Elective Reports 2013
Ophthalmology Departments, St John of Jerusalem Eye Hospital and Hebrew University – Hadassah Hospital (Ein Kerem), Jerusalem.
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 (i.e. part of the order of St John) has many bases for ophthalmological care across the West Bank and in 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 spending time with a nurse doing imaging and diagnostic neurological tests (OCT, ERG), with 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 Anabta and Hebron where I spent time.
The hospital in Jerusalem also runs an outreach service throughout the West Bank on several 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 as well. On this occasion, alongside the Paediatric Clinic I was able to accompany the doctor on to Paediatric Intensive Care for retinopathy of prematurity screening. A usual day would start around 7:30 am and finish by 2:30pm unless I was on outreach which may finish around 4pm.
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 programme 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 open opinions about the political situation in 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 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 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, retinal, corneal and general ophthalmology including cataract surgery. There is a large paediatric department. In all of these subjects I was able to spend time in clinics. I was able to spend time in theatres for cataract, retinoblastoma, and retinal and other emergencies. The department has a strong commitment and dedication to research which I found inspiring.
Every weekday began with lectures for residents at 7:15 except on Wednesday when there was a grand round at 7 which all the doctors attended (conducted 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 session. 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, as well as most of the discussion. I do not think anything like this happens in the UK – 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 (Western Wall) 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 for the Shomronim Pesach Festival (Samaritan Passover) which was an incredible experience.
I am really grateful to the Jewish Medical Association UK for their support in making this elective possible for me and would like to say a huge thank you to them. I can unreservedly recommend an elective in Israel to anyone considering it!
General Practice, Maccabi Family Practitioner Centre, Netanya
As a part of my elective I chose to spend three weeks at a general practice in Israel. As I am hoping to move to Israel after I qualify, and am interested in pursuing general practice, I thought I could use this as an opportunity to get more familiar with the Israeli medical system and determine whether I could be comfortable working in Israel.
I chose the practice based on good reviews from British students who had done electives there previously. It also had the advantage of being in Netanya, where I had access to a flat so that accommodation was free!
The practice is located in the centre of Netanya and has four doctors and a nurse on site. It is associated with the Maccabi Health Fund, but is not controlled by them, so that private patients are also seen.
The population in Netanya is very diverse and includes a mixture of Israeli born, English, French, Russians, South Africans, Germans and several others. The four doctors spoke at least six languages fluently and the practice had become so well known for this in Netanya that several holiday-makers had come specifically to the practice and waited for hours to see the doctor that spoke their native language.
I spent most of my time sitting in with a South African doctor who was fluent in English and Hebrew. Approximately 40% of the patients he saw were English speakers. As my Hebrew was not very good, this mix was advantageous as I could easily understand a lot of the consultations and could improve my medical understanding as well as working on my Hebrew. Unfortunately, my level of Hebrew prevented me from being able to clerk patients before they were seen by the doctor unless they were English speakers, but by the end of the placement I could understand most of the Hebrew conversations as well and was starting to be able to speak more confidently as well.
The multitude of languages in the practice led to a rather unique challenge for the doctors as it was important for them to know in which language to greet the patient. The practice was so busy that they rarely had time to look at a patient’s notes before they came in and, if they were greeted in the wrong language, the patient would immediately know that the doctor did not remember them, thus creating a breach in their relationship.
During my placement, I was most struck by the computerised system the doctors used to document their notes. The Maccabi health fund has an internet-based system that can be accessed by any other Maccabi-associated-doctor in the city. This meant that the doctors could simply write their notes from the consultation on to the system and this would then be accessible instantly to another doctor in the city. This removed the need for referral letters as the doctors would simply give the patient a form to make an appointment with a specialist who would be able to look at the reason for the referral on the system. This saved an enormous amount of time and was much more efficient than the UK system. It meant that the doctors could send a patient for blood tests and chest x-rays and see the report as soon as they were available, allowing them to act promptly where necessary.
It was also interesting to note that, because the population is almost completely Jewish, in the week preceding Yom Kippur the doctors had to be slightly more wary than usual in prescribing drugs such as antibiotics as they were aware that most people would be fasting and inclined to miss pills.
Overall the experience was extremely valuable and I gained a huge amount of medical knowledge as well as very valuable information about the way medicine works in Israel. It has given me a lot more confidence to consider working in Israel in the future.
King’s College London
Tel Aviv Refugee Clinic and Emergency Medicine Eilat
On the 10th of February 2013, after completing my final year examinations at Oxford University, I left England on my medical elective. I had three main aims for this period :1) To broaden my insight into global medicine and the cultural factors involved in this, 2) To experience how health care is delivered in places other than the UK, 3) To both use and build upon my clinical knowledge from medical school.
