I undertook a medical elective in Jerusalem, Israel. This involved six weeks in the Plastic Surgery Department at the Hadassah Ein Kerem Medical Centre. Plastic Surgery was my chosen speciality in this elective, because I have had very little exposure to the specialty prior to commencing this elective. Israel was my chosen destination, being renowned for its infrastructure and innovations in healthcare.
The Plastic and Aesthetic Surgery department at Hadassah is renowned on a global level and in Israel for its work in reconstructive surgeries for trauma and congenital malformations, and cosmetic surgery. It is also well known for its work in paediatric plastic surgery, hand and microvascular surgery. The hospital, a very modern sprawling complex in the Judean hills, which includes a medical and dental school sits at the forefront of Israeli Healthcare, and is known for its progressive and high standard quality care.
Healthcare in Israel is universal, and all citizens are mandated to have medical insurance with any of the four Health Maintenance Organisations, which receive funding from the government, derived from the health insurance tax. This entitles access to basic medical and dental health coverage. Individuals also have the right to purchase additional private insurance to cover additional treatments not covered by the basic insurance.
At Hadassah, the day commenced very early with ward rounds assessing new emergency surgical intakes to the department, and reviewing the progress of postoperative patients. This was followed on alternating days with time spent in the operating room, or the day and minor surgery clinics. Furthermore there were afternoon pre-operative meetings for patients admitted for elective procedures, to make final assessments and discuss with the patient and other surgeons about the proposed surgical procedure.
Being a student in the department I was well received and strongly encouraged to have hands on participation. Despite having no previous experiences with plastic and reconstructive surgery, I was able to apply knowledge from other specialities I had come across. Most notably dermatology, seeing as the most common presenting cases were dermatological related especially with the high prevalence of lipomas, congenital nevi, skin cancers (BCCs, SCCs and melanomas), and burns. It was surprising to note how much crossover knowledge from other specialities are involved in managing cases, such as in the repair of cleft palates and ear reconstruction for microtias, drawing knowledge from other specialities like ENT and Maxillofacial surgery.
Furthermore it was surprising to know that most of the breast surgery (in particular reconstructive) was performed by the plastic surgeon, in comparison to being performed by the specialist general surgeon in the U.K. In my time in Hadassah I got to observe and participate in various types of breast repair from implants, flap reconstruction, fat grafts as well as nipple reconstruction and breast augmentations Having a good knowledge of anatomy is key to achieving good aesthetic results, and the six weeks in plastics afforded me time to revisit and reapply knowledge of the subject.
As a surgical speciality, I had many occasions to scrub in and assist with surgeries both in the operating room and day clinics. Which made for greater appreciation of surgical procedures, as well as serving as an avenue to practice suturing, whilst learning new suture techniques. Towards the end of my elective I had the chance to perform minor procedures under supervision, such as the excision of suspicious moles and lipomas.
As a foreigner in Israel, cultural differences such as having Sundays as a working day, differing dietary customs or the cessation of activity within the city on Shabbat made for rapid readjustments. More so was getting used to a new language. Although most Israelis speak English, Hebrew is the working language and was the language-spoken in majority of consultations, however this didn’t hinder my learning as the doctors always readily provided translations. Jerusalem is a very dynamic cosmopolitan city, and having Spanish and French for second languages certainly had its benefits within and outside the hospital.
Summertime in Israel also meant having time to do a lot of travelling, from exploring Israel’s stunning and diverse landscape, to adventuring along its numerous hike trails. From experiencing its colourful and vibrant urban life, to marvelling at its ancient monuments, learning and appreciating the history, cultures and religions that enrich the Israeli heritage.
My time in plastic surgery has provided much insight about the specialty, removing misconceptions about the profession. I got to see how integral the plastic surgeon’s role is in relation to other medical and surgical disciplines, and also appreciate the science, craft and artistry involved in this discipline. My hospital experience coupled with this cultural discovery, have surely made this elective both a unique and memorable experience. I would like to express my gratitude to the Jewish Medical Association (UK) for their support of my elective.
Adeoye Debo-Aina
Belfast