Over the past eight years, the number of ultra-Orthodox Jewish male and female nursing students has increased tenfold. Opting to become a nurse is a response to the recognition within the ultra-Orthodox Jewish sector that not every man is able to devote his days and nights to learning and to the growing need for a viable livelihood - and also suits the community’s emphasis on acts of loving-kindness (hessed). Contrary to common belief, the Rabbis see no halachik problem in touching female medical patients: “It is a matter of saving lives (pikuah nefesh)
Hila Weisberg 09/08/2019
Bentzi Forges, a 34-year-old ultra-Orthodox Jew (Haredi) living in Bnei Brak and a nurse at the Ichilov Hospital emergency room, will never forget his first patient. “I introduced myself to him,” he recalled his meeting of two years ago, “and he said: 'No sir, I don't want a Hevra Kadisha worker, I want a real professional nurse.’” People see an ultra-Orthodox Jew with a beard and wigs and they sometimes think it means that this person is not a professional. After they get to know me, their opinions change."
Along with Forges, who is married and a father of five, dozens of male and female Haredi nurses began working at Ichilov in recent years, and also in other medical centers: from Sheba and Hadassah to Mayanei HaYeshua, Shaare Zedek, Assaf Harofeh and Kaplan, and also in psychiatric hospitals. And the meter is still ticking.
According to data from the Council for Higher Education, processed at the request of "Globes", over the past eight years the number of Haredi (women and men) nursing students in first and second degrees has increased tenfold, from 58 students in 2010 to 561 students in 2018. In the past four years, their number has increased 2.4-fold, while the total number of nursing students has also increased over the same period—from 4,700 students to 6,370 students—but at a lower rate: only 1.4-fold. As in the general population, the overwhelming majority of Haredi nursing students is still women. It is estimated that out of 68,000 nurses in Israel today, at least 1,000 are Haredi, of whom only 100-150 are men. But in the next few years their numbers are expected to increase gradually.
Forges, who belongs to the Belz Hasidism and who was formerly the parliamentary aide to MK Israel Eichler (United Torah Judaism party), recounts that “the Admor of Belz (Rabbi Yissachar Dov Rokach) suggested that I study nursing.” That was about eight years ago, when the Rabbi told Eichler that he wanted to see someone from the Belz Hasidut study nursing. “Eichler told me, 'Maybe this is right for you, because you are a volunteer at the ZAKA and Magen David Adom emergency response organizations.” It was just at that time that the first cycle of nursing degrees for Haredi men at the Academic College of Tel Aviv-Yaffo was launched, held at the “Bnei Brak College for ultra-Orthodox Jews” (Mabar), and Forges decided to accept the Rabbi's proposal.
"Not everyone is able to sit and study day and night, so the Rabbi encourages those who do not learn to go out and make a living, realize their potential. Our congregation has lawyers, engineers, Ministry of Defense employees. It is customary to find employment at places that the Rabbis have approved. When I asked the Rabbi if Ichilov Hospital fits the spirit of our congregation, he said that as long as I have a place where I can study the Torah and continue to maintain a religious lifestyle, it is fine.”
Wasn't the Rabbi concerned about the profession entailing contact with women?
"No, there is no halachik problem, because it is not a touch of affection. The halacha permits you to do what is necessary to care for people; it is a matter of saving lives. Working as a nurse gives me great satisfaction. All my life I dreamt of working in a profession in which I can help people."
Unlike regular programs, the ultra-Orthodox nursing programs do not require matriculation or a psychometric test, but do require students to successfully complete a one-year preparatory course in which they study several basic subjects (chemistry, biology, English and mathematics), along with passing a psychotechnical examination called Til and an admissions interview. Forges successfully completed the preparatory year, while working in the evenings as a phlebotomist at a HMO. His wife, who owns a hair salon in Bnei Brak, also assisted with the family's livelihood during the schooling, which lasted about four years.
Why work specifically in Ichilov and not in more religiously oriented hospitals, such as the Mayanei HaYeshua or Shaare Zedek?
“We undertook our third and fourth year clinical experience at Ichilov, and that is how we established a connection with the hospital and subsequently received job offers from it. Ichilov was accommodating and the attitude was positive, so that was the right fit. The learning ability and professionalization in a large hospital is on a different scale.”
Alongside Forges studied Yossi Malka (39), who is married and a father of three from Bnei Brak, and who also currently works at Ichilov. Within about two years, he advanced to the post of deputy head nurse in the prestigious neurosurgery department at the hospital. “Because of financial constraints, after three years at a kollel, I realized that just learning is not for me," he says. "I worked for a few years at Partner and progressed there, but at one point I felt it was better for me to learn a profession. I deliberated between nursing and social work, I consulted with the rabbi, and decided to pursue nursing. “At first," he recalls, "it was clear that it was not a 'home', not my natural environment. But the reception was welcoming and I am an open-minded person, so it was easy to integrate. "
Another class member of the two is Nathaniel Foxbrumer (30), who is married and a father of four from Jerusalem, who has been working for the past two years as a nurse at Shaare Zedek Hospital in the city. He served as a soldier-teacher in the IDF, and after completing his army service, he considered studying law. "But the family said: 'Go learn something you love.' This is how I ended up in nursing.” During his studies, he began also a Masters in Public Health at the Hebrew University of Jerusalem. “I had to complete my matriculation in a preparatory course and it was very difficult," he recalls. “I started from scratch, at the level of studying ABC and multiplication. English is the Achilles heel of the entire ultra-Orthodox community.”
