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The first part of my elective was based in Groote Schuur Hospital, Cape Town. This hospital  opened in 1938, is the main teaching hospital in Cape Town, and is renowned as being where the first human heart transplant was performed in 1967. It is government funded and has 893 beds with departments in most major specialities.

The Paediatric Department has an infant ward, a teenage endocrine ward and specialist clinics in Rheumatology and HIV. On the infant ward I was part of the clerking team presented on ward rounds and helped junior doctors – taking bloods, catheterising, weaning off oxygen, and chasing results. HIV clinics were run both in the hospital and as outreach clinics in the townships. Attending these clinics gave me insight into the complicated and widespread issue of treating HIV. I encountered many different issues about poverty, stigma and compliance.

Electives at the University of Cape Town are much in demand and places are taken very fast so need to be booked at least a year in advance. The elective administrator can be contacted directly: paschaline.jacobs@uct.ac.za. Accommodation is not provided, but is at some of the other University hospitals. The international students private house is based in Observatory near the hospital but is not in a safe are so one has to be careful. For shabat I went to Sea Point to stay with families there – the community was extremely friendly and I was taken care of very well. Kosher food is not a problem because there are big sections in main supermarkets, Hillel House is on the main campus, and there are restaurants in Sea Point. During the time I spent alone I learned that it is safe to walk around during the day but at night time you should not go out unless in a big group.

The second part of my elective was based at Sheba Hospital, Tel-HaShomer Hospital, which opened in 1948 and is the largest hospital in the Middle East with 150 departments and clinics, and 1700 beds. There are many specialist centres where leading international research is undertaken.

I chose the Department of Plastic Surgery because I had had minimal experience of the field but it did fascinate me. The Department includes the main Burns Unit for the whole of Israel, which is managed by specialist nursing. The majority of cases were reconstructive plastic surgery. The plastic surgeons works closely with the oncologist in treating breast and skin cancer. I attended ward rounds and clinics and had a lots  of opportunities to assist in the operating theatre

I arranged my elective through the electives office (fimsil@post.tau.ac.il). They also have an extensive website dedicated to elective students which was very helpful: http://www.medicine.tau.ac.il/index.php/medschool/electives-for-overseas-students.  In July /  August accommodation is not provided officially as it is used by exchange programmes, but living with the exchange students proved clean and cheap and was a short bus ride away from the hospital.  This meant that I could meet the other elective students and join them in social activities, although I could not go on the Tel Aviv University Medical School activities arranged for them as these were on shabat. The accommodation is across the road from a mall with a supermarket and restaurants.

Leah Mintz
Leeds

I had met many South Africans during my gap year in Israel whilst attending the Machon L’Madrachai Chutz L’Aretz programme, and after five years I reconnected with them during my elective.

On arrival in Cape Town some of our preconceptions were clearly unrealistic. The city was very “Western” and developed and this was reflected in the hospitals, where development and access to technology seemed no different from what we were used to in the UK. Modern medical equipment – MRI scanners, ECG machines, computers – was all available.

But there was just less money available to spend on this equipment and resources. Clinics had double the number of patients, and hand alcohol gel was shared between several rooms and was distributed in empty coke bottles rather than in a convenient bottle with plunger dispenser. In the UK to lower transmission of infection between patients, much equipment is disposable. At Tygerberg heads of auroscopes and blood taking equipment, were routinely cleaned and reused. The hospital was opened in 1976 and appears somewhat dilapidated. In comparison the old Queen Elizabeth Hospital in Birmingham was founded in 1939 but did not appear as old inside as Tygerberg Hospital. The new Queen Elizabeth Hospital opened in June 2010, whereas Tygerberg Hospital is not due for refurbishment or redevelopment any time in the near future.

During our elective South Africa we had an incredible opportunity to see a style of medicine which – on the face of it – was very similar to what we were used to back home. Only when we had spent some time there did we begin to realise that subtle differences in the culture, resources and prevalence of disease had major repercussions in how medicine was practised. We discovered the importance of language to healthcare, ensuring that you understand your patients and that they understand you. We found how low resources can affect patient care and how lucky we are in the UK to have so much money to spend on health. We learnt how different prevalence of disease in different countries affects diagnosis and the implications of this for treating foreign patients in the UK. We explored the importance of understanding the culture of a patient in treating their disease and that a social history should always be taken before deciding how to treat a patient.  We observed the different health beliefs that are held by some patients and how these can be integrated into the care we provide as doctors. We saw the contrasting methods of undertaking medical procedures and appreciated the traumatic effect that these can have on children of a young age. We observed the outbreak of a disease which we would not be able to see normally and gained experience in medical procedures with which we were not previously familiar. We appreciated the extra clinical decisions that doctors in other countries have to encounter. Overall out experiences in South Africa were very positive and we learnt lots of skills and ideas that will have a clear practical impact on our future medical practice as doctors.

