science correspondent, placed first in the health, science, and technology category for “Got ____? Aphasia: At a loss for words.” The judges called it an “interesting and informative article on a health problem that most of the general public never even heard of. Wahrman does a good job of explaining what it is, how it affect individuals, and the treatment available at a local center.”

Another first was won by Bram Boroson, in both the daily and weekly categories, for his review, “A Novelist’s Search for (Divine) Life in the Universe,” of a book by Herman Wouk called “The Language God Talks.” The judges called it a “thoughtful and insightful review that gives the reader a number of ideas to ponder.” Boroson, an assistant physics professor at Clayton State University in Morrow, Ga., is performing research at the Harvard-Smithsonian Center for Astrophysics in Cambridge, Mass. He is the son of Rebecca Boroson and her husband, Warren, a contributing editor at the Standard.

Warren Boroson took second place in the enterprise/series/investigative category for his three-part series on ant-Semitism, “The disease that won’t go away.”

A columnist as well for NewJerseyNewsroom.com, Boroson took two other second-place awards, one in the online essay category for “What it’s really like to be retired” and one in the online public service category for “Frank financial advice for young people.”

Rebecca Boroson placed second for her editorial “Boorish blogging and a merited medal.”

Sara Lee Kessler of Englewood and her NJN Public Television team took a first place award in the Best Media Affiliated Website category for NJN’s “Decoding Autism” website. The judges called it “an attractive and easy-to-navigate site addressing a serious topic. The combination of information (including Fast Facts list) videos, and resources helps demystify the subject of autism for the average person.”

The “Decoding Autism” documentary, which is now airing on PBS television stations across the nation, debuted on NJN on Sept. 27, 2010. The Standard’s Abigail Klein Leichman previewed it in this newspaper on Sept. 24.

The Standard’s publisher, James Janoff, said he was delighted at the paper’s strong showing. “It demonstrates,” he said, “the Standard’s commitment to editorial excellence and to covering the community.”

 
 

Israeli doctors learn robotics, with the help of local M.D.s

Robots to boldly go where no one has gone before

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Dr. Deane Penn of Alpine is flanked by visiting Israeli Drs. Jacob Borenstein, left, and Adi Lazar, who came to the United States to learn about robotic surgery. Miryam Wahrman

It has been called “Star Trek Surgery,” but California-based Intuitive Surgical makes sophisticated surgical robots for the here and now. And thanks to a program supported by the Jewish Federation of Northern New Jersey’s Partnership2Gether, Israeli doctors will learn how to use the mostly American-made devices with the intention of introducing robotic surgery into Israeli hospitals.

“They’ve sent us doctors to teach us about emergency reponse and we’ve sent them doctors to teach them about bloodless surgery,” said Dr. Deane Penn, describing earlier aspects of the P2K program. This month the program brought two Israeli surgeons to northern New Jersey for the latest initiative, to improve medical practice and technology in Israel by teaching Israeli doctors robotic surgery. Penn and his wife, Susan, hosted a reception and talk in their Alpine home on July 13, where the two sponsored doctors shared their perspectives with members of the community. Penn, a retired gastroenterologist, works as a medical stock analyst, advising hedge funds on medical technology investment strategies. He also runs The Center for Medical Weight Loss in Englewood with his partner, plastic surgeon Dr. Herbert Feinberg.

“Laparoscopic urology is less invasive than regular surgery, but robotic is even less invasive,” said Penn. “With the 3D lighting effect you can see the tissues better and the robot can get into places that human hands cannot. There is less bleeding, and the patient can leave the hospital the next day,” he added.

The four-armed da Vinci robotic apparatus (named for Leonardo da Vinci who drew and designed the first robot) has computer-controlled mechanisms that hold two or three surgical tools as well as an endoscope, i.e., a tiny camera and light. The advanced systems use algorithms to translate hand movements of skilled surgeons into fine motions of minimally invasive surgery. Since it can be used for removing tumors or repairing tissues with minimal damage, robotic surgery is particularly useful in urology as well as obstetrics. Hence the two doctors chosen for this initial visit were a urologist and an obstetrician.

One of the two doctors, Dr. Adi Lazar, 41, was born in Romania, and attended medical school there. After residency training in Israel and France, he settled in Israel and is now a senior urologist at Western Galilee Hospital in Nahariya.

“Most of the radical prostatectomy in the U.S. is done by robots,” said Lazar. When traditional prostate surgery is performed there is a significant risk of complications such as incontinence and impotence. Lazar explained that with robotic surgery, prostate cancer survival rates are better, with fewer side effects. He estimated that the systems for robotic surgery could cost between $1 million and $2 million.

Dr. Jacob Borenstein, 56, who has served as the head of obstetrics and gynecology at Western Galilee Hospital, came to the United States with the program to learn about robotic surgery for gynecology.

“Robotic surgery is very successful in the pelvic region,” said Penn. “It is a narrow area and very difficult to see, so it is hard to dissect the area.” Robotics are used to remove benign cancers of the uterus and ovaries, explained Penn.

