medicine – Page 3 – ToewsTravels

another day in the northern west bank

one day during march a big group of my medical school colleagues took a self-planned day trip in a bus up to the northern west bank cities of qalqilya and nablus. great to see these kids wanting to see life from the other side. we were joined by some medical professionals from the u.s. first stop was qalqilya, a palestinian city which is 95% surrounded by israel’s separation barrier. there is just one road in. major problems from a public health perspective, as the surrounding townsfolk now need to travel hours to get to the clinic or hospital, trips that used to take them 5 minutes. sometimes the one entrance to qalqilya is shut completely by the israelis for hours or even days at a time. we visited the only united nations relief and works agency (unrwa) hospital in the west bank, where the director of the hospital welcomed us with the customary long-winded speech and selection of sweets, and gave us a tour of the facilities. unrwa provides free healthcare to palestinians, provided they can get to the facilities, which often is the insurmountable obstacle. generally speaking, the challenge for healthcare in palestine is that it is disjointedly provided by a slew of intergovernmental and non-governmental organizations that do not integrate particularly well with each other. that and the barriers to access created by restriction of movement. qalqilya is host to palestine’s only zoo, a profoundly sad place. during the second intifada in the early 2000s the animals were starving to death despite the best efforts of the committed zookeeper. one day a grenade exploded and startled the zoo’s giraffe, who subsequently hit its head on a metal beam and died. the zookeeper became a taxidermist out of necessity, and today one can see the stuffed animals whichwere alive in better days gone by. vice news did a piece on these stuffed zoo animals.

next we headed east to nablus. unbeknownst to anyone on the bus, our tour guide had lined up another host, a palestinian liberation organization (plo) guy who had spent much of his life in israeli prisons. upon arrival in nablus we picked him up and were taken to the top floor of city hall, where we had a red carpet meeting with the mayor, who is also on the plo’s executive committee. he waxed poetically on the need for equality as well as peace, commenting and answering questions on current peace negotiations, while triple-life sized portraits of arafat and abbas looked down on us and the city of nablus spread below us. after all the unplanned formalities, we finally got the chance to wander around the streets of nablus, sampling its specialty desert kunafa, and peering into its secluded ancient courtyards and hammams.

family medicine – in circassia!

i did my six week family medicine clerkship with five good friends in galilee, northern israel. we lived in an apartment on the ha-emek hospital compound in the town of afula in central galilee, and each of us took buses each day to different places to work with different primary care physicians. afula is the largest town in israel’s jezreel valley, and is just down the road from megiddo, posited by some as the place where the world will end. it is also in the shadow of mount tabor, believed to be the site of Christ’s tranfiguration. i got really lucky, as i was placed with a friendly doctor who loved to teach in a very unique town called kfar kama, one of just two circassian towns in israel. the circassians are an ethnicity who originated in the north caucasus — what is now russia around the area of sochi. coincidentally the winter olympics occurred in sochi during the time i was working in kfar kama. these people lost the circassian war to russia in the 1700s, and some small numbers were resettled by the ottoman empire in what is now northern israel. they were warriors back in their homeland, but settled into an agricultural lifestyle in the middle east. they have held on to their religion, sunni islam, and retained their unique culture and language, called adyghe. they also speak hebrew, arabic, and more english than average, which was another reason i was happy to be there. there are only about 4000 circassians in israel, split between two towns. they marry only other circassians. the men serve in the israeli military at the will of their elders; women cover their heads, wear ornate dresses and basically control the place. the women are seriously empowered, and many are highly educated. the teenagers still get acne and the elderly still get hypertension.

circassian society is rather insular, so being in a family medicine clinic provided a remarkable glimpse into their culture which otherwise might never have been possible. there is only one clinic in the town, and just two physicians, each of whom has been working with the community for years and knows everyone in town. on one occasion we learned that an elderly man had unfortunately passed away, so we left the clinic and walked down to his house, which is an unspoken obligation of the clinic staff. half the town was sitting in the home mourning, men in one room and women in another; kids playing outside. the mourning period lasts for three days. they passed around cookies and strong coffee and i was the only one who took any. oops.

