Elective Reports 2010

Hebrew University Medical School / Hadassah Hospital

With the help of the Jewish Medical Association (JMA) UK, I spent my medical elective at the Hebrew University Medical School / Hadassah Hospital, undertaking research into infertility in the laboratory of Dr Ariel Revel and Prof Reuven Revel. Despite my negligible knowledge of Hebrew, and relative research inexperience the laboratory team were hugely welcoming, and made every effort to ensure the research was both of relevance and of interest to me.

During my time with the group I wrote a review on a newly described molecular link between the invading embryo and invasive cancer, and I did the benchwork for a project which aimed to characterise differences in miRNA expression between fertile women and women who had repeatedly failed in vitro fertilisation. The results look very promising, with an apparently significant difference between the two groups; and the experience of being thrown into the Israeli medical research world was fantastic.

Research in Israel, like in the UK, has its difficulties, but the challenges in Israel are different – due to cultural and religious reasons, as well as to the structure of the Israeli health system. I would encourage British medical students unreservedly to consider an elective in Israel:  it is fairly easy to organise, especially with the help of JMA (UK) contacts; the medical system is sufficiently similar to that of the UK; and the language barriers are really not an issue.

Juliet Stevens

 

General Practice, Maccabi Health Centre, Netanya

My main objective for my elective was to compare the working life of a GP in England (where I spent the other half of my elective), with that of one in Israel.  I spent most of my time sitting in with the GP during consultations, joining them on home visits and discussing their work and lifestyle.  In order to get views of other doctors about their working life, I designed a short questionnaire and distributed this to the doctors in the practice.  Although I did not get many opportunities to see patients on my own, I was always invited to examine patients and elicit signs.  Being based in Netanya, a good proportion of the consultations were in English, while others allowed me to brush up on my Hebrew!  Speaking to English patients who had retired to Netanya gave me the unique opportunity to compare the health services in Israel and the UK from the patients’ perspective.  I worked mostly only mornings and early afternoons, Sunday to Thursday.  Having Friday off to prepare for Shabbat was useful, although I did miss my Sundays!  I was in Israel for Rosh Hashanah, Yom Kippur and Succot, and it was a pleasant change not to have to explain why I wanted time off like I do every year in England! I had a wonderful time and the experience will definitely contribute to our decision about whether or not to live and work in Israel.

Emma Shaw
Medical student, KCL

 

Dept of Otorhinolaryngology, Meir Hospital, Kfar Saba, Israel

I arranged my elective through Tel Aviv University Medical School.  In the Otorhinolaryngology department, I was supervised by Professor Ophir but also had the opportunity to work closely with Professor Finkelstein, one of the leading Otorhinolaryngologists in Israel.  A typical day would start at 7.30am with a departmental meeting, followed by a ward round and then either clinic or a theatre list for the rest of the day.  As we were renting a flat in Netanya, I got a bus to the hospital which took approximately 45 minutes.  Although I had an early start every day, I was usually finished at the hospital by 4.00pm.   All meetings and clinics were in Hebrew  but the team made a special effort to translate to ensure that I could follow what was happening. By the end of the elective I had picked up enough Hebrew  to understand the flow of the meetings/consultations.  The whole department was extremely welcoming and I really enjoyed my time there.

Emma and I spent our free time together, and took the opportunity to relax and explore Israel! The public transport in Israel is cheap and accessible so we were able to do other activities such as visiting the Na’agalat centre for the Blind and Deaf in Tel Aviv (where we ate a meal in pitch blackness, being guided by a blind waiter – an incredible experience!), hiking in Ein Gedi, floating in the Dead Sea and spending time in Jerusalem.

We really enjoyed our electives and are happy to discuss our experiences further should any other students be interested!  We would also like to thank JMA(UK) for the sponsorships for our electives.

Ben Shaw
Medical student, UCL

 

Marcus Autism Institute, Emory University, Atlanta, Georgia / Saint Francis Memorial Hospital, San Francisco / Morgan Autism Centre, San Jose

I spent the entire eight weeks of my elective in America in the field of psychiatry as I am hoping to pursue a career in this field.  The aims of my elective were to gain exposure to different psychiatric settings (clinic, hospital, school and academic), see the range of services that are available, discover the similarities and differences within the subspecialties as well as comparing it to the UK and most importantly see a wide variety of patients!

I started in the Marcus Institute, a child outpatient clinic handling the age group 3-22 mainly with autism and attention deficit but also with anxiety, depression, post traumatic stress following sexual abuse. Consultations (typically 90 minutes) involved taking a thorough history from the parents to determine which diagnostic tests, medications or further services were necessary. There was a weekly telemedicine clinic with consultation by web camera from an outreach location for patients unable to come to the clinic and was a great way to provide psychiatric services to people who would not usually have access.

The Saint Francis Hospital has an adult psychiatry ward for 24 patients and a partial day programme.  Patients were admitted from accident and Emergency or by the police for three days for assessment and treatment. I sat in on consultations, group meetings, art therapy and multidisciplinary teams.  I also went to the ward judicial hearings for patients contesting their detention, and went to the local court for one of the cases. The patients presented mainly with acute psychosis or were suicidal, but the variety of presentations was very interesting and it was a fantastic opportunity to see patients who were acutely unwell with obvious psychiatric signs!