Foxbrumer is almost the only male nurse, alongside many female nurses, in the Pediatric ER and Dialysis Department at the hospital. Over the years, he learned Arabic so that he could communicate with dialysis patients, most of whom speak Arabic.
Interesting concept. A Haredi nurse who speaks Arabic.
"Yes, there is full coexistence here. People sing Hasidic songs alongside ones who sing in Arabic. It works.”
"We started with ten ultra-Orthodox - and multiplied"
The main reason for the increase in the number of ultra-Orthodox brothers in recent years is the opening of several nursing education courses specifically designed for them. Apart from the Academic College of Tel Aviv-Yaffo academic course in Bnei Brak, which teaches about 25-30 students a year, there is also a course for men at the Lev Academic Center, which opened four years ago. There, about 40 religious men study each year, including 20 Haredi students. The Lev Academic Center also teaches nursing to about 100 ultra-Orthodox women every year in three different programs: one in Bnei Brak (only for Haredi women) and two in Jerusalem. The Ruppin Academic Center, too, has classes for Haredi women as of 2013, in collaboration with the Laniado Hospital, Netanya.
The idea of promoting ultra-Orthodox nursing programs coincided with plans that were put in place at that time by the Planning and Budgeting Committee (PBC) of the Council for Higher Education (CHE) in collaboration with the Ministry of Health and Finance, to increase the number of nursing students in Israel at universities and especially in colleges, to cope with the shortage of nurses in Israel, which is estimated in the thousands. Between 2010 and 2019, the number of nursing students increased by several thousand, especially in the academic colleges, and last year it was decided to increase the number of first-year nursing students by another 800 - a program that was budgeted, through the treasury, at NIS 22 million.
This year, nursing in Israel has reached a record number of 4,000 students, which is approaching the Ministry of Health's goal for 2025: 4,800 first-year nursing students each year. Despite this increase, the proportion of nurses and graduates of nursing degrees in Israel is still significantly lower than the OECD average, so the number of students should continue to increase. “We need another 650 chairs from the CHE," says Dr. Shoshi Goldberg, head of the nursing administration at the Ministry of Health." Every chair we open - fills up. There is great demand for the field, which gives meaning, stability and opportunities for professional advancement and diversity."
The programs for the ultra-Orthodox, Goldberg says, turned out to be a resounding success. “The graduates of the Latal Campus for women (Lev Academic Center), for example, are at the top of the list in the government licensing exam scores and other metrics. We want to see more Haredi male and female nurses because this is a quality group.”
According to Prof. Haya Greenberger, dean of the Faculty of Life Sciences and Health at the Lev Academic Center, and Dr. Pazit Azouri, dean of the School of Nursing Sciences at the Academic College of Tel Aviv-Yaffo, also the success rates of ultra-Orthodox men on the certification exams are impressive, and stand at 100%.
As Chairman of the PBC in 2009-2014, it was Prof. Manuel Trachtenberg who considered the match between the need to increase the number of nurses in the economy and the willingness to integrate ultra-Orthodox Jews in higher education and employment. In combination with Tel Aviv University, Ichilov Hospital (led by then-CEO Prof. Gabi Barash) and Academic College of Tel Aviv-Yaffo, the first ultra-Orthodox nursing study program was inaugurated, accompanied by student scholarships and subsistence allowances, according to the students’ needs and financial situation. "Trachtenberg contacted us in 2012, he asked if we could take on this project, "Azouri recalls." We decided to go for it. The first conversations were during Chanukah and I felt that the very fact that the program was taking form was a kind of miracle. "
The studies themselves are adapted to the ultra-Orthodox. For example, experiences in women's health, such as giving birth, are done on dolls in simulation centers with the assistance of actresses, and all the lecturers are male.
"It is harder to attract Haredi to the high-tech sector than to health care professions," says Trachtenberg in a conversation with Globes, “because prior math and computer knowledge is required to study engineering or computer science, and then the success rate (in the required preparatory courses) is lower. I believe we can extend much more the learning programs for Haredi in the health care professions. Yes, it is not easy and there are barriers, ranging from their fear of schooling to the need to complete academic gaps, but we should not be deterred."
"The team of care givers becomes the mirror of society
Ichilov's decision to join the initiative stemmed from its desire to diversify the medical staff so that patients from different populations would feel comfortable inside the hospital. “The main goal is to create a situation where the treating staff is a mirror of society," says Ichilov's CEO Prof. Ronnie Gamzo, who previously served as CEO of the Ministry of Health. “Our plan is to push the nurses not only to work in hospitals near their residential area, but also in other areas like Tel Aviv. We would be happy if the new government promotes more projects of this kind."