I began my elective with five weeks in Israel, where I had arranged through the Ben Gurion Medical School in Beer Sheva to spend some time initially in Tel Aviv experiencing the Refugee Clinics, and then in Eilat in the Emergency Department.
The Tel Aviv Refugee Clinic was based in Jaffa, run by the Physicians for Human Rights (PHR) organisation. This clinic, served by volunteer doctors and other staff, aims to provide health care to anyone without the means to receive it in Israel. This includes migrants, asylum seekers or anyone whose legal status is as yet undetermined. What was evident from the start of my time at PHR was the huge range of cultural and religious backgrounds that attended the clinic. On my first day alone we were presented with patients from Somalia, Nigeria, Eritrea, North America, Argentina, and Palestine, offering a huge range of languages, and backgrounds. Despite very few consultations being held in the patient’s or the physician’s first language, the staff at PHR amazed me with their huge range of language abilities, allowing consultations to occur despite this. I spent time with a range of doctors and nurses each day, from the triage nurses, to specialist psychiatrists and surgeons, providing huge variety in aspects of clinical care. For example, one patient I saw with the family doctor regarding a chest infection, I then saw later with the psychiatrist for post traumatic stress disorder which was related to his seeking of asylum in Israel.
A highlight of my time in Tel Aviv was an evening spent with the mobile sexually transmitted diseases (STD) clinic, the Lewinski Clinic, which is based in the Tel Aviv new central bus. The mobile service is a relatively new project, set up to serve high risk populations that were at less likely to seek medical help. This particularly includes refugees, sex workers, drug users, and those living in more deprived areas of the city. The clinic really opened my eyes to the depths of Tel Aviv as we visited the brothels and overcrowded apartments serving as centres for groups of refugees. They provided information, advice, contact points and also confidential STD testing to anyone wanting it. Most of the places we visited knew the clinic staff and welcomed them in, a relationship which has taken the staff a long time to establish, and I was grateful to be able to be a part of this.
My experience in Tel Aviv was a huge contrast to the medicine I am used to in England. Even more so than the medicine itself, my learning focused on the backgrounds of some of the refugees, the cultural diversity present within these communities and the medical and social problems that are associated with this. From taking patient histories it was evident that many of the patients had made huge journeys and been placed in diverse undesirable situations along the way to reach Israel and seek asylum. These were situations which I had never experienced before in medicine, and highlighted the specific social needs of these patients along with the medical needs we all have. The volunteer doctors were fantastic at providing both social support and medical care to the patients that really needed it after arriving from often awful situations to a completely new and unknown place to them.
My Tel Aviv placement was supervised by Professor Alkan who was fantastic both at teaching in the clinic, and also as a host. He educated me into the history of Israel, its politics and populations as well as providing stimulating medical cases. I also got to meet some of the medical students in Israel, and it was great to compare our experiences of medical school and to make some new friends.
As well as my work within the clinics, I had some time to explore Israel itself. Having never been there before, this was something I was looking forward to doing very much. I made a day trip to Jerusalem which offered so many wonders to see, with the Old City showing an unbelievable mixture of religious backgrounds working together. Having a keen interest in cooking, I found Israel to be full of culinary delights. I very much enjoyed going to the buzzing Carmel Market in Tel Aviv, and having Shabbat dinner with Professor Alkan’s family, as well as tyring the delicious local street food such as falafel, baba ganouch and sabich. A highlight also was the festival of Purim whilst I as in Tel Aviv. During this weekend the whole city was alive with music, dancing, and happiness, with people dressed in every imaginable costume: it really was an occasion to remember.
For the second half of my time in Israel, I worked in the emergency department of Joseftal hospital, Eilat along with three other students from Ben Gurion University. With just 65 beds, this is the smallest and southernmost hospital in Israel, and serves a vast area including most of the Negev Desert. The emergency department is run by Dr Arad who, along with his team, was extremely welcoming and a fantastic teacher. At 8 am each morning the day would begin with a roundup of the patients from the day before and any new admissions. Dr Arad would focus on the conditions which came up and use these as the starting point for teaching sessions within the meeting. This was great as it meant we covered a wide variety of emergency medicine topics, constantly testing our knowledge and learning new things. I would then spend the day clerking patients – if they we able to speak English or using my limited French – and improving my practical skills of suturing, plastering, chest drain insertion and lumbar punctures, many of which I had not had the chance to do before. Being one of the closest emergency centres to the Red Sea, the hospital has a special interest in hyperbaric medicine, having a decompression chamber onsite. This was a completely new and interesting experience in medicine for me, and despite not seeing any patients with diving related problems, I gained excellent knowledge on the methods used in this area of medicine.