my preceptor also staffed another clinic in a small moshav, which is similar to a kibbutz (both are small, communal zionist agricultural communities. kibbutzim are completely communal – i.e. truly communist, while in a moshav each family takes care of their own finances). the moshav was called ha’zorim, and was in a valley just southwest of tiberias. it was started by holocaust survivors, a group which still make up the majority of its population. we would typically go there later in the evening for a couple hours, and a really nice nurse would prepare biscuits and hot tea without fail. i’d do blood draws while the family doc caught up on local gossip in the vernacular.

one evening we rented a car for my friend mayuri’s birthday, and drove up a mount carmel overlooking haifa, where there is a string of druze towns. the druze are an insular pseudo-islamic ethnicity and religion. we got countless plates of salad and wandered the freezing streets. it actually gets quite cold in corners of the middle east during the right time of year. another evening we took the bus up another big hill in the other direction to the arab city of nazareth, where we ate at the oldest and most expensive restaurant in town, and sampled some coffee which has been constantly brewing for the last 70 years! we then realized that we’d missed the last bus back, so spent half the night in the only establishment that was open – a dry shisha-sports-bar, trying to figure out how to get home on our budget. family medicine – fewer dull moments than you’d expect!

neurology… in suburbia, tel aviv

my neurology clerkship was at assaf harofe hospital, in the south tel aviv suburb of zeriffin. five of us got to commute every day from beer sheva, and it was a long one. one hour on a train each way, along with a 30 minute taxi ride with an angry chain smoker that usually had to be waited for. oh well, it was just two weeks, and it was the only clerkship of the year that didn’t involve an exam at the end, so it was a nice change. there were israeli students from tel aviv university who were there with us as well so that was fun. the hospital compound was a former british military base. it is a huge campus of a hospital. and the cafeteria food was unparalleled!

a few days i made a detour through jerusalem part of my commute. even ran into some old friends there which was great!

one day as we were leaving the hospital someone yelled out that they had found an abandoned box at the bus stop, which everyone immediately suspected might be a bomb. very quickly the highway was shut down and a robot was called in, as is standard in israel. everyone stood back a couple hundred meters. a non-descriptly dressed guy drove up in an unmarked car and casually loaded the machine gun on top of the robot with ammunition. the robot then made its way over to the item of interest – probably just a package someone had forgotten at the bus stop. a protective cover unfolded over the suspicious item, and the robot shot it to hell. everyone cheered. nothing exploded. we then went on with our commute.

pediatrics …in haredi-land!

my pediatrics clerkship was amazing! four of us spent six weeks at mayenai hayeshua hospital in bnei brak, a suburb east of tel aviv that is populated completely by haredi jews, or the “ultra-orthodox.” bnei brak is one of the poorest and most densely populated cities in israel.

these are the old-school jews of your imagination, who wear black suits and hats and side curls and follow their rabbi’s suggestions to the letter. the haredi population is growing exponentially in israel, and it is a society that in many ways is at odds with the more secular jewish majority. for example, the vast majority of haredi men do not work, rather spending their days studying the torah (old testament) and praying in yeshivas (roughly the jewish equivalent of a seminary). the government subsidizes this life-long education, a significant drain on the national economy which is despised by many secular israelis. the government also financially subsidizes having children in israel, with each family receiving a monthly check for each child. thus, 10 – 15 or more children per family is the norm in bnei brak, in large part because having a large quantity of children is the only way most families can afford to subsist. many israelis are also frustrated that the haredi are not required to serve in the military as other israeli jews are – an issue so charged that it was essentially the storyline of the last israeli national election. many secular israelis stereotype the haredi as being stuck in the past, exemplified by recent high profile altercations such as a haredi man spitting on a teenage girl because he thought her skirt was too short and haredi bus lines that make women sit in the back of the bus. because the haredi population has become so large and is constantly increasing, their political parties have firmly entrenched themselves as kingmakers who “punch above their weight” in israel’s political system of proportional representation. that is why the subsidies continue, allowing for the continued expansion of a population whose lifestyle would not be viable without the financial support of the government.

anyway, for the most part these big societal issues weren’t relevant when we were taking care of the children. i love children so much! one day each week we were in the neonatal department. the hospital has 1200 births per month, the second busiest in israel after soroka hospital in beer sheva. in the cribs of the haredi babies, instead of cartoon animals or colorful shapes, there are pictures of frowning elderly rabbis. what a world to be born into! and what fun to do newborn baby checks! palpate, palpate… is that a testicle?… urine fountain! fun time! snuggle time when its over!

