For my elective I spent four weeks in the paediatric general surgery department of the Sourasky medical centre in Tel Aviv. The hospital is a large tertiary referral centre as well as a teaching hospital of Tel Aviv university. Paediatric surgery is split up into sub-‐specialty teams: Paediatric orthopaedics, plastics, urology, neurosurgery and general surgery, which are independent departments.
Every morning I joined the departmental handover meeting, followed by the ward round. Elective theatres took place on 3 days of the week, and emergency theatre as needed. I usually went to theatre when my department had a list. Towards the end of my attachment I usually was scrubbed to assist in small cases and was allowed to close the skin if it needed suturing. I usually observed the larger cases and any laparoscopic surgery. When there was no theatre, I joined clinic or went to the A&E department to see patients that had been referred to our team. When theatre or clinic was finished I was given the choice to stay on the ward or go explore Tel Aviv. Wednesday mornings were reserved for journal club. I contributed by presenting a paper describing a new approach to treating pilonidal sinuses.
My department consisted of three doctors in training, three senior specialist doctors and the chief of department. All doctors were very welcoming and translated, explained what was happening and answered all my questions, even if their English was not entirely fluent.
The working language of the department is Hebrew, even though most doctors were able to speak Russian or Arabic as well. I tried to learn some basic Hebrew prior to my attachment and picked up surprisingly much throughout my time in the department. Of course this was not sufficient to be able to understand conversations within the team, with patients and also patient notes. This certainly limited me in my understanding of handover, in clinic or on ward rounds. However I was surprised that I usually had a rough idea of what was going on. Many medical words are the same or similar to English, and I could understand the non-‐verbal communication (e.g. pointing of the patient) or was able to pick out the Hebrew words I did know. Fortunately the doctors filled the gap in my understanding by summarizing the discussion or case afterwards. I knew that I would be facing a language barrier previous to starting my elective, so I expected to struggle to understand. This meant that I was neither surprised nor frustrated by the limitation. Quite on the contrary, it was a very rewarding experience as I have never previously been so immersed in a foreign culture and language and I was impressed by the speed I managed to pick up new words.
There are a lot of paediatric surgery departments in Israel and there is no system of centralizing care to specialist centres as there is in the UK: rare and complicated conditions are not collected in one hospital but are treated in the local hospital. This meant that during my time in the department I saw many short and common surgical cases such as hernias, undescended testis, line insertions and biopsies. I also learned about Hirsprung’s disease and saw all steps of management: I observed the biopsy to diagnose it, rectal irrigation, surgery and the patient follow up post-‐OP. Amongst the larger surgical cases I observed bowel resections and there was a patient on the ward with a complicated recovery after a tracheo-‐oesophageal fistula.
Tel Aviv is one of the most vibrant, cool, young and diverse cities I’ve come across. There is a very good restaurant and food scene, interesting museums and cultural opportunities and of course the beach! It is certainly a city I could easily spend more time in. There are also some other electives students in the hospital, and the doctors have a very international background too, which led to new friendships and stories from medical school and medicine in different countries.
I thoroughly enjoyed my time in the paediatric surgery department and could not have wished for a better elective! The Sourasky medical centre would be an excellent option for doing a fellowship later in my career. I would like to thank the Jewish Medical Association for their support.
Logistics:
To organise my placement I applied via the online electives portal of Tel Aviv University. The exchange office staff were very friendly and quick to respond. Thus I managed to arrange a placement despite applying much later than the recommended timeframe. University fees for electives are 50 Euros per week. The hospital provided me with scrubs and white coats and there is a staff canteen with amazing and very affordable lunch. I did not live in hospital accommodation but stayed with friends who lived close to the hospital. Hospital accommodation can be quite far away however there are a lot of flat-‐share opportunities in Tel Aviv so it should be easy to find a room (my recommendation). My friends and family were concerned about my safety, but it is likely to be more safe walking the street by myself at night in Tel Aviv than in London.
Julia Zimmermann
Imperial College London