The population attending Joseftal hospital was a big contrast to those in the Refugee Clinics I had experienced in Tel Aviv. There were very few immigrants, with the largest population consisting of local people, closely seconded by tourists. The hospital covers a vast area, with no other emergency department for 240km, and so many patients had travelled a long way to be seen. Any emergencies that could not be managed in this small hospital were transferred to Soroka Hospital in Beer Sheva either via ambulance or helicopter. Joseftal hospital itself was undergoing renovations whilst I was there, expanding the emergency department and modernising the equipment, which will be of huge benefit in the future as often space was limited, and I imagine this is even more of a problem during the peak summer season.
Eilat was an incredible place to spend a few weeks, getting excellent medical teaching accompanied by great weather despite it being Israeli ‘winter’, and a beautiful coast line to explore after a day at work. The other students and I stayed in a flat owned by the hospital which was within walking distance, and despite being fairly basic with minimal cooking facilities, was adequate for the small amount of time we spent there each day. We ate lunch every day at the hospital, which provided a fantastic spread of unlimited hot options, soups and salads for just one shekel (around 18p!) which kept us going for the rest of the day. Along with the other students and doctors, I snorkelled in Coral Bay, hiked in the desert, and even had a weekend trip to Petra in Jordan. I would thoroughly recommend this placement to anyone interested in Emergency Medicine as Dr Arad is an exceptional teacher, and the small department makes it a very friendly and welcoming environment to work in with many opportunities for developing practical skills.
Overall my experience of medicine in Israel was absolutely fantastic and one I would recommend to anyone. Splitting my time in two locations provided huge variety in the populations and the medical problems as well as allowing me to see a larger area of the country. I feel I met all of my initial aims of experiencing global medicine, foreign health care and practicing and improving my clinical skills, with the practical skills particularly being highlighted during my time in the Emergency Department in Eilat. I also feel I exceeded these initial aims, gaining a far better understanding of refugees in general as well as their medical problems, cultural diversity within medicine, the history and politics of Israel and Jewish culture, and aspects of medicine I did not expect to encounter such as hyperbaric medicine. I made friends and contacts both of other medical students in Israel, and doctors, that I hope to keep in touch with for many years to come, and who helped to make this experience so memorable.
I would like to thank the Jewish Medical Association (UK) for making this learning experience possible for me. Not only has it been medically stimulating, improving me as a doctor in the future, but it has also opened my eyes to a fantastic country I previously knew very little about. I cannot speak highly enough of my time in Israel, and I am very much looking forward to going back to this wonderful country, hopefully to experience more medicine there in the future.
Neurology, Hadassah (Ein Kerem) / Hebrew University Medical School
I have had an interest in neurology for many years, and having completed my rotation at Queens Square in London, I was inspired to spend further time in the field. I have always enjoyed travelling and volunteering in Israel, and it now seemed like a perfect opportunity to spend time studying and working in Israel.
I spent 6 weeks in the neurology department of Hadassah Ein Kerem Hospital. It did not take me long to appreciate the truly outstanding level of personal care and treatment at Hadassah. It was heart-warming to see that at Hadassah, patients of all backgrounds are treated equally and indeed, the staff work together in harmony.
My supervising consultant was a humble man who is a leading expert in the field of multiple sclerosis. He introduced me to the department and to the various members of the medical team. My day would usually start at around 7.45 am, where I would help the residents in their daily tasks. We would then join with the consultant for the ward round, which often lasted until midday or, on Thursdays, when we had a Grand Round, well into the afternoon. The Grand Round is based on a traditional European-style round, with the whole medical team and consultants seeing all the patients. Despite it being a challenge to get to the front of the crowd of 20 or so members of staff on the round, it was nonetheless the highlight of the week. I also spent time in the various outpatient departments, and down in the busy emergency room, seeing the acute cases.
Medical students in Israel are active participants in the medical team, and I was encouraged to participate in ward round discussions, journal club meetings and indeed and was asked to voice my opinions on the diagnosis and management of patients. This collaborative approach with medical students allowed me to extensively increase my knowledge in the various fields of neurology. The department had a varied case load, and I was able to learn about a plethora of diseases I had never seen before in the UK. These included neuro-infectious diseases such as Lyme Disease and West Nile Virus and the neuroimmunological diseases such as ADEM, and optic neuritis. Whilst in the department, I was also able to complete a research study looking into the views and opinions of neurological patients of their treatment, exploring the psycho-social aspects of medical care.
Whilst in the department I was made to feel very welcome by the hospitable members of the neurology team. Despite having a limited Hebrew when I first joined, this proved not to be a major problem as I had first envisaged. The staff were very happy to talk in English, when necessary; and indeed many patients speak some English. Furthermore, it proved to be a fantastic opportunity to improve my Hebrew. However, I found that as the weeks went on, I improved my Hebrew dramatically, and indeed was even able to learn a little Arabic, which is widely spoken by many of the patients at Hadassah.
