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With the help of the Jewish Medical Association (JMA) UK, I spent my medical elective at the Hebrew University Medical School / Hadassah Hospital, undertaking research into infertility in the laboratory of Dr Ariel Revel and Prof Reuven Revel. Despite my negligible knowledge of Hebrew, and relative research inexperience the laboratory team were hugely welcoming, and made every effort to ensure the research was both of relevance and of interest to me.

During my time with the group I wrote a review on a newly described molecular link between the invading embryo and invasive cancer, and I did the benchwork for a project which aimed to characterise differences in miRNA expression between fertile women and women who had repeatedly failed in vitro fertilisation. The results look very promising, with an apparently significant difference between the two groups; and the experience of being thrown into the Israeli medical research world was fantastic.

Research in Israel, like in the UK, has its difficulties, but the challenges in Israel are different – due to cultural and religious reasons, as well as to the structure of the Israeli health system. I would encourage British medical students unreservedly to consider an elective in Israel:  it is fairly easy to organise, especially with the help of JMA (UK) contacts; the medical system is sufficiently similar to that of the UK; and the language barriers are really not an issue.

Juliet Stevens

We undertook our electives in Tel Aviv at the Ichilov (Sourasky) Hospital in Tel Aviv.

Lizzie worked  with the Infectious Diseases team under the supervision of Professor Shapiro.  She spent most of her time on ward rounds and in clinical meetings.  The team were very friendly and conducted all of their clinical work in English while she was there, which made her experience much more worthwhile.

Owen worked with the Neurology team headed by Professor Giladi.  This was a large department which offered an excellent opportunity to see a broad range of conditions.  The grand rounds and journal clubs, which were run weekly, were particularly interesting.  There was a very “relaxed” atmosphere among the doctors on the ward and I was made to feel very welcome.

In addition to our time spent in the hospital and around Tel Aviv, we felt this was a brilliant opportunity as first time visitors, for us to explore Israel.  We visited Jerusalem, the Dead Sea, Nazareth, the Sea of Galilee, Haifa, Acre, Eilat and also made a short trip to Petra.  It was a wonderful experience and we are both very pleased we chose to do our elective in Israel.

Elizabeth Orrin and Owen Ingram
Final Year Medical Students – University College London

I arranged this myself through a private contact and was supervised for three weeks by a doctor who had trained in South Africa.  I sat with each of the four general practitioners, and their trainee, all of whom spoke good English and were very friendly.  This itself was interesting as each had a different background and attracted different kinds of patients.  They were all keen to teach, happy for me to ask questions and encouraging to examine patients.  They would call me if they had a particularly interesting patient, and I took part in assessment for referral to hospital. Before I went, I was concerned that my limited Hebrew would be a problem. I was amazed how much I picked up and although it was sometimes a bit limiting, the majority of the patients knew English, even if not as a first language. By the end of the elective, I could understand the flow of the consultations.  The only limitation was that the building was small and there were never any rooms free for me to see patients and then present them. I  would be happy to pass on details to anyone else who is considering an elective in General Practice in Netanya.

Rachel Baigel
Final Year Medical Student – University College London

I undertook my medical elective at The Alfred Hospital in Melbourne, Australia in the Diabetes and Endocrinology department. I attended clinics and MDT meetings as well as taking on responsibilities for patients on the wards. I became an integral member of the team and increased my knowledge in the area of diabetes and endocrinology. I also completed a research project whilst in the department looking into ‘Steroid-Induced diabetes’, the factors affecting it and the optimal treatment available.

Whilst in Melbourne I was in touch with the President of the Australasian Jewish Medical Federation (AJMF), Dr Wayne Lemish, and was able to attend some of their events including a photographic exhibition with the renowned photographer Emmanuel Santos. I was also in touch with the Jewish medical students and helped to facilitate a medical student social event, the first of its kind in Melbourne. Furthermore I helped establish a student led division of the AJMF, which has successfully recruited new members and will be hosting student events in the future.

I met many Jewish doctors and medical students during my time in Melbourne, made exciting new connections and formed new friendships. I would like to thank JMA(UK) for all their help and sponsorship for this elective.

Aliza Abeles
Final Year Medical Student – University College London

I spent my elective in autumn of 2008 at Hadassah, Ein Karem, Jerusalem for 6 weeks in the departments of Internal Medicine and Neurology. Both departments had a heavy and varied case load, and included HDU bays with intubated patients. I attended and contributed to lengthy and discursive ward rounds, and attended departmental meetings and journal clubs. I vastly improved my medical Hebrew and I compiled a dictionary of over 800 words intended for the JMA(UK) electives’ website. In Israel, medical students are taken seriously and are expected to be well read and so I learnt a lot of medicine as well as deepening my understanding of Israeli medical care.

