Yediot Ahronot, one of Israel’s most prominent newspapers, recently profiled on its YNET Website, the work of several Occupational Therapists who have been helping victims of October 7th and the Iron Swords War rehabilitate from their injuries. The article “Occupational therapy clinics bring the injured back to life” is part of a series called, “The Rehabilitators.” A translation of the article into English is below. The original Hebrew article can be found at https://www.ynet.co.il/health/article/s1hrm1og0
In a new chapter of the series the “Rehabilitators,” YNET investigates the work of occupational therapists in helping those with war injuries come back to life.
Eitan Gefen|07.05.24 | 07:39
Occupational therapy clinics bring the injured back to life: “Don’t think about what’s lost, think about what’s left”
Regaining independence after an injury is a slow and complex process, all the more so when one is injured in war. Occupational therapists Inbar Lavid and Shir Lindner-HaCohen who work at the Beit Levinstein rehabilitation hospital and the Sheba Rehabilitation Center tell Ynet about their significant role in patient rehabilitation: how they provide motivation, about the emotional disconnection with the patients (which doesn’t really exist) and what you do when you have to treat someone you know. “There is a feeling of shared destiny with your patients We are part of the journey,” they said.
Getting up in the morning, brushing your teeth, getting dressed, eating breakfast and going to work – what if one day all of these actions, which seem so obvious, were taken from you? For quite a few of the wounded during the Iron Swords War, this is a daily reality. How do you regain lost abilities, and how do you deal with abilities that probably cannot be regained? Among other things, the occupational therapists, who work in the various rehabilitation departments around the country, are entrusted with this job.
“Occupational therapy is a profession that works with many populations and each population is a little different,” says Inbar Lavid, who has been working for about three years as an occupational therapist in the rehabilitation department at the Beit Levinstein Rehabilitation Center. “By and large, our goal is to enable as much functioning as possible despite a limitation or injury. I work with the patient on the things he or she would do on a daily basis and try together with him or her to achieve as much independence as possible.”
“[Occupational therapy] is a paramedical profession that includes all aspects of the human being in a functional orientation, whether these are motor, cognitive or psychological functions,” explains Shir Lindner-HaCohen, an occupational therapist in the “Returning to Life” rehabilitation department at the Sheba Medical Center.
“The thinking at the forefront of our minds is to understand where the patient is now and where the gap that separates him/her from functioning independently. We divide our work into basic functions – such as getting up in the morning, getting dressed, brushing one’s teeth, and higher functions, such as – actions that require more thinking and planning, whether motor or cognitive, like going shopping at the supermarket, going to work, or taking care of the children.”
Shir Lindner-HaCohen: “We treat every kind of injury. We have patients who have lost their ability to function with one or two hands. There is a patient who has lost his sight, or a patient with an amputated limb who used to play soccer and will no longer be able to play. The loss exists and we need to show them what’s left, what’s still there.”
The work routine of these two occupational therapists has changed quite a bit since October 7. “Before that, most of the people I treated were people who were in car accidents or had some kind of back surgery that might have gotten a little complicated,” says Lavid. “I have worked in this department for a year and a half, and before that I was in the neurological department, where I treated patients with diseases related to the spinal cord.”
“I come from the field of head injury rehabilitation,” says Lindner-HaCohen. “The department where I work now, ‘Returning to Life’, is a new department that was opened at the beginning of the war, and it is intended for anyone who was injured as part of the Iron Swords War. All the therapists in this program came from different departments Inside the hospital with some kind of orientation to the injuries that are coming to us. We treat soldiers and reservists, and at first we also treated civilians wounded on October 7. Rehabilitation is a broad field, and each department has its own specialty.”
The work is difficult. “Many soldiers who come to us were hit by an RPG (rocket propelled grenade), or stepped on an IED (improvised explosive device),” said Lavid. “The soldiers who come to me specifically are soldiers with spinal cord injuries. The location of the injury on the spinal cord, and the number of affected vertebrae determine the extent of the injury and the future of the functional limitation of the legs or the back.
“There are people who come to us in a wheelchair, with an relatively high injury on the spinal cord that does not affect the use of their hands. In these cases, we see difficulty in balance, weakness of the back, difficulty in bending forward, and of course the ability to take care of one’s self. I don’t even mention that they have difficulty in walking, because this goes without saying.”
