medicine – Page 4 – ToewsTravels

WAR. and such

as you may have heard, there was recently a rather significant war in the middle east. call it gaza war # whatever we’re at now. our city of be’er sheva happened to be right in the middle of it. things really got started when the idf (israeli defense force) surprise assassinated ahmed jabari, the head of hamas’ military wing in gaza, as punishment for hamas rockets being fired into southern israel over the last couple years. we got advance warning from the israeli medical students who were taking our neglected tropical diseases module with us – they got some texts from their friends with connections and told us we better go home asap and hide in our bomb shelters, as all hell was about to break loose. and indeed, it basically did. hamas responded with a continuous and sustained barrage of rockets, as did israel, that continued for the next week or so – about 1500 rockets each. it was crazy. no school. no going far from the bomb shelter (which luckily for me happens to be my room). sirens, quickly followed by huge sonic booms that rattled the windows and the fridge. many of be’er sheva’s residents as well as most of my classmates fled town; some even left the country. my roommate and i decided to stick around. soon i started getting cabin fever, and would (probably unwisely) go on runs in the eerily deserted streets, sometimes hiding behind something when the sirens went off, others times simply continuing to run and cranking my ipod to drown out the sounds of war. we had the strange and unfortunate honor of being the center of the world’s attention for a few days. cnn’s wolf blitzer was even tweeting live from close to my apartment – i quickly got on my bike to go try to find him, but he had already moved on to interview some more rocket attack victims.

israel has developed a missile defense system called the iron dome, which shoots down rockets heading toward developed areas with at least 90% accuracy. it is truly beautiful to watch this system in action at night (watch it at work here protecting a wedding – coincidently this is just meters from my apartment: https://www.youtube.com/watch?v=2M-BQtp4Www). one concern has become that the iron dome provides incentive for israelis (and me) to go outside to watch “the fireworks” when the sirens go off, rather than to hide in their bomb shelters. despite the dome, some rockets definitely still get through and hit be’er sheva and other towns in southern israel. for example, one shattered the front window of some of my friends’ house.

and of course, the people of gaza have no such protections, as evidenced by the fact that 160-some gazans died in this latest war compared with six israelis, a gross disproportion fairly typical of israeli-palestinian violence. i have really tried not to make this a blog about my political positions, but allow me to briefly state what i see as the most important root cause of this particular conflict: life in gaza is hell. no economy allowed; no hope. the vast majority of gazans aren’t allowed to leave, ever. they can’t get life saving medicines in for their children without impossible-to-get permissions from israel. israeli doctors who want to go volunteer in gaza are barred from doing so by the israeli government. food going into gaza is rationed. fishermen get shot if they stray more than three miles from the shore – not really far enough to catch many fish. 95% of gaza’s children have clinical signs of ptsd (post-traumatic stress disorder). the list goes on… and on… and on. no one can expect people to live under these conditions without resorting to desperate measures. it is true that hamas is a terrible organization. their stated targets are israeli civilians, which is completely wrong; indeed evil. but the israeli government can’t blame anyone but themselves for the fact that hamas is popular in gaza. and the saddest thing is that not much has changed after the now ceasefire. conditions are still horrible in gaza, and pro-violence hardliners retain popular support on both sides. this war will repeat itself, sooner rather than later. okay, enough from my political soapbox (although i would argue that its not really about politics, its about innocent people’s lives). of course, there are a myriad of other factors that also play into the region’s propensity for conflict, and others predictably point fingers in other directions. just always remember: conflict, especially in the middle east, is invariably more complicated than can ever be described in one paragraph, news clip, facebook sharable infograph, or even dissertation. unfortunately, the only thing that the leaders of both sides agree on is that they probably aren’t going to start getting along any time soon. that doesn’t mean we shouldn’t be doing everything we can to try to help that start to happen.

anyways, about a week into the conflict, things were looking pretty bad. rockets were hitting tel aviv and jerusalem (for the first time since the 1970s), there was a bus bombing in tel aviv that had every israeli worrying about a third intifada, and an israeli ground invasion of gaza seemed imminent. my school’s administration decided that it would be best to end the semester early. ironically, just a few hours after they made that announcement, a ceasefire was unexpectedly agreed to, and actually stuck. so, we got off early, but we need to go back early too, and attend school on weekends to make up the lost time. unfortunately this means i have to miss my main man devin’s wedding which i was really stoked about attending, and spend christmas day on an airplane, and have even less time this spring to start preparing for the biggest exam of our lives, the usmle step 1 board exam, but at least my classmates and i can all be thankful that we survived this thing, unlike the 160 or so who weren’t so lucky. war is terrible.

fall 2012

-studied a lot; passed some exams!

