In Israel, a sterile kindergarten built so cancer patients can just be kids

From outside, the house in Ramat Gan’s Kfar Azar district — just a few blocks from Tel Hashomer Medical Center — doesn’t look all that unusual. Only the heavy blue security gate and bilingual warning signs at the entrance hint at what’s inside.

The colorful cartoon characters posted around the lobby add a lighter touch to more somber, but essential, decor: There is anti-bacterial paint on all interior walls; double-glazed windows, with shutters between the window panes, keep out dust and dirt; extra-large tiles make the floor easier to clean. There’s also a custom air-conditioning system that maintains air pressure as well as airflow out of the building, strict hygenic protocols for everyone who enters, and protection from the sun in outdoor areas.

Welcome to the Daycare of Dreams (or “Gan HaHalomot” in Hebrew) — a purpose-built kindergarten for tots with cancer, that is billed as “the world’s first sterile educational and recovery center.”

Indeed, a quick Google search revealed only one other facility resembling Daycare of Dreams: the Morgan Center in Suffolk County, New York. But while that Long Island kindergarten takes precautions to protect children with suppressed immune systems, it wasn’t built from the ground up specifically with those kids in mind.

Ayelet Rafalin, the director at Daycare of Dreams, said her 400-square-meter (4,300 square foot) facility is designed to resemble a hospital isolation ward —without a hospital feel to it.

“The children who come here are sick, but they have permission from their doctors to visit only this place,” said Rafalin, who has run the facility since it opened in late 2014. “They can be together with other children who also have compromised immune systems. But if they come into contact with sick kids — even though they may have finished their treatment — it could be deadly for them.”

In fact, only last week the kindergarten reopened after a 28-day closure because one child was accidentally exposed to chicken pox.

“We don’t take any chances,” Rafalin said. “Everything had to be scrubbed down, and the kids had to go to hospitals and get treated, since not everyone can receive vaccinations. Without this treatment, they couldn’t come back here.”

Reducing contamination risks

Daycare of Dreams is the flagship project of Larger Than Life, (G’dolim M’HaHaim) a Givatayim-based nonprofit group established in 2000 to assist Israeli children recovering from cancer, regardless of their religion, ethnic background, gender or socioeconomic status. Since then, the organization has helped more than 15,000 children and their families endure the hardships of pediatric cancer.

At the moment, 35 boys and girls from six months to seven years of age attend school here, with the average child staying one to two years. Some come from as far away as Haifa every day.

Most of these kids have lymphomas of various types, while six or seven suffer from leukemia, and another half a dozen have brain tumors. One little girl has uterine cancer, and another small child has diffuse intrinsic pontine glioma (DIPG), a rare, aggressive type of brain tumor that usually results in death within nine months of diagnosis.

“Sometimes the parents know there’s no cure. We have five children like this here now,” said Rafalin. At the same time, she said the kindergarten “is a very happy place.”

“We give them the feeling they’re normal,” said Rafalin. “They can study here, learn to read and write, sit with other children. If they’re tired, they can go to sleep.”

Daycare of Dreams has a 22-member staff, with 14 people on site every day. Like Rafalin, who has degrees in education management and special education, all have previously worked with disabled children.

“Before coming here, many of these kids were alone with their parents. They don’t have friends their age. It takes a long time until you see them having fun,” Rafalin said, noting that they’re often embarrassed about their baldness as a result of chemotherapy.

Others have a hard time walking or keeping food down. “You can meet kids here who haven’t spoken for a year, because they were afraid. And now you have to encourage them to make eye contact and speak again,” said Rafalin.

Besides all the architectural considerations, this specially constructed facility also makes sure those who visit wear face masks. Staffers constantly wash their hands, and every evening, a cleaning crew comes and thoroughly scrubs the tables, chairs, toys and anything else the kids may come in contact with — all this to further reduce the risk of contamination.

Help for kids of all ethnicities

Ellin Yassky is Larger Than Life’s fundraising director.

“When a child leaves here and graduates from kindergarten, he or she is well enough to be integrated into a normative school system, and into their age group. They won’t be behind in a social or educational sense,” she said, noting that kids with cancer generally miss two to three years of schooling due to their illness and treatments. “That takes away a huge amount of stress for the child. They’re going into a new environment, and anything that helps make it a soft landing is better.”

Lior Shmueli, Larger Than Life’s CEO, says the kindergarten has helped roughly 50 children during their recovery from cancer annually. That’s nearly one-tenth of the 600 or so cases of pediatric cancer diagnosed each year.

