Elective Reports 2012

Infectious Diseases and Clinical Genetics, Hadassah, Jerusalem

Placement

I completed my 8-week elective at Hadassah Hospital in Ein Karem, Jerusalem – four weeks in the Department of Infectious Diseases and four weeks in the Department of Clinical Genetics. I applied for the elective through the Jerusalem Society of Medical Students (JSMS) whose Exchange Officer and secretary were very helpful throughout the process.

My placement in Infectious Diseases (ID) was interesting as I got the opportunity to see cases of infections that are rare in the UK, such as measles, Q-fever. I was unaware that in Israel ID is a consulting specialty only, and not a ward-based one so I spent most of my time shadowing the residents who were happy to talk me through cases and answer any questions I had. However, at times there was very little to for me to do in the department due to a lack of new cases or the unavailability of some residents. Overall, I was treated well by all the staff and I had a very positive experience in the department.

The second half of my elective in Clinical Genetics was also intriguing, especially since this is a specialty that I am interested in. I observed consultations in clinics, led by doctors and genetic counsellors, with Jewish and Arab families from the region. The consultations involved a range of symptoms and I learned about the standard tests that the department uses to narrow down the list of differential diagnoses. Besides the general clinics, I also attended specialist paediatric and genetic oncology clinics and shadowed doctors on hospital consultations. Overall, the placement was enlightening and educational.

Accommodation

After being informed by the JSMS Exchange Officer that accommodation in the university dormitories was not guaranteed, I set about searching online for a place to live. Through a classified adverts website, I found a flat in Baka’ (Ge’ulim) in south Jerusalem which I shared with some other foreign students. Unfortunately, the flat was not in the best shape, but the area was nice, populated by American, French and British olim and only a short bus ride away from the center of Jerusalem.

Food

Food is definitely one of the strengths of Israel; good food was ubiquitous and relatively cheap. Due to the multi-ethnic nature of the country, I had the opportunity to try lots of different cuisines such as Iraqi, Ethiopian, Italian, Yemenite, Sephardic, vegetarian, Palestinian, traditional Jewish food like challah, and of course the local favourite: falafel in pita.

Social Activities

I toured the historical sites in the Old City of Jerusalem, and visited Yad Vashem and the Israel Museum which were all interesting. Each weekend, I tried to visit a different city and managed to go to Tel Aviv/Jaffa, Akko, Haifa, Tiberias, Hebron, Bethlehem and the Dead Sea – these trips were very enjoyable and informative.

Natives

Despite their legendary chutzpah (which I experienced in its full force) and complete inability to form a queue, Israelis are quite friendly and helpful – although less so in Jerusalem where the natives are presumably fed up with tourists. The local medical students even included me in their friends’ circles and I got the chance to improve my Hebrew and experience Israeli culture first-hand. In my experience, people were  friendlier and more welcoming in the northern towns.

Daniyal Daud
Newcastle

 

Diabetes, Northern District Hospital, Vanuatu

My elective involved a 6 week clinical placement at the Northern District Hospital on the island of Espiritu Santo, Vanuatu. This was a unique opportunity to observe and involve myself in another culture, quite removed from my own.

The hospital serves 66% of the nation of Vanuatu and is one of only two secondary care centres. There are five wards (medicine, surgery, obstetrics and gynaecology,  paediatrics and tuberculosis), an outpatient department and a small Accident and Emergency Department. I was impressed by the standard of care provided given the resource limitations, particularly the theatres, where the sterile techniques and equipment were not too dissimilar from the UK. The doctors were all excellent generalists, but what was really lacking was specialist expertise.

My day would begin with an early ward round, followed by observing surgery or going to outpatients clinics. The doctors were quite keen for us to help, and once I had learnt the local language (Bislama, a simple yet vibrant pigeon English) I was able to run my own clinics.