-we started trying to learn clinical hebrew. i am in the beginner group with two good friends, also novices. our teacher is a sixth year israeli medical student and she is really nice.

-got to go on a weekend retreat with some other christians at my school to the galilee! it was so nice to spend some time looking into God’s word, relaxing around a campfire fueled by palm leaves, and getting to know some of the first year students. also, one day we hiked upon mount arbel, which has a huge cliff overlooking the sea of galilee. then a few of us did some seriously muddy off-roading in a field with one of our rental cars and it was totes the funnest thing ever! then on the last day, those in my car and i one-upped any other possible thing that could be done by visiting an outdoor roman-era hot spring/spa facility in the golan heights called hamat gadar. it was funtabulous! they have waterfalls of hot sulfurous water that you can sit under and an extensive alligator farm!

-joined some of the visiting international undergraduate students at the university for a trip to the western wall in jerusalem to see the prayers of slichot which occur throughout the night before yom kippur. this is the biggest day for public prayer in judaism, seemingly especially among sephardis. the head rabbi of israel was leading prayers at the wall and there were tens of thousands of people fervently praying in their own unique styles. the university had also hired a guide who had many unique insights; we learned a lot about the themes of repentance and forgiveness in judaism; a very interesting time.

prayers of slichot at the western wall, jerusalem

-ran a nice 10km race in tel aviv in the night along with 30 000 other people, including about half of my classmates! lots of fun!

negev style!

this is a music video starring my class! i find it rather entertaining!

semester 2 complete!

prom, medical school for international health

my first tear of medical school is complete, and it was a good one! thankfully i passed all my exams, and now we’re into the second year – systems! this means we will now study just one subject at a time and have an exam every three or so weeks. we recently finished hematology, and now we’re into endocrinology!

a few happenings of the last semester:

-holidays: purim (think jewish halloween), hag b’omer (collect scraps of wood all year so that they can be thrown into a huge bonfire that can be partied around), holocaust remembrance and israeli independence day (minutes of silence during which everything in israel stops, including all traffic on the freeways, followed by a huge party with epic fireworks right outside my apartment), ben-gurion university student day (live music all night; pool party all day)

-a disaster management module that was quite interesting

-ran the dead sea half marathon with a number of my classmates; the lowest race on earth!! 1:37; i was happy with that. afterward we got to swim in the extremely salty dead sea water, which felt great on some our freshly chaffed nipples – you can imagine the yelps!

stretching for the dead sea half marathon

-had the opportunity to go to two christian “student conferences” that involved jewish as well as arab believers. really good times and great to meet some people outside of beer sheva.

-msih prom: bringing the american high school experience to israel.

-some unplanned school-free rocket days (they come from gaza). after one, we made some young israeli friends hanging out in a bomb shelter. they took us to where one of the rockets had hit that day – it decimated a school. good reminder that it is important to hide when that siren goes off.

-perhaps the most profound three hour conversation of the semester was with an american college student who had just finished three months of nonviolently documenting abuses of the occupation with christian peacemaker teams in hebron, palestine. check out some of his documentation of what’s going down in hebron here: http://www.cpt.org/underattack. the occupation is so messed up, yet so intractable – so seemingly impossible to do anything about. but this guy found a way to really put himself out there in a politically poignant yet very Christ-like manner, and i found it nothing short of inspirational.

winter in the desert

four months later, i think its about time for a post!

what’s gone on since the last time:

– so very much studying. it is, after all, what medical school is all about!
courses this semester include: pathology, pharmacology, physiology, epidemiology, microbiology (continued), hebrew and a dash of anthropology and history taking.