“We see a lot of complicated limb injuries, as well as well as other injuries,” adds Lindner-HaCohen. “Most of the wounded were injured as a result of being hit with an explosive blast, whether it was a grenade or an IED that caused them some kind of concussion. Many injuries are related to nerves, fractures, tissue damage and multiple injuries. The patients don’t just have injuries to their hands, the damage is also to their internal organs causing very deep wounds. However, the main injuries are gunshot wounds or head injuries as a result of an explosion that included some kind of blast, or injuries from the collapse of a building, for example.”
“Laugh with them, cry with them”
Despite the difficult circumstances that characterize the work in the rehabilitation department, Lavid says that the atmosphere is actually positive. “It’s a fun atmosphere,” she says. “The patients come full of energy and motivation for rehabilitation and bring a young spirit to the department – their laughter and fun. I myself am 27 years old, so we are relatively close in age.”
However, rehabilitation is a complex process, and even more so – a long one. In a routine that can sometimes stretch over many months, the professionals deal in many cases with young patients, who come with a desire to finish the rehabilitation and get back to life as quickly as possible. In most cases this is not really achievable.
“It’s a very long process that can take months or even years,” Lavid explains. “I think a very noticeable thing is that when the patients arrive, they are motivated and just want to do and practice, practice and practice. At some point, an understanding comes that this is something that takes time, and then you are also with them in this frustration of ‘Ugh, why isn’t it happening yet?’” I think that once they understand the importance of progress, even if it is small, it gives them a little more of the independence they so badly want to return to. If someone needs to pick up something that fell to the floor, and realizes that he is able to do it alone – that is very important.”
“You realize that eventually you’ll have to take care of someone you know.” Shir Lindner-HaCohen, Occupational Clinic, Sheba Rehabilitation Center
Lindner-Hacohen agrees. “The culture here is ‘as soon as possible.’ We tell the patient, ‘Stop. You have an injury. It will take time.’ Soon they will return home and have to cook and prepare food or go to the bathroom and they will no longer have someone to help them. We have to show them the whole picture.”
How do you do it?
Lindner-HaCohen: “We introduce them to a very broad and enriching agenda. We really reinvent ourselves to address the parameters they need. For example, in the matter of sleep problems, we have yoga treatments. We have gardening, carpentry workshops. We introduce a lot of leisure content to show the patients another facet to functional work, to give them a rich and full life experience within the rehabilitation process.”
Lavid: “Something that is very important to emphasize is knowing how to achieve a professional balance. They need to focus on their rehabilitation, but also beyond that – on leisure, hobbies or just being with friends – things that make them feel good. For example, we had a group of soldiers who were all injured in Gaza, each one in his way. We set up a kitchen food preparation group for them where we also work on mobility skills so that they will be able to bend forward, pick up pots, open drawers, take things out of the fridge and cook
“Through this, we came to work on the components of function, and it also created a leisure activity, which is very, very meaningful to them. It became a kind of social group. As part of the therapeutic process, we make a big lunch and it’s very nice. I had a patient who likes to cook and before the injury he was very good at making dough, and suddenly I happened to hear him say that he feels like himself again, a sentence that really moved me.”
Still, there must also be challenges.
Lavid: “There is an element ongoing trauma here. With normal patients, a pinpoint trauma happened, and then it stops and you can digest it, but for the victims of October 7 it is something that continues. An injury happened, but they still hear every day what is happening on the news, they have lost their friends or are worried about their friends who are still fighting.
“In addition, there is always this fear of returning home for the weekend. It makes them confront their new reality. Questions arise such as ‘how will I manage?’ and ‘Who will help me?’ However, almost always after they return from a weekend away from the hospital they are happy. It is very significant for us, that we know we are a part what allows them to return to their routine after everything they’ve been through. I also encounter challenges. We have to accompany them through various states and situations, including their grief, for instance, knowing that someone cannot come to treatment because they are going to a funeral. We have to be in these difficult places while there is a war going on outside.”
Lindner-HaCohen: “We take care of many young people who are at their peak: at the peak of their physical activity, at the peak of starting a relationship, of leaving home for the first time. People went out to fight and said, ‘Okay, we will go out as warriors or we will come back heroes, or we will die – and we will die heroes.’ No one took into account the long rehabilitation. It was usually not part of the script.