The medicine itself was mixed in pathology. Communicable disease are still problematic, notably TB and osteomyelitis, but have declined significantly in recent years. The new, evolving challenge to the pacific island communities is the burden of non-communicable diseases, particularly diabetes. Preventive health care was almost non-existent due to the distances that people had to travel, such that it was not uncommon for people to present with end stage complications of diabetes. Therefore I undertook an audit to assess the incidence of diabetic amputations at the hospital. I also encountered tropical medicine I am unlikely to experience in the UK, ranging from a girl who had been concussed by a coconut to cerebral malaria and ciguatera poisoning.

Although there was no Jewish presence on the island, my elective was not without a Jewish component. I visited the Jewish museum in Sydney en route to Vanuatu, and I made an effort to compare the traditional values within Vanuatu to my own Jewish ones. Of particular interest was religion within Vanuatua. The traditional practices are very superstitious and mystical but have been largely replaced by Christianity due to foreign missionaries. The missionaries’ activities were evident throughout the town, and even in the hospital there were posters they had put up. However superstition was still a large part of the local outlook, with anything good being attributed to ‘papa G-d’ whereas anything bad blamed on ‘black magic’. Other traditions, such as the ceremonial drinking of kava (a slightly narcotic drink) are still part of the daily life and remain largely unchanged. I thought that this was comparable to the challenges we as Jews have experienced to our religion and culture in the face of modernity and religious intolerance throughout the centuries.

Overall I thoroughly enjoyed my elective and I would recommend Vanuatu to other students. I would like to thank the Jewish Medical Association (UK) for their financial contribution and I will be happy to speak to any members who wish to undertake a similar elective.

Aaron Hughes
UCL

 

Paediatrics, Soroka Medical Centre, Beersheva

Thank you very much for awarding me an elective bursary from the Jewish Medical Association.  This made a great difference to my time in Israel – enabling me to explore much more of the country than I would have been able to otherwise.

I spent three weeks working in the various wards and clinics of the paediatric department at Soroka Medical Centre, Beersheva.  Beersheva is known as the ‘capital of the Negev’ and Soroka is the primary hospital for southern Israel.  Many patients travel long distances from across the Negev desert to receive care at Soroka.  Soroka is the main teaching hospital for Israeli medical students at Ben Gurion University and for American medical students in a programme run by Columbia University.  I travelled with two fellow medical students from my university.

The hospital itself surpassed all my expectations.  The doctors were incredibly eager to teach.  They made a great deal of time for us, despite having students from Ben Gurion University and Columbia University also for teaching.  They were also very keen for us to explore the country.  There was no set timetable, but we were allocated a doctor who talked with us about our aims for the placement and then crafted a timetable that enabled us to see all that we wanted.  I really wanted to expand my knowledge in neonatology as I felt I did not get enough exposure to this at university.  The structure of the wards, rounds and clinics was very similar to the UK model – meaning that we settled in quite easily.  What was also remarkable was the friendly and encouraging attitude from the doctors towards their students.  I felt there was a greater rapport between the medical students and the doctors, which was much more conducive to learning.  Much of the hospital’s patient population was Bedouin, many of whom had consanguineous marriage, meaning that there were certain rare genetic diseases we encountered that we would be unlikely to encounter in the UK.

The Israeli medical students were incredibly welcoming.  The administrative side of things was well run: a second-year medical student actually coordinates the electives in a volunteer role, but she does it expertly.  She introduced us to many areas of the city and organised all our accommodation in the student halls conveniently located opposite the hospital.

One of the main difficulties was that I did not speak Hebrew or Arabic well enough to converse fully with the patients.  However, the doctors and Israeli students were always happy to translate where they could.  But improving my Hebrew was part of the excitement of living in Israel and I came away much more confident with the language than when I arrived.

Due to Beersheva’s proximity to Gaza and being a reasonable large city, it is often the target of rocket attacks from Gaza.  Although we were apprehensive about this before we arrived, I am actually glad we got to experience the sudden sirens and the rush towards the nearest air raid shelter.  For this gave us the real experience of what life was like for the people of Beersheva and a greater understanding of what they live with on a day-to-day basis.