– a couple amazing thanksgiving potlucks around that time

– the cinematic event of the year: the beer sheva premiere of “twilight: breaking dawn part one!”

– a retreat to the sea of galilee with some of the other christian students at msih! we did some hiking and went to capernum and the mount of beatitudes

– unexpectedly frequent homemade korean cuisine fests!

– some ups and downs in the ol’ personal life

– got to go back to the usa to visit my family for christmas! houston, texas and new orleans, lousiana! i wont elaborate because traditionally this blog is only about stuff that goes down in the eastern hemisphere, but i will say that it was really nice to see my family again and there were numerous trips to walmart!

– watched the superbowl live at the local shanti bar until it finished at 5am! then got some breakfast, and went to eight hours of class the next day. gotta get ready for those 36 hour days in residency!

– went to jaffa (which is the historical area / rapidly gentrifying part of tel aviv) one friday to visit a clinic run by physicians for human rights – israel (phr-i). they are an ngo run completely by volunteers that provides free medical care for the migrant worker/non-jewish immigrant/refugee population in israel. there have been tens of thousands of refugees coming to israel in recent years from places like sudan and eritrea, but these people are not covered but israel’s universal healthcare coverage, have no mechanism for becoming citizens as they’re not jewish, and typically can’t legally work. its a huge, intractable problem for the government, and really sad on a personal level. these people risk their lives journeying across north africa in the hopes of making it to the “free western world” – many of them end up in protracted slavery in the sinai or even having their organs harvested at the hands of the human smugglers on which they depend. then, even if they make it across the border into israel without getting shot, they can’t work, so many end up sleeping in a park in tel aviv indefinitely. phr-i also does mobile clinics in the west bank and gaza, where people are also definitely not privy to government funded universal healthcare. i think that phr-i is amazing, especially considering it is fueled entirely by volunteer health professionals!

– last week was special: all our classes were devoted to issues relating to cardiovascular health and atherosclerosis. we also, for the first time since my class has been here, did everything that week with our colleagues at the israeli medical school. it was great to meet some new friends, especially considering that sometimes our classes are in the same buildings! we made posters in groups and presented them outdoors in the february warmth that only beer sheva can provide. i can tell you all about statins now. we also had fun stuff like yoga and zumba classes! zumba is my new favorite sport! turns out my default dancing technique has always been zumba inspired – i just didn’t know what to call it until now!

– the biggest highlight of the year so far has definitely been once-a-week clinical days. in small groups we get to go to various wards in the hospital or clinics in surrounding towns and learn how to interview patients. the language barrier can definitely be a challenge but that’s just the way it is. this week i to went to a bedouin family’s house in the nearby settlement of tel sheva. they even made us a huge lunch, which we ate from communal plates while lounging on their floor!

the bedouin are an interesting people group. traditionally they were pastoral nomads who wandered around the deserts of the middle east. with the creation of secure borders between modern nation-states like israel, however, they found themselves hemmed in. at the creation of the state of israel 60 years ago there were 10 000 bedouin in the negev desert around beer sheva – today there are 100 000. that’s a steep growth curve! they also have a tendency for consanguinous marriage (ie. with their cousins) which inevitably leads to high prevalence of rare genetic defects. indeed, beer sheva’s own soroka hospital (where our classes are) is internationally famous in genetics circles. most of the children at soroka are bedouin and most of the elderly are russian. maybe that is a phenomenon for another blog entry. anyway, the bedouin live in towns and villages that spot the desert surrounding beer sheva. some were set up by the government, while others are “unrecognized.” the government likes to periodically bulldoze homes in unrecognized villages to remind everybody who is in charge. i went to a lecture (in an underground bomb shelter) the other night by a bedouin guy who is getting a law degree in part so he can work to protect his unrecognized village. he was a good guy. i’m sure the guys who operate the bulldozers are too, its just too bad they can’t be using them to do something productive.

documentation of destruction of bedouin villages in the negev

fish pedi. physician’s oath.