Non-medical highlights of my elective included the mandate-period Rockefeller Antiquities Museum, a debate on the state of Israeli democracy launching a book by Shulamit Aloni, and an “Alternative Tourism Group” trip to Bethlehem, Dheisheh and Hebron.

Bernard Freudenthal
Final Year Medical Student – University College London

Throughout my time at medical school and previously, I have had an interest in the care of people with Intellectual and Developmental Disabilities. I have been able to explore this through an SSC with the paediatric neurodisability service at Ryegate Children’s Centre, Sheffield, through volunteering with Sense and Teddy Bear Hospital and through my part-time employment at Step Up Support currently. However, I wanted to use my elective period to fill a gap in my experience in the medical care of adults with Intellectual Disabilities (ID). Through contacts at the medical school and beyond, I was able to arrange an elective with the Intellectual Disability Psychiatry team at the Chaim Sheba Medical Center, Tel Aviv in Israel.

I aim to develop an understanding of healthcare in Israel and appreciate differences in their health and welfare system.

Israel’s National Health Insurance Law requires all citizens to register with one of the four Health Maintenance Organisations (HMOs), the largest of which is Clalit (כללית). I was able to see during my placement that Clalit serves a significant proportion of the underprivileged, including people with disabilities (Balicer, et al., 2011). As far as I witnessed, health funds seemed to fulfil the principles of “justice, equality and mutual assistance” (State of Israel: Ministry of Health, n.d.) upon which they were based. While they have their differences, both Israel and the UK have universal health coverage.

I will gain an overview of the care of people with intellectual disabilities, including psychological aspects, physical aspects and social care.

While describing in depth the health policy and welfare systems in place for people with ID in Israel may be instructive for the reader, I have the advantage of being able to refer to authors I met in the country for this information (Halperin, et al., 2005). I have gained a good understanding of health service commissioning in Israel for people with ID through discussions with two of the authors of the above, as well as with professionals I met on placement and during the interview stage of my research project.

I have been able to see many aspects of care for people with ID. I have met doctors, nurses, psychologists, behavioural therapists, speech and language therapists, teachers and researchers. However, time constraints did not allow me to visit other specialist services, such as a dental service specifically for people with ID. More planning of activities before my arrival to Israel would have allowed me to organise this more effectively, although my time was more than filled adequately.

My experience of psychiatry will be enhanced, with particular emphasis on the impact of culture on mental health diagnoses.

The Bnei Brak clinic is specifically for the Jewish Orthodox population. However, in all of the clinics I was in I was able to see how culture influenced the relationship between doctor and patient, the acceptance of treatment and the role of the family in the process.

In terms of differences in psychiatric care in Israel, there is one issue which stood out for me. I saw that challenging behaviour was not an uncommon indication for prescribing antipsychotic medication. This is not an indication I have seen here in the UK, and I need to do further research to find if it is common practice. As a result of my hands-on experience, I am inclined to promote non-medical management for challenging behaviours, and I am not convinced of the ethics of this method of ‘chemical restraint’ when experience has shown me how behaviours are usually a response to the environment.

I hope to work on an audit or research project during my time in Tel Aviv.

The title of my research project was: ‘Stakeholder perceptions of guardianship and supported decision making for people with intellectual disabilities in Israel.’

Recent research has promoted the use of supported decision making, in contrast to historical methods of substitute decision making when working with people with intellectual disabilities. In Israel, people with disabilities are protected by the Legal Capacity and Guardianship Law of 1962, which was amended in 2016. This research considers how these recent changes are perceived by professionals in Israel.

Professionals with experience in policy making, law, social work and with direct experience working with people with intellectual disabilities (ID) were interviewed using semi-structured interviews and one focus group. Interviews were recorded and subsequently coded and analysed qualitatively.

Two major themes were identified. These were: The Law and its Phrasing, and Changing Culture. Findings highlight the process of change within guardianship law and practice and the challenges in implementation encountered so far and anticipated in the future.

Results from this study support those that have been found in previous studies from other parts of the world. More evidence is required to identify the most effective way to manage capacity and guardianship issues for people with ID.

My project is now complete, and we are in the process of submitting the final report for publication.