My last placement was at the Morgan Centre, which was established in 1969 and is a special education programme for children who cannot be served by the school district.  There are 65 students aged between 5 and 22 with autism, developmental delay, epilepsy, hearing impairments, Downs Syndrome and other chromosomal disorders.  They are taught in individual cubicles on a 1:1 basis. I was able to take the role of a staff member working with the children on their academics as well as helping during art, physical education, and meals.  There is also an adult programme with 35 clients and with a focus on independent living skills and vocational training.  It was a great opportunity to spend lots of time with the patients, get to know them and gain insight into the complexities of their conditions.

I volunteered at the 9th Annual Autism Conference at Santa Clara University which had 460 people in attendance and 40 exhibitors.  There were talks on the biological basis of autism, nutritional interventions and new methods of communication.  I was invited to the speakers’  dinner and prepared a poster about the Morgan Autism Centre, and also presented a poster on the Magnocellular Theory of Autism based on the work I had done supervised by Professor Baron Cohen in Cambridge.

The time I spent doing psychiatry was invaluable.  I learnt a lot, saw many more and a wider variety of patients with psychiatric disorders than ever before and definitely stimulated my interest in the subject even further.

I would like to thank the Jewish Medical Association for the bursary they gave me for my elective, which has given me a greater insight into the field and many great memories.

Abigail Martyn
Cambridge University / King’s College London

 

Save a Child’s Heart (SACH), Wolfson Hospital, Holon, Israel

During my internship, most mornings I would arrive at the hospital at about 8am for the paediatric ICU ward round. This involved the ICU consultant, a couple of residents/interns, nurses and two Chinese doctors who were being trained in Israel by SACH. The Israelis would obviously speak among themselves in Hebrew, and although I do speak basic Hebrew, I could not keep up with their fast, medically-based conversations. The Chinese doctors certainly could not either. So the ward rounds would be conducted—often with a polite reminder from me—in English.

Some mornings and afternoons I would go to the operating theatre, where I saw cardiac surgery being performed on children with congenital problems such as Tetralogy of Fallot or septal defects (i.e. problems with the architecture of the heart and its great vessels). At other times I would attend the paediatric cardiology clinic where children were seen for pre-operative assessment and for follow-up. I saw lots of echocardiography (cardiac ultrasound) being performed there. Dr Abrahams, a friendly Ethiopian doctor being subspecialty trained in paediatric cardiology as part of SACH, was based mostly in the paediatric cardiology clinic and, like the other doctors, was always happy to teach me when time allowed. The clinic was a fun place to be. Many of the children in the waiting room would be running around, chasing each other, dancing, posing for photographs, or generally being boisterous, which was great considering many of them could not do this before their operations; their heart simply had not been strong enough. That goes to show just how much of a difference SACH is making to their lives, both in terms of quality and longevity.

I saw lots of patients but the one that stuck in my mind the most was a Kurdish child (about 10 years old) on the paediatric high dependency unit, and his mother. Unfortunately, his congenital heart condition and surgery had been more complicated than normal and he was very unwell. His mother was sat by his bedside all day long (possibly all night long). Neither the child nor his mother spoke a word of Hebrew, English or Arabic, and none of the staff spoke Kurdish. All communications were done by gesticulation. I cannot imagine how frustrating this must have been for them. They cannot possibly have fully understood what was going on in terms of the child’s progress. The boy was very pale, often tearful, and his mother often had a tired and forlorn expression on her face. A couple of times a day I went to say hello (I would just smile and wave), and sometimes would get a smile out of them. His mother would often get out of her chair to stand when I arrived. She would do this for every doctor, nurse or volunteer, seemingly out of respect. Every time I tried to intimate that this was unnecessary but she still did it. Anyway, on a positive note, towards the end of my internship the boy was looking much better. He was more ‘smiley’, and the colour had returned to him. His mother was also visibly happier…and so was I.

On another note, it was amusing to see how the quintessentially casual, laid back Israeli attitude was just as prominent in the hospital as outside of it. This held true even in the hi-tech and intense environment of the ICU where the medical care has to be—and of course is—razor sharp. Personally, I like the fact that the ICU consultant wore jeans and a t-shirt, and how I was allowed to wear casual clothes. In that particular respect, it could not be further removed from the hospitals in the UK, where every aspect of clothing is subject to ‘hospital policy’, down to the jewellery, watches and ties that are worn (or more accurately are not worn). I thought the cleanliness and attention to medical hygiene was excellent in the Wolfson Hospital, and there appeared to be no rampant nosocomial infection epidemic, even though the doctors were allowed to wear watches. All in all, I thought the relaxed environment had a very positive impact on the staff, the patients and their families. There were lots of smiles all round.

As part of the internship, I spent one day in the SACH House, where I joined in with the children playing games and generally being downright silly, along with some Canadian girls and an another English medical student, who were volunteering there. Again, it was amazing to see the mothers of the children from such vastly different countries and cultures all socialising in the kitchen whilst they were making dinner.

All in all I had a great time during my SACH internship. It was fun, inspiring and educational, and you really have to see it for yourself to understand what a special atmosphere there is throughout the SACH infrastructure. As a medical student with an avid interest in cardiovascular health and disease, it was a fantastic experience, and as a Jew I feel very proud of what’s being done in Israel for this huge multicultural spectrum of children.  I would like to thank everybody at SACH for allowing me such a wonderful opportunity, and the Jewish Medical Association (UK) for their generous scholarship. I intend to visit again next time I am in Israel, and I would encourage you to do the same.

Warren Backman
University College London

 

Further information on SACH can be found here

 

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