The city itself is very accommodating to students, with many of the local students describing it as a ‘student city’ – with plenty of bars, clubs and shops in easy reach.  However, there were limited sights of interest ‘for the tourist’ within the city itself, so we ventured beyond the city every weekend.  Travelling through Israel can be easy and cheap.  We made much use of the inter-city buses, which were very reliable.  We visited Tel Aviv, Herzliya, Jerusalem, Bethlehem, Tiberias, En Gedi and the Dead Sea.  However, my favourite place was the crater of Makhtesh Ramon in the heart of the Negev.  This geological wonder was breathtaking.  The silence of the desert and the sheer expanse in front of you was extraordinary.

I’ve learnt a great deal from my time in Israel – my knowledge of paediatrics has improved and I doubt I will ever forget some of the patients I have met.  But most poignantly, I’ve learnt from the Israeli students’ welcoming attitude to us – which made a big difference.  At my university, I think we view elective students simply as people who are stealing our places in clinics or our time in the operating theatre.  But we should be flattered that they are choosing to learn in the same hospitals in which we have chosen to learn.

The three weeks I spent in Israel were incredible.  I wholly recommend experiencing medicine in Beersheva.  Soroka is a large, well-organised hospital, with such a diverse patient population.  The hospital infrastructure allows you to follow your academic curiosity to whichever subspecialty you wish – and you will always be warmly received.

Alexander Beadel
King’s College London

 

Trauma and Orthopaedics, Sheba Medical Centre, Tel Aviv

My 5-week medical elective took place at the Sheba Medical Center at Tel Hashomer, in the Orthopaedics department. It was a lifetime opportunity to be able to meet and work with the professional health care providers and patients at this impressive 1,700 bed hospital.

A typical day would start with the trauma meeting at 07:30. Then I had the choice of either going into the operating room or going to the outpatient clinics. It was a difficult choice to make every day as they were both very interesting and academically fruitful. In most of the operations I was allowed to scrub in and assist, while the doctors would also take the time before and after the operation to explain to me what was going to happen and how it went, respectively. In the outpatient clinics, although 95% of the conversations were in Hebrew, the doctors would almost always take the time between or even during consultations to explain to me what was going on.

In addition to the operations and the outpatient clinics, I carried out a service evaluation on the recognition and management of malnutrition on the orthopaedics ward. In contrast to common belief, the medical notes of the patients are not written in English. At the beginning this was a hurdle I had to overcome as I did not speak Hebrew. The dieticians and nurses, however, were very helpful in assisting me to gather all the information I needed to carry out the service evaluation.

During my stay in Tel Aviv I stayed in the nursing school accommodation which I found comfortable and quiet. I found the food variety very interesting and I had the chance to taste a lot of local dishes.

Social life is very active in the central parts of Tel Aviv and meeting people was easy. I found local people friendly, a common characteristic of Middle East and East Mediterranean cultures. The citizens were helpful in giving directions and making me feel comfortable. The Tel Aviv medical school also organised a gathering for elective students where I had the chance to meet other medical students who were also on their elective.

Demetris Tsiakkis
Birmingham

 

Paediatrics, Hadassah Ein Kerem, Jerusalem

Having undertaken the majority of my final year elective at Great Ormond Street Hospital, I was keen to spend some time in Israel.  I joined the Hadassah Paediatrics Department on the Ein Kerem campus for a week in October 2012, with the intention of learning more about the Israeli medical system in general and paediatrics in particular, with a view to emigrating to Israel and specialising in paediatrics.

I stepped off the El Al night flight early on Sunday morning, and made my way bleary eyed to Ein Kerem, Jerusalem, where I was welcomed by Ayelet, the elective organiser, a medical student herself.  I was immediately struck by the hospital’s pleasant appearance, replete with a shopping mall, which compared starkly with the somewhat dreary-looking NHS hospitals we often find ourselves.  The paediatrics inpatient department occupies a floor in the relatively newly built “Mother and Child Pavilion”, a modern building linked to the main hospital, with outpatient clinics, obstetrics, and neonatal and paediatric intensive care on the other floors.