Whilst in Israel, I was also able to attend the Israeli Neurological Society Conference. This meeting, held annually, brings together physicians and researchers from Israel. It was an opportunity to hear about the multitude of pharmacological, technological and scientific breakthroughs in the various subspecialties of neurology.
Throughout my time in Israel I was also able to experience the full benefits of Israeli society and culture. I attended a number of social events, visited some historical museums and travelled to some intriguing archaeological sites. Other highlights of my trip included travelling to Tverya and Tzfat.
I would highly recommend any student to carry out their elective in Israel, and in particular, the experience that can be gained from studying at Hadassah Ein Kerem. I am happy to assist any other student who has any queries, advice or tips for spending time on elective in Israel.
Finally, I am extremely grateful for the very generous award from the Jewish Medical Association towards funding my elective, without which I would not have been able to have had such a thoroughly enriching academic and cultural experience.
University College London
Somerset Hospital, Cape Town, South Africa and Tamale, Ghana
My elective was split between Cape Town in South Africa and Tamale in Ghana.
The first month was a placement in the Emergency Room at the Somerset Hospital in Cape Town. Whilst being state-funded, the unit was very well-supplied as it had lots of equipment sponsored by large South African companies. We were expected to start at 08:00 each morning for the Emergency Room ward round, at which we would see all the patients that had been brought in that night. We would get a number of jobs to do from that ward round, and once they were finished, we would begin seeing our own patients. The level of competence and knowledge expected of a doctor was similar to that expected In UK but the doctors’ practical skills were perhaps better. Socially the environment in Cape Town was vibrant, with a number of local medical students based at the hospital.
After Cape Town it was time to go to Tamale, a large town in northern Ghana. I was placed on the general surgery division, and this placement involved attendance in surgical theatres, ward rounds and surgical liaison in the Emergency Room. It was a very interesting month. Whilst many of the surgical trainees were far more skilled than their UK counterparts, the procedures in theatres were very similar. The main difference came in the clinics, where we would see very late presentations of serious disease such as breast cancer and hernias. The entire time there was very interesting.
The elective was made possible in part by the generous contribution of the Association and the experience has contributed to my clinical practice and outlook in ways that I never thought possible.
King’s College London
Meyer Children’s Hospital, Rambam Campus / Technion Medical School, Haifa, Israel
In November-December 2012, I spent my six week elective placement in the Paediatrics A department of the Meyer Children’s Hospital in Haifa. I had been searching for a paediatric placement, preferably in a dedicated paediatric hospital, in Israel, in which speaking Hebrew was not a requirement! The Meyer Children’s Hospital is the only children’s hospital in Northern Israel and so seemed like an excellent choice where I could spend my placement.
The Rambam Campus primarily serves Haifa’s population, but also serves the wider population of Northern Israel. The hospital had a mixture of Jewish, Arab Muslim and Arab Christian doctors and patients, who were all treated together. Haifa itself is well known for the levels of religious co-existence and this was certainly the case within the hospital walls.
The department to which I was attached was a general paediatrics department and so I was exposed to a wide variety of paediatric conditions. Professor Shehadeh, the Director of this department, has a particular interest in type 1 diabetes, and therefore there were always a number of patients with newly diagnosed diabetes on the ward. The hospital is affiliated with the Technion Medical School and there was a firm of medical students on the ward together with me.
The day often started with a ward round, which was always attended by a very large number of doctors. Where conversations took place in Hebrew, one of the doctors or medical students was always happy to act as translator. During the placement I attended a number of the medical students’ bedside teaching sessions. All the doctors and medical students spoke English to a very high level and the medical students’ bedside teaching sessions were almost always conducted in English in order that I could join them. I was also able to clerk the patients on the ward who could speak English and then discuss the cases with one of the residents. All of the doctors and medical students on the ward were extremely friendly and helpful.
I particularly enjoyed being in the hospital during the festival of Chanukah. There was a strong holiday spirit with a seemingly constant flow of Chanukah treats for the children, including visits from all of Haifa’s sports teams! Another highlight was that the hospital is on the beach …..which is where a great deal of my free time was spent
During my elective I also had time to explore both Haifa and Israel more widely and spend time with friends who had made aliyah and moved to Israel permanently. A weekend spent at the Dead Sea was particularly memorable.
I had a rewarding, interesting and exciting time on my elective and would like to thank the Association for their support.
University College London
Surgical Trauma Unit, Beilinson Hospital Rabin Campus, Petah Tikvah, Israel
Hannah Shields from Birmingham University went to Petah Tikvah. Her detailed report can be found here.