I will learn some basic Hebrew and discover the culture of Israel.

I had hoped to find a class (Ulpan) to be learn some Hebrew while in Israel, but this was not possible for various reasons. This is another part of the trip which would have benefitted from more preparation. However, after some time in the country I was able to understand much more of the language.

During consultations I was surprised how much I could understand from expression and the little I had picked up of the language. I was also able to assess the majority of a mental state examination through only observation, and I certainly feel more competent with this.

My choice of Israel was a surprise to many of the people I met there, as I am not particularly religious. I was raised Catholic, and Israel is predominantly a Jewish state. However, the country held an interest for me as a place steeped in history and political controversy. Security threats were a minor concern: I reasoned that in light of recent attacks throughout the rest of the world, the danger for me in Israel was not much more than my colleagues in other parts of the world if I followed government advice. Whilst in Tel Aviv, I was surprised and comforted by the level of security displayed. My bag was searched at hospitals, bus stations, supermarkets and train stations and on some occasions I was asked to show my passport. On further reflection, I can see that while this increased security was a new phenomenon for me, the experience may have been less unpleasant as suspicion towards me as a white British female is relatively low.

On my first day at Sheba Medical Center, I met with Joav Merrick who explained much of the information contained in the referenced article on health policy (Halperin, et al., 2005), as well as directing me to spend time with many of his colleagues. One of these was Mohammed Morad, another of the authors, who welcomed me with true Middle Eastern generosity into his town of Beer Sheva a few weeks later.

In one morning at his clinic, I encountered a traditional Jewish Israeli man, an orthodox Jewish lady, a Russian lady and an Ethiopian man. I understood that the clinic and its branches also serve the Bedouin community in the area. It is an incredible example of Jewish and Muslim living harmoniously: the doctor I met with was Muslim, his partner at the centre was Jewish. They talked to me for a long time about how they formed a group years ago to highlight the importance of doctors acting ethically and not be influenced by race, religion, politics or any other factor. In my position as a privileged and open-minded person, I have never considered allowing those things to alter the care I provide. However, it was clear that driven by propaganda, fear sets communities in this continent apart. As educated professionals, I hope, as they do, that we can set an example around the world of how to transcend these differences.

My interest in the care of adults and children with Intellectual and Developmental Disabilities has not changed as a result of this trip. I am still passionate about this population. However, what I have found is that my career interests lie primarily in the diagnosis of children with developmental disability, and the behaviours they present with. As I am approaching foundation programme applications, I will be considering training pathways in more detail.

I am also finalising my research report and I am in constant contact with my supervisors to continue progress towards publication. I hope to do more research in this area.

I have been able to network abroad and attend conferences. I plan to attend the next conference at Beit Issie Shapeiro and I am looking at further conferences closer to home.

Rebecca Davies

Topic: “Immunisation – a Jewish question? Problems and Solutions?”

Date: Monday 8^th May 2017

Venue:

19:00 Buffet Reception G02 Roberts Building Foyer, UCL, London WC1E6BT (entrance from Malet Place) 

19:45 Panel Discussion G08 Roberts Building, Sir David Davies Lecture Theatre, UCL, London WC1E6BT 

There has been considerable recent publicity about the decline in uptake of the MMR vaccine – and of other immunisations – in the strictly observant London Jewish community.

Several Association members have been involved in this debate; and, at their request, in late 2016 representations were made to the public health authorities about the best way to tackle the problem.

Six months later we are told that progress has been made, and this discussion meeting will provide an opportunity to hear about it, ask questions, and draw lessons for the future.

The topic will be introduced by Dr Tammy Rothenberg (Paediatrician at the Homerton Hospital). She will be followed by Ms Laura Sharpe (Chief Executive of the City and Hackney GP Confederation) who will update on the current situation and on new plans. Rabbi Avraham Pinter, (Chair of the Charedi Jewish Community Health Forum), Dr Joseph Spitzer (a local General Practitioner), and Dr Jonathan Cohen (UCLH Paediatrician, involved particularly in handling infectious diseases) will participate. A visiting Nigerian Public Health Physician, Dr Rilwan Raji (who trained at the Hebrew University School of Public Health, sponsored by the Pears Foundation) will comment on how he handles health promotion questions such as this, albeit in a different context. After questions and answers from the floor, Dr Fiona Sim (Past Association President, and past Chair, Royal Society of Public Health) has agreed to summarise and suggest possible future directions.