The day began at 8am, when junior and senior staff alike meet to handover patients from the previous night, and to discuss management of the more difficult cases.  On several days of the week, this was followed by departmental teaching, either given by one of the trainees or by a clinician from elsewhere.  I was very impressed by the standard of material presented, which I felt surpassed that of comparable meetings I have attended in the paediatrics departments of the North Middlesex and UCL Hospitals.  Interestingly, Israeli doctors tend to present in Hebrew with a smattering of English phrases, yet their lecture slides are almost entirely in English.  Of note, several senior doctors not responsible for ward cover that week also attended these morning meetings to contribute to discussions on patients’ care, something I have not observed in the UK.

The doctors split into their two ‘teams’ to carry out ward work prior to the ward round starting at 11am.  It is worth mentioning that senior doctors responsible for patients on the ward are all subspecialists, as the concept of a general hospital paediatrician does not exist in Israel as it does in the UK.  The majority of Israeli paediatricians are generalists working in the community, and a minority subspecialise and form the corpus of hospital paediatricians.  For example, the consultant I joined is a paediatric neurologist.  Nonetheless, all subspecialists must maintain their competence and knowledge of general paediatrics as patients under their care while they are responsible for the ward cover the gamut of general paediatrics.

While the ward round was comprehensive, it reflected a style of practice somewhat outdated (for the better) in the UK.  The team would enter a patient’s room and have a discussion about their care without involving the patient or their parents, and without any introductions from the doctors.  Questions would be fired at the parent to clarify the history, and often the team would leave the room without providing any update on the patient’s progress.  I felt that the communication skills and bedside manner in Israel were somewhat lacking, although my Israeli medical student counterparts assured me that this is starting to change.

I joined the Hebrew University final year medical students on the ward for their teaching.  They received consultant teaching most days of the week (UCL take note!), which was to a high standard and was similar in style to what I was used to.  I found that my knowledge was generally similar to the Israeli students although they certainly had a better grasp of pharmacology than UCL medical students.

I also had the opportunity to join some clinics, which generally were only scheduled in the morning.  I joined Dr David Zangen, a paediatric endocrinologist whom Prof Katz had introduced us to during a Student JMA tour in 2009, and Professor Michael Wilschanski, a British paediatric gastroenterologist who had studied at the Royal Free Medical School.

The working day pleasantly ends at 4pm, after which the night shift team takes over in A & E and on the wards (they do a 26-hour shift), although I had the impression that many doctors work in community clinics afterwards to supplement their modest income.

In terms of patient demographics, the majority were Haredi or Arab, with the remainder being secular and ‘national religious’ Jews, which reflects the current trends in the changing Jerusalem population.  It was immensely useful to have Arab and Russian doctors on the team in overcoming language barriers.

Finally, my description would not be complete if I did not describe the unique experience of working in an Israeli hospital environment.  Looking out of the windows at the panoramic views of the Jerusalem hills surrounding the hospital (see the image below) was emotionally stirring and made day-to-day life working there feel more meaningful.  I felt a bond with staff and patients alike unparalleled during the past few years I have spent in UK hospitals; joining the hospital synagogue services where one would pray alongside all sorts of people from patients and doctors to hospital porters and chefs had a very natural feel to it.

I would like to thank the Jewish Medical Association for their generosity in supporting me to have such an enjoyable and worthwhile week in Hadassah, Ein Kerem.

Leo Arkush
UCL

Cardiovascular surgery, Sheba Hospital – Tel-HaShomer, Israel

I spent my medical elective in Israel assigned to vascular surgery at the Sheba Medical Centre in Tel Hashomer, a suburb of Tel Aviv. This is the largest tertiary referral hospital in the Middle East with 120 departments; originally built in 1948 as the first military hospital.