Borenstein’s medical niche is the lower female genital tract. He practices gynecologic oncology and laser therapy and does research on the human papilloma virus, which causes cervical cancer. He said that “every day I make 25 to 50 decisions, many of them life and death.” He recalled that when he came to WGH in 2003, “laparoscopy was very minimal. We began a service of laparoscopy for ectopic pregnancies, salpingectomies [removal of Fallopian tubes], treating ovarian cysts, and now hysterectomies and other advanced laparoscopies.” However, he added, “robotic surgery helps you do surgery easier, better, preserving nerves and blood vessels. It is very successful.”

Borenstein also spoke in detail about medical education in Israel, providing information on a medical school that is about to open in the northern region of the country. He was recently appointed associate dean of the new medical school.

“There are big problems with the number of physicians in Israel,” said Borenstein. “In the ‘90s there was immigration from Russia and many physicians came,” he said. However, now the country is faced with a shortage of doctors, as the four medical schools — Hebrew University’s Hadassah Medical School in Jerusalem, Tel Aviv University’s Sackler School of Medicine, Ben Gurion University Medical School in Beer Sheva, and Technion Medical School in Haifa — do not produce enough doctors for Israel’s needs.

“Each medical school produces about 80 to 100 graduates per year, but we need at least twice that number,” said Borenstein. He reported that some Israelis go to Europe to study, for instance to Hungary and Italy. “But the tuition in Hungary is three to four times that of Israel. So we needed another medical school.

“There was a big fight as the deans of the other schools did not want a new one. But the decision was made to fund a new medical school and put it in the Galil, since there was fear that [the region had] less and less Jews,” said Borenstein. Where in the Galil would the school be situated? “This led to another fight. Every hospital [in the north] wanted it nearby,” he said. Although Western Galilee Hospital was the largest in the region, with 700 beds, the decision was made to build the new medical school in Safed, at the Rivka Ziv Hospital. “But it could not be the main teaching hospital as there were not enough patients for students to be exposed to,” said Borenstein. So WGH in Nahariya, which was already affiliated with Technion for training medical students, became a teaching hospital for the new medical school as well.

The school, which will be part of Bar Ilan University, does not have an official name yet, but Borenstein reported that it may be called “Ilan BaGalil,” which means tree of the Galil. “The campus is in a beautiful place in Safed,” he said “It has two classes … a total of 110 to 120 students, registered to start in October.” Borenstein reported that about half the entering class is female. “The students are excellent, but we were surprised that there are very few non-Jews, perhaps four or five, in the class.” This was surprising since the hospital serves about 50 percent Jewish and 50 percent non-Jewish (Druze, Muslim, and Christian) patients.

Borenstein also spoke of the economics of the medical profession in Israel. “The salary became lower and lower, so that a doctor who works full time in a hospital can’t make a living. You need a private practice in addition.” As a result, said Borenstein, “Now there is an ongoing strike of physicians in Israel.” Because they cannot completely suspend the practice of medicine throughout the country, “every week somewhere else they are not operating. It is already in the courts.”

While Israeli medicine had been proud to be at the forefront of medical science, “We now feel that we are a little behind. It has deteriorated,” said Borenstein. “To buy equipment back home, we need donations.”

Borenstein was scheduled to spend a day in the department of obstetrics and gynecology at Englewood Hospital and Medical Center with Drs. Theodore Tobias and Michael Vardy, observing procedures and learning about the technology. Dr. Adi Lazar visited Mount Sinai Medical Center, together with Penn, where he met with and observed urologist Dr. David Samadi, a pioneer of the SMART system for robotic surgery of the prostate.

Lazar also joined Drs. John Scheuch, urologist, and Penn, Partnership2Gether’s Medical Task Force chair, at Holy Name Medical Center in Teaneck that day.

Bernard Hammer of Teaneck has been involved with Partnership 2000 from the beginning. “The exchange with doctors has been very meaningful to those doctors and their patients,” said Hammer. Hammer explained that the original partner community was in the south, at Ofakim, but it did not work out, and was soon changed to Nahariya, where the hospital served a more diverse community. “Overall, it’s been an interesting and successful project,” he said.

Dr. Ted Tobias, who has also been very active in the Partnership 2000 bloodless surgery program, spoke about the success of that training initiative in Israeli hospitals. “Western Galilee Hospital is one of the major hospitals for bloodless medicine. It is outstanding in bloodless medicine, which has led to saved finances and increased health of patients. The Jewish Federation of Northern New Jersey has made a tremendous contribution in that area.” He continued, “Englewood Hospital has the best machines and we hope to bring Israeli surgeons there, in order to export robotic surgery to Israel.”

For more information on JFNNJ’s Partnership 2000, go to www.jfnnj.org/section.aspx?id=59, or call Sarit Ron at JFNNJ at (201) 820-3907.

 
 
 
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