it has been a week full of excitement! last weekend was our physician’s oath ceremony, during which my class recited a paraphrased version of the hippocratic oath, meant to get us thinking seriously about the journey we are embarking on. indeed, it was a poignant time! we all dressed executively in white and groomed ourselves well beforehand. for my friends cherec, julia, diana and me this involved getting a fish pedicure in beer sheva’s old city! special fish eat the dead skin off your feet! i cannot recommend this experience highly enough! so exhilarating!

back to the oath – ben-gurion university was actually the first medical school in the world (decades ago) to start doing the physician’s oath at the beginning of medical school. it had traditionally happened at graduation, but it was felt that doing it at the beginning would be totally way better. during the 90’s the trend spread, and today every medical student in america says a physician’s oath at the beginning of medical school. after the ceremony there was a delectable catered dinner, skits/movies created by each class, and music and dancing compliments of some musically talented physicians-to-be and the co-director of the program on guitar!

medical school for international health white coat ceremony

last weekend was also the 100th anniversary of the keilah/church that i go to here. there were over one hundred visitors there from all over the world in honor of the occasion. particularly encouraging to me was that they had a palestinian pastor from bethlehem come and lead some worship songs. i really believe that one of the main goals of the church here (and everywhere, but especially here) should be to encourage peace and reconciliation among populations that often don’t get along so well, as this is one way that we can tangibly show that the love of Christ transcends divisions of ethnicity, culture, politics, and indeed even theology. unfortunately it doesn’t really happen enough in this region, so that was a really encouraging time.

now, we’re on a four day weekend for rosh hashanah, the jewish new year! the first night some of my classmates made an amazing meal and we watched a movie outside in the couches that populate their yard. some of us were thinking about going to petra in jordan for the weekend, but that ended up not happening. so yesterday morning i got up at 5 am for a little day trip to hebron….

ani lomed evrit!

view from my apartment, beer sheva, israel

ani lomed evrit = “i learn hebrew!”

i’ve been here in beer sheva for a month already! i like it here. beer sheva is an ethnically diverse university town of about 200,000 in the middle of the desert. i’m so stoked to finally be starting medical school, and in the middle east no less! my 35 classmates at the medical school for international health are wonderful. they all have such passion and varied life experience: a good percentage of them already have advanced degrees. i am really honored to be a part of this remarkable group of future physicians. and importantly, we all get along really well! for the last month we’ve been immersed in an intensive, four-hours-a-day hebrew course called an ulpan. though i’m a lot closer to the bottom of the class than the middle when it comes to language learning skills, i feel like i’ve learned a lot and am finding that hebrew can be fun. my classmate natalie has been kind enough to tutor me, which has helped a lot. thanks natalie!

for the rest of the day we’ve been taking an emergency medicine class, where we learn the pre-hospital course of treatment for emergency situations such as trauma, choking, cardiac arrest, israeli snake bites and the like. we also practiced the art of i.v. line insertion on each other! there was a lot of blood. we just had the final exam for the course which involved a lot of practical scenarios – fun fun! tomorrow begins the “real” medical school courses – the first semester lineup includes biochemistry, molecular and cellular biology, microbiology, biostatistics, immunology, histology, genetics, “global health and medicine” and more hebrew. i’ll be studying a lot.

during this orientation month we’ve had a lot of fun. various shabbat dinners/potlucks and great times on the weekends. one day the whole class went to jerusalem! we filed through such epic sites as the garden of gethsemane, the tomb of david, the western wall, the via dolorosa, and the church of the holy sepulchre. though i spent two weeks in jerusalem a few years ago, i can never get enough! really lucky to be living near such a historically (and otherwise) significant locale.

garden of gethsemane, jerusalem. this tree has reportedly been alive since the time of Christ

the class also took an evening trip further south from here into the desert to sde boker, where david ben-gurion (the namesake of our university and first prime minister of israel) had his kibbutz and is buried. we hiked in the full moonlight through a wadi (a dried up waterway carved into the rocks), ending with a campfire! also took the train to tel aviv with some friends from my class… a couple times already! amazing beach; frolicking in the waves; a mall with an h&m: could life get any better?! maybe if it were cheaper. but what are ya gonna do.