Every morning I would attend the vascular ward round, although I could not understand what was said between the patient and the doctors, the doctors would kindly translate for me. It was lovely to see the gratitude from both the patient and the relatives when they saw the medical team. It was clear that the doctors worked in a close knit environment. Surprisingly there were no juniors on the vascular team. I noticed that there were fewer nurses on the ward, but more health care assistants then in the UK. Once a week I would attend the vascular outpatient clinic, which was a mixture of referrals and post-operative checks. Clinics gave me the opportunity to practise my vascular examination and to perform small medical procedures such as removing stitches and changing dressings.

The majority of my time was spent in theatres and in the angiography suite. I was fortunate to watch several complicated procedures, such as axillary–femoral bypasses, femoral to femoral bypassing, carotid endarterectomy and open abdominal aortic repairs. It was interesting to see how the surgeons manipulated the blood supply of the patient creating new pathways to ensure good circulation. Having the opportunity to scrub in and assist in procedures allowed me to gain valuable experience and see the anatomy up close.

Academically I gained in depth knowledge on vascular medicine; I also had a morning’s master class on how to suture. I practised cannulation with the nurses which helped me to develop confidence in these skills. Overall, the quality of teaching was excellent. All the doctors spoke perfect English, they were very approachable and more than happy to share their knowledge and answer any questions that I had.

Whilst in Israel I stayed in a guest house near to the hospital. The accommodation was in a great location as I could catch a bus to both Tel Aviv and the hospital. I also visited some of the sites that Israel has to offer such as Masada, the Dead Sea, Haifa, Zichron and my favourite – Jerusalem. After placement, I would meet the other exchange students and we would often make our way down to the beaches in Tel Aviv, allowing us to consolidate what we had learnt and seen that day and experience typical Israeli culture. Weekends in Israel were from Friday to Sunday and most shops and public transport would not run, which took a bit of getting used to but only added to the experience. Wherever you were people were friendly and willing to help, this was great, especially when figuring out some of the bus timetables. Israel was a fantastic place for my elective; I would like to thank the Jewish Medical Association for their contribution and would recommend this elective to anyone who wants to experience what Israel is really like.

Charlotte Ziff
Southampton University

 

Paediatrics – Sheba Medical Centre, Tel Hashomer, Israel

King’s College London allows students to organise their own 3 week placement as part of the paediatric rotation.  With a deep interest in Israel I decided to use this opportunity to get a feel for paediatric medicine at the Sheba Medical Centre, Tel Hashomer.

I spent the first week mainly attending paediatric outpatient clinics, mostly in the mornings, which included endocrine, respiratory, neurology, haemato-oncology and dermatology.  All the doctors were keen to teach me and patients and their parents were happy to have a foreign student present.  Tel Hashomer has developed a special interest in cystic fibrosis, and offers acupuncture as treatment alongside regular physiotherapy.

The afternoons I spent with the Tel Aviv university medical students on their paediatric rotation, joining them for their lectures and small-group teaching sessions about various topics.  Most of the lecture slides were in English, only the lecturing was in Hebrew (Ivrit), but both the students and doctors had very good English and were more than happy to translate words I didn’t know.

The second week I spent on the wards. The mornings would begin at 8:00 a.m. with a departmental morning lecture or grand round with all the senior and junior staff, followed by a handover of new inpatients from the previous night and a discussion of the ongoing care of the more challenging cases.  The department would then divide up into two teams and each team would review all the inpatients under that team’s care, and discuss their management and jobs that needed doing that day.  The patients would then be divided up amongst the team and each junior doctor and registrar would go and see their particular patients.  This was then followed by a ward round with the full team led by the consultant.

As a student, as well as joining this whole morning procedure, I was also given patients to clerk myself and then present to one of the doctors later on that morning in a teaching session with the other students.

During the third week I joined one of the student groups in the paediatric A+E department. We each clerked patients as they arrived and then presented to a junior doctor in a teaching session to discuss the cases.  Every afternoon the students had lectures and small group teaching usually in the form of case discussions.

