Orthoptics in Israel and the Palestinian Territories

Judith Musallam D.B.O
A Journey to: Israel and the Palestinian by Judith Musallam D.B.O

During the 1970s, Israel offered a form of orthoptic training, which was useful to manage squints and amblyopia patients. However, this phased out as students looked for a higher training in European countries such as England, France and Italy. On returning to Israel, these orthoptists, on the strength of their qualification certificates, were able to register with the Israeli Ministry of Health and practice orthoptics both in hospitals and private practice. In 1999, the number of Israeli registered orthoptists was approximately 40. That figure has remained static to date, unlike the Israeli population , which is now approximately 7.5 million. Many Israeli orthoptists are now due for retirement and concern recently arose for the preservation of orthoptic practice in Israel.

The Order of St John has provided an ophthalmic service through the St John Eye Hospital (SJEH) in Jerusalem for more than 125years. This is a charitable organization which provides care to all who ask, regardless of race, religion or ability to pay. However, as the Israeli infrastructure is well developed, SJEH in reality serves mostly the Palestinian population of East Jerusalem, West Bank and Gaza and is the only provider of complete orthoptic care for the entire population of approximately 5 million.

Before 1985, a few sporadic expatriate orthoptists worked short term contracts at SJEH. In 1985, Hospitaller, Sir Stephen Miller, created an 18 month rotation for six British orthoptists. The idea was that each would be granted three months “study leave” from their work in the UK and so provide an orthoptic service at little expense to The Order. The service proved to be so valuable that in August 1987, one orthoptist was recruited on an annually renewable, paid contract.

The single-handed orthoptic department initially managed around 3,500 patients per year, based at the main hospital in Jerusalem and weekly on outreach visits to the West Bank and Gaza. The annual patient total increased yearly and with the help of some annually contracted British orthoptists, it reached nearly 10,000 by 1999. Following “ 9 11” the subsequent travel restrictions of Palestinians into Jerusalem effected a sharp reduction of patients who could access SJEH. Great concern was for the 5,500 children who could not attend the Orthoptic clinic during 2000 but the subsequent opening of SJEH satellite clinics in the north (Anabta, near Nablus), south (Hebron) as well as Gaza helped to relieve the struggle.

Development of the department workload was not possible without expansion of the workforce. Few foreigners were interested to travel to Jerusalem in the light of the countries instability, so it was necessary to train local staff to do orthoptic work.

In 2004, Israel was not in favour of re-establishing a local orthoptic school, so it was decided to develop the skills of two SJEH nurses with at least three years experience in ophthalmology. A two year training was devised which consisted of  three months of lectures on basic orthoptics, simultaneous one to one practical training, six month’s practical consolidation and finally six weeks of advanced orthoptic lectures. Two SJEH Orthoptic Assistants (OA) qualified by written and practical examination in 2005. A second course to train two more students began in February 2010.

The misfortune is that the SJEH OA course is not yet recognized by the Israeli Ministry of Health and so a safe working policy was drawn up which allows the St John OAs to work under the jurisdiction of the St John orthoptist.

The orthoptic department is now a team which can provide an accessible service to most of its patients both in the main hospital as well as the satellite clinics. It gives an academic input to the hospital by teaching and stimulating professional development and will provide an efficient data base for research and reports.

Judith Musallam D.B.O (D)
Head Orthoptist
St John Eye Hospital,

12th April 2011.

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