Dr. Avram Mark Clarfield on geriatrics in the Negev

Avram Mark Clarfield
Avram Mark Clarfield

Avram Mark Clarfield is a Toronto-born doctor and director of Ben-Gurion University’s Medical School for International Health. He previously worked as chief of geriatrics at the Sir Mortimer B. Davis – Jewish General Hospital in Montreal and as head of McGill University’s division of geriatric medicine.

In 1992, he made aliyah and headed the division of geriatrics in Israel’s Ministry of Health. He was subsequently appointed head of geriatrics at Soroka Hospital in Be’er Sheva. His research specialties include Alzheimer’s disease and the related dementias, the organization of health care services and medical history and ethics.

Earlier this month, Clarfield spoke at an event in Toronto presented by the Aliyah Division of UJA Federation of Greater Toronto and Canadian Associates of Ben-Gurion University called “Medicine in Southern Israel.”

What kinds of things did you speak about at the Toronto event?

I addressed medical services in southern Israel and talked about my amazement, as a Canadian, at how excellent the medical system in Israel is in general. It’s a country in the middle of nowhere surrounded by Arab countries, most of which are hostile to Israel. And despite the lack of natural resources, over the years, the country has developed a one-of-a-kind system of medical care.


I spoke specifically about Ben-Gurion University, where I work, and the fine medical schools that exist there – there’s one school for Israelis and another one for foreigners. The Medical School for International Health specializes in global medicine. It’s the only medical school in the world to focus on that and it’s in the middle of nowhere. Students come from all over to study there

Then I talked about the boycott, divestment and sanctions (BDS) movement and how, oddly enough, Israeli academics have tended to be very blasé about it. In my view, it’s a very serious threat, but it’s been difficult to mobilize Israeli academics against it. BDS is big in North America, particularly in the humanities fields – less so in the hard sciences – so you can understand why Israeli academics, especially those not in the humanities, are fairly oblivious to it.

We talked about how BDS is mainly run by anti-Semitic anti-Zionists. I pointed out that not every anti-Zionist is anti-Semitic, but most BDS leaders are both anti-Semitic and anti-Zionist.

How have you seen the efforts of the BDS movement play out in the medical field in Israel?

Fortunately, in the medical field, we almost don’t see it at all. I’m involved with BDS stuff because I’m an academic, but its presence is rare in medicine, engineering, physics, chemistry, etc. It’s common in the humanities – particularly in disciplines like anthropology and linguistics. Still, I’m convinced that if we don’t do anything about it, it will seep into medicine.

Why do you think it hasn’t affected the hard sciences much?

I think it has to do with humanities thinkers’ way of looking at the world. Much of anthropology literature is now neo-Marxist, and that’s never been sympathetic to any kind of nationalism, though I do think that BDS supporters in the humanities are capable of criticizing Jewish nationalism while at the same time being sympathetic to Palestinian nationalism. They give them a free ride for their behaviour, but criticize us for ours.

In what ways is Ben-Gurion University leading the charge on geriatric care?

Because Be’er Sheva is the only major city in the Negev and Ben-Gurion University is the only medical faculty in the Negev, it’s essentially the only game in town. That means we organize all these services for the elderly that are co-ordinated with the hospital. So there are really good community services, and we’re able to liaison between them.

This is unique, because in other places, people often come home from the hospital and then get lost in the shuffle in terms of community or medical services. We’re trying to build services that reduce the likelihood of people getting lost.

We also do research at Ben-Gurion University on dementia and care. For example, we did a study comparing Israeli institutions with Canadian institutions and divided the Canadian ones into Jewish and non-Jewish. We looked at Baycrest and Sunnybrook (which isn’t Jewish) in Toronto, and in Montreal, we looked at Maimonides Geriatric Centre and a Catholic hospital in Quebec.


We compared these four Canadian hospitals to two hospitals in Israel, looking at the rates of tube feeding for patients with last-stage dementia. We found that Israel has a high rate of feeding patients with a tube, while in Canada, it’s lower. We also found that the Jewish institutions in Canada have a higher rate of using tube feeding than the non-Jewish ones.

What’s the relevance of comparing rates of tube feeding?

There’s an ongoing discussion in geriatrics about whether to tube feed end-stage dementia patients at all.

A lot of doctors don’t believe that tube feeding is the best way to feed end-stage dementia patients, but instead believe you should feed the person with a spoon, and whatever they take in, they take in. The idea there is that people with end-stage dementia are like end-stage cancer patients, that we shouldn’t force-feed them, but focus on palliative care. We hypothesized that religion and culture play a role in the decision to use tube feeding, and we found that it does.

We found that Jewish religion and culture emphasize feeding a patient over not feeding them. We’re not saying one approach is necessarily better than the other, we’re just looking at the different values at play. I actually think it’s worse to force-feed patients.

This interview has been edited and condensed for style and clarity.