By Lonye Rasch
When children get severely ill or badly hurt, their first encounter with the medical complex is typically an overwhelming and frightening hospital emergency department (ED).
Recognizing that reality, the physicians and nurses in the pediatric ED at Hadassah Hospital Ein Kerem know “it is crucial to approach the child and his family with a kind heart,” says Dr. Saar Hashavya, who heads up the ED. “They know they have to treat the child, the parents, and the illness.”
“About 25,000 children each year are cared for in this 18-bed ED. The staff’s focus,” Dr. Hashavya explains, “is to provide these young patients with “an anxiety-free and pain-free environment.” Surrounded by colorful curtains sporting zebras and owls, the children meet volunteers who play with them, medical clowns who make them laugh, and medical teachers from the Hadassah School, who explain the procedures they will undergo and what it will feel like. Once a procedure is over, the child often receives an Artik, the cool soothing ice cream on a stick that is famous in Israel.
“Seeing a child going out happy from the ED,” says Dr. Hashavya, “is most rewarding.” He recalls a day recently when a paramedic came to the ED, with tears in his eyes. He told Dr. Hashavia that his son, who is now about to go into the army, had been treated successfully for leukemia at Hadassah, beginning in the pediatric ED. Sometimes the contact with the ED staff only spans a few hours, Dr. Hashavya notes, “but the emotional footprint is significant. People remember.”
Dr. Hashavya didn’t know from the outset that he wanted to be a pediatrician. He became a doctor because his parents advised him to do so. But, he says, “When I met my first patient, I understood that I wanted to be a doctor.” After he and his wife worked in an Ethiopian orphanage as part of the Hadassah Medical Organization’s ART-Joy-Love project, established by Prof. Dan Engelhard to save the lives of orphans dying of HIV-AIDS, Dr. Hashavya knew pediatrics was for him.
Following a one-year pediatric emergency medicine (PEM) fellowship in Sydney, Australia, it became Dr. Hashavya’s mission to share his new expertise with colleagues around the world. For example, he taught a pediatric emergency medicine course in Addis Ababa, Ethiopia, and he trained Kurdish and Italian physicians, as well as Palestinian pediatricians at Hadassah Hospital. Once these physicians returned home, he remained available through telemedicine.
Now he has his sights on providing training to doctors in Oceania, which includes the subregions of Micronesia, Melanesia, and Polynesia, as well as Vanuatu, in the southwestern Pacific Ocean.
Dr. Hashavya’s larger vision includes the creation of a pediatric disaster relief team. When disaster strikes anywhere in the world, whether triggered by earthquakes, hurricanes, or war, Israel is renowned for sending a rescue mission to spearhead disaster relief. But, Dr. Hashavya notes, there is no pediatric disaster rescue team, specifically geared to helping children during these mass casualty events. Dr. Hashavya and Dr. Lea Sarna Cahan, a Hadassah pediatric ED specialist who participated in a fellowship in pediatric disaster management at Harvard University, want to change that reality. It is their vision and their concrete goal to create such a team that will be ready to respond immediately to help the children affected by whatever catastrophe arises.
The pediatric response team would include mainly pediatric ED specialists, but also perhaps a surgeon and intensive care specialists. In his vision, Dr. Hashavya elaborates, the rescue team would be ready to leave immediately when disaster strikes — not in 48 to 72 hours, which is more typical now.
To prepare for this mission, Dr. Hashavia sees his physicians going to developing countries to train in managing disasters in the specific environment. Having been a part of Hadassah’s Medical Humanitarian Mission to help Ukrainian refugees, he will incorporate lessons learned there.
Whatever the project in a developing country, Dr. Hashavia’s vision doesn’t end with treatment. His philosophy is that it is “better to train than just to treat,” so that someone will be able to care for these children once he has gone home. Recently, Drs. Hashavia and Cahan hosted Israel’s first symposium on pediatric disaster management. The Israeli Health Ministry, Magen David Adom, and several of the country’s hospitals were represented.
Like most Hadassah physicians, Dr. Hashavia also does research. It “leads the way forward” in medicine, he comments. Recently, he has been identifying markers for abdominal and head injuries and looking into how best to assess infections in infants.
In his May 2023 article in the Journal of Clinical Medicine, Dr. Hashavya and his coauthors conclude that adjusting the chronological age of preterm infants according to their gestational age is important in assessing preterm infants with suspected infection. As they write, “The findings support the claim that an age correction of preterm infants should be considered since the risk of serious bacterial infections correlates with the corrected rather than the chronological age.”
The authors recommend that “premature infants, especially those below a corrected age of three months, should be evaluated with caution and considered for more extensive care when presenting at the pediatric emergency department.”