Medical Student Israel Tour 2009 Report
Wednesday 26 August 2009
Seven very bleary-eyed students were identifiable at Ben Gurion Airport, where we met with Monica and Dalia who were already in Israel. Following the Prof’s lead, we found our way into the station and took the train up north to Nahariya. English-speaking fellow-passengers may have been slightly bemused to hear such lively conversations about medical ethics, research projects, exam stress and the GMC at 7am on a Wednesday morning!
On arrival in Nahariya, we went straight to the Western Galilee Hospital. We were given a very interesting and clear summary presentation about the hospital, its structure and the population it serves. We were shown pictures of the damage caused during the 2006 Lebanon war and the measures taken to avoid further casualties from rocket fire within the hospital itself. The hospital is especially proud of its enormous fans, housed underground, which are designed to protect it against suffering in any potential attacks. Despite this being a major part of the hospital tour, the extraordinary feats of engineering, was perhaps not appreciated fully by us medical students! We were far more impressed by the full co-operation, and mutual sympathy and understanding, between the Jewish and Arab doctors, nurses and patients, who were working alongside each other in spite of all the inevitable tensions that one reads about in the press.
We drove south to Haifa, where we had an opportunity to freshen-up at our hotel overlooking the bay – helpful after the overnight journey and the running start! After a snack-lunch, we visited the Magen David Adom (MDA) station in Haifa. A young Druze paramedic, who had begun his career as a teenage volunteer for MDA, gave us a presentation on the structure of the organisation and the nature of its work. It was most surprising to learn that MDA receives no government funding, regardless that it is the national ambulance service. We were shown into the central control room for the region, and then we were shown the various types of ambulance they use according to need.
The last visit of the day was to Prof Gad Rennert’s Cancer Epidemiology Centre. Despite incipient exhaustion we managed to grapple with disease incidence patterns and with fascinating comparative statistics. Finally Prof took us to his favourite Haifa restaurant and walked those still standing back to our hotel.
Thursday 27 August
After a more civilised early start, and a good Israeli breakfast, we travelled to Jerusalem. Our first stop was a general practice surgery where we met with Dr Alexander King, who runs a Maccabi clinic on the borders of Meah Shearim. Having made aliya about 10 years ago, he was in a perfect position to describe to us the differences between the Israeli medical system and the British, and also tell us about his experiences as a doctor in an army combat unit. He explained how GPs in Israel are starting to establish themselves more fully, as the system in Israel is moving away from the American model whereby patients immediately seek specialists’ opinions before seeing a family doctor. We were suitably impressed to hear and see the efficient running of the system in Israel, with very short waiting-list delays and the ability to see a GP on the same or the next day. (What went wrong with the NHS?!)
After lunch and some time to wander along Ben Yehuda, we met up again and travelled to Sha’arei Tzedek Hospital. Prof introduced us to the background of the hospital, explaining its long tradition of links to British Jewry, and the outlined the underlying concept of running a hospital predicated on Jewish values and observance of halacha. We were shown around the hospital by Dr Max Godfrey, a paediatrician who is finishing his residency, who had made aliya shortly after graduating from UCL. The hospital had a unique atmosphere expressing a combination of the usual hubbub one would expect from a busy city hospital with a more “religious feel”.
Friday 28 August
Yet another good breakfast, this time accompanied by a pianist at the Prima Royale Hotel gave us an enthusiastic start to the day! We headed straight to Ein Karem, where we were met by Dr David Zangen, a paediatric endocrinologist. He gave us a tour of the Hebrew University Medical School and the Hadassah Hospital, which was an interesting opportunity to compare our medical teaching to that of our counterparts in Israel. The high level of research conducted at Hadassah, and its high reputation, was notable. The adjoining shopping mall, which provided a necessary opportunity to stock up on rogelech, was a surprising addition which gave a more leisurely feel! Dr Zangen also told us about his part-time job as an army doctor. He was very involved in refuting unfounded claims of atrocities committed by the Israel Defence Forces in Jenin during Operation Defensive Shield in 2002. He discussed with us the implications of such issues on Israel in general and the Israeli medical community in particular.
We then met with Prof Mark Clarfield, originally from Canada, a geriatrician (although he has worked extensively in public health as well) who is based at Ben Gurion University and Soroka Hospital in Beersheva. He told us about the public health concerns in Israel due to the ethnic diversity and the age profile of the population. Perhaps most interesting, he told us that one third of the elderly (and thus many of his geriatric patients) are holocaust survivors, and explained how this affects their medical needs. We also talked about the effectiveness of the Israeli health system, and its pros and cons when compared to the British and American models.
Finally Prof Elliot Berry, also an oleh from the UK, gave his perspective as a doctor mainly involved in research and told us about his own work involving nutrition. After answered a barrage of questions, he showed us to the bus stop and taxis where we returned to the centre of Jerusalem for a free afternoon / preparation for Shabbat!
On Friday night, most of us went to the Kotel, just 15 minutes walk from our hotel. After joining a group of yeshiva students for a stirring Kabbalat Shabbat service, we walked back to Prof Katz’ (and Dr Katz) apartment in Yemin Moshe. Unfortunately we were witnesses to a relatively violent protest by a vocal minority, which interrupted the otherwise serene atmosphere of Jerusalem on Friday night. After a delicious meal, Prof Katz led a discussion about circumcision, and discussed the legal, halachic and medical issues that have been raised about this in the UK and Europe. He explained the possible responses against criticism of the procedure. At first this subject matter seemed uncomfortable, but it became clear that it is an issue that Jewish medical students need to understand and be ready to discuss and explain the subject at home in the UK.