The student teaching was at a high level, covered a wide range of topics and was generally, very well organised.  The doctors and students were very welcoming, and included me in everything that was going on, and were particularly keen to practise their English!  I watched bronchoscopies, attended physiotherapy sessions for cystic fibrosis patients, NICU, joined X-ray meetings and spent some time on-call.  Not all the doctors were Israeli Jews, many were Israeli-Arab, and there were Russians as well as Olim (immigrants) from America, South Africa and the UK.  As the patient population also encompasses patients from all these nationalities, it was particularly enjoyable to witness how everyone worked together to understand each other and ensure efficient use of resources and optimise patient care.  This also helped make me feel comfortable as a foreign English-speaker.

During my placement Operation Amud Anan (Pillar of Defense) against Hamas in the Gaza strip occurred, and thus I had experience of work in the medical profession in war time.  Tel Hashomer is located on the outskirts of Tel Aviv and is thus within range of missiles fired from Gaza. This meant that we had a number of siren “red alerts” (“tzav adom”) while in the hospital.  The first one occurred while I was in an outpatient clinic and we were all ushered into an “Ezor Mugan” – “safe area”.  This is an area surrounded by re-inforced concrete walls which when all the doors are closed becomes a shelter.  There are several of these areas located in every part of each floor throughout the hospital.  After ten minutes we were all allowed out to resume normal clinic routine. Everyone seemed to take the situation in their stride, though all were glued to the news on their phones to find out where the missile had landed.

Another siren was sounded while I was in the emergency department. The paediatric emergency department in Tel Hashomer was built with reinforced concrete and the whole department is effectively a safe area.  So business here continued as normal, with few even stopping for a moment to consider the possible missile target.  This was my first experience of war, and was a particularly interesting experience being both a civilian walking around and finding myself in a shopping centre during a siren alert, as well as in a hospital where life has to carry on as normal. Of particular interest given the political situation in Israel, is the prevalence of Palestinian patients in the Israeli hospitals.  During Amud Anan, several inpatient Palestinian children and their families found themselves stuck in the hospital and unable to return to their homes.  It was interesting to see the more human side of the political situation, albeit a very an unusual situation for a country to be in while at war.

I thoroughly enjoyed my placement in Tel Hashomer. The medical teaching and practice I saw was of a very high standard, with much enthusiasm for the profession. It was a good opportunity for me to speak to doctors who have moved to Israel from the UK in recent years and hear about how they have settled and acclimatised to their new environment.  I was able to use my current good Ivrit skills which improved dramatically as a result of my speaking to patients and listening to the doctors.

Thank you to JMA for the support and assistance in enabling me to have this fantastic experience.

Adi Gordon
KCL

 

Geriatrics, Royal Prince Alfred Hospital, Sydney and Infectious Diseases, Royal  Melbourne Hospital Melbourne

I began my elective in a rather rainy Sydney at the beginning of June in the department of Geriatrics at the Royal Prince Alfred Hospital. I worked primarily in the high turnover Geriatric Medical Admissions Unit which was a fantastic opportunity to see a wide variety of common presenting complaints. The department was large, modern and well-staffed by a dedicated multi-disciplinary team, which allowed a high level of patient care. I was particularly impressed that, despite a 48 hour time-limit on Medical Admission Unit stays, patients always had a comprehensive plan for the continuation of their care in place before they were discharged from the unit. I had not anticipated that I would encounter significant communication issues in an English speaking country; however, as Australia is relatively young country, many of the elderly population are immigrants and do not speak English. Particularly in Sydney, suburbs are often populated by specific ethnic groups who have maintained native-language speaking communities so we were frequently reliant on family members as translators – which is far from ideal.

The Jewish community in Sydney were very welcoming and I was able to attend a Shabbaton in the beautiful Blue Mountains during my trip. I was also able to reconnect with friends I had met in Israel on my gap year who showed me around the city and ensured that I had hospitality for Shabbat. I was also fortunate that, after my initial housing arrangements fell through, I was able to stay with a lovely local Jewish family who I met through connections with my synagogue at home.

