St John of Jerusalem Ophthalmic Hospital / Hadassah – Hebrew University, Jerusalem, Israel

For my medical school elective I spent eight weeks studying Ophthalmology in Jerusalem and the West Bank. This time was split into four weeks with the St John of Jerusalem Eye Hospital and four weeks in the Ophthalmology Department of Hadassah Ein Kerem Hospital in Jerusalem.

St John (part of the order of St John) has many bases for Ophthalmological care across the West Bank and East Jerusalem which I was able to visit (and a base in Gaza which I did not go to). The main hospital in East Jerusalem is the tertiary referral centre for Ophthalmology for Palestinians in the whole of the West Bank and Gaza and therefore I met many patients from these areas. The consultations were mainly in Arabic but the notes were written in English and doctors were great at translating for me. I was able to spend time in many different clinics and theatres – for example in Occuloplastics, Glaucoma, Paediatrics, Vitreo-retina as well as time with a nurse doing imaging and diagnostic neurological tests (OCT, ERG), Orthoptists and an Optometrist. I also spent some time on-call with a resident who taught me how to use the slit lamp to examine patients. There are satellite St John Eye Hospitals in both Anabta and Hebron which I spent time at. The hospital in Jerusalem also runs an Outreach service throughout the West Bank many days a week. Everything needed to set up an Ophthalmology clinic (including slit lamps with their tables) is packed into the back of a mini bus which travels to a community building or doctors surgery in a village. The Outreach team sees difficult cases which may have been booked by a local doctor, common Ophthalmological conditions in the region (allergy, blepharitis, vernal catarrh, keratoconus) performs diabetic retinopathy check ups, makes referrals for further investigations and performs visual acuity screening. One of the times I was with the Outreach team we visited the Bethlehem Caritas baby hospital. This time the team included Orthoptists aswell. On this occasion, alongside the Paediatric Clinic I was able to accompany the doctor onto Paediatric Intensive Care for retinopathy of prematurity screening. A usual day would start around 7:30/8am and finish by 2:30pm unless I was on Outreach which may finish around 4 at the latest.

The opportunity to see corneal cross linking – a specialised treatment for keratoconus was incredible. Some of the conditions I saw in patients were a result of consanguineous marriages between cousins, for example congenital glaucoma. One morning in Jerusalem I joined in with a program run by a local school in co-operation with the hospital social worker to entertain children waiting for their appointment in the children’s play area opposite the clinic. I joined the case conferences which ran once a week (mostly in English) where patients with difficult conditions were brought in to see many of the doctors at once who would then discuss the case, examine the patient and plan together the future treatment or investigations. In Jerusalem I met students on the Specialist Ophthalmic nursing course run by St John. I was also able to attend the Third Ophthalmic Nursing Conference in Al-Bireh (a twin city with Ramallah) at the Palestinian Red Crescent Society where I heard a variety of presentations including one on blindness amongst Palestinians in the region supported by research carried out by St John, and one on the diabetic screening program St John is carrying out in the West Bank.

I found the staff of St John very welcoming and keen to teach me about various Ophthalmological conditions and I was given plenty of opportunity to examine patients. I was able to learn a fair amount of Palestinian Arabic whilst with St John – especially from the kitchen staff – which helped in building relationships and understanding consultations. I saw both positive and negative encounters of the Christian and Muslim Arabic staff amongst each other. I chose not to mention my Jewish heritage and as a result I think I may have heard more of people’s opinions on the political situation of the region.

For the second half of my elective I went to Hadassah Ein Kerem Ophthalmology Department, a tertiary centre in Israel with most patients coming from the Jerusalem area and nearby settlements in the West Bank. Israeli Jews including settlers in the West Bank and Israeli Arabs are seen alongside Palestinians from the West Bank and Gaza referred by St John (an Eye Hospital in East Jerusalem). The doctors working at Hadassah include Israeli Jews, Israeli Arabs, Palestinians including some who work or have worked at St John Eye Hospital and residents and fellows from South America. The hospital is a meeting place for people from different cultures who may not mix so much in life outside of the hospital. I loved seeing the diversity of patients in the waiting room. Within a few minutes of spending time with doctors, nurses and patients I could easily hear many different languages spoken – Hebrew, English, Arabic, Spanish and Russian for example! Hadassah struck me as an excellent community model of an organisation coming together for the benefit of quality healthcare and displayed good relationships amongst patients and staff.