Please notify the Association Administrator as soon as possible (e-mail: info@jewishmedicalassociationuk.org) whether or not you will be able to attend.

 

The annual dinner took place on Tuesday 23rd March 2017 at St John’s Wood Synagogue Hall, 37-41 Grove End Rd. Lord Turnberg was the main speaker at this event.

The dinner was chaired by the London President, Miss Jo Franks, who introduced the speakers and who succeeded skillfully in making sure that the proceedings ran smoothly.

Over 150 doctors and medical students were present.

At the start of the evening a minute of silence was observed for those killed the previous day on Westminster Bridge and outside the Houses of Parliament. It was noted that Lord Turnberg had been in Parliament at the time and had not been allowed to leave; and that Dr Sebastian Vandermolen (a junior doctor present at the dinner) had been one of the St Thomas’s doctors who had gone on to the bridge to tend to the injured.

The loyal toasts were proposed by medical student leaders Jessica Franklin and Avi Korman.

The toast to the Association was proposed by Dr Abigail Swerdlow, junior doctor trainee in psychiatry, who reflected on the activities during the past year..

In his response Prof Katz thanked her on behalf of the Association not only for her toast but also for her contribution to all aspects of junior doctor activities, including the dinner. He highlighted that several junior doctors had contributed to the Association’s programme, during the past year, citing Dr Noam Roth and Dr Adam Levine, who had participated in recent meetings, and Dr Brett Bernstein who had reported on the Anglo-Israel Cardiovascular Meeting. He commended the medical student elective reports which were included in the brochure, and reflected that the Association is the sum of its members.

In her introduction to the guest speaker Ms Franks reminded those present about Lord Turnberg’s contribution to British medicine, and congratulated him on his recent birthday for which a celebratory cake had been included in the desserts.

In his address Lord Turnberg outlined the main features of his recent studies about the Balfour Declaration, which will be published shortly. He noted that the origins of British support for Jewish settlement in today’s Israel dated back to well before the time of Balfour, as evidenced by Lord Shaftesbury’s campaign for the “restoration of the Holy Land to the Jews”. He summarized Balfour’s early career, how he had been influenced by Joseph Chamberlain, and how the role he played in 1917 had to be seen in parallel with the Sykes-Picot agreement which was at that time still secret. He emphasized that although the Balfour Declaration was an important document of principle, the real legal substance of British involvement in the Zionist endeavor emerged from the San Remo Conference in 1920.

Dr Michael Fertleman introduced his remarks by quoting from one of Lord Turnberg’s prescient reports: “We found a health service under pressure. Services across the whole spectrum of care, from those in the community and primary care to those in hospitals, were sorely stretched. Although the impact of these pressures was most keenly felt in the care of elderly people and those with mental illness, others were not immune from the failures to meet an acceptable standard of service . . .Furthermore, there is evidence to suggest that the pressures are increasing.” Dr Fertleman noted that this item was reported in Parliament in 1999, and that by a quirk of fate the next speaker was a Dr Tonge….He concluded that all present were grateful not only for Lord Turnberg’s talk but also for his eloquent and passionate commitment to Israel.

 

 

 

 

 

 

 

Shaare Zedek Hospital is located next to Har Herzl in southwest Jerusalem and is the fastest-growing hospital in the capital. The hospital has 1000 beds and treats over 600,000 patients a year in over 30 inpatient departments and 70 outpatient clinics. In 2014, over 22,000 babies were born in Shaare Zedek, more than any other hospital in the Western World (1).

I spent three weeks in the Department of Oncology at Shaare Zedek, with the generous support of the Jewish Medical Association. There is a friendly electives coordinator who helped me arrange the elective. My objectives were to gain a deeper understanding of the diagnosis and management of the malignancies; to learn how these conditions affect the lives of patients of different cultures; and to practise speaking to staff and patients in Hebrew and improve my vocabulary.

My time was split between the oncology ward, outpatient clinics and departmental meetings. On the ward, there were weekly ward rounds with Dr Amiel Segal, the Director of Inpatient Oncology, and also Prof Nathan Cherny, head of palliative care. I was included in the ward rounds and doctors went out of their way to explain what was going on and to ask me questions. I used the ward rounds to learn as much Hebrew as possible, and found the medical Hebrew surprisingly easy to pick up. The ward staff were very friendly and I was constantly fed coffee and cakes by the head nurse!