Nursing has the potential to attract the ultra-Orthodox population, as it is a required, stable profession with respectable monthly salaries, ranging from NIS 10-20,000, depending on the scope of work and seniority. Haredi men have increased their employment rates over the past two decades, from 36% in 2003 to about 50% today, with a slight decline in their employment rates in the past few years. But in general, recent years have witnessed a growing trend of seeking employment in the ultra-Orthodox community (especially among ultra-Orthodox), in order to support the family and improve the quality of life. The profession's values - based on care, kindness and giving - also fit the values of the ultra-Orthodox society. “That's why we saw the potential for the profession and the program," says Greenberger, "and we haven't exhausted it yet. We can add another 100 Haredi students to nursing every year, without any problems. The challenge at the moment is obtaining permission from the CHE.”
Still, right now, while the ultra-Orthodox women are flocking to the nursing profession - according to Greenberger - the men’s shift toward higher education is a slow one, and patience is needed. “There is still concern about halakhic issues related to the profession," says Greenberger, "and there is also an issue of image. A man in nursing is still not an easy thing for everyone to accept. We are seeing a change, though it is slow. We started with 10 Haredi men, and have doubled that number.”
"I have learned to be patient," says Azouri. “In the regular nursing programs, I tripled and quadrupled the number of students each year, and in the ultra-Orthodox program, this did not happen, which is sometimes frustrating," she admits." Trends in the ultra-Orthodox public are slowly happening and under the radar. There were years when we were afraid to stir up too much noise within the ultra-Orthodox society, so that they won’t say 'God forbid.' We preferred that the gospel be passed on by word. There are Haredi families that are supportive, and those who support but are still afraid that a male Haredi will be exposed to a new field and environment.”
Even for the ultra-Orthodox who want to study nursing, adapting to the intensive curriculum is not easy. “The cultural part is the Achilles heel," Azouri says. “Initially, students do not understand what it means to study 11-12 subjects per semester, what a multiple-choice test means, what it means that a lecturer stands in front of them and what his job is.” And despite these difficulties, Azouri says, "they show excellent learning, memorization and understanding. They really want to understand. And later on, in the hospitals, they do the work in awe, and receive excellent feedback."
Why is the increase in nursing students mainly in ultra-Orthodox women? There are several reasons. First, ultra-Orthodox women work at much higher rates compared to ultra-Orthodox men - 76% compared to less than 50% among ultra-Orthodox men. But it's not just that: In recent years, more ultra-Orthodox women are matriculating - 50% of them graduated in 2016 compared to only 30% in 2009, according to the Israeli Democracy Institute - which makes it easier for them to enroll in higher education. The ultra-Orthodox girls have seminars where they complete matriculation, while yeshivas do not include secular studies, so there is no matriculation.
Ultra-Orthodox women are also turning to more diverse areas of practice than in the past. In 2009, 57% of ultra-Orthodox women were in education, and in 2016 only 38%. Also, the nursing profession in Israel is clearly female (88% women) - which in itself may discourage men in general, not necessarily only ultra-Orthodox men.
Hava Real (34), an ultra-Orthodox female nurse, studied at Bnei Brak (Mavhar College) through the Lev Academic Center. Initially, she learned in a teaching seminar, but then "I realized it was not my field and searched for something else.” Through working at the Mayanei Hayeshua hospital for several years, she realized that the field interested her, and she began nursing studies after completing a preparatory year. While studying, her husband - who served in the IDF’s MAMRAM computer unit - went to work to provide for the family. “There is a revolution today among ultra-Orthodox women and in the fields they choose to study. “It's no longer just a teacher and a kindergarten teacher,” she says. “A new generation is forming here, which is more open to the world and the changes that are happening in it."
"The fact that a few years ago half the ultra-Orthodox women worked in education and today less than 40% - is dramatic," says Dr. Gilad Malach, Head of the Haredi program at the Israeli Institute of Democracy. “The Haredi community have finally understood that it is a given that a woman will work, and, if possible, in a job with a good salary.” This perception has even seeped into the matchmaking market, “so if a women has a job in high-tech, it will be highly regarded.” While ultra-Orthodox women in the high-tech sector working outside the ultra-Orthodox centers are at the top of the ultra-Orthodox income scale, nursing, according to Malach, “gives the mid-way answer. A stable job with good wages, in the public sector, as well as employment opportunities "within the sector,” in hospitals such as Shaarei Tzedek, Maayanei Hayeshuha and Laniado.” Another unique phenomenon in the ultra-Orthodox community, according to Malach, is that there are more ultra-Orthodox women students in engineering courses, and that in terms of hourly wages, ultra-Orthodox women earn more than ultra-Orthodox men.
Do you think we will see more ultra-Orthodox Jews in nursing and other health care occupations in the coming years?
"Yes, because nursing also meets the needs of the ultra-Orthodox society, when working in traditional fields such as teaching is no longer enough; and, at the same time, it meets the needs of our economy. Will a tenth of medical students soon be ultra-Orthodox Jews? Probably not, because ultra-Orthodox Jews who wish to undertake medical studies face many barriers. But it will happen wherever there are programs tailored to the ultra-Orthodox that do not require a high-level of academic background."