there have been huge protests in israel over the last month, precipitated by an increasing cost of living. there is a live-in tent city in the median of rothschild blvd (one of tel aviv’s most affluent streets) that goes for miles. beer sheva also saw the largest protest in its history, right outside soroka hospital where we have our classes.

largest protest in beer sheva’s history, precipitated by cost of living concerns

i’m doing my best to keep my mouth shut when it comes to politics here. sometimes its really tough. but its probably a good thing. after all, i’m here to become a physician, not a political talk show host.

currently fighting the urge to turn this post into a politically charged rant. there’s always a lot of juicy cause for that in this part of the world.

i’ve procured some nice things recently! like a bike, which makes life so much easier! and an iphone! some super cool classmates and i got a family plan together! now i wonder how i ever survived without a smartphone before! and a quality hair cut! this metrosexual guy who washed my hair both before and after! we also found the cheapest source of food in town: the buffet-style hospital cafeteria! so glad that place exists! and a buzzing shuk (outdoor market) with best-priced fresh produce. and i found and moved into the apartment i’ll be living in for the year! my classmate flatmate’s name is seungjin. sometimes he cooks amazing korean cuisine! we live in a choice location on the 16th floor. with a great view of the hospital. anyone and everyone is welcome to come visit!

there is a nice little church here! except its not called that: its a keila, or congregation, or literally a herd of sheep. there are some really nice people. everything is translated into russian, english and spanish, audible through little headsets that most of the people there need to wear. it looks like i’ll be helping with setting up the audio equipment. afterward we’ve made a habit of patronizing the gleeda (ice cream) place! its about the only place open on shabbat.

there have been some missiles from gaza landing in be’er sheva over the last few weeks. it started with an attack on a tourist bus in southern israel near eilat. in fact, the casualties of that attack were evacuated by helicopter to our very own hospital, and we watched them being rushed into the emergency room from our classroom. the retaliations and counter retaliations spiraled into what became the most intense back and forth between israel and gaza in the last few years. when rockets are coming into town a loud warning siren goes off, giving us 60 seconds to find a bomb shelter, descend to a lower floor, or at minimum hide on the eastern side of just about anything. one day there were almost 100 missiles. israel has very recently unveiled an innovative laser guided interception system called the iron dome that is supposed to shoot em down before they get here, but despite that at least one person was killed in beer sheva and a lot of the rockets still land close enough to hear. our hebrew class moved to a bomb shelter, and my room is actually a shelter too, so sometimes the sirens give me an excuse to stay in bed a little longer. i’ve actually never once felt scared in any way here. though i hate violence with every fiber of my being, i get something of a rush out of finding myself in the midst of it. it helps remind you that life is meaningful. and though it often brings out the worst in people, it can also bring out their best.

i’ve found time for some nice long runs in the surrounding desert. my favorite is running to a war monument on the top of a hill on the outskirts of town, where there is an amazing view. there are a lot of war monuments in this town. hopefully i’ll find time to run in the midst of biochemistry and all that jazz. let me rephrase that. the more i run, the better i’ll do in biochemistry. you gotta do what you gotta do.

today i had lunch in an astro-turf yard with a third year from my school who made amazing coffee and serenaded us with his oud and psalms in arabic. it was nice!

i think that pretty much catches you up! not such a bad first month of medical school, eh!?

my class, medical school for international health, class of 2015

good bye to kenya :(

i spent the last week in kijabe on the men’s ward of the hospital. headed into nairobi on friday and made a stop at westgate, the nicest mall in kenya. good thing i didn’t discover it sooner, or i would have gone there far too much! went to my aunt andrea’s house who lives in nairobi – and got to hang out with my aunt sheila and cousin sonya who are on their way through to tanzania; it was a family reunion! there was even supposed to be another aunt and uncle around but unfortunately they are stuck because of the icelandic volcanic ash cloud. i was supposed to leave early saturday, but the airline pushed the flight back to sunday. went out to lunch with my cousin sonya and did some more window shopping. had amazing ethiopian dinner with the extended family, and headed to the airport at around midnight.

i’ve really enjoyed my time in kenya, and learned a lot. the people at kijabe hospital are amazing – they exemplify what it means to truly love people and to make personal sacrifices that translate that love into something tangible – no money involved. and it has definitely confirmed for me that i should be a doctor.

