The formidable title of "Doctor", by R. Mayuri Garikepati

Graduates throw their caps in the air as they are proclaimed "Doctor".

As we watched the fourth years take on the formidable title of “Doctor” I couldn’t help reminiscing about my own Physician’s Oath ceremony almost one year ago. Back in September the feeling of being in Hebrew-immersion summer camp had not yet worn off—but the Oath was recited and I replied “Amen” in acceptance. After the speeches there was a random—but beautiful—classical guitar performance and later at dinner, I recall people grumbling that the drinks had run out. For me, a mixture of solemnity as well as absurdity characterized the entire occasion…Aaaand back to the present.

Many of us have endured the academic ritual of donning gowns and caps, zoning out during inspirational speeches, then enthusiastically tossing our caps in the air. The dullness however, is punctuated by a few powerful moments. Something that deeply resonated with me that evening was a BGU tradition that allows physician parents to present the M.D. diploma to their graduating son or daughter. Two students and their families observed this custom and it served as a potent reminder that our achievements are in no small part due to the support of our families (whether or not they are doctors). Congratulations MSIH Class of 2012!  - R. Mayuri Garikepati

Did you come to Israel through Sinai? by April blogger of the month R. Mayuri Garikepati

“Did you come to Israel through Sinai?”First-time patients at the Tel Aviv Bus Station Refugee Clinic usually answered, “Yes”. Prior to living in Israel, I did not know the implications of this route; terrible violence and human rights abuses are rampant in countries like Eritrea and Sudan compelled these people to make a very treacherous journey into Israel.

Levinksy Park, Tel Aviv

Thousands of African political asylum seekers, refugees or illegal immigrants—their official status is ambiguous—cross the border from Egypt through the Sinai on foot smuggled in by Bedouin guides. The risks are rape, torture, and enslavement, even organ theft.  In Israel the newcomers are not welcomed, but are held for some time at a detention facility in the Negev then given a one-way ticket to Tel Aviv where many take up residence at Levinsky Park outside of the bus station. Social services are limited and they must look for health care in places like the Refugee Clinic that is funded by the Israeli Medical Association where I recently began to volunteer.

Patient room at refugee clinic.

During the times I sat with the physician, her frustration at the language/cultural barrier was obvious, and she admitted that her ability to help was limited when she couldn’t truly understand what patient—even if they could speak some Hebrew or English. Also individuals also came in with various aches and pains with no other apparent signs of illness; interestingly the physician felt these symptoms were psychosomatic in nature—something she could not effectively address during the brief consultations.

I was surprised to find that I was by myself at the reception registering patients my second time at the clinic. Thankfully the multi-lingual patients in the waiting room would help translate for the Tigrinya and Arabic speakers; other times I’d manage with English, broken Hebrew and hand gestures. The entrance was crowded with patients without appointments hoping to be seen by the one doctor and nurse working—some cases could wait and others were urgent. A distressed pregnant woman in severe pain arrived with her anxious husband. They waited for over an hour before she was allowed to see the doctor who ordered a urine test. She was very weak so her husband and I helped walk her to the bus station bathroom to so she could provide a urine sample. The sample tested high for ketones and the doctor insisted that they go to the emergency room right away. As I watched them leave I hoped, but was not sure that everything would be okay.


The Haaretz newspaper quoted Benjamin Netanyahu’s statement regarding the African refugees: “If we don’t stop their entry, the problem that currently stands at 60,000 could grow to 600,000, and that threatens our existence as a Jewish and democratic state.” The hardships faced by the refugees have no easy solutions and it is difficult for countries to deal with the costs and cultural misunderstandings that come with such an influx of immigrants. Each visit to a clinic reminds me of the complexity of global health and that medicine is but a small part of the cure. - R. Mayuri Garikepati

Pesach Vacation, by April blogger of the month Radha Mayuri Garikepati

Elephants

Pesach Vacation: Sri Lanka, the location of my future, now imaginary, destination wedding, is beautiful country—lush green hills and glittering beaches, humid with daily torrential downpours (at least while I was there). The most interesting sights involved some moderate to intense aerobic exercise and so I climbed stairs, biked, or walked through Buddhist temples and ancient cities where I saw worshippers leave bunches of lotuses as an offering to the Buddha. This peaceful image was disturbed when the entire country went into tsunami panic-mode after an earthquake hit Sumatra. Mercifully, there was no tsunami and I continued my journey to the glorious southern coast. I met some lovely people along the way—the four of us united by the fact that we had purchased tickets for a cancelled train route. The final days of my trip passed lazily going out dancing, swimming and sitting on the beach as the sun rose on the Indian Ocean. Then it was time to come home.

