Training physicians to be mohelim

FARAH NAZARALI SPECIAL TO THE JEWISH BULLETIN

It is the most common surgical procedure performed on males, and its history spans 4,000 years. For Jewish people, it officially began with God's commandment to Abraham to circumcise himself and his future sons. It has become an immensely significant religious ritual symbolizing the bond of love and devotion between God and the Jewish people: Circumcision is one mitzvah almost universally upheld by all Jewish people, observant and non-observant.

The ceremony known as brit milah involves the procedure of circumcision, as well as religious rituals that mark this important covenant. Recently, a small group of physicians from around the world participated in a unique program offered by the Jewish Theological Seminary (JTS) and the Rabbinical Assembly to train medical doctors with experience in performing circumcisions to become mohelim (circumcisers) capable of and committed to serving their communities as spiritual and religious leaders by performing the brit milah.

With the last course being offered 10 years ago, doctors from a variety of medical specialties jumped at this opportunity. Since the program began, it has trained a total of approximately 70 physician mohelim (including this year's group). (Physician mohelim differ from mohelim in that physician mohelim are both licensed medical doctors and qualified mohelim.) There are very few physician mohelim in North America – Vancouver is among those communities fortunate to have a physician mohel who graduated from the JTS course.

Dr. Neil Pollock, a local medical doctor and one of two recognized mohelim in British Columbia – the other being Rabbi Falik Schtroks of the Centre for Judaism – decided to attend the course even though he had previous training and has been a mohel in Vancouver for more than 10 years. His desire for "deeper spiritual and religious understanding" propelled him to attend the program.

Pollock had been previously trained as a mohel in 1990 in a six-month course designed specifically for him by the Conservative and Reform rabbis in the province. He viewed the JTS program as an opportunity to deepen and solidify his commitment to Conservative Judaism and to serve his local community more effectively as spiritual leader.

"Serving my community as a mohel has deepened my sense of humility and spiritual reverence and has enhanced my ability to practise surgery in a caring and compassionate way," said Pollock. "Furthermore, my medical training and research has been of great help in allowing me to combine the art of medicine with the sacred tradition of brit milah. Both work in beautifully synergistic ways."

Pollock was concerned by what he saw in his medical training when he was being taught how to perform infant circumcision. He was bothered by the lack of attention to pain control in infants circumcised in a hospital setting. Consequently, he has devoted significant effort to finding ways to make circumcision as comfortable and painless as possible.

In his surgical practice, which focuses exclusively on no-scalpel vasectomy and infant circumcision, Pollock has developed pain control methods that have piqued the interest of the Canadian medical community, as well as the international medical community. Interested in his pain management protocol, researchers and doctors in the department of pediatrics at the University of Toronto worked with Pollock in documenting the effectiveness of his technique; the results of which were published in the Journal of Pediatric and Adolescent Medicine in 2002. This study has been a landmark article frequently referenced, demonstrating the effectiveness of a multi-modal approach to minimizing or eliminating pain during a baby's circumcision: The most recent consensus statement of the American Academy of Pediatrics recommended that when circumcision is performed, anesthetic should be used.

Pollock trains doctors and physician mohelim from all over North America who have been referred to him by the JTS, the Rabbinical Assembly and other authorities in the medical community, including pediatrician Dr. Edgar Schoen, chair of the 1989 American Academy of Pediatrics Task Force on Circumcision. Schoen refers to Pollock as a "leading physician who [has] mastered the technique of performing newborn circumcisions safely, quickly and painlessly."
Dividing his time between his four private clinics in the Lower Mainland, every year, Pollock performs close to 4,000 surgeries (no-scalpel vasectomy and infant circumcision).

When asked about his use of anesthetic in the ceremony of the brit milah, Pollock says, "the position held by the Rabbinical Assembly, which is my halachic [Jewish legal] authority, is that using methods of pain control is consistent with halachah, which puts the baby's well-being and comfort at the forefront. As a licensed physician, I am able to provide this."

The JTS course from which Pollock graduated included intensive study of the Torah and halachah. While the course focused exclusively on the religious aspects, participants shared their medical expertise and experience.

One of the participants, Harvey Marchbein, a Connecticut obstetrician, said he was impressed that all of the participants shared "a fervent love of Judaism and the need to be part of something much bigger than [themselves] – the continuity of the Jewish people." For Marchbein, "the brit milah is an integral part of this continuity and we [participants] are now an integral part of the brit milah."

"It was one of the most amazing experiences of my life," said Louis Marmon, a pediatric surgeon based in Washington, D.C. "Being a mohel gives me an opportunity to combine my religious life with my professional life," he continued. "Medicine, the art of helping others, is very much a spiritual experience.... At the brit milah, God's presence is in the forefront."

Course participants were selected on the basis of their experience as physicians in performing circumcision and their commitment to the ideals and principles of the Conservative movement. While participants were from all over the world, their composition was quintessentially Jewish – a faith that spans the globe, yet remains connected through language, religious beliefs and the ideal of klal Yisrael, solidarity with and commitment to the entire Jewish community. The 19 attendees were from five countries.

Offered by the Rabbinical Assembly, the international membership organization of Conservative rabbis, and the JTS, the course focused on the brit milah ritual within the context of Conservatism. The course was conducted in both English and Hebrew.

Serving the Vancouver community as a physician and mohel, Pollock considers the practice of the brit and other key mitzvot "integral to [his] Jewish identity and [his] commitment to the continuity of Jewish traditions." As physician mohelim, Pollock and the other doctors who attended the course are now uniquely able to bridge the gap between medicine and religion.

Farah Nazarali (www.farahsword.com) is a Vancouver freelance writer specializing in articles on health and complementary medicine. E-mail her at farah@farahsword.com.

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