A global health summer program at MSIH
by Ioana Scherbakova, first year Columbia University College of Physicians and Surgeons student
I couldn’t have asked for a better or more rewarding summer than the one I experienced in Israel through the Global Health Summer Program at Ben Gurion University. I spent a total of 5 weeks in Israel, from June 24 to July 31 of 2017, and completed two rotations in which I shadowed physicians and learned about the Israeli health care system. My trip began at a pediatrics clinic in a small Bedouin town in the Negev desert called Tel Sheva. Tel Sheva can be tricky to find on a map, and is serviced by only one municipal bus from Be’er Sheva, the dusty #10. On the way to Tel Sheva each morning, I gazed out of the #10’s windows as we passed dry fields of grazing camels, Arabic posters, watermelon stands and clusters of squat homes. The clinic was a cool sanctuary from the summer heat and always seemed more lively than Tel Sheva’s small streets as parents and squealing, crying, giggling kids filled the waiting areas each morning. This was the only pediatrics clinic in town, and the nurses and physicians were constantly fielding questions, examining patients, taking blood samples, answering calls, reading through medical records and writing chart notes. As a student who does not speak Arabic or Hebrew, my ability to interact with patients was limited, but Dr. Eldan was careful to give me an outline of every case and to let me play with the patients and practice clinical skills like auscultation and examining throats and ears. Since all of the patients were Bedouin and almost all of the physicians and nurses were Jewish Israelis, there were often language and cultural gaps between the patients are caregivers that reminded me of health care in New York, where interpreters are frequently needed and the importance of cultural awareness and sensitivity in medicine cannot be overstated. When I went back to Be’er Sheva in the afternoons, I could read a bit about the conditions I’d seen during the day: tonsillitis, otitis media, strep infections, congenital CMV, impetigo, vitamin D-resistant rickets, hand-foot-and-mouth disease, torticollis, brucellosis, and so on. It was a real treat to be taken under Dr. Eldan’s wing and to spend each day for a couple of weeks in a Bedouin town, among children and parents, seeing how both similar and different health care is in such wildly opposite settings as New York City and Tel Sheva.
After a one-week break in which I visited Jerusalem, I traveled to the southern tip of Israel for my next and final rotation at the Emergency Department of Yoseftal Hospital in Eilat. Eilat is a resort town on the Red Sea and a popular destination for beach-goers and scuba divers—while I was there, every day was astoundingly sunny and the temperature usually hovered around 110°F. The ER, however, was a world unto itself, with Dr. Koby Arad as its energetic head and a team of intelligent, efficient and high-spirited residents and interns bustling around him. Dr. Arad deeply enjoys teaching and there were three other students, both foreign and Israeli, who were also on summer rotations at Yoseftal. Every morning at 8, we gathered for rounds and visited each patient who was in the ER, talking through their case in English so that the other students and myself could follow along and chime in when Dr. Arad questioned us about mechanisms of illnesses or treatment options. Many of the patients who visited the ER were seasonal workers with construction or restaurant-related injuries, or tourists who had suffered beach-related accidents (fish bites, dehydration, gastroenteritis, cuts that needed to be stitched). After the rounds, we feasted on an amazing breakfast prepared by one of the hospital’s volunteers, and settled into the conference room for the morning report. Once again, Dr. Arad seized the opportunity to quiz us students, and helped us think through cases logically and systematically as we learned about different ER patients and how their courses of treatment had progressed. The rest of the day was spent back in the ER, darting between patient’s rooms with the residents to see what they were doing and occasionally helping to set a cast or interpret for foreign patients (as I got to do a couple times for Romanian and Spanish-speaking patients) or, when there was down-time, looking through EKGs or X-rays and talking about the different features we noticed. At Yoseftal, I was always surrounded by patients, other students, and physicians who were eager to talk to and teach all of us. I appreciated being able to get a sense of the ER’s rhythm, since we won’t have an emergency rotation as part of our foundational clinical training at P&S. Furthermore, I’m grateful to Dr. Arad for the time and effort he generously put into reviewing concepts with us, teaching us about different organ systems and diseases, and emphasizing systematic thought in clinical problem-solving. It was wonderful also to get an inside peek at how Israel’s health care system works, with health insurance guaranteed for all citizens and foreign workers, provided through different companies and administered quite efficiently at hospitals and clinics with in-house pharmacies and excellent electronic health record software. And, of course, there were the nations of Israel and Palestine, and their people, who made this summer program a rich and wonderful experience that I will not forget.