heading west….

i spent last week in wairegi, the men’s ward of the hospital. i learn a lot from the morning rounds. it is really nice of everyone here to let me join them for their rounds, and ask questions, etc. the ward is extremely crowded, with only about a foot between each bed and beds in the hallway and whatnot. also spent a night in casualty with my friend joel and watched a few too many people die. like one guy not much older than me who we had admitted to the ward that morning for very non life threatening things. a nice guy. he got out of bed and collapsed, and then we got called and tried to revive him but he died. then about five minutes later the same thing happened with a little baby in the nursery. spent the easter weekend at home with the bransfords. there was a very nice sunrise service on sunday morning, followed by a potluck breakfast attended by all the kijabe mzungus. thank God for easter!

a couple weeks ago i swallowed a doxycycline tablet before bed (taking it for malaria prophylaxis). long story short, it stayed in my esophagus and basically burned a hole in it. the pain has been almost unbearable, especially when swallowing. thankfully now it is getting a bit better.

the bransfords left on vacation to mombasa yesterday. because mrs. bransford is not here to cook i eat my dinners at mama chiku’s hotel (around here, hotel means restaurant). i just tell the mama that i want a good meal, because i have no idea what’s on the menu. actually i don’t even think they have a menu. usually what comes out is something like rice, beans, meat and chapattis, for the equivalent of less than $2. yesterday i went to the cure hospital, a separate hospital right beside kijabe hospital that specializes in pediatric orthopedics. i watched some fascinating surgeries, like a club hand repair. and lots of casting of broken bones. monday i went into nairobi to buy a bus ticket for an epic trip that i’m leaving on very shortly. lets just say that if you never see another post here again its probably because i’ve been kidnapped by rebels somewhere deep in the rainforest on the other side of lake victoria…

from kibera to githunguri

i have spent this week with the aidsrelief team, who are a special medical unit fighting valiantly to fight hiv/aids in the kijabe catchment area. they provide free antiretroviral therapy (arvs) and various symptomatic treatment free of charge to all hiv positive people who want it – courtesy of pepfar- the president’s (of the united states) emergency plan for aids relief. so i have been learning a lot about cd4 count trends, viral loads, the various antiretroviral regimens, protocol for switching to second line therapy, etc. two days i spent in their clinic in the hospital – doing rounds of the aids patients who are in the hospital at the time and then clinics. and then i went to two rural clinics in places called gilgil and githunguri, where the clinicians go to the people’s towns for their follow up appointments. because one of the worst things that can happen is that people will start taking arvs and then be inconsistent – and the virus easily develops mutations to the drugs – and they spread it – and next thing you know the drugs won’t work on anyone anymore. so the biggest challenge is keeping people adherent to their regimens. its such a big deal that there are people hired to go around to patients homes and make sure they are taking their meds. remarkably, even though the drugs are the cheaper ones available, many people can live their entire lives on them and never come down with aids.

last weekend, i got to go into nairobi and stay with my aunt who lives there for a couple nights. it was a lot of fun. on sunday we went to nairobi baptist church (huge and basically western despite the lack of mzungus [white people]) and then got some chinese food. and on saturday i hung out with some fellow canadians! two nurses who are volunteering at an internally displaced people (idp) camp, and a guy who is working at an orphanage.

we went to the famous kibera, the second largest slum in the world after soweto south africa, and got a tour from a really cool kenyan guy who lives there. he is spearheading a large number of development projects there, and earns his money by organizing the filming of various documentaries and films such as the constant gardener. it was very interesting just to walk around in the slum – the kids in there certainly weren’t suffering for lack of happiness! conditions were pretty bad though, as you can probably imagine. the worst problem is the lack of garbage and sewage disposal, so those two things in particular tend to pile up all over the place.

we then went to the giraffe center – a place where one can get up close and personal with a special breed of giraffe that is almost extinct. if you put some grass in your mouth the giraffe will kiss you! it was fun. then we went to a japanese restaurant for some pretty good sushi. this weekend i am going with the same peeps to mombasa on the coast (indian ocean), so it should be a great weekend!