mayenai hayeshua is the only hospital in israel built specifically to serve the haredi population. there is a hospital rabbi who calls most of the shots. it is a kosher zone, no outside food may be brought unto the premises. this was especially fun during the first week of the clerkship when we were living in the hospital as they hadn’t found us an apartment yet. the hospital cafeteria is of course kosher, as is every hospital cafeteria in israel. this one though is also gender segregated – i wasn’t allowed to sit with my female classmates at lunch. we got to chat with the hospital rabbi and he was a really interesting guy. he is a lot more liberal than many other rabbis in the community on a lot of issues. i would have loved to discuss ethics with him for hours, at least before he started talking about jewish-arab relations. he spends a lot of his time convincing people to have procedures done that they are waiting for a rabbi’s permission for. a simple thing like draining an abscess is an ethical question that must be deferred to a rabbi for some people. some rabbis are wackjobs, recommending against lifesaving treatment. there is one rabbi that many consider the authority when it comes to medical issues. he promises to have a response to your question for free within 15 minutes, and is always available. he has considerable financial resources at his disposal, and has been known to fly people halfway around the world for organ transplants at his expense on the spur of the moment, which only adds to his mythical miracle-worker reputation.

if there is a man in the elevator when a women gets on, he often will turn and stand with his face in the corner. all of the women wear head coverings – wigs count. there are as many wig stores as there are bakeries. some sects in bnei brak speak yiddish. some of the children are so sheltered that they only speak yiddish – not even hebrew. that’s like growing up speaking exclusively latin in inner city america – a) how does that happen? and b) how is the child going to survive? no family has any chronic diseases – when you ask them that is. they actually have quite a few. but because marriages are arranged, no one wants to ever admit to any diseases in the family, as that may harm their children’s potential to get the best marriage match. nowadays genetic testing is done before marriage matches are made to minimize the prevalence of certain genetic diseases that had unfortunately become increasing common in certain jewish populations. this approach has worked quite well in decreasing the prevalence of these diseases!

our attending physician was excellent. she was from california and had a bit of a hippie vibe going on. we got to go to clinics out in the community a few days. we lived about a 45 minute bus ride away in the secular city of petach tikva, a world away from bnei brak. petach tikva is often considered israel’s most boring city. but i thought it was great – there was an epic shopping mall and an ethiopian disco-bar/restaurant that we visited on a regular basis. it was great being in the suburbs of a big city like tel aviv where it is possible to get around on shabbat (saturday). this isn’t possible in beer sheva. a few of us visited the tel aviv art museum one day – it was really impressive actually with some excellent photography exhibits and warhol, van gogh, picasso, etc. we patronized the local microbrewery, jems. it was freezing for a lot of the time. i mean it was literally below freezing, which never happens in tel aviv where heaters are unknown. most of the levant got snow – it even snowed in cairo for the first time in 100 something years!

my favorite were nights in the pediatric emergency department. after countless attempts, my first successful intravenous line insertion on a baby was a happy time! best clerkship ever!!

west bank mobile clinic

one saturday during my pediatrics clerkship i was able to go into the west bank on a mobile clinic day with physicians for human rights – israel (phr-i). phr-i is an ngo that sends volunteer israeli physicians to do clinics in the west bank, has a free clinic in tel aviv for migrants without healthcare coverage, and sends physicians to check on prisoners – especially palestinian political prisoners – in israeli prisons. their overall goal is to see the israeli occupation of the palestinian territories end, a goal which i wholeheartedly support. the reality is that human rights violations and unacceptable disparity in access to basic healthcare will always exist in palestine as long as there is a military occupation. many accuse the group of political action under the guise of medical assistance, but many others realize that the fight for basic human rights for all is far more important than which geopolitical side you happen to be supporting. the occupation is bad for palestinian’s health – therefore as physicians we have an obligation to try to end it, end of story. politics and human rights are not mutually exclusive in this part of the world. many of the volunteer physicians go to the clinics in the west bank not because the palestinians particularly need a free clinic, but out of solidarity. they feel that the occupation is a disgrace and is ruining people’s lives, and they want as many palestinians as possible to know that there are israelis who also want it to end. they want to see the palestinian’s faces, and they want palestinians to see their faces. they want to humanize the conflict. they want to do something.

i am picked up in downtown tel aviv on a rainy saturday morning by a spunky elderly woman driving a rusted out volkswagon golf. though she is not a healthcare professional, she volunteers every saturday at the clinic, which is in a different town in the west bank each week. promptly, the car stalls, and won’t start. she starts freaking out, and we try getting the car to start for about 45 minutes to no avail. i say a little prayer and the car starts! i’m not going to claim it was a miracle, but i have no doubt that God is happy that these clinics are happening. then, it was off to the border, where we meet up with a group of about 20 physicians and take a minibus into the west bank.

while i go to the palestinian controlled areas (area a) of the west bank all the time, it is technically illegal for israelis. when they do enter as groups, it is almost always under the “protection” of the army. of course, phr-i refuses such “protection” (it would likely never be provided in the first place), as it is precisely what they view as the problem. israelis in area a are well received without a military escort – having one would indeed likely make things more dangerous. it is interesting to chat with the physicians about what other israelis, including their own families, think of their volunteering in the west bank. one doctor goes to the clinics in defiance of his wife’s wishes. she also wants the occupation to end but is legitimately scared for his life. like almost all israelis, she has never been to area a. the doctor rants about the ignorance of most israelis who, if they think about the west bank at all, think of it as a hell-hole that the army needs to control. these are typical israelis in tel aviv, not the settlers. we don’t even need to talk about the settlers. we talk politics, and we agree. this is the first time i’ve ever agreed with an israeli about politics. we start talking about traveling, and i tell him about my trip to lebanon. i’ve never talked to an israeli about lebanon before. he loves it. he would love to go to lebanon if he could.

we go to the town of attil north of tulkarm. we arrive and the town mayor gives a big speech as the group of doctors from israel sit shivering, drinking cardamom-laced arabic coffee beneath a giant photo of yasser arafat. it is honestly beautiful. these two groups of people are supposed to hate each other. no israeli in their right mind likes yasser arafat. but when we choose to swallow our pride, the hate dissipates, and we find ourselves welcomed. hate is often for policies, not people. phr-i is welcomed with open arms by the leadership of every palestinian town they have ever gone to. i spend the day mostly looking into children’s ears with a pediatrician.

the executive director of phr-i, a bro named ran cohen, comes along to hang out at the clinic that day. really cool guy. big white-man afro. gives me numerous high fives. he is at the forefront – indeed phr-i is in many ways the vangaurd – of the “leftist” human rights movement in israel. you know there is something wrong with the perspective of most of society if the fact that you support human rights automatically makes you a “leftist.” the israeli knesset (parliament) is trying to pass a law that would ban ngo’s that are anti-nationalist. this is widely perceived to be an attack on ngo’s that oppose the occupation. ran cohen is the real patriot, fighting for what is right whatever the government legislates. remember, all these israeli physicians are breaking the law just by coming to these clinics in area a. i love it! i give him another high five, just because i can. he’s quoted in news publications all the time. his girlfriend is cool too. she directs documentaries.

at the checkpoint on the way out of the west bank, our minibus is stopped and the young israeli soldier asks the one muslim woman on the bus with a higab to step outside the bus for further questions. this woman is a speech pathologist who lives in israel and was translating for the physicians. racial profiling happens all the time, and one typically just begins to acquiesce to it. but not on this minibus. ran cohen announces that if they need to question the woman in the higab further, they’ll need to question all of us. we all get off the bus. ran has a good long talk with the soldier. it is inspiring to see israelis who care about these issues. in israel, these are my people.

internal medicine in ashkelon

this was our first clinical clerkship of the year. we did a large number of blood draws each morning. i spent some good time in the emergency department, especially toward the end when i made some orthopedic resident friends who took care of all the little lacerations. every day for ten weeks, four great ladies and i got to commute one hour each way from beer sheva to ashkelon in a school provided shuttle. every day we would drive by the erez crossing into gaza (and i’d wish i could go in), and through the town of sderot which is famous for being the town in israel always hit by hamas rockets (so it is where all the american politicians go for photo opportunities if they want to be known as the israel-loving type). ashkelon is also just a few kilometers from gaza, and barzilai hospital where we were at is having a new rocket-proof wing built. i guess evacuating the emergency department every five minutes during the gaza wars was hampering some people’s style.