Dagoba

Older generation cough suppressants make a great travel companion—I had developed a hacking cough during my trip and could only find the drowsy kind of medicine. I do not even recall changing flights. After an exhausting return journey through Amman I finally stepped into the Jerusalem Central Bus Station and filled my nostrils with the familiar smell of chocolate croissants (they are a staple here). I boarded the bus and saw a young soldier peacefully napping on the bus with his M-16 slung across his lap. I relaxed in not one but two seats and watched the pale buildings in Jerusalem move past in the glow of a pinkish sunset. Reassuring sights and smells. Home.

Lotuses

It’s May and almost make-a-decision-about medical school time—exciting!  I expect that you may want to hear another perspective about life in B7. Apologies if it lacks some originality but here I go: I have met many splendid people with a broad range of accomplishments—some are ardent students of global health and some are not. Shabbat dinners or casual get-togethers usually guarantee delicious cooking and decadent gluten-free desserts. Dairy, produce, and chocolate simply taste better here. I’ve also been fortunate enough to celebrate some Hindu festivals with my classmates—a spur-of-the-moment Diwali celebration and almost a Holi water balloon fight that was cancelled due to the most recent rocket fire. Overall, life is good.

Chalva and Nick

 After my trip I realized that I had spent the amount of my entire tax refund without having filed my taxes. I’m on the verge of broke. Keeping that potential drawback in mind, I strongly recommend some international adventures during 1^st year. It’s one year ago I visited Israel to make my decision about MSIH, on LagBaOmer, a Jewish celebration involving bonfires. Time has zoomed by! Finals are over. Whoa. I just became a 2^nd year. - April blogger of the month Mayuri Garikepati

Start Your Systems, by blogger of the month Nicole Magpayo

Panoramic view of the Monastery in Petra

Hello! My name is Nicole Magpayo and I’m the May Blogger of the month otherwise known as “the girl who got hit by a car in Israel her first year of medical school”- yes, that really did happen. Luckily, I had an amazing support system here at MSIH and even better, no one can argue with me about drivers in Beersheva (just kidding!). 

Anyway, just to give you more background about myself, I’m originally from San Francisco, California, but have been living in Massachusetts for the last nine years. I graduated from Northeastern University in Boston, MA and worked for four years at Massachusetts General Hospital in Radiation Oncology doing academic research and now… I’m here and absolutely loving it!

Soaking in the breathtaking view!

We recently just finished another round of final exams last week and are starting to get back into classes once again. Today was actually our first class of Hematology. I’m excited to start systems and find them to be a bit more intriguing than the first semester. I also like the fact we have more frequent exams rather than all crammed in at the end of the semester.

The colors of the rock were AMAZING!

Monastery in Petra

Having a marathon of exams takes a lot out of you, but I think the hardest part for me recently was dealing with the uncertainty. Sure, it’s easy to say after an exam that you got 90% of the questions right, but there is still that feeling of not really knowing exactly how you did. 

Dealing with that anxiety, even for a few days, is still something I’m getting used to. Although I do like surprises (especially for our class birthdays!), it’s a bit unnerving not knowing what lies ahead. Just like in life, it’s nice to plan for the future, but unfortunately that’s not always how it works. 

Actually, it’s almost fair to say there’s a really good chance things will go the complete opposite of your original plans. Even so, learning to deal with the anxiety of uncertainty will be good practice for us as future doctors. Did this treatment work? Will my patient respond? These are all issues we’ll have to deal with and the answer won’t be around the corner. It will take a combination of both patience and faith to sit there and wait. I guess this is what it means to be an “adult” (darn, the time has officially come).

Safe to say, after finals, a few of us headed to Jordan to see Petra and Little Petra. We left the day after exams and took a bus down to Eilat and crossed the border from there. I have to say it really is an advantage being here in Israel where in a weekend, we can explore a new place, even better, a new country. 

Weekend, yes, one weekend, when if you were somewhere else, it would probably take you close to an 8 hour plane ride. Another thing I love about this school are the people and that 99% of them love to travel and explore. Little did I know that Petra was more than a live Indiana Jones movie. 

 Bumping into classmates in Petra =
silly picture in front of the Monastery!

The cabs stopped on our way to Petra to let us watch the sunset. 

In addition to the treasury, we went to see the monastery (which my pictures could never do justice to) and actually ran into a few of our classmates! So of course, we had to take a silly picture (for those of you who don’t know me, I love pictures- so expect many of them in my future blogs!) I still can’t believe sometimes of how lucky I am to be able to explore the world while doing what I love. It was a fantastic weekend away with great company, but now it’s back to classes. I’m actually excited to see what systems will be like (nerd alert :P) so I don’t mind being back. Also, I kind of missed having class with everyone- it’s some sort of weird, needy bonding that happens with your class…or wait, is that just me? Until the next one!

Sunset in Jