Elective in Emergency and Obstetrics and Gynaecology Department, Shaarei Zedek Hospital, Jerusalem

In April 2015 I left the UK to spend seven weeks in Shaarei Zedek Hospital – three weeks in the Emergency Department and four weeks in the Obstetrics and Gynaecology Department.

The Emergency Department had undergone a major reconstruction in 2004, increasing its capacity by 330%, and as such is the busiest Emergency Department in Israel. The Department is housed on the 2nd floor of the hospital, and it was explained to me how the lower 3 floors of the hospital had been built underground – including the Radiology Department and operating theatres – in order that the hospital would be able to continue functioning during wartime.

I arrived on my first day and was welcomed by the head of the department. He showed me around and explained the setup of the department. The emergency room is split into different sections including surgery, acute medicine and orthopaedics. Each section has its own set of doctors who exclusively see those patients. The Department is close to the Radiology Department and the operating theatres, allowing fast and effective diagnosis and management of patients. There is another smaller area in the Department called ‘mahalchim’. Patients are sent here by the triage nurse who deems their condition to be more minor, and the setup is similar to a GP clinic. It was here that I was able to sit in my own room and see patients alone, before presenting my findings to the doctor and agreeing on a management plan. There was a huge variety of patients here, including a patient taking warfarin who presented with minor bleeding and a patient with Crohn’s disease who presented with diarrhoea.

During my time in the Emergency Department I rotated around the different areas which enabled me to see a wide variety of patients. Whilst many of the doctors spoke English, very few of the patients did, which enabled me to practise both my conversational and medical Hebrew. Although it was challenging to work in such a fast-paced department in a language in which I am not fluent, I very much enjoyed the challenge and my time there.

After my time in the Emergency Department I spent 4 weeks in the Obstetrics and Gynaecology Department. This was a huge department with a large labour ward, daily clinics such as fertility clinics, In Vitro Fertilisation (IVF) clinics, antenatal clinics, general gynaecology clinics and more. Each morning there was a Multidisciplinary Team (MDT) meeting where interesting or complex cases were discussed and management decisions made. On the first morning I was welcomed by the head of the department and introduced to the team after the MDT.

Most of my time was spent rotating through the different gynaecology clinics. One patient who stands out in my mind is a lady of Ethiopian origin who attended the fertility clinic. She had had one pregnancy four years previously in Ethiopia which had ended in a stillbirth and a surgery of which type she was not clear. However, since then she had not had a period, bringing into question whether the operation she had had was a hysterectomy. The doctor had to break the news of this possibility to her, and arranged for her to have an ultrasound to determine if this was the case. Observing this case emphasised to me the difference in health beliefs between cultures and the importance of both an honest and an empathetic approach when it comes to breaking bad news.

During my time in the Department I was given the opportunity to spend some time in the IVF lab where egg retrieval was carried out. Follicular fluid containing eggs was aspirated and the fluid was then passed through to the IVF laboratory where a technician identified the eggs and prepared them for incubation. It was very interesting to watch the high level of expertise displayed by the laboratory technicians.

I thoroughly enjoyed my time in Shaarei Zedek and would like to thank the Jewish Medical Association UK for supporting me in my elective in Israel.

Miriam Sharman
Imperial College London

Published in General News, on March 20th, 2017

 

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