Monthly Archives: November 2012

LaBreeoot- To Your Health: Healthcare in Israel

Guest Blog Post

Let me introduce myself.  I am the Chuck who Ada Beth has mentioned in her posts.  In addition to being the official blog photographer, I am a doctor, grandfather, rower, and Ada Beth’s husband and life partner.    I practiced medicine for almost 20 years and during that time became interested in how the healthcare system affects the health of populations in addition to providing care for individual people. That led me to a number of medical leadership positions trying to manage the cost and quality of care, and participation in national groups that measure and improve quality of care in the US; so it was natural for me to explore how the Israeli health care system works during our stay in Israel.  I am fortunate that our good friend Cindy has contacts with a number of leaders in healthcare in Israel and arranged for me to meet them.  I want to thank her and all of those people who so graciously shared their time and opinions with me.


How much should healthcare cost?

Should everyone have the same access to healthcare?

What health care benefits and services should be considered basic?

How much should we invest in healthcare technology?

How do we provide support and incentives for individuals to take care of themselves to prevent illness and manage their chronic conditions?

How do we best measure quality and value in health care?

Sound familiar?   These are questions that were on the minds of the leaders of Israel’s largest Kupat Holim (literally, sick funds in Hebrew). They call themselves HMOs – I guess they haven’t heard that the term “HMO” has been replaced with other terms, PPO, EPO, consumer directed plans, etc., after HMOs were bashed in the 1990s for trying to manage the quality and cost of healthcare (more on this later).

The Macro Overview

In Israel today, everyone has access to healthcare.  It’s considered a basic right and is funded by a progressive tax paid by all Israelis that starts at 3.1% and increases to 4.8% for higher earners.  Even though 95% had access to health care prior to 1995, in that year Israel passed the National Health Law that assures that all citizens have access to health care and determines the basic basket of services that must be provided. The basket of services offered through the plans sounds very similar to that in the US – all basic preventive and acute care, transplants, cancer therapy, and specialized care. This national system covers about 60% of all health care costs and supplemental insurance (which most people purchase) and out of pocket expense (co-payments and services that are not covered such as dental care) make up the rest.  The government owns about half the hospital beds in the country and currently provides all of the mental health care services.

While the funding comes from the government, everyone has the ability to choose which of 4 HMOs to join (this has some similarities to the exchanges proposed in Obamacare).  The HMOs were founded between 1920 and 1940, well before the growth of health insurance in the US.  The largest HMO is Clalit that covers about 53% of the population, employs physicians directly and owns a number of hospitals.  The other HMOs contract with physicians in a variety of ways and include hospitals that are owned by Clalit or by the government.  Everyone is able to choose their doctors (mostly GPs) from the network of their HMO and get most of their care from GPs.

There is a special fund and program for children originally started by Hadassah in 1913 called Tipat Halav (a drop of milk).  Tipat Halav is separate from the health plans and there is no copayment for basic child health care. There is a fixed budget for hospital care, so hospitals have to be relatively efficient. The hospitals are all paid by the HMOs for their services at prices the government sets – similar to Medicare DRGs.  The hospitals can give discounts to HMOs, but cannot charge more.

So far so good – everyone has access to essential health care services at an affordable price and a relatively efficient administrative process.

Now for the downsides –

While the basic health plan covers all basic services there are co-payments and additional services, such as dental care (this is true in the US as well), are not covered.

While there is good access to GPs and primary care, there can be long waits (months) for specialty care (although this is increasingly common in the US as well).

Most people buy supplemental insurance, an additional cost that allows them more benefits and covers some of the co-payments.

As in the US, the clinics in the poorer areas are more challenged – they get the same capitation rate for their members, but the members require more time and are sicker than those in the higher socio-economic areas.

If you use the basic insurance, you will get access to good specialty care, but you won’t be able to choose which doctor (remember the Patient Bill of Rights issues?).  For example, if you need a hip replacement, you will be referred to an orthopedist and will see whichever one is available.  If you want to see a specific one, you can do so, but you will have to pay out of pocket to see them at their private office.  The “top” specialists all have two practices – the HMO practice and the private practice.  If you choose to pay for the private practice, you will see the doctor of your choice and you can be seen sooner.

There are some private hospitals that cater to those who can pay out of pocket.  These hospitals still can receive payment for the hospital admission from the HMOs, but they can charge patients more for nicer rooms, better food, and, of course the easier access (see the website for Hertzeliya Medical Center which is in English and that says something too – appeals to a higher socioeconomic group). The private hospitals boast that they only give hospital privileges to the “top” doctors, and in fact do restrict privileges to doctors with more experience and who are chiefs of departments in their HMO practices.

Conversations in Israel

How to manage with limited income – creative, but challenging ideas

After Ada Beth and I got married, I started our honeymoon with a clinical clerkship at one of the major teaching hospitals, Belinson Hospital in Petach Tikva.  In 1972, Petach Tikva was a separate little town outside Tel Aviv.  We stayed in a “dormitory,” that was more like a youth hostel or summer camp staff quarters.  The hospital itself had good basic services, but was a far cry from the NYU medical center.  Now Petach Tikva is essentially part of greater Tel Aviv and Belinson is a huge hospital complex with the Schneider Children’s hospital, cancer center, gynecologic center, etc.

Forty years after my clerkship, I visited with one of the leaders at Schneider Children’s Hospital ( ) on the Belinson campus.  The hospital is the only comprehensive children’s hospital in the Middle East and serves children from Israel, the Palestinian Authority, Jordan, Gaza, and Africa.  As it attempts to balance its budget, it has explored using medical tourism to increase its revenue.  It can provide expert care to people from countries where care is not available, such as the former Soviet Union.  Because of the large influx of people from those countries in the 70s and 80s, there are a lot of physicians and other healthcare professionals who speak Russian and other languages that makes the care delivery more attractive and efficient.

The people from these countries pay the “rack rate,” of whatever the hospital wants to charge, so they fund additional staff and services that the Israeli budget does not, but here is the rub.  While the hospitals currently run at 100% capacity of their budgeted beds, they have some space and can add a few beds for the “medical tourism” patients.  This increased income also allows them to hire additional nurses who will serve the foreign patients as well as the Israeli patients.  When they do so, the press and Israeli public complain that the hospitals are providing care to make money while the Israeli patients are waiting.  Even though these foreign patients are not taking beds from Israelis and are paying for additional services that go to Israelis, the public relations challenges have caused a reconsideration of the program.

Anecdote of management in Israel: Quality is in the eye of the beholder

I have spent much of my career trying to evaluate and improve health care quality, so it was natural for me ask about quality of care in Israel.  How do you know if your doctor is good?  The usual aphorism in the US is that people choose their doctors according to the 3 “As” – Accessibility, Affability, and Ability in that order.  It’s very hard for a patient or even professional peers to evaluate a doctor’s quality. It requires clear measures, adjustment for patient risk factors, and a large enough population to be able to draw some conclusions.  Hospitals can meet some of these criteria and publicize their quality (see the ads by the various hospitals such as Special Surgery and Cleveland Clinic in the NY Times).

When I met the head of one of the best known private hospitals in Israel I asked why people come there and pay out of pocket rather than get their care in one of the government or HMO hospitals.  He answered that there are two reasons – the doctors are better quality and the care and surroundings are better.  I saw on my tour that the care and surroundings are quite nice.  They are more similar to those in the newer hospitals in the US, like the renovated rooms at Morristown Memorial where Ada Beth had her hip surgery, than the routine rooms at Mt. Sinai in NY, and the nursing ratios are higher than in the other hospitals.  As to the quality of the physicians, I was not surprised to learn that there is no data about the doctors’ performance.  The doctors at this hospital are those who are the chiefs of department in their public hospital, have years of experience or have some unique skills, but, as in the US so far, no one has measured success rates, complication rates, or whether the patients fare any better than in public hospitals. By the way, this story is no different from that in US where specialists have gotten together to open specialty hospitals, again without any data that the outcomes are better. On the other hand, there is something to be said about the value of experience and respect of one’s peers.

Innovative practices

The employed GPs are expected to see patients every 7-10 minutes or so.  This high volume is not that different from the US, but many doctors (and patients) do not find this satisfying.  I visited one practice that has developed an innovative approach that works well in part because of the nature of the HMO payment system.

The practice has 4 doctors and 2 sites.  One is in an apartment building in a very nice neighborhood in North Tel Aviv.  It reminded me of the doctors’ offices in Manhattan brownstones.  There is a very small staff with the doctors having one exam room/office.  The doctor, Galit, calls in her patients, talks with them at her desk where she has access to all of their electronic medical records.  Galit alternately looks at the record and the patient with both being able to see the computer monitor. She highlights areas for the patient to see and points out changes in weight, cholesterol or other findings.  She uses this approach both to confirm her recollection and to provide feedback and educational messages to the patient.

One patient came in with a contact dermatitis (skin irritation) from jewelry, a common problem anywhere in the world.  The doctor had already treated the patient with steroids, but the rash was no better.  With the patient looking on, Galit opened “Up to Date,” a reference tool used commonly in the US, to search for alternate treatments.  She found stronger treatment options, then checked to see what was on the member formulary and sent the patient on her way with a recommendation to come back in a few days if it did not get better.  Galit said she understood that doctors didn’t do this kind of real time research in the US.  I explained that they do, but just not in the exam room with the patient.  We still like the mystique of the expert professional.

This visit took 15 minutes so I asked how the practice manages to provide more time for each patient.  Galit explained the doctors agreed that since the quality of their work was the most important factor to them, they decided to have 15 minute visits.  They are able to do this since the HMO pays them a quarterly capitation (a monthly retainer) for every member they see that quarter.  Rather than have patients come back for follow up that could be done in a more efficient way, the practice developed a website with educational materials about diet and common medical problems as well as the ability to communicate by email.  Instead of follow up appointments to generate more revenue as would happen in the US where doctors are paid per visit, this practice uses email to communicate efficiently and open up more time for patients in the office. The practice is different in other socially conscious ways as well.  They have a special clinic for children with persistent developmental disorders, provides care for patients with HIV, and volunteer at a free clinic for refugees.


The more things change, the more they stay the same

Good news

The Maccabi HMO recently started a new call center to help people with complex illnesses and with chronic illnesses.  The doctors refer patients for evaluation and if they are accepted into the program, the health plan assigns a nurse who educates the member and family about their condition, coordinates with the treating physician, and helps the family get the services they need.  They are focused on the frail elderly, people with asthma, diabetes, chronic obstructive lung disease (COPD – which, by the way in Hebrew is COPD), and heart failure.  The program is only 4 months old and they have only a few thousand people so far, but they are very enthusiastic about the anecdotes they have so far.  The challenges have been similar to those in the US, such as how to engage the physician and collaboratively plan care.

Bad news

Programs like this have been used in the US for years.  They are called disease management programs and there is a lot of good data about their performance.  The data shows that while some programs, heart failure and care of the frail elderly, produce better outcomes at lower cost, the rest of the programs appear to do neither.  I guess we are all destined to make our own mistakes.

Physician evaluation – challenges like the US and issues similar to education

Ada Beth and I have often talked about the challenges of evaluating professional performance.  Both doctors and teachers practice alone, deal with widely varying groups of clients (students or patients) with cultural and socioeconomic challenges, language challenges, social supports, etc.  What data should we use to evaluate doctor or teachers?

The Maccabi HMO (the second largest with about a quarter of the population) uses the medical record system to provide doctors with reports about their practice and compares them to their peers.  Doctors can see how well their patients with diabetes are doing for example.  So far, other than sharing the data there is no incentive to use the data but, anecdotally, the doctors who use the data are the higher performing doctors, the ones who need it the least.  There has been talk about pay for performance – paying more to doctors who score better – but so far the issues of equity and measurement challenges have not been resolved.  The debates are very similar to those regarding both teachers and doctors in the US.


The policy perspective

  • The Israel health care system provides good access to care for everyone.
  • Care in Israel is economical.  In the US, the cost of care is currently at over 17% of GDP and over $8,500 per person per year according to the World Health Organization.  Israel spends about 7.6% of GDP or $2100 per person.
  • The quality of care judged by public health measures appears to be very good.
  • There are concerns about rising cost, the evaluation of health care quality, and how to afford health care as the technology and capabilities continue to advance.
  • There are variations in access and quality in ways that are similar to those in the US – the higher socioeconomic groups have better access.  There may be a two tier system, but at least the lower tier has guaranteed affordable care, unlike in the US.


A personal perspective

I received the following in an email from one of the physician leaders I met.  She sent it during the recent military hostilities with Hamas in Gaza, including rockets fired at Tel Aviv.


This morning, I am in my hospital  “wearing two hats”. I am the senior ICU physician for the weekend, and am also the Chief medical officer.

Draw this picture in your mind: in our ICU there are twelve beds. 3 are occupied by orthodox Jews from Bnei Brak. 2 are occupied by Bedouins from the Negev, one is occupied by a patient from Ashkelon, one is occupied by a Palestinian from Gaza, 2 are occupied by Israeli Arabs from the area around us and one is occupied from someone from Tel Aviv…all together… in one ICU ward, in Israel.

I walked in to all the wards of the hospital this morning to make sure that all the staff and parents know exactly what they should do in case of a rocket alarm… Everyone is just the same as everyday… with sarcastic remarks, but still…knowing exactly that this is possible… even more than just possible… right now, right here… and it really does not matter who you are or where you come from…

Then I received a sad call from our Bone marrow transplant unit. They called to say that one of their patients, a 7 years old boy from Gaza, who has been hospitalized in our hospital for a long period of time and has undergone transplantation a while ago, is dying. They called me because the father, who is with him, is afraid that once the child will die, he will not be able to go back. And he wants to go back because he is really worried about his family and his children. So they wanted to see if there is any way to help him return to Gaza. I have some very good connections with the civil administration of the IDF as you know. So I am trying with them to find a way to do that.

Just as I am writing these words, I was told that he died and that we have arranged for the Erez crossing to be opened so the family can return to Gaza with their child for his funeral.


While the story is sad because of the death of a young child, it illustrates in so many ways the values of Israel’s healthcare system and the best of Israel.  In Israel, everyone, really everyone, is entitled to decent and humane healthcare.

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What I have loved, what worries me, and what gives me hope about Israel

Today was our last day here and despite the military campaign in Gaza and the shelling of southern Israel, it was a perfectly beautiful and calm day in Tel Aviv.  Not one cloud in the sky, 75 degrees, a light breeze off the sea, and we spent the entire day outside wandering around Jaffa and walking 5 miles back to our apartment on the Tayelet (walking promenade) along the Mediterranean. Here’s one of Chuck’s pictures of Jaffa and one of Tel Aviv from Jaffa from today.  Don’t you love that incredible blue sky?

As we strolled and periodically stopped to feel the sun on our faces, almost trying to store up warmth to take home, I thought about what I wanted to say in this final blog entry from me.  (There will be one more, from my guest writer Chuck, about the healthcare system in Israel.  He’s been visiting with healthcare leaders here, but he’s been so busy photographing and posting his pictures, he hasn’t had time to write.  He promises to do it on the plane.)  As you can tell from the title of this post, there’s a lot to say.

Yesterday, I met with Tzipi Libman, the president of Kibbutzim College, who was out of the country when I visited the College earlier in our stay here.  We had a delightful conversation, mostly in Hebrew, about Montclair State, Kibbutzim College, teacher education, fundraising, our grandchildren, and of course about my stay in Israel.  When she asked me what’s it been like and whether we had been to the museum where we were having coffee at that moment, I laughed.  I told her we had been to 14 museums this month, including one she didn’t even know about in Ramat Gan.  I said,  “Imagine being in the middle of Tel Aviv, with no responsibilities to anyone or anything, waking up each morning and deciding what to do and where to go and only doing what pleases us at the moment. That’s been our life for the past five weeks.  As my Grandma Molly used to say, what could be bad?”


ISRAELIS:  They are energetic, intense, in your face, outgoing, fun-loving, affectionate and sometimes outrageous. They are fiercely proud and at the same time highly critical of their country. I feel right at home with that. We’ve had incredible conversations with many strangers, but especially with cab drivers.  In Israel, they are mostly middle-class men who are eager to talk about all the things I’ve explained Israelis want to discuss.  Politics, religion, family, country, money, and where did we learn to speak such terrific Hebrew.  Yesterday, we rode to Ramat Gan with a cab driver who told us an incredible life story.  He is named after his uncle who was murdered 80 years ago in the Old City of Jerusalem by his Arab neighbor.  In the first Gulf War, he took his family to Eilat to escape the rocket attacks that were reaching Tel Aviv.  While in Eilat, his building in Ramat Gan was hit by a rocket and destroyed.  He talked about how exhausting it is to live in Israel, how much pressure there is, and how he is tired of war.  He explained that his son, who visited and loved India and returned there to learn Ayurvedic Medicine, now lives in Kauai Hawaii, practicing Ayurvedic Medicine and surfing.  He said although he misses his son terribly, he understands why he chose to leave Israel and go to Hawaii.  This is such a complicated society.

In a few short weeks, my hairdresser, manicurist, housekeeper, various restaurant workers and shopkeepers, and our wonderful tutor Lior have become our friends who greet us warmly, often with kisses and hugs, and whom I will genuinely miss. There is no way that could have happened in such a short period of time back in South Orange.

And then there are the specific Israelis we already knew and were delighted to visit with here. We’ve spent quality time with our friends Nadav and Orlee and their daughter and her fiance, with our family in Haifa, with Lee and Mira and David and Havi in Jerusalem, and with colleagues at Kibbutzim College who have become friends. Israelis, despite their intensity, love to just sit and talk. This is a cafe society and no one rushes through breakfast, a cup of coffee or a glass of wine.  We Americans have something to learn from Israelis.

TEL AVIV- We have loved living in a small apartment in the middle of a vibrant, dynamic, happening Jewish city on the Mediterranean.  It has been such fun exploring so many different neighborhoods, restaurants, galleries, shops, and parks.

Although I’d been rather nervous about coming to spend all this time in an apartment sight unseen except for pictures on the internet (and we all know how misleading those can be), this apartment has been almost perfect.  I still don’t love the 4 flights up, but I am used to it by now.  We love the roof deck, the very comfortable bed, and most of all the location.  Almost everyday we have walked 3-6 miles, cumulatively more than I have walked in the past five years! I wore out two pairs of shoes, but my stamina is way up.  Here’s a photo of our lovely Bauhaus building with Denise and Jim on the roof deck.

This last week, we have wandered all over the city, including along the Yarkon River where Chuck has been rowing.  There were egrets and herons all around and it was lovely to see.  Here’s a heron and a rower on the river.  It has been a great joy for me to see Chuck photographing to his heart’s content, composing shots, changing lenses and filters, and waiting patiently for the best picture. Being together, just the two of us so much of the time,  has been wonderful.

