On the 10th of February 2013, after completing my final year examinations at Oxford University, I left England on my medical elective. I had three main aims for this period :1) To broaden my insight into global medicine and the cultural factors involved in this, 2) To experience how health care is delivered in places other than the UK, 3) To both use and build upon my clinical knowledge from medical school.

I began my elective with five weeks in Israel, where I had arranged through the Ben Gurion Medical School in Beer Sheva to spend some time initially in Tel Aviv experiencing the Refugee Clinics, and then in Eilat in the Emergency Department.

The Tel Aviv Refugee Clinic was based in Jaffa, run by the Physicians for Human Rights (PHR) organisation. This clinic, served by volunteer doctors and other staff, aims to provide health care to anyone without the means to receive it in Israel. This includes migrants, asylum seekers or anyone whose legal status is as yet undetermined. What was evident from the start of my time at PHR was the huge range of cultural and religious backgrounds that attended the clinic. On my first day alone we were presented with patients from Somalia, Nigeria, Eritrea, North America, Argentina, and Palestine, offering a huge range of languages, and backgrounds. Despite very few consultations being held in the patient’s or the physician’s first language, the staff at PHR amazed me with their huge range of language abilities, allowing consultations to occur despite this. I spent time with a range of doctors and nurses each day, from the triage nurses, to specialist psychiatrists and surgeons, providing huge variety in aspects of clinical care. For example, one patient I saw with the family doctor regarding a chest infection, I then saw later with the psychiatrist for post traumatic stress disorder which was related to his seeking of asylum in Israel.

A highlight of my time in Tel Aviv was an evening spent with the mobile sexually transmitted diseases (STD) clinic, the Lewinski Clinic, which is based in the Tel Aviv new central bus. The mobile service is a relatively new project, set up to serve high risk populations that were at less likely to seek medical help. This particularly includes refugees, sex workers, drug users, and those living in more deprived areas of the city. The clinic really opened my eyes to the depths of Tel Aviv as we visited the brothels and overcrowded apartments serving as centres for groups of refugees. They provided information, advice, contact points and also confidential STD testing to anyone wanting it. Most of the places we visited knew the clinic staff and welcomed them in, a relationship which has taken the staff a long time to establish, and I was grateful to be able to be a part of this.

My experience in Tel Aviv was a huge contrast to the medicine I am used to in England. Even more so than the medicine itself, my learning focused on the backgrounds of some of the refugees, the cultural diversity present within these communities and the medical and social problems that are associated with this. From taking patient histories it was evident that many of the patients had made huge journeys and been placed in diverse undesirable situations along the way to reach Israel and seek asylum. These were situations which I had never experienced before in medicine, and highlighted the specific social needs of these patients along with the medical needs we all have. The volunteer doctors were fantastic at providing both social support and medical care to the patients that really needed it after arriving from often awful situations to a completely new and unknown place to them.

My Tel Aviv placement was supervised by Professor Alkan who was fantastic both at teaching in the clinic, and also as a host. He educated me into the history of Israel, its politics and populations as well as providing stimulating medical cases. I also got to meet some of the medical students in Israel, and it was great to compare our experiences of medical school and to make some new friends.

As well as my work within the clinics, I had some time to explore Israel itself. Having never been there before, this was something I was looking forward to doing very much. I made a day trip to Jerusalem which offered so many wonders to see, with the Old City showing an unbelievable mixture of religious backgrounds working together. Having a keen interest in cooking, I found Israel to be full of culinary delights. I very much enjoyed going to the buzzing Carmel Market in Tel Aviv, and having Shabbat dinner with Professor Alkan’s family, as well as tyring the delicious local street food such as falafel, baba ganouch and sabich. A highlight also was the festival of Purim whilst I as in Tel Aviv. During this weekend the whole city was alive with music, dancing, and happiness, with people dressed in every imaginable costume: it really was an occasion to remember.

For the second half of my time in Israel, I worked in the emergency department of Joseftal hospital, Eilat along with three other students from Ben Gurion University. With just 65 beds, this is the smallest and southernmost hospital in Israel, and serves a vast area including most of the Negev Desert. The emergency department is run by Dr Arad who, along with his team, was extremely welcoming and a fantastic teacher. At 8 am each morning the day would begin with a roundup of the patients from the day before and any new admissions. Dr Arad would focus on the conditions which came up and use these as the starting point for teaching sessions within the meeting. This was great as it meant we covered a wide variety of emergency medicine topics, constantly testing our knowledge and learning new things. I would then spend the day clerking patients – if they we able to speak English or using my limited French – and improving my practical skills of suturing, plastering, chest drain insertion and lumbar punctures, many of which I had not had the chance to do before. Being one of the closest emergency centres to the Red Sea, the hospital has a special interest in hyperbaric medicine, having a decompression chamber onsite. This was a completely new and interesting experience in medicine for me, and despite not seeing any patients with diving related problems, I gained excellent knowledge on the methods used in this area of medicine.

The population attending Joseftal hospital was a big contrast to those in the Refugee Clinics I had experienced in Tel Aviv. There were very few immigrants, with the largest population consisting of local people, closely seconded by tourists. The hospital covers a vast area, with no other emergency department for 240km, and so many patients had travelled a long way to be seen. Any emergencies that could not be managed in this small hospital were transferred to Soroka Hospital in Beer Sheva either via ambulance or helicopter. Joseftal hospital itself was undergoing renovations whilst I was there, expanding the emergency department and modernising the equipment, which will be of huge benefit in the future as often space was limited, and I imagine this is even more of a problem during the peak summer season.

Eilat was an incredible place to spend a few weeks, getting excellent medical teaching accompanied by great weather despite it being Israeli ‘winter’, and a beautiful coast line to explore after a day at work. The other students and I stayed in a flat owned by the hospital which was within walking distance, and despite being fairly basic with minimal cooking facilities, was adequate for the small amount of time we spent there each day. We ate lunch every day at the hospital, which provided a fantastic spread of unlimited hot options, soups and salads for just one shekel (around 18p!) which kept us going for the rest of the day. Along with the other students and doctors, I snorkelled in Coral Bay, hiked in the desert, and even had a weekend trip to Petra in Jordan. I would thoroughly recommend this placement to anyone interested in Emergency Medicine as Dr Arad is an exceptional teacher, and the small department makes it a very friendly and welcoming environment to work in with many opportunities for developing practical skills.

Overall my experience of medicine in Israel was absolutely fantastic and one I would recommend to anyone. Splitting my time in two locations provided huge variety in the populations and the medical problems as well as allowing me to see a larger area of the country. I feel I met all of my initial aims of experiencing global medicine, foreign health care and practicing and improving my clinical skills, with the practical skills particularly being highlighted during my time in the Emergency Department in Eilat. I also feel I exceeded these initial aims, gaining a far better understanding of refugees in general as well as their medical problems, cultural diversity within medicine, the history and politics of Israel and Jewish culture, and aspects of medicine I did not expect to encounter such as hyperbaric medicine. I made friends and contacts both of other medical students in Israel, and doctors, that I hope to keep in touch with for many years to come, and who helped to make this experience so memorable.

I would like to thank the Jewish Medical Association (UK) for making this learning experience possible for me. Not only has it been medically stimulating, improving me as a doctor in the future, but it has also opened my eyes to a fantastic country I previously knew very little about. I cannot speak highly enough of my time in Israel, and I am very much looking forward to going back to this wonderful country, hopefully to experience more medicine there in the future.

Victoria Ormerod
Oxford University