Within the Ophthalmology Department is a large tumour service which is the only one in the country to treat retinoblastoma via intra-vitreal chemotherapy (which I was able to see happen in theatre!) and which developed the use of mitomycin-C drops for occular surface malignancies. Patients with retinoblastoma come from all over Israel, the West Bank and from countries such as Russia due to the expertise and commitment to save sight as much as is possible displayed by doctors at Hadassah. The department also has high quality services in Uveitis, Neuro-Ophthalmology, Retina, Cornea, General Ophthalmology including cataract and a large Paediatric department, all of which I was able to spend time with in clinics. I was able to spend time in theatres for cataract, retinoblastoma, retina and emergencies. The department has a large commitment and dedication to research which I found inspiring to be exposed to.

Every weekday began with lectures for the residents at 7:15/7:30 except Wednesday Grand round at 7 which all the doctors attended (all in English). The teaching was exceptional, in depth and spread across all areas of Ophthalmology, I felt really privileged to have been able to attend this . Whilst at Hadassah I was able to attend one of the monthly series of Ophthalmology lectures on a friday morning (weekend). Ophthalmologists from all over Israel and some from the St John Eye Hospital in East Jerusalem along with some Orthoptists gathered to hear case presentations and about new techniques in Ophthalmology and then discuss them. All but one lecture was in English aswell as most of the discussion. I don’t think anything like this happens in England, representatives from Ophthalmology Departments across a whole country gathering once a month with a commitment to collectively improving and developing Ophthalmology treatments!

Clinics/theatre ran from after the resident’s teaching until they finished which could be anytime from 11:30 to 16:30 depending on the day and speciality! I was given plenty of opportunity to practice using the slit lamp and even a couple of times the opportunity to use additional 78/90 lenses for visualising the retina – accompanied by teaching by the friendly residents. The residents worked 24 hour emergency on-call shifts and were happy to teach me and have me join them on these. Being with the resident on call meant I got to see more of the hospital out of hours including the Adult and Paediatric Emergency Departments, a Maternity Ward and the Paediatric Oncology Intensive Care Unit. I saw some emergency surgery for retinal detachment during one of these emergency on-call times. I saw a huge variety of cases during the emergency on call shifts, a few Arab women with burns to their faces from cooking stoves, a soldier with viral conjunctivis, someone with a large conjunctival haematoma, foreign bodies etc.

Most consultations were in Hebrew, with some in Palestinian Arabic and some in English. I could speak a fair amount of Hebrew before I started at the hospital which was really useful in conversation with staff and patients and in understanding consultations.  Doctors, nurses and patients were very keen to help me learn more and as a result I picked up lots of new words especially during quieter moments of on calls when I would chat to the nurses on the ward. Being able to read and write somewhat in Hebrew also proved a useful skill. I was able to speak some Palestinian Arabic (that I had learnt at the St John Eye Hospital in East Jerusalem before coming to Hadassah) with doctors and patients which was valuable in building relationships and understanding consultations. Again I found doctors helped me to pick up some new words. Neither Hebrew nor Arabic are needed for a placement here as all of the doctors speak exceptional English.  Many of the residents were from South America and were fluent in English and knew varying amounts of Hebrew. The nurses I met spoke varied amounts of English.

I felt very welcomed at Hadassah by all of the doctors and nurses I encountered. Their enthusiasm for Ophthalmology, the excellent teaching I received, and the opportunity to see a wide variety of cases and treatments which I had not been exposed to as part of my medical school curriculum in the UK was amazing.  I am seriously considering applying to do an Ophthalmology residency there in the future.

This elective has undoubtedly been the highlight of my time at medical school as I have been able to explore Ophthalmology in much greater depth, alongside meeting people, building relationships and travelling in Israel and the West Bank. During my time in Israel I was able to visit the Kotel during Pesach (Passover), take part in Yom HaZikaron (Memorial Day) and Yom Ha’atzmaut (Independence Day) with Israeli friends and experience Israel at Shavuot. I also went to Mount Gerizim in the West Bank to the Shomronim Pesach Festival (Samaritan Passover) which was an incredible experience.

I am really grateful to the Jewish Medical Association for their support in making this elective possible for me and would like to say a huge thankyou to them. I can unreservedly recommend an elective in Israel to anyone considering it!

Rebecca Chislett

Published in General News, on September 13th, 2017


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