thankfully, i found a bro in the hospital who offered me a room in his apartment for a few weeks so i didn’t have to commute as much. later i was able to sleep in a hospital provided room. evening runs along the beach followed by swims in the mediterranean sea were excellent, and ashkelon has a few remnants of its history as a philistine and later muslim city. overall though, nowadays ashkelon isn’t really considered a desirable place to live for many. it has a lower cost of living than many other cities in israel, so there are huge numbers of immigrants, especially from the former soviet union. indeed, all the elderly patients on our ward spoke russian, usually exclusively. at times it was difficult to find a patient on the ward who even spoke hebrew. interestingly – because any jew can move to israel and receive free health care from the state, there are stories of elderly russians who don’t even really want to be in israel moving here in their old age, after being diagnosed with a chronic disease, for example. not the majority of course, but it happens.

the highlight of the clerkship occurred one day in the gastroenterology suite. as the gastroenterologist was pulling the colonoscopy probe out of the patient’s anus, we heard a loud rumble and before we knew it a projectile splattering of moist diarrhea coated everything in the room. as we and gastroenterologist wiped it out of our eyes, we shared a good laugh. medicine is fun!

this year’s class video!

summer is for studying…

this summer was devoted to studying for the usmle step one board exam. 14 hours/day, every day for a little over six weeks. for focus’ sake, i felt the need to go back to the temperate climate, easy conveniences and loving parents in canada. my parents had recently moved to a new town in southern alberta. i studied at the local community college, where for most of the time, i was the only person there other than the security guards. i almost went insane, but am quite proud of myself for sticking it out. even when i was driving home from the college and running i was listening to audio pathology lectures. it was very nice to be at home with my parents even though the only time i was able to spend with them was a few minutes for dinner each night. special thanks to my mother for cooking and even doing my laundry for me so i could maximize time for studying! enjoying the conveniences of canada was also spendid, things like $6 footlongs at subway. go ahead and laugh, but see if you’re still laughing after trying to find yourself a satisfying meal in israel for $6. its impossible. and driving a car again- that was amazing!

southern alberta experienced the worst flooding in its history this summer. one day i joined some folks from our local church to do some serious sandbagging to attempt to save portions of the town. it was nice teamwork. we were even working alongside the canadian military who were sent to help with the effort! attending the church my parents go to there was a highlight of the summer. its an exciting place with lots of little kids running around and a pastor who one couldn’t help but respect even after just a couple weeks. the one and only church here in beer sheva – well, my comments are probably best left off the world wide web. lets just say that i love going to church when its the right kind of church. my family also flew down to tennessee for one day to attend my cousin’s wedding. it was a great time.

i’m glad the summer of studying is over. it is a right of passage of sorts for medical students, but not really my style. on the way back to israel i had an all day long layover in athens, greece, where i chillaxed on an amazing beach! now we’re spending our time in the wards of the hospital instead of listening to lectures – a nice change!

long weekend in america!

one weekend in march i was lucky enough to fly half way around the world to attend the amsa (american medical student’s association) annual convention in washington dc! big thanks to the amsa chapter at my school and to my university for almost all of the funding! flew there through both zurich and london – the more flights the more free food and movies, eh!

the convention was quite interesting. we heard from the real-life dr. patch adams! turns out he didn’t even want that robin williams movie made about him, and he doesn’t like it. he’s also a pyjamas-in-public, self-described communist who did quite a bit of ranting about capitalism. he’s worked his entire professional life for free. he did have some very practical and apt thoughts on how physicians can better relate to patients. we also heard from recently retired johns hopkins neurosurgeon, author, and recently potential presidential hopeful dr. ben carson.

for me, the best talk was from another johns hopkins neurosurgeon, dr. alfredo quinones-hinojosa. from rural mexico, he entered the united states undocumented as a child and started picking vegetables. long story short, he ended up becoming a prominent neurosurgeon, and a down-to earth one at that. proof that citizenship or a certain background isn’t a prerequisite for living the american dream. when someone suggested that he change his last name because it was hard for americans to pronounce, he changed it by hyphenating and enlongating it in honor of his mother, and as a symbolic flippage of the proverbial bird to those who would want where he came from to hold him back. love it! cnn did a nice piece on him too which can be read here.

almost got to see every medical student’s favorite pathologist and bodybuilder dr. edward goljan, but alas he got sick at the last minute. a cool thing about the conference was that it overlapped with a conference of the international medical student’s association, so we got to meet a bunch of medical students from all over the world! for example, we were hanging out at a party and met the israeli and the lebanese medical student contingents, and we all started dancing together! where else does that happen!?! it warmed my heart. i also got to hang out with my sister maria for a day, which was so nice. also a great day at the zoo with my friend sylvie, with whom i had been skyping quite a bit. and a big thank you to my friend joel who let me stay at his house!

the rest of second year

just from this blog, it would seem that my life is just one holiday after the next. actually, i spend almost all my time studying. m2 as it is called (the second year of medical school) was a lot more interesting than the first, but also significantly more academically demanding. instead of semesters, the courses were divided into “systems,” each lasting two to five weeks and culminating in a final exam. these fascinating systems had titles like hematology, endocrinology, pulmonology, cardiology, gastroenterology, nephrology, musculo-skeletal, reproduction, neurology and neuroanatomy, interspersed with anatomy of the thorax, abdomen, head and neck, limbs, etc. i especially loved the anatomy, as we got to spend our afternoons (and some eerie solitary all nighters too) in the cadaver lab – truly a remarkable place! throughout the year we also had twice weekly sessions on the hospital wards in which we learned various physical exam skills and how to perform a medical interview in hebrew. the hebrew was, and continues to be, rather rough for me. i put in some serious effort though, especially toward the end, and managed to pass the clinical osce (practical exam) at the end of the year in hebrew! overall though it was a great year! i truly love studying medicine, and though sitting around with your face in a book isn’t always the funnest thing one can imagine doing, i wouldn’t want to be doing anything else.

some random other things that happened:

-did some zumba! epic sport! lots of hebrew commands that can be tuned out; just dance! at the first session i was the only male there, with about 60 ladies. at one point our chain-smoking leader makes an announcement in hebrew, and everyone turns towards me and applauds. weird, right? after i learned that it was because i, a male, showed up to a zumba class! lol, a truly special memory!

-during the jewish holiday of purim, we had a customary costume party. before that, my conservative jewish friend read the megillah, or story of esther, in hebrew. a custom during this reading is to make noise with noisemakers and air horns and incessantly boo whenever the name haman is mentioned, because he wanted to eliminate the jewish race. his name is mentioned probably at least 100 times in the story, so lots of booing.

-a new shopping mall opened in beer sheva – the largest mall in israel! some may know that i am obsessed with malls, so needless to say i was living with eager anticipation. it is an amazing place! it even has an h&m, which is probably the most epic thing to have ever happened to beer sheva. one more reason to visit!

-i ran the dead sea half marathon for the second time, with a good group of classmates.

-some of my friends organized an excellent ted event at ben-gurion university, tedxbgu. there were a few very interesting speakers. my personal favorite was a blind arab-israeli lawyer named abbas abbas. no one, not even his family or doctors, believed he could amount to anything in life because he was blind and had other disabilities. on top of this, success for arabs in israel doesn’t exactly come easy. against all odds, he was able to graduate with a law degree from hebrew university and founded an organization that seeks to defend the rights of disabled arabs in israel. he was so enthusiastic that he kept shuffling further backwards without realizing it, and was soon speaking from the back corner of the stage. no matter. it was so inspirational on so many levels to see this blind arab commanding the attention of an auditorium full of israelis. doesn’t happen as much as it should, but it did that day. i probably cried a little.

-my roommate and i had two fourth year students from our program live in our apartment for a number of months, minsoo and david. david taught himself a few languages while here, and also self-taught himself how to play the oud, a classic arab instrument. i like to think i played at a least a small part in convincing him to perform a song in arabic at their class’s graduation ceremony, and he absolutely nailed it!