Category: Uncategorised

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

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

I spent my elective in the Department of Ophthalmology at Emek Medical Centre (EMC) in Afula. I was welcomed very warmly by everyone there, and was immediately integrated into the working of the department. The doctors made sure that I was allowed to examine patients in order to learn some basics in the field. I learned to use a slit-lamp, and the diagnosis and treatment of some common eye disorders. I was recruited to help write three case reports, which are in progress.

My time at EMC was very valuable in helping me decide to pursue a career in ophthalmology, and in preparing me for that. The case reports and the experience I gained will stand me in good stead when applying for specialist training. In addition, I enjoyed the experience enormously. I arranged with the residents that they would call me if anything interesting happened when I was not around; that way I made the most out of my time.

Apart from the work I was doing during the week, I was invited to the homes of several colleagues over shabbat. Dr Briscoe, the head of the department, and Dr Feldman, one of the residents, were particularly kind in this regard.

The Jewish Medical Association (UK) grant made it possible for me to finance the elective in Israel. As a student I am not yet earning, and it might have been difficult to find the money in such a short time.

Samuel Borin
Cambridge

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