Justin Copitch
Birmingham

I undertook my medical elective a Hadassah Medical Centre in Jerusalem in summer of 2011. This was made possible by the generous scholarship provided by Jewish Medical Association UK.

Hadassah Hospital is located at two campuses; Ein Karem and Mount. Scopus in Jerusalem and it is part of the Hebrew University of Jerusalem providing teaching and education in the fields of medicine, dentistry, nursing and other health sciences. The larger of the two, the Ein Karem campus provides 700 beds in over 130 departments and clinics. In 2005 the Hadassah Medical Centre was nominated for a noble peace prize in acknowledgment of its equal treatment of all patients, regardless of ethnic and religious differences, and efforts to build bridges to peace.

I spend eight weeks at the Cardiology department. I began my days with 8am ward rounds, followed by cardiac catheterisation labs and clinics in the afternoon. I got the opportunity to witness a variety of cardiovascular conditions however the great majority of the workload concentrated on caring for elderly with heart failure and those admitted with myocardial infarction. My limited knowledge of Hebrew proved of some help however it was difficult at times to follow the discussions in Hebrew when a lot of medical terminology was used. But on most occasions the medical team kindly conducted their discussions in English so I could also understand. The language barrier was more of an issue when communicating to patients who didn’t speak English. But with the help of the Israeli medical students and the nurses I managed to clerk most with no major problems.

My elective in Israel was eye opening. I am passionate for cardiovascular medicine and I had the opportunity to observe and experience the science being applied to patients at such an advanced level. But more so the experience was eye opening considering the political sensitivities of the region. Having been exposed to the western media on the Israeli-Palestinian conflict and having heard comparisons to an “apartheid state” it was surreal to see the level of equality practised on the ground where Palestinian patients comprise a large number of hospital admissions and they are cared for with the highest standards. And the practise is not just limited to the Israeli-Arab citizens. I personally witnessed a Palestinian patient being admitted with severe myocardial infarction. He required urgent valve replacement and spent one week in the Intensive Care Unit and only when he was stable he was transferred to the hospital in Ramallah, West Bank. The stories of such are commonly heard at various departments. It was moving to see the human side of the conflict; that regardless to one’s religion or background, everyone deserves medical care at point of admission, it is not a privilege but it is a human right.

My elective in Israel meant a lot to me; as a medical student and as a Jew. It helped me realise that a career in Cardiology is something that I would strongly consider but beyond that, it opened sides of the Israeli society that I would not have witnessed any other way. It highlighted the human and the Jewish values that are the foundations of the State of Israel which I am so proud of. May it be that one day our shared humanity helps us to forget our differences and create lasting peace in the Holy Land.

MA

4th year medical student
Southampton University

I undertook my medical elective in Melbourne, Australia during August and September of 2011.

I spent my first four weeks in A & E at the Alfred Hospital, a large state trauma centre, receiving at least three or four helicopter transfers from smaller state hospitals each day. This was organised through an exchange programme between King’s College London and Monash University in Melbourne. During the placement, there was very little expected of me, with my supervisor stating that I should attend between 20 to 40 hours per week. There were two shifts; 7am to 3pm or 4pm to 9pm. However I found as a student, it was more beneficial to start late morning at around 10.30am and stay later until 7pm around four days each week. As with any Emergency department, there was little structure and it took a while to find which Consultants were willing to teach and let me get involved. The department was divided into fast track (minors), ‘majors’, short stay, ‘resus’ and trauma. Once I settled, there was plenty to do: endless bloods, cannulas, plaster casts and suturing. Eventually they were also happy to let me get involved with the trauma, where most of the “action” happened. This included a man with a depressed skull fracture from an exploding wheel valve, with cerebral spinal fluid pouring out of his forehead; and a farmer who had an epileptic seizure into a tank of hot alkali. It was amazing to watch the team coordinating efficiently, learning immediate management of multiple traumas.

I then spent four weeks attached to the Respiratory team at the Royal Melbourne Hospital, organised through the University of Melbourne. My supervisor was Prof Louis Irving, head of the Respiratory and Sleep Medicine Department. He was very attentive from the beginning and ensured that I was aware of all the opportunities available to me. This included daily ward rounds, bronchoscopy, EBUS (endobronchial ultrasound), various out-patient clinics, MDM meetings and radiology as well as various teaching sessions. The team was based on a respiratory ICU consisting of four beds (patients needing non-invasive ventilation were sent there). They also took care of other respiratory referrals in the hospital. Each day started at 8am, and as the consultants also encouraged me to go out and see the city, I attended four days per week. There was little hands-on but plenty of opportunity to learn, especially XRAY/ CT interpretation and NIV use, thus providing a very useful placement for final year and beyond.