“After being part of significant action on the battlefield, one is suddenly forced to focus on one’s self and one’s injury and the consequences of the injury. It is not easy.
“There are stories that don’t let go of me”
And what do you do when work meets personal life – an option that is very likely in such a small country. Lindner-HaCohen says, “As therapists, there is a kind of a feeling of shared fate with your patients, and part of that is that you have to be prepared that you will get to know one of the soldiers. My encounter with the war became very intimate when a patient came to me who was actually my neighbor.
“He is an oral and maxillofacial surgeon who worked as part of a complex operation to identify corpses in Gaza’s Indonesian hospital, and he was hit by an IED. This caused him injuries to his upper and lower limbs and also an internal injury. This required a very personal component to our care. We live in the neighborhood and to suddenly meet him in a very difficult situation with a very complex injury – it really ranges between friendship and care, and entering into the depth of caring for a soldier, this is really the most shared fate.”
Is there any distance with the patients or are you really friends?
Lavid: “You are speaking to someone who is not good at maintaining distance. Our treatments are five days a week and the hospitalization period is long. We see each other every day, so the relationship is very intense.
“You are together every day, and you experience with them everything that they go through. There is no way that they do not enter your heart. It happens that they come to me in a bad mood and then we talk and find out that the reason is that today is a significant date that marks two months of something. They also share their frustrations. I find myself thinking about them and how they are managing even after work hours. They become some kind of friends.”
Lindner-HaCohen: “I can say that the boundaries are often blurred in these situations, because as I have already said, we are in a partnership of shared fate. Suddenly, the patient’s injury is also part of my lifestyle. And maybe he also serves in the army with my husband? And this happened as well. As part of the treatment, there is a lot of discussion about very personal subjects. On the one hand, we discuss these intimate subjects because it is our professional responsibility. On the other hand, we relate to them as peers, because we are part of their journey.”
Do you pay a personal price for doing this job?
Lavid: “I don’t think so, no. I think that working during the war actually helped me. It gave me the feeling that I could take part in the national effort. Even if I’m not in the battle or in the reserves, I do take part in contributing to the country. It also gives me such an island of sanity. In the early days, doing this work forced me to cut myself off from the news.”
Lindner-HaCohen: “I worked in the department very hard before the war, so I usually know how to make the distinction between work and home life. I have two small children at home. I come home and take off my uniform, but now there are stories that don’t let me go. I think it might be worth mentioning that there were sometimes we treated female hostages. Sometimes the issues really burn inside me, in all of us.
“I hear everything. Sometimes a lot of tangible details come out and I am affected more than usual, that’s for sure. However, I find that my ability to be somewhat involved in giving care is significant in the war. This also applies to telling the story of the wounderd. They are serious fighters. And there are female fighters, girls, too.”
It is also important to mention the injured women.
“In addition to the hostages I treated, we had an amazing female patient, a military paramedic who fought in Gaza and received a gunshot wound. For a woman to be in such a male environment, it takes a lot of strength. On the other hand, the same paramedic fought for a month or two in Gaza and fought alongside men in a very equal way, and I didn’t see for a moment that it undermines her as a woman – on the contrary, she shows them how it’s done.”
This period has been very divided politically and conflicts erupt every day. However, the two therapists say that at least in the hospital, political opinions remain outside. During such a tense time, in a way, the ability to keep politics at bay gives a little hope.
“The hospital is always a place with representatives of every sector, both in terms of the staff and in terms of the patients: ultra-Orthodox, Arabs, national religious, Yeshiva students, secular people, Druze. Really everyone,” says Lindner-HaCohen.
“Today I treated a Druze man, an amazing guy, a career soldier who has been serving in the Givati Brigade for years. A grenade exploded in his hand and he survived. He has a very complex injury. He is simply a hero. After that, I treated a national religious guy from Samaria with a hip injury who needed a full hip replacement and is in a very long rehabilitation. After him, I took care of a young man from Tel Aviv who had just started his student life and went out to fight.
“Politics comes in, but I think every fighter who enters Gaza puts his opinions aside. Everyone has some kind of common goal, and this unity is also preserved during the rehabilitation. The relations between everyone are excellent. Sometimes people are even funny and cynical, and I wish they would show it in other places as well, to live, as possible, in partnership.”