In July I moved to the department of Infectious Diseases at the Royal Melbourne Hospital for the second half of my elective. In contrast to my geriatrics placement, I was mostly based in out-patients as the department holds clinics for the whole state of Victoria and is therefore very busy! The department holds clinics dedicated specifically to HIV, TB, Hepatitis and Travel Medicine as well as general infectious diseases sessions and clinics for refugees. All of the patients at the refugee clinic had been ‘picked up’ through immigration health screening with a variety of infectious diseases, particularly latent TB and hepatitis B, often at an advanced stage, and many had no idea that they had been carrying these illnesses for years. It was also very interesting for me to see tropical diseases that are rarely seen in the UK, such as Dengue Fever. I was fortunate to be able to stay with a friend from my gap year in Israel and then another friend I knew through volunteering at Limmud so I felt very much part of the community and get a true insight into the Jewish life in Melbourne.

I am very grateful to the JMA for their bursary which helped to make my elective possible.

Joanna Ish-Horowicz
Newcastle

 

Nephrology, Sheba Medical Centre, Tel Aviv, Israel

I spent three weeks in the Department of Nephrology at Chaim Sheba Medical Centre, Tel Hashomer, under the supervision of Prof. Eli Holtzman. During my time with the nephrology service, I was attached to the renal consult team and the peritoneal and haemodialysis team members.

The outpatient clinics I attended included general nephrology, which gave me great exposure to a wide range of renal medicine from Lupus Nephritis to Familial Mediterranean Fever to Polycystic Kidney disease. Many of the outpatients were post-transplant, and were being monitored for their immunosuppression regime and some were being investigated for transplant complications such as polyoma virus reactivation or graft rejection. I found the teaching on the interpretation of the various renal profiles and urine microscopy results to be invaluable to my understanding of basic nephrology.

I accompanied the attending consultant on the daily renal consults to the various inpatient wards, appreciating the necessity for nephrology input to patients who are oliguric or have raised creatinine. Interesting and challenging cases included a patient with Lupus Nephritis, another with suspected Churg Strauss Syndrome and a third with newly diagnosed multiple myeloma who had renal complications. The discussion of these cases with the consultant, and their proposed management and investigation was of real benefit to my approach to internal medicine patients.  The pharmacology of diuretics, ACE inhibitors and ARBs was particularly relevant on my elective, and I feel much more confident and aware of their indication and side effects on patients with renal impairment than before.

I attended the renal biopsy conference, and examined biopsies for patients with minimal change nephritic syndrome, focal segmental glomerulosclerosis and membranous nephropathy. This enabled me to appreciate the variety of investigations – from ultrasound to biopsy to renal profiles -that are indicated for various symptoms and signs in renal medicine.

I thoroughly enjoyed my elective at Sheba Medical Centre. The staff were wonderfully welcoming and educational in their efforts to include me as part of the team. I certainly learned a lot of nephrology which will be of great use to me in my clinical finals and as an Intern. My experience of Israel and Tel Aviv are extremely positive, and I am grateful to the Jewish Medical Association UK (JMA) for assisting me with the opportunity to visit such a culturally and medically enlightening place. I would strongly encourage other medical students to avail themselves of an opportunity to do elective with Tel Aviv University (TAU) – in fact I managed to convince my two best friends to come along with me and they both enjoyed their electives in general surgery and cardiology respectively.

David Mark Kelly
Trinity College Dublin

 

Tygerberg Academic Hospital, Cape Town

Adam Sher travelled to Tygerberg Academic Hospital on the outskirts of Cape Town, South Africa. He has a BMedSc in Medical Ethics and Law, for which his dissertation was a consideration of the relative merits of the Israeli Patients Rights Act 1996 and English law when patients refuse life-saving treatment. He further developed his work on patient autonomy in South Africa, and considered the concept of ‘trust’ within physician-patient relationships. He found that due to the unique character of the South African healthcare establishment, paternalism reigned despite attempts to empower the local patient population. His full report is attached here.

 

 

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