Melbourne is a great city with plenty to do; bars, shopping, sports, museums, music, culture, beaches (on the odd warm day!) in addition to surrounding state attractions such as Phillip Island, Mornington Peninsula and the Great Ocean Road. The city also has a vibrant Jewish young professional scene. It was very easy to meet people at the synagogue and I was inundated with invitations for Shabbat meals. The main drawback of elective in Melbourne related to it being winter time, when contrary to prior reassurance it was cold and became dark early in the day. This took some adjustment coming from the UK in summer.

My time in Australia was a valuable experience for a number of reasons. Firstly, I had previously considered going to work for a year in Australia and this was a positive ‘trial period’ where I found it very easy to adapt to the lifestyle, the community and above all the medical system which is similar to the NHS but places greater emphasis on the use of private healthcare for those who can afford it. The placements proved to be varied, achieving a good balance of skills practise and learning opportunities to build on prior clinical experience.

Dalia Nelson
KCL

This past autumn I had the unique opportunity to spend two months on the West Coast and the Gulf Coast of the USA. As part of my medical elective I spent 4 weeks at The Stone Clinic in San Francisco, California, a world renowned centre for orthopaedic surgery, sports medicine and rehabilitation. Dr Stone and his exceptional team provide a holistic approach to musculoskeletal injuries: cutting edge stem cell surgery, comprehensive physiotherapy and extended follow-up. It was apparent from all the patients I spoke to at the clinic and surgery centre how highly they value their mobility and how much faith they had in Dr Stone’s ability to improve their health & quality of life. While I was there I also started a qualitative research project looking at case histories of patients with meniscal allograft revisions, and I am looking forward to completing that work here in London. San Francisco is a phenomenal city, with unparalleled architecture, a healthy-living vibe and an inclusive, open minded outlook. I was fortunate to attend Kabbalat Shabbat at Mission Minyan, an independent group offering Carlebach style services to an ever growing number of students, young professionals and local families. It was a lovely, meaningful evening which I would highly recommend to any Jewish person who finds themselves in the Bay Area.

I spent another month at Singing River Hospital, located in Pascagoula, Mississippi, a small city of approximately 23,000 souls. I was fortunate to spend time both in the radiology and internal medicine departments, and took a trip to George County Regional Hospital- a rural healthcare facility in Lucedale, Mississippi (pop. 2,500). At Singing River the high use of technology on the wards and in surgery allows for increased efficiency & quality of care, but would be for naught without the extraordinary commitment shown by the physicians in developing strong doctor-patient relationships. The Gulf Coast is a beautiful part of the United States and has shown tremendous resilience in the aftermath of Hurricane Katrina which caused such widespread devastation. I spent two Shabbatot at two different Conservative shuls: Ahavas Chesed in Mobile, Alabama & Beth Israel in Gulfport, Mississippi. Ahavas Chesed gets a small crowd on Friday night but benefits from a spiritual and creative rabbi who endeavors to make services relevant to the community he leads. Beth Israel was very welcoming, with a mix of children, teenagers and adults – services were partially led by a boy preparing for his Bar Mitzvah, and there was a sweet little oneg afterwards in honor of another young congregant who was about to start his studies out of state. While speaking with one of the families afterwards I got a sense of the challenges there are to being Jewish in the South, but also what strategies they use to keep children confidently connected to their religion and their heritage.

I am tremendously grateful to the Jewish Medical Association UK in assisting me with my elective, allowing me to achieve my educational objectives as well as visit some very special Jewish communities in North America.

Naomi Kaplan
UCL

I spent 6 weeks working within the anaesthetic department at the Royal Prince Alfred Hospital in Sydney. From the start I was included as part of the team and encouraged to take an active role throughout all operations and procedures. I was able to get valuable experience and practice of practical skills such as managing patient’s airways and learning how to intubate. Having done an anaesthetic attachment in London, I feel that in Sydney I was able to be much more hands on, allowing it to be a really valuable learning opportunity. I was made to feel really welcome within the department and consultants were always keen and happy to teach me while sitting in theatre during operations.

I chose to work in anaesthetics as I was considering pursuing it as a career path but felt that I had had limited experience of it so far during medical school. This experience has confirmed my interest in the field and made me more certain that it will be a great specialty for me to enter into.

I was so touched by how kind the Jewish community was throughout my stay. I have some family over there but before my trip did not know anyone my age. On my fourth day in Sydney there was a Jewish ball which allowed me to meet lots of people who throughout my stay invited me to their homes for Shabbat and over Yom Tov and made me feel so welcome. I had such a great time throughout my elective and thoroughly enjoyed being able to visit family members who I had never met before and making some great new friends.

I would like to thank the Jewish Medical Association for the generous bursary they gave me for my elective, helping me to have such a fantastic experience. I fully intend to visit again and would be happy to talk to any other students who wish to go to Sydney should they like any help or advice!

Emma Pack
UCL

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

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

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

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