“In the last 10 years, we have grown to become the largest organization open to all sick children with life-threatening disease,” said Shmueli, noting that his group serves Arabs, Jews, whites, blacks, religious and secular kids — and all others — because cancer doesn’t discriminate.

“The religious organizations in Israel serve only the haredi and Orthodox,” Shmueli said. “For us, that’s unacceptable.”

And unlike Arizona-based Make-A-Wish International, a foundation which fulfills one dream for one child, he said, “Larger Than Life is with families the whole time — from the first day of diagnosis, all the way until the child’s full recovery three or four years later. We support them all the way to the end.”

Survival rates now average just over 80%, depending on the type of cancer. These days, about 90% of kids with leukemia make a full recovery, with much lower recovery rates for those with brain tumors or Hodgkin’s lymphoma.

“The statistics in Israel are the same as in the Western world,” Shmueli said. “Today, Israeli children receive the same medical protocols as a child in Europe or the States.”

Summer camps and smile trains

Says Claude Grundman-Brightman, an official of Netanya Academic College who chairs Israel’s Friends of Larger Than Life: “Our medical team as well as psychologists and other staffers take a total approach to do whatever is necessary to lighten the pressure and stress on families. This is rare, because organizations usually do just one thing rather than take a total approach.”

As such, the organization arranges for 300 sick kids and their siblings to attend summer camps around Israel, and sponsors the Purim Carnival Smile Train. It pays transportation costs to hospitals for families that have no car or way to get there, and at the midpoint of a child’s chemotherapy, it takes the entire family for a week-long “recovery vacation” to Eilat for some time off.

Twice a year, Larger Than Life also flies 40 kids across the ocean for a US vacation — usually in October to Los Angeles and in March to Orlando, Florida, home of Disney World.

In June 2018, Larger Than Life organized Israel’s first-ever conference on treatments and clinical trials for kids with cancer. The event, led by Miriam Ben Harush, director of the hematology-oncology department at Haifa’s Rambam Hospital, included 70 physicians, specialists, nurses and researchers from across the country.

Building on the success of its Ramat Gan facility, Larger Than Life has already begun construction of a second, even larger sterile kindergarten in Beersheba to serve the entire Negev. Many of the Jewish, Arab and Bedouin kids with cancer in Israel’s southern periphery come from poor families and their parents can’t afford to care for their sick child.

For this reason, the Beersheba project envisions an extended educational center that will serve kids from 7 to 11 years of age, as well as preschool and kindergarten-age children. Located adjacent to Soroka Medical Center, it will include four classrooms for grades 1 through 4, as well as a kindergarten classroom outfitted with a toddlers’ nursery and gymboree play area.

A network of kindergartens

Larger Than Life has already started work on its third and fourth centers — in Haifa and Jerusalem — and eventually hopes to have a network of eight sterile rehabilitation and recovery centers next to every Israeli hospital that has a pediatric cancer ward.

All this costs money, of course. The Beersheba facility alone is estimated to cost $3 million (NIS 10.5 million).

Larger Than Life operates on an annual budget of about $6.8 million (NIS 25 million). Less than half of one percent of that comes from government funds. The rest are all donations — 65% from within Israel, 25% from overseas, and the remaining 10% in-kind goods and services.

To meet its goals, the charity aims to raise $12 million during 2019. On February 10, it will sponsor an annual gala fundraising concert at Tel Aviv’s Heichal HaTarbut featuring singer Shiri Maimon, pianist/composer Rami Kleinstein and other musicians. Tickets costs between NIS 1,000 and 2,500 ($265 to $663) depending on seating, and some 2,400 people are expected to attend.

Besides the kindergartens and summer camps, the charity spends about $1 million (roughly NIS 3.8 million) a year on cancer medications not reimbursed by Israel’s Ministry of Health. It also brings about 100 Israeli kids a year to receive specialized treatment in North America — mainly at the National Institutes of Health in Bethesda, Maryland; Memorial Sloan Kettering Cancer Center in New York; Toronto’s Hospital for Sick Children, and the Laurie Proton Therapy Center at New Jersey’s Rutgers Cancer Institute.

For families lacking private insurance, Larger Than Life pays for an apartment rental, a car, round-trip airfare and other expenses to allow the immediate family of a sick child to travel there as well; the average expenditure comes to $10,000 per patient.

“We are not doctors. Rather, we give the doctors support so they can do everything they need to save the child,” Shmueli said. “And if a doctor says the only suitable treatment for a kid is at NIH, for example, sometimes we’ll spend up to a million shekels. It might be a new type of research that can be done by a pharmaceutical company only in a certain hospital somewhere.”

Shmueli added: “Even if it’s only 20 children a year, for us every child is 100 percent.”