Israel's child focus owes a debt to Australia Australia can take credit for two great initiatives that have left an indelible mark on Israel. Both are transformative, forever twinning the two countries in pursuit of a better and more sustainable society. While Hadassah was an emerging presence during the first, it was the affirmative action model for the second. The first was the introduction of the Eucalyptus tree in the late 19th century. Its purpose was to dry the swamps that plagued early settlers, but their real worth emerged later in Israel’s evolving honey industry. The second, more than a hundred years later, was the introduction of a life-changing early childhood-based project called Goshen. Unlike the eucalyptus, this was fit-for-purpose from day one and its relevance has grown over time. It is not only changing the way the community in Israel views early childhood, it is revolutionising the child health industry. The Australian-made project Goshen is revolutionising the child health industry in Israel. Like the ubiquitous trees that pay homage to Australia, Goshen is a constant reminder of what two small, fiercely independent countries can do for each other. The matchmaker that brought Goshen to the chuppah was the venerable Hadassah Hospital, a pioneer of westernised medicine in Israel, together with Hadassah Australia. The seeds of Goshen, which has flourished in Israel since 2010 (becoming an independent not-for profit in 2014), were sown in Melbourne by Professor Frank Oberklaid AM. Prof Oberklaid is Honorary Professor of Paediatrics at the University of Melbourne and Foundation Director of the Centre for Community Child Health at Melbourne’s Royal Children’s Hospital. Not only is he an international authority on childhood community medicine on which Goshen is based, but it was his work from 2007 with leading Israeli paediatricians that led to the historic shift in thinking. Significantly, Prof Oberklaid’s reputation in Australia gave the original syndicate of five communal Foundations the confidence to provide seed funding for Goshen. Other major Australian donors played a critical role through AUSiMED. Indispensible to Goshen was also the leadership of senior paediatricians at Hadassah. It can be difficult for Australians to understand how significant Goshen has been to the way Israelis parent their children. This is because we are blessed with a community of doctors, nurses and therapists that has championed a model of consultation and service delivery that looks beyond the narrow focus of childhood diseases to consider broader developmental issues that can influence a child as they grow. Israel’s system was way behind and we wanted to help change things. And things are definitely moving in the right direction. Identifying these issues early not only makes for less conflicted families, but for societal harmony as well. I was recently privileged to participate in a round table meeting via Zoom with the proponents of Goshen in Australia and Israel. Hearing their stories not only filled me with enormous pride as an Australian, but with satisfaction at the way Israelis – individuals, the healthcare industry and government – have embraced this new paradigm in child health. Dr Dafna Idan and Dr Maya Ya'ari from Goshen, and pioneer of the project, Prof Frank Oberklaid. It helps to understand Goshen by the numbers. There are around 3,000 paediatricians working independently in Israel, of which almost 45% have been exposed to Goshen in some form. One can argue that after 10 years that may not seem like such an impressive statistic. As Goshen’s Director of Research and Evaluation, Dr Maya Yaari, pointed out, paediatricians in Israel are traditionally trained to give patients five minutes of consultation time and it is almost always focused on disease. That was what they were taught and it is what they practised. It was never challenged until the advent of Goshen. Prof Oberklaid offered the paediatric and child health community in Israel a new paradigm for paediatric training. Medical and paramedical professionals in Australia no longer focus on organic disease, but on children who present with developmental, behavioural and psychosocial disorders. It can be everything from faecal incontinence, bedwetting, and sleep problems, to language disorders and developmental delay. In Australia, these are very common affecting around 20 to 30 percent of all children. Goshen Communications Director Lisa Samin explained that in Israel government is committed to investing in health albeit with limited resources. However, ‘wellbeing’ hasn’t traditionally been its priority. That’s why Goshen is not only increasingly important for young families, but has now become a valued partner with government in the wider child health eco-system. This isn’t merely ground-breaking but, in the words of Dr Basil Porter, Emeritus Professor of Pediatrics at Ben Gurion University, life changing. An early adopter of Goshen, Dr Porter recognised how important it could be, especially for vulnerable communities in Israel. In its formative years, Goshen became involved in training paediatricians in Israel and also providing evidence-based information for parents via its website ‘How You’ve Grown!’, based on Australia’s Raising Children Network. Dr Yaari says social media including a content-rich Facebook page has become a major pillar of Goshen’s outreach to the general population of Israel, including the ultra-Orthodox, Arab-Israeli and Ethiopian communities. It currently receives more than 60,000 hits a month, and its Arabic-language website has topped 20,000 hits a month from Israel, the Palestinian Territories, Saudi Arabia, the UAE, Egypt, Iraq and Lebanon. The need for Goshen as an information hub has been amplified during the COVID-19 lockdown, when access to face-to-face medical services has been limited. What has been particularly heartening for me is the way that one of Israel’s oldest and most trusted health providers has been embraced by its newest. Hadassah introduced Tipat Halav (Mother and Child Health centres) in the 1920s. For too long, this nursing service, which reaches 97 percent of the population, was under-resourced and not highly-regarded by parents. Two years ago Goshen was commissioned by the government to work with Tipat Halav. According to Dr Yaari, it allowed Goshen to leverage an existing national infrastructure to effectively revolutionise child health in Israel. Tipat Halav’s traditional role as a medical-expert model morphed into a partnership-based model. Parents are listened to and respected. They’re empowered through better parental well-being and self-care, which not only improves parental confidence but results in more positive parenting behaviours. It has truly come into its own during the COVID-19 pandemic. Local Tipat Halav nurses have begun reaching out to young mothers via Zoom, guiding and supporting them, based on their learning experiences through Goshen’s Tipat Halav Initiative (THI). THI is designed to upskill Tipat Halav nurses to support parents in providing optimal care for their children in early childhood and beyond. Goshen launched a national leaders training program for 34 Tipat Halav nurses to improve leadership skills and expand professional expertise to support parents and achieve better outcomes for children. In a ‘train-the-trainer’ model, more nurses are being trained in this holistic approach. The success of this service resulted in its scaling up and an innovative new initiative, known as Tiponet, was born. Dr Yaari told the meeting that if this pilot continues to prove successful, it will strengthen the case for government investment in tele-health as an innovative complementary service in Tipat Halav. Melbourne expat, Darren Rockman, joined the Goshen board after seeing the radical shift in early childhood health as a result of the organisation. With a background in finance, Darren believes that while governments are typically risk averse, Goshen is proving to be an attractive option for the Israeli government. In order to keep growing in the short term, however, it needs a direct investment from the philanthropic community and that is happening exponentially. Since its establishment, Goshen has ventured out into research as well as training and the provision of services. This is helping government to better understand why this holistic approach is so important to the future wellbeing of society. Continued funding for innovative basic research is critical if we want greater government buy-in on child health in Israel. The Chair of Goshen, Prof Eitan Kerem, summed up the purpose of Goshen very well. He said, “Children comprise 30% of our population, but they are 100% of our future. That makes them our very best investment.” Among the attendees at the Zoom meeting were Prof Frank Oberklaid and Israeli paediatrician Dr Einat Martonovich-Lantsberg, currently undertaking an AUSiMED training Fellowship at Melbourne’s Centre for Community Child Health, and Lisa Samin, Dr Maya Yaari and Darren Rockman from Goshen in Israel. Ron Finkel AM is Chair of Hadassah Australia and a member of the Goshen board of management.