Category: Uncategorised

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

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.