The outpatient clinics were an opportunity to learn about the diagnosis and management of the common cancers, mostly breast, bowel and lung. I spent time with five different consultants, each with a unique approach, and learnt a lot about communicating difficult news and patient-centred management plans. I also had the chance to take my first ever history in Hebrew, and with some difficulty I succeeded in gathering a full history of a patient recovering from a colonic resection due to cancer. I was also encouraged by one consultant to read a paper from the Israeli medical journal Harefuah, and so I spent the next week reading my first Hebrew paper, on the treatment of bowel cancer with peritoneal metastases with cytoreductive therapy combined with intraperitoneal hyperthermic chemotherapy. These experiences gave me a lot more confidence in communicating and learning in Hebrew and using every patient encounter as a linguistic as well as medical learning experience.

There was a wide variety of departmental meetings that I had the option of attending. For my first few days the doctors were kind enough to speak in English for my benefit! Every Thursday morning at 8am there was a kosher breakfast with presentations about the latest clinical research in oncology and how it might affect practice. There was also a weekly gynae-oncology meeting, a breast cancer meeting, radiology meeting and nuclear medicine meeting, which involved the review of PET scans. The weekly ward meeting included very interesting discussions and debates about the management of difficult cases, for example a lung tumour which histologically was identified as a squamous cell carcinoma but also had a component of adenocarcinoma.

Yom Hazikaron was a special day with a ceremony outside the hospital led by Professor Halevi, director of the hospital. This was attended by many staff and patients and particular attention was given to those soldiers who died while fulfilling medical duties.

I am very grateful to the Jewish Medical Association for their generous support of my elective.

Reference:

1. http://www.szmc.org.il/About/2012Statistics/tabid/1448/Default.aspx

Eitan Mirvis
Imperial College School of Medicine

As part of my elective I spent just over three weeks in the busy anaesthetics department of New Somerset Hospital, a public hospital based in the picturesque Waterfront area of Cape Town. I had a number of objectives, which included getting hands-on with all the different aspects of the anaesthetics role, and gaining an insight into the different lifestyles and healthcare needs of the diverse population and, in particular, of the Jewish community.

The elective more than lived up to my expectations. The whole team, from the doctors to the nurses to the porters, were all extremely friendly and welcoming and I got to know them quite well during my time there. My days started at 7.30am and tended to finish at around 6pm. From day one, I was allowed to get involved with the entire care of the patients. This started with meeting the patients, getting to know them a bit, performing a thorough anaesthetics assessment, explaining the anaesthetic and reassuring the patient. This was a very rewarding and educational part of my role. I was then allowed to manage the patient’s airway and perform a variety of practical procedures. These included some more routine things such as intravenous cannulation and also some more difficult procedures such as endotracheal intubations and LMA insertions, depending on the operation and patient. This was an amazing experience as I am considering a career in anaesthetics but had never had the opportunity to perform these procedures. It was such a thrill to learn these new skills and every procedure on every patient was very rewarding, as was helping to wake the patients up and ensure their post-operative care was optimal.

During my time in the operating theatre, I learned a lot about how the anaesthetic machine works and essentially how to give an anaesthetic from beginning to end. The staff  were often keen to teach and I learned a great deal of physiology and pharmacology as well. I spent quite a lot of my time in the Obstetric Theatre and was lucky enough to learn a lot more about obstetric anaesthesia in addition to performing the spinal anaesthetics.

Although the hospital did not have a formal outreach service, the anaesthetists would go and assess sick patients on the ward, particularly those who were post-op or who were being considered for an operation. I went with, and helped, in the assessments and treatment and found this a very useful and rewarding part of the elective. This really gave me the confidence in assessing and treating the critically ill patient, which will help me in my role as an FY1 next year.

In addition to getting a very hands-on experience of anaesthetics, I was also able to see a lot of conditions and scenarios that I had not seen in the UK. These included end-stage AIDS patients, systemic TB infections, trauma such as stabbed hearts and much more.

My day started and ended with attending daily services in the Sea Point area of Cape Town, which, in addition to staying there over Shabbat, allowed me to get to know the Jewish community of Cape Town. I met doctors, medical students, dentists and a few teenagers considering a career in medicine and enjoyed interacting with them and getting to know them. I was also able to see quite a bit of Cape Town and beyond, which is truly a beautiful city, with so much diversity. Thanks to the grant from the Association, in addition to being able to get to Cape Town, I was able to see and do a lot more and really felt that I got a flavour of what life is like for the Jewish community of Cape Town and for all the diverse population of Cape Town, from a healthcare perspective and what life in general is like.

Edgar Brodkin
UCL