MUSEUMS- Did you know Israel has more museums per capita than any country in the world?  I think we were in half of them this visit!  (That’s an exaggeration for sure.)  Chuck and I love museums, but at home we just don’t make it a priority.  What a luxury it’s been to go to almost every single museum we wanted to visit in Tel Aviv.

LEARNING HEBREW- Improving our Hebrew has been a wonderful, tangible outcome of our time here.  For more, see the prior blog entries on Learning Hebrew.

THE LAND- As I’ve written, this is a magnificent country with desert, sea, mountains, farm land, incredible scenery, and a mix of ancient and modern that doesn’t exist in many places, and it is one of the spiritual centers of the world.  From our stay in the Negev, to our visit to the Hula Valley, from holy Jerusalem to the hopping scene in Tel Aviv, we have soaked up and loved the land of Israel.

SHABBAT- Even though Tel Aviv does not shut down for Shabbat the way Jerusalem does, everyone wishes you Shabbat Shalom, most Israelis have Shabbat dinner with family, and Shabbat is a day of rest and relaxation even if not in the religious sense.  In the USA, I am used to being  a minority member of a mostly Christian country, but it feels wonderful to be in a country that is openly Jewish. While wandering yesterday, I saw this sign in a kosher restaurant window and asked Chuck to take a picture.  I love it- Kosher, so closed for Shabbat, but otherwise 24/6.


WAR: Here we are in the midst of a new military operation in Gaza in response to the shelling of southern Israeli towns.  War and/or the threat of war has been a part of life in Israel for its entire existence. Now the Arab countries in the region are newly unstable, Hamas is a constant worry, and Iran’s nuclear potential looms large.  When my cousin Zilla’s son was born 43 years ago, her grandmother, my great-aunt, said, “Maybe his generation will not have to go to war.”  It has been the fervent hope of every parent and grandparent for generations and it is still not true.  Americans don’t know what it is like to fear your home will be hit with rockets and how it feels to send every 18 year old off to the army and possible mortal danger.  Israelis do, and it is a terrible weight on the society.

RELIGIOUS EXTREMISM: When a Jewish woman is arrested in Israel for wearing a prayer shawl and praying out loud at the Wailing Wall and a child is attacked for the supposed immodesty of her school uniform, there is something serious to worry about.  The power and privilege of the religious fringe in Israel are unacceptable to secular Jews and something bad is brewing here.

THE OCCUPATION OF THE WEST BANK: This ongoing stain on the soul of Israel worries many Israelis who fear what it has done to the society, to its youth who serve in the army and enforce the occupation, and to the ordinary citizens of the West Bank who are not terrorists.  It cannot go on forever and peace is still illusive. Our friends Orlee and Nadav tell us they will not step foot in the West Bank until there is peace and clear borders and I can understand why.

RIGHT WING POLITICIANS: Yes, there are right wing crazies in the US, but they do not control the government.  Many Israelis told us they are fed up with Bibi Netanyahu and they long for a change.  But, no one has stepped up as a plausible leader from the more progressive parties.  More Bibi is worrisome.

That’s a lot to worry about, no?


YOUNG ISRAELIS: Spending time with Itai Harari, our idealistic guide in the Maktesh Ramon; our beautiful young friend Shira Levine who joyfully prepares secular Israelis for their Bar and Bat Mitzvahs in a progessive synagogue; our tutor Lior Yatsiv who teaches English and Hebrew to African refugees as a volunteer; the impressive young leaders of ACRI, ASSAF and Mahapach-Taghir; and the Kibbutzim College students preparing to become teachers who work for social justice, all gave me great hope for Israel’s future.

THE DESIRE FOR PEACE: In the end, most Israelis want peace more than anything and I believe their Arab neighbors feel the same way.  Extremists exist everywhere, but they are not most of the Arabs or the Jews.  I have to believe this because I love Israel and want a peaceful future for this amazing country.

I  have loved writing this blog and I thank you for reading it and for the wonderful feedback you’ve shared.  This experience will be with Chuck and me forever and we are grateful beyond words for every minute of it.

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The Pursuit of Social Justice is Alive and Well in Israel

A great deal of the news about Israel in the US is negative, focusing on the complex, vexing and disturbing military occupation of  the West Bank and Gaza where only Jewish settlers live under Israeli civil law, the security wall built in the middle of West Bank villages and farms, the often unjust situation for Israeli Arabs.  All of it can paint an awful picture of Israel and the news media often goes out of its way to do so.  Because of that, it is important to remember that despite its serious problems with human rights, Israel is the only democratic nation in the Middle East and that in Israel, it is legal and acceptable to protest government action and policy, to pursue legal remedies for injustices of all kinds, to demonstrate for peace, to fight for equal rights in the courts, to publish vitriolic criticism of the military. In other words, it is possible to  pursue social justice in Israel and that is the work of many courageous and fine citizens of Israel.  The New Israel Fund and the organizations and agencies it funds are proof positive of this.

My sister and brother-in-law, Denise and Jim, are active supporters of the New Israel Fund, to which Chuck and I also contribute.  It is a controversial organization in Israel for many reasons, but remember, even though some powerful people in Israel vilify NIF, it is absolutely free to follow its mission, attract donors, and annoy its detractors.  Nowhere else in the Middle East, nor in many other nations of the world, could NIF exist.  On its website, it says,

The New Israel Fund (NIF) is the leading organization advancing democracy and equality for all Israelis. We believe that Israel can live up to its founders’ vision of a state that ensures complete equality of social and political rights to all its inhabitants, without regard to religion, race, gender or national identity. Our values drive our work. We fight inequality, injustice and extremism because we understand that justice is the precondition for a successful democracy — and the only lasting road to peace.

Denise arranged for the four of us to spend a day last week with some of the agencies that the NIF supports.  We spent time with leaders and staff members of ACRI, the Association for Civil Rights in Israel;  ASSAF, an aid organization for asylum seekers in Israel; and Mahapach Taghir, a feminist community empowerment organization in Jewish and Arab communities.  It was informative, moving, and heartening to meet these people and learn about their work.

ACRI is the Israeli equivalent of the ACLU, promoting civil and human rights for all segments of Israeli society.  They challenge unjust laws in court and fight for equal housing, freedom from religious coercion, gender equality, and human rights in Israel and the West Bank.  They are very well-established and well-known in Israel, much as the ACLU is in the US.  Our sense was there are highly skilled and dedicated lawyers and other staff members at ACRI who do essential, sophisticated and tireless work on behalf of all the residents and citizens of Israel. New Israel Fund is a major funder of ACRI.

Our visit with ASSAF was sad but inspiring.  There are over 45,000 asylum seekers in Israel, mostly from Sudan and Eritrea in Africa, who have witnessed and survived horrific conditions including torture, rape, and human trafficking.  They have no legal status in Israel, receive no aid and cannot work legally.  They are in legal limbo and ASSAF provides pyschosocial support, food, help with housing, family and individual counseling,  tutoring and a youth club, and legal advice to these refugees.  Their budget is shoestring, their dedication steadfast and palpable, and they are doing holy work in my eyes.  I was glad to hear that students from Kibbutzim College volunteer at ASSAF.

Mahapach-Taghir especially resonated for me personally because they employ the methodology of critical pedagogy first championed by Paulo Friere in Brazil and I am a strong believer in this approach to educating and empowering people in poverty and because they work in the neighborhood in Jerusalem where I lived 43 years ago.  They work in seven different Jewish and Arab neighborhoods, establishing women’s councils, helping mothers pursue higher education, tutoring children, and pushing for community growth and development.  The organization is co-directed by Jewish and Arab women. Once again, we learned that Kibbutzim College students volunteer here too.  I really connected with one of the staff members we met and  I hope to work with Mahapach-Taghir when I return next time to Israel.

As I’ve written before, Israel is an imperfect society, but there is hope for the future because so many talented, dedicated people are pursuing social justice and tikkun olam, the repair of our fragile world.

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Learning Hebrew: Part II

Sadly, today was our last in-person Hebrew lesson with our teacher, Lior.  We have grown very fond of her and will really miss our time together, sitting on our roof deck learning Hebrew by speaking Hebrew.  Usually we met in the early morning, but while Denise and Jim were here, we met one evening and Jim snapped a picture of us, with Lior ready to write in our vocab notebook and me with the dictionary at hand.

As I wrote in an earlier post, improving our Hebrew was one of our goals for this trip to Israel. Before I reflect a bit on how and how much we’ve progressed, I must make a confession.  When we got here, I was pretty sure (and others confirmed) that my spoken Hebrew was better than Chuck’s, although not by much.  After a month here, Chuck’s Hebrew has clearly surpassed mine.  He has a knack for languages that somehow enables him to get along in French, German, and Russian as well as in Hebrew. I have been impressed with his new-found ability to express himself and talk about complex matters in Hebrew and he has left me in the proverbial dust.  Nonetheless, my Hebrew ain’t bad either at this point!

In English, I pride myself on my vocabulary, correct grammar and syntax, and on my ability to speak my mind on almost any subject in a reasonably articulate fashion. Since most Israelis, especially well-educated ones, speak excellent English and enjoy using their English, whenever I’ve wanted to have serious discussion with Israelis over the years, I’ve reverted to English. Lior never allowed us to do that, reminding us whenever we got frustrated to have patience, take it slow, and explain what we wanted to say with as many words as we needed to use. Her ever-present confidence that we could express everything we wanted to in Hebrew was inspiring and supportive. Furthermore, it was clear to us that she was always thinking about what words we needed to add to our vocabulary and she introduced them in our conversations in a natural way.

When we first arrived, we could not follow Hebrew well on TV or in conversations around us.  Our ability to read Hebrew newspapers and signage was pretty limited as well.  Now, we catch almost everything on TV and can understand what we read most of the time.  When we don’t, we use Google translator or our handy paperback dictionary at home.  We’ve learned and really internalized so many new words- more than I ever expected to acquire- and words I knew long ago but forgot bubble up and come out of my mouth in an astonishing fashion.  Chuck and I talk about how our life in Israel this month has not been “real life” with responsibilities, obligations, bills to pay, etc.  One advantage of this fantasy life we’ve led has been our ability to immerse ourselves in the language, at a leisurely but dedicated pace.

Two nights ago,  that immersion included a performance at the Nalaga’at Center in Jaffa.  Nalaga’at means please touch and  the website for the Center says:

The Nalaga’at Center is a meeting place for deaf, blind and deaf-blind and the wide public that through an artistic and cultural experience engage in a dialogue between equals by means of the Nalaga’at Theater, “Kapish” café, “Blackout” restaurant, workshops and training programs. The Nalaga’at Center develops and offers unique employment opportunities that assist deaf, blind and deaf-blind individuals in providing for themselves while developing their own unique talents, skills and abilities. We believe all humans were created equal but different and that every person has the right to make his or her contribution to society. The Nalaga’at Center employs people of all races, religions, sex and gender.

We had heard that we should not miss seeing a performance at Nalaga’at and we are very glad we went.  It was a moving, educational, and entertaining evening.  Before the play, the Artistic Director got up and spoke for about 15 minutes on the history of the acting troupe and about this production in particular which has Jewish, Muslim and Samaritan actors.  Chuck and I were thrilled that we understood it all- even the little jokes- and we understood the  Hebrew in the play.  The actors use sign language, but behind each actor there is someone speaking their parts.

Tonight we went to a live music performance of a female pop vocalist and that too was both entertaining and an immersion experience.  For the most part, we understood the song lyrics and the banter between the singer and her husband who played the keyboard- at least as much as I usually get all the lyrics to songs in English!  A couple of weeks ago, we saw an Israeli movie we highly recommend- Fill the Void- about the Haredi (fundamentalist) Jewish society.  It had subtitles in English, which was helpful at times, but we loved watching the movie in Hebrew.

I am happy to tell you that the “language dance” I described when we first got here (when we speak Hebrew and the Israeli we’re talking to speaks back to us in English) is happening less and less.  We still have American accents, but our fluency sounds real and seems to elicit Hebrew in return more often than English.  But, lest you think we haven’t occasionally made fools of ourselves, here’s two funny anecdotes.  Chuck is loving the incredible bakeries here in Tel Aviv and he went into one and asked for the bread with bracelets, instead of the bread with raisins.  Bracelets is szmedim and raisins is szemukim- awfully close.  My embarrassment was when I told my cousin Zilla I loved seeing the pea instead of the egret at the nature preserve.  Pea is afunah and egret is anafah.  Zilla with her wry sense of humor warned me not to go into a restaurant and ask for egret soup!

We did another Streetwise Hebrew lesson with Guy Sharett ( at Trumpledor Cemetery, which is very close to our apartment.  In the early 20th century, this cemetery was outside the city limits but now it is smack dab in the center of Tel Aviv, totally surrounded by apartment buildings.  (It must be weird to look out your apartment window into a packed cemetery filled with the graves of so  many famous and historical figures, including Guy’s great uncle, Moshe Sharett, who was the second prime minister of Israel.)  Guy taught us Hebrew and history by asking us to read and translate the tombstones, by telling us stories about the deceased, and by using his ubiquitous white board to conjugate verbs and teach us grammar.  Fun, informative and interesting!

I realized how far we had come with our Hebrew when we went to dinner at the apartment of an esteemed colleague at Kibbutzim College, Nimrod Aloni and his wife Sima.  Last year, Nimrod was a visiting professor at Montclair State and they came to our house in South Orange for a Shabbat dinner.  When we came to their apartment here and spoke Hebrew, Sima was astounded.  “When did you learn Hebrew like this?” she asked.  We realized we had not spoken any Hebrew with them in the US, and Sima didn’t realize we could.  It felt so good to surprise her like that.  To be honest, a lot of our conversation that lovely evening was still in English, but we switched back and forth with ease.

Perhaps the strongest sign of how comfortable I now feel in Hebrew is the fact that I find myself thinking in Hebrew! I love it.  I remember vividly during my university year here when I woke up and realized I had had a dream in Hebrew- a real milestone in fluency and comfort in a second language.  That hasn’t happened yet this time, but I am so happy with how far we’ve come nonetheless.

Now, as we get ready to go home at the end of the week, we think about how we can keep up and even advance our Hebrew fluency after we leave Israel.  Lior suggested we buy some DVD’s of movies and TV shows in Hebrew with English subtitles, that we read Hebrew online regularly, speak Hebrew to each other, and best of all, that we Skype with her to continue our lessons.  Won’t that be lovely?

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The Birds of Hula Valley and Korazim

Our landlord Ron told us that one place we had to visit while here is the Hula Valley in the north of Israel, because it’s migration time for cranes and many other birds.  Thank you Ron! We waited until Denise and Jim came and last Wednesday, we rented a car and drove north.  On the way, we stopped at an archeological site of an ancient Jewish community, Korazim, overlooking the Sea (actually Lake) of Galilee.  Here are Denise and Jim at an observation point with the lake below, just before we arrived at Korazim. It was possible to imagine ancient Jews and Jesus at the very same lookout point, one of the things I love about traveling around Israel.

The town of Korazim began at least in in the time of the Second Temple and the New Testament mentions Jesus visiting Korazim.  The ancient synagogue there, which was built at the end of the 4th century or the beginning of the 5th century, is considered to be one of the most beautiful discovered in Israel.  It is made of basalt and decorated with carvings of floral and faunal patterns, human figures pressing grapes and even lions, a difficult feat using extremely hard basalt.  The only others there with us was a group of American Christians who were giving testimony and praying for healing in a moving demonstration of deep faith.

After a lovely lunch at Vered Hagalil, a dude ranch believe it or not, we drove to the Hula Valley nature preserve. The Hula valley is an agricultural region in northern Israel with abundant fresh water. It is a major stopover for birds migrating along the Syrian-African Rift Valley between Africa, Europe, and Asia. The marshland around Lake Hula, a breeding grounds for malaria, was drained in the 1950s. A small section of the valley was later reflooded in an attempt to revive a nearly extinct ecosystem. An estimated 500 million migrating birds now pass through the Hula Lake Park every year. (Wikipedia)

This was the season for the crane migration and it was truly an awesome experience to see and hear thousands of cranes flying, landing, and finding their mates.  At times, the sky was nearly black with the cranes as we got close to sunset. Apparently the birds were destroying planted fields in the valley, so many governmental and NGO organizations joined together to put food for the birds in certain fields and to set noise cannons near the planted fields to keep the birds away.  It appears to be working for the most part.

Chuck took stunning pictures, a few of which I’ll put here.  Don’t forget to click on them so they’ll enlarge, but if you want to see more of these, go to         and click on the pictures themselves to also get Chuck’s explanations.

One of the nature guides at the preserve told us the birds were so noisy because they mate for life and they find their mates in the masses of birds with their individual calls and voices.  He also said at dark, they settle down and it’s very quiet, but unfortunately the park closes just before dark and we didn’t get to hear the quiet.  We were all so glad we had come and I was delighted to see what a terrific job the Israelis have done with the nature preserve.  From the Negev desert to the Hula Valley we were awed by nature’s displays on this trip. As our grandson Ezra told us, God lives in Israel.  Israel is a tiny country but the geography, climate and flora and fauna are as diverse as Israel’s people!

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A Cooking Lesson in Israel

We loved having my sister and brother-in-law Denise and Jim with us in Israel.  It felt like we were students again, sharing a small apartment, laughing a lot, drinking lots of wine, and exploring new places.  The next few posts will cover some of our adventures together, that ranged from a cooking class, to an amazing trip to the Hula Valley to see thousands of cranes and other birds on a migration stop, to a day visiting with social justice agencies in Tel Aviv. First for the cooking part.

My sister Denise and I signed up for a day with Orly Ziv, an Israeli nutritionist/chef, that included eating breakfast (at many different stops!) and shopping for ingredients at the Carmel Market and then cooking a multi-course meal in her home kitchen, and finally eating the meal with her family. All along the way, Orly taught us about middle eastern ingredients, food and nutrition.  Here’s her web-site  and I promise if you have time next visit to Israel, you’ll love this experience or others she offers around the country. It was delightful, fun, informative, and incredibly delicious. Coincidentally, the other participants were two lovely sisters from the US- one who works in the same healthcare domain as Chuck and one who used to work for my friend Mary at Boston College.

I plan to use all the recipes when I’m back at home and will invite guests to join in the bounty, so get ready.  We started in the market/shuk with a breakfast stop at the exact same hummus joint Chuck and I stumbled on during our first week here!  This time, I tried hummus with shakshouka, a mixture of tomatoes, garlic, onions and spices topped with fried eggs- delicious.  At other stops, we tasted different kinds of bourekas, felafel, fresh pomegranate juice and breads.  Good thing we were walking a lot….

One of the most interesting stops in the shuk was at a colorful spice shop.  In the front of the picture there are mixtures to add to rice to make all kinds of different ethnic flavors.  Orly taught us about sumac, a gorgeous purple powder I recognized because it was on top of a salad we had eaten without knowing what it was.  It has a lovely, lemony flavor and of course the color adds to the presentation.  Needless to say, this isn’t the poison variety of sumac!

Another of our many stops was here, where a Druze woman was making bread with what appeared to be asbestos coated fingers as she handled the burning hot bread.  We also visited a Yemenite baker whose little bakery room looked like it hadn’t changed (or been cleaned) in 100 years.  Standards of hygiene and cleanliness are not what we’re used to in the US, but the food products are incredibly delicious and no one seems to get sick, so when in Rome….

For lunch, we cooked two different kinds of hummus, two different baba ghannoush dishes, gluten-free tabouli (the secret is tiny, food-processed pieces of cauliflower), roasted cauliflower with pomegranate seeds and silan (a date syrup I’ve tasted at my Iraqi families’ homes), fish kebobs with tahina sauce, Iraqi rice with red lentils called kitchry and a rich dessert called malabi.  Here I am with my sister Denise in our Cook in Israel aprons, followed by the bounty on the table before we attacked it.

I love being with my sister anywhere, but spending the day with Orly was a special treat that both of us enjoyed.  Are you salivating yet?

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Musings on Israelis and life (for real) in Israel

It is hard to believe that we’ve been here for  four weeks and will be going home in six days.  We miss everyone at home terribly, but it will be hard to leave.  We feel like we belong here.  When we returned from our week-long trip to our apartment, we felt like we were coming home!  Now, when we walk around the neighborhood, shopkeepers and restaurant staff wave and ask how we are.  When my sister Denise and her husband Jim arrived to stay with us for the week, we proudly showed them around the neighborhood, walked on the promenade along the sea, went to our favorite cafe, and sat out on our rooftop deck for wine and snacks before we went out to dinner.  If it weren’t for the situation back home and missing everyone, life could not get much better.  To all our family and friends who suffered through the long aftermath of Sandy, and especially to Cindy and Jay who hosted my parents for almost two weeks, we send love and hopes for a quick return to normal.

This post is going to be a hodgepodge of impressions and vignettes about Israelis, their lives, and our encounters with them.  I cannot say this has been systematic research; in fact it’s highly anecdotal and impressionistic so take it for that but I hope it provides some insights and interest.

Although as I’ve written before, Israel is an incredibly diverse society, there are some generalizations that seem appropriate.  For instance, most Israelis are talkative, demonstrative and outspoken.  The American taboo subjects- money, religion and politics- are their favorite topics.  Every single Israeli we have met has asked us who are voting for and did we vote already.  Almost all have voiced strong opinions when we say we voted for Obama.  We had one ugly encounter with a racist cab driver, but mostly we’ve met many patriotic Israelis who fear Obama’s policies toward Israel and worry he won’t confront Iran about their nuclear capacity, and we’ve spoken with a few Israelis who wanted Obama to win and feared the conservative policies of Romney.

There are some good aspects to the Israeli penchant for argumentation.  There appears to be real public discourse about difficult subjects and this manifests itself even in television interviews with politicians and pundits where they are challenged and confronted in ways that would never happen in the US.  Chuck thinks the Israeli news coverage of the American election has been more in-depth and nuanced than the American coverage! Unfortunately, much like in the US, Israel has a strong right-wing in politics and a fractured liberal to left movement.  There are corrupt politicians going to jail and getting out of jail and being investigated, there is a major void of leadership on the liberal left, and lots of jockeying for power among the various political figures as the election in Israel nears. Sound familiar?  I won’t go into the various characters on the political stage here, but there are as many repugnant right-wingers here as there are at home and similar unholy alliances.

The Israeli economy is booming right now, but it is very expensive to live here.  Many things cost as much as they do in the States, and some things are more expensive, but Israelis are acquisitive for the most part- especially around gadgets and electronics- and there are iPhones everywhere we go.  At one time, most Israelis lived off credit cards, but the government changed that by outlawing credit cards.  What everyone has is a debit card with a specified amount of overdraft and that’s it.  But, you can extend payments and when you charge something here with an Israeli card, they ask, “One, two, or three payments?”  Just as in the US, young families depend on two incomes and as my cousin said, “It’s hard to make it to the end of the month.”  My hairdresser here, cab drivers, our relatives all talk about how hard you have to work to have a decent standard of living.  Sound familiar once again?

My cousin Zilla’s daughters (our kids’ ages) are married and each has four children.  We see a trend toward larger families, even among secular Israelis.  The love of children (and dogs, who are allowed and taken everywhere here) is profound and palpable in Israel.  We also see a major change in the parental behavior of fathers here, who used to take a patriarchal hands off approach to child raising but now are wearing their babies in front carriers and taking a very active role in parenting.  It’s lovely to see, despite the Israeli tendency toward macho behavior in other ways.  Israelis in general are very affectionate and demonstrative and I now kiss my hairdresser and house cleaner hello and goodbye!

On Sunday and Monday, I spent time at Kibbutzim College, giving a lecture and sitting in on campus-wide discussions about democracy that were scheduled to commemorate Rabin’s life on the anniversary of his assassination. Here I am lecturing.  You can’t tell the faculty from the students as faculty members here dress as casually as the students!

Kibbutzim College was established by the secular Kibbutz movement here to prepare teachers for Kibbutzim, the cooperative agricultural settlements that blossomed in the early history of the country.  Now, it is the top ranked teacher preparation college in the country and it is no longer tied to the Kibbutz movement, but it retains the social justice, left-wing foundations of that movement.  It was so heartening to listen to the students discuss what strengthens and what weakens democracy in Israeli society and how democracy is manifested in schools in Israel.  The students were articulate and passionate about human rights, equality between Jews and Arabs, and the responsibilities of teachers in the realm of social justice.  There was significant disagreement about whether teachers should reveal their political views to students and whether Arabs in Israel should be allowed to observe Nakba, which is a day of mourning for them on Israel Independence Day, but the disagreements were civil and respectful. Most of all, the students reminded me of Montclair State teacher education students- committed to making a difference for children and their lives through teaching despite the lack of respect and support for teachers.  It gave me hope for the future of Israeli society.

I’ve been away from blogging for over a week, but have lots to tell and show about our recent adventures, especially while Jim and Denise were with us.  Stay tuned for more posts and stunning pictures.

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Roughing it in the Negev: Travels in Israel Part II

The first time I saw the Negev was in 1969, when my college roommate Mary came to visit in Israel while she was studying in London for the year. We took a bus from Jerusalem to Eilat (the southernmost tip of Israel on the Red Sea) where we slept on the beach for three nights, including one when Eilat was strafed by Jordanian war planes. (Oh my, I was young and adventurous once!) I can still remember how breathtaking it was when the vista of the Negev appeared. It was just how I imagined the moon might look and it was like nothing I had ever seen. Well, that hasn’t changed at all. Here’s how it looks now and here is one of the road signs to give you a sense of what a different world it is.

On the way to Maktesh Ramon (more on that later), we stopped at Kibbutz Sde Boker where David Ben Gurion lived and died. We visited his home and the exhibit was much more moving this time than when I saw it years ago. Ben Gurion was the first Prime Minister of Israel and one of the giants of Israel’s founding. in 1953, at age 67, he resigned from the government and went to live on this remote Negev kibbutz, shoveling manure and feeding chickens. He first saw the fledging kibbutz when he went to the Negev to oversee the development of Eilat as an Israeli port. He loved the Negev and had a vision for its development and its importance to the future of Israel that was amazing in its time. He later returned to government, but retired again to Sde Boker and died there. At age 64, my perspective on his move in 1953 is very real and his pioneering spirit combined with his vision and historic leadership are inspiring.

Then we were off to Maktesh Ramon. Maktesh Ramon is the largest erosion crater in the world and such formations are only found in the Middle East. In fact Maktesh is the official word in all languages for such a formation. It is 25 miles long and 1,640 ft. deep, has many different kinds  and colors of rock, extinct volcanoes, desert fauna and flora and the ruins of a 2000 year old structure that the Nabateans used as they traveled with camel caravans on the Spice Route. In fact, in one spot outside the wall ruins, the ground is black and that was the camel dung heap from 2000 years ago. There is a small town, Mitzpeh Ramon (Viewpoint of Ramon) on its rim, with about 5,000 residents. In recent years, the Maktesh has become an ecotourism destination and Mitzpeh Ramon, long a sleepy town of poor immigrants mostly, has now attracted many idealistic, crunchy granola, and modern Orthodox young pioneers. Last year, a luxury hotel called Beresheet (In the beginning, the first word in the Bible) opened on the rim. It is a gorgeous place, with low-rise stone buildings that fit in the landscape. The combination of incredible natural beauty and luxury is my cup of tea these days- a long way from sleeping on the beach in Eilat!

Chuck got up at 5 both mornings we were there to go out and take pictures of the sunrise over the Maktesh. As you can see, it’s magnificent. There were many Ibex around, with some interesting encounters between males and males and females, indicating it’s mating season. Enjoy the photos and don’t forget to click on them to enlarge them and to go to the sidebar to see more of Chuck’s photos once he gets them up on Flickr.

On our first night there, we went out stargazing with Ira Machefsky, an astronomer who made aliyah a few years ago from Englewood NJ- following his daughter and her family who chose to be pioneer-type settlers in Mitzpeh Ramon. (Israel is such a young country that the original pioneers were only slightly older than my grandparents.) Here’s his website: Although it was a nearly full moon and thus we couldn’t see the gorgeous canopy of stars I was hoping for, it was amazing to see the moon, Saturn and Jupiter through Ira’s telescopes and to learn about stars, constellations, and the night sky. The other feature in the sky that night was quite a scene- numerous Israeli fighter jets coursing and diving through the sky at amazing speeds and leaving their contrails of smoke. The Negev is the largest part of Israel, mostly uninhabited, and therefore the site of various military maneuvers. In any case, stargazing with Ira is a definite must-do should you find yourself in the Negev!

The highlight of our time in the Negev was a 4 hour Jeep tour in the Maktesh with Itai Harary of I looked up and corresponded with a few Maktesh tour companies before we left NJ, and somehow felt that Itai was the one for us. Boy, was I right! He explained that when he spent time there at the Field School before the army, he had a life altering experience and has been in love with the Negev and especially the Maktesh ever since. In the small world category again, when he heard I was an education dean, he told me had just guided Lee and Judy Shulman the week before. For those of you not in education, Lee Shulman is one of the most important researchers and policymakers in teacher education in the last 50 years and one of my heroes in my field. Then, as we talked, we found out that Itai was a graduate of Kibbutzim College, MSU’s partner teacher education institution in Tel Aviv, where I’m lecturing on Sunday, and he went to the first democratic school in Israel. Itai was a terrific example of the idealistic, passionate young people who have flocked to the area. He was a great teacher, using sand and water to show how the Maktesh was formed millions of years ago and his windshield to draw maps with markers. On top of that, he was a great driver over cliffs and rocks where I sometimes had to close my eyes! I couldn’t stop saying Wow- it was so breathtaking, fascinating, and informative. Next time you visit the Negev, do contact Itai for a tour. Needless to say, Chuck has many pictures, but here are a few. The last one shows a verrtical column of volcanic basalt that traveled underground through the rocks in rays and pushed out and hardened.  Very cool.

Yesterday, we visited an Alpaca Farm right next to the Maktesh. Yes, an alpaca farm. It has become a tourist destination, but it started as a business venture when 150 alpacas were flown to Israel from South America to raise them for their wool. Here’s Chuck being surrounded by hungry alpacas when he fed them. (I was happy to operate the camera and let Chuck have them slobber all over his hand…)

There was a tour group of South American/Israelis there and we joined them for their introductory lecture on the farm. What a hoot! First, the tour guide on the farm told the group how he lived in Spain for a few years and owns a farm there and with their encouragement, he went on a tangent talking about his experiences in Catalan! He switched into Spanish sometimes, but there was one woman in the group who had clearly married in and didn’t speak Spanish- Batya was her name-and she insisted he speak Hebrew to the groans of the rest of the group. Only in Israel.

On the way home, we stopped at a godforsaken spot in the Negev where an Israeli couple, the Kornmehls, started the first family owned farm in the Negev in 1997 on the site of a Bronze age farm.

They raise goats and sheep and make excellent cheese. We ate a delicious lunch (cheese dishes of course) at the restaurant and bought cheese to take home. They are now one of many young farmers and vintners who have settled in the Negev.  I don’t think I would have considered moving to the Negev even when I was an idealistic young person, but I can still admire the passion and commitment of this new generation of Israeli pioneers.

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