Bioethics in Practice: Northwell Yeshiva Site Open
Bikur cholim ein lah shi’ur (Nedarim 39b).
The warmly lit Sh’or Yoshuv hallways teemed with life. Echoes of Torah learning circulated from the coatroom to the beit midrash, where talmidim sat. Close together. All day. Learning, exchanging svaras, sharing seforim and, occasionally, a basketball. There is also a gymnasium here.
Though the students are gone, the gym in Sh’or Yoshuv is anything but empty.
Sh’or Yoshuv Institute in Lawrence, NY, is the largest yeshiva in the Five Towns. Nestled on the manicured, tree-lined lawns of Cedarlawn Avenue since 2003, the site normally functions as a place of post-high school Torah learning, with a focus on community outreach. Since closing in accordance with government guidelines, the yeshiva has hosted its shiurim online.
In response to the COVID-19 pandemic, this center of Torah received a major Madda makeover. The coatroom now functions as a triage ward, and the gym houses a fully-equipped potential hospital, with 384 beds and over 100 ventilators. The shul is a sanctuary of first-aid supplies. Conveniently, the yeshiva cafeteria is outfitted with numerous hand-washing stations.
The driving force behind this entire operation? Concern for the community.
I spoke with Eli Rowe, a Hatzalah paramedic and founder of its aviation division, HatzolAir, to get a grasp on how the Sh’or Yoshuv site, now a satellite location of Northwell Health, came to be. The project is best understood from the panicked perspective of society just a few weeks ago, when what Rowe calls an “almost apocalyptic fear” set in, with the realization that hospitals might run out of beds. What would happen if people continued to get sick once hospitals were filled to capacity?
Hatzalah, as an organization, is a link between the community and the hospital system. Hundreds of ambulances service people to provide access to hospital care. Imagining a scenario, then, where Hatzalah could not fulfill its mission — where ambulances wait on endless lines to deposit the infirmed at a hospital — led to the question: “What would happen to the patients?” If there is no hospital available, where can patients be taken? Ultimately, Rowe explained, the goal is to “treat the most amount of people with the fewest providers … to get the biggest return on our investment, from a human resource standpoint.”
With this in mind, gathering support, information and supplies, a team of visionaries set out blueprints for a field hospital, a place where, at the very least, patients could be triaged and treated until hospital space became available. The sketch materialized at Sh’or Yoshuv Institute, a facility with an ideal open floor plan and fully accessible amenities, located in a populated area lacking a major local hospital. The rosh yeshiva, Rabbi Naftali Jaeger, agreed to repurpose the facility in order to care for the sick. The only request made was that the main sanctuary remain untouched, as it has, unless absolutely necessary.
Within a week of its conception, the field hospital was fully set up. It was developed, funded and staffed entirely by the community, under the medical guidance of Dr. Avishai Neuman, an anesthesiologist and co-founder of HatzolAir. Monetary donations for equipment made it possible to secure beds, monitors, ventilators and oxygen, as well as essential supplies such as medications, full protective gear, cleaning supplies and electric wiring. Room dividers were fashioned from repurposed mechitzahs, which were contributed by party planners. 500 iPads, enough to be distributed to each patient and healthcare worker, were designated to facilitate remote communication with family members. Equally critical to the operation’s success was the hard work and time put in by all members of the team, as well as sustained volunteer efforts. The way that Eli Rowe puts it, the creation of the Sh’or Yoshuv site was the “foresight to build something that we always hoped would be the biggest waste of money.” To date, the hospital wards have not been used.
That is not to say that the site has remained lifeless. The next step in the process stemmed from a phone call with Dr. Gita Lisker, the director of the Respiratory Care Unit at Long Island Jewish Medical Center (LIJ), consulted for advice on stocking and staffing a hospital unit. Dr. Lisker recommended partnering with a health system “to ensure that all safety and quality standards would be met” in the facility. In the days before the Navy ships docked in New York or the Javits Center became a hospital, Northwell Health leaders were invited to visit the Sh’or Yoshuv premises. Eli Rowe proudly describes the impression that the site left on the representatives — “they were flabbergasted,” he says. Michael Goldberg, the Executive Director of LIJ, was among the twelve Northwell delegates initially given a tour of the facility. Mr. Goldberg commented that he is “continually inspired by the way this community supports one another...to build an unbelievably well thought out center to provide care.” The goals of the Sh’or Yoshuv site, Mr. Goldberg maintains, “aligned perfectly with our Northwell mission to help.” A similar sentiment is expressed in Dr. Lisker’s reflection on the pivotal phone call, which included Northwell leadership, Hatzalah, Achiezer and Orthodox community leaders — “it was one of the proudest moments of my life,” she says, “as so many of the different and wonderful aspects of my life came together to do great things.”
And that’s how you end up with Siyata D’shmaya markings atop Northwell Health signs.
Northwell’s Lawrence Ambulatory location, as Sh’or Yoshuv is officially known, is currently operating as a COVID-19 testing and evaluation site. It is staffed by a Northwell Emergency Room physician, community volunteers and EMTs, as well as Sh’or Yoshuv staff members. Thanks to around-the-clock security, operations have been able to run smoothly. The facility has seen over 200 patients (as of May 6) since opening on April 22. Once registered, patients are received in the spacious (and regularly disinfected) waiting room, until evaluated and tested for COVID-19 by the doctor. Patients can be referred to Northwell’s homecare program (which may include oxygen, if needed), and referrals are also available for telehealth visits with a Northwell pulmonologist. Pulse oximeters are given out to patients for home monitoring when indicated.
“Even though trends were reversed, we decided to open in limited capacity,” said Eli Rowe, acknowledging the aspects of the facility left unused. A number of ventilator units, as well as other in-demand supplies, were donated to various hospitals when it seemed the field hospital would not need to open. However, we are still amid the crisis. Because all equipment remains in place and the Sh’or Yoshuv site is already part of the health system, Rowe reminds us that the flip of a switch is all that will be necessary to begin treating over 200 patients, should the need arise. “We’re in it and we can treat it,” he says.
It is inspiring to work with the kinds of people who dwell not on the good they have already done, but on how much more there is to do. Everyone involved — the dedicated doctor, proficient clerical staff and meticulous cleaning crew — is invested in maximizing the facility’s capacity to help. Max Rowe, a Hatzalah EMT who has been volunteering since day one, emphasized how meaningful it is to “answer a lot of questions the community has [about coronavirus],” providing reassurance and “helping people get the care they need to make it feel like everything will be ok.” This is a testament not only to Sh’or Yoshuv’s clinical capabilities, but to its role in providing support and reassurance to those in need.
The fate of the Sh’or Yoshuv facility is intertwined with that of the community; like the people, how it is treated is largely dependent on the jurisdiction of the healthcare system. The nature of what is deemed essential changes every day. Today, I might measure a patient’s vital signs as the doctor prepares the COVID test swab. Tomorrow might find me scheduling an appointment for serologic antibody testing. We’ll all be hanging in there until, someday, hopefully soon, the triage center will be restored to its former glory as a coat room.
Photo Caption: Northwell and Hatzalah team members outside the facility on its inauguration day
Photo Credit: Talya Lisker