Shabbat 29 August
We met again as a group at lunch, where Prof Katz had arranged for us to be joined by Andrew Balcombe, chairman of the Zionist Federation, and his wife Jean. The table conversation was of a slightly less medical nature, as we argued over the extent of antisemitism in the UK at present.
Soon after Shabbat, we drove down to Beersheva, where we had a late session with Prof Shimon Glick, Emeritus Professor of Medicine at the medical school. Prof Glick, who is himself observant, and is the Israeli Medical Ombudsman, discussed with us various ethical issues which are relevant specifically in Israel. He explored the tensions between the secular and religious ethical systems, with particular regard to end of life issues, and the ways that the Government has found to make progress with the support of all sections of society. He described the importance of considering patient autonomy issues from a Jewish perspective, and might lead to different conclusions from those reached within a secular ethical one.
Sunday 30 August
We made an early start, driving to Soroka Hospital in Beersheva, where we were given a presentation and then a tour by Dr Tzachi ben Tzion, who combines his work in the hospital with a second career in stand-up comedy. The hospital covers an enormous area, stretching south to Eilat, and has an unusual mix of patients, ranging from large numbers of Bedouins to Russian immigrants to a charedi community. Aesthetically the hospital was not spectacular in the same way as the Jerusalem and northern as attractive as others we had visited, we had the impression of a busy hospital with state-of-the-art facilities. We were also shown the damage inflicted during the recent Gaza war and the precautions taken. It was very saddening to hear that it was clear the hospital had been intentionally targeted.
We were joined by Dr Rafi Boehm and drove to Yeroucham, a development town in the Negev, not far from Beersheva. A young South American doctor from the local family practice described the provision of healthcare and the particular problems arising in the town. We were somewhat surprised by the amount of emergency facilities housed in the practice surgery, to avoid the need to drive to Beersheva.
Dr Boehm led us to the Yeroucham Day Care Centre for the Elderly where we were given a tour and lunch, while they described the activities for the clients and the medical screening done within the centre. The last visit was at the municipality offices where the Mayor, Amram Mitzna, a previous Labour candidate for Prime Minister, gave us a general presentation about the town. He explained the enormous challenges Yeroucham faces, and their pride at the increasing numbers of local school students continuing to further education, including one medical student. This gave us an insight into one of the most formidable challenges Israel faces: integrating immigrants into society and tackling inequalities.
Leaving the Negev, we drove north to the Weizmann Institute of Science in Rehovot, where we were welcomed by the Vice President, Professor Haim Garty. He introduced us to Weizmann and explained the important place that biomedical research has in the institute. We then met with Dr Eran Hornstein, a doctor scientist who has done important fundamental research on microRNA in the Molecular Genetics department. He discussed how he decided to embark on a research career from a medical background.
We continued very full day with a brief visit to Ichilov Hospital in the centre of Tel Aviv. We were met by two junior doctors, one of whom (Dr Talya Finn) had recently made aliya having studied at UCL and completed FY1 in Oxford. They described life as a junior doctor in Israel, which sounded remarkably similar to that in the UK.
Finally we enjoyed the free evening in Tel Aviv!!
Monday 31 August
We made an early departure to Sheba / Tel Hashomer Hospital, on the outskirts of Tel Aviv (near the airport). The hospital made a positive impression compared to what we expected when we had been regaled en route with Prof’’s reminiscences about working in Pathology housed in army huts decades ago!
Prof Brian Reichmann gave us perhaps the most moving tour of the entire visit around the paediatric department of the hospital. The building, its décor and friendliness endeared the place to us all! We were surprised to hear that as many as 60% of patients in the paediatric cardiology ward are Palestinian Arabs, receiving regular Israeli medical treatment. We heard moving stories of Palestinian children injured during war, in beds alongside Israeli children injured by rockets in Sderot, during the last war. The state-of-the-art facilities provided for allcomers and accommodation for their families for many months is an aspect of Israeli medicine that is rarely observed by the outside world.
We were shown around the rehabilitation centre and orthopaedic department by Prof Michael Heim. Probably the most extraordinary was the room housing a virtual reality simulator, resembling Star Wars, designed both to diagnose mobility impairments and to practice using prosthetic limbs. Amongst their patients receiving prosthetic limbs at present are 60 Fatah fighters who had been punished by Hamas forces by mowing down their legs in machine-gun fire.
The visit concluded with an excellent lunch at the Israel Medical Association (IMA) offices. Their legal director, Malke Borow, told us about the IMA and it’s role in and out of Israel, and this led to a discussion about attacks on Israel and accusations against it’s especially those emanating from British doctors. Questions about how we can counter this and answer pro-boycott positions were raised. Finally we were joined by Dr Tzaki Ziv-Ner, director of the Sheba Rehabilitation Centre, who heads the World Fellowship, an IMA initiative bringing together Jewish doctors from around the world.
Overall this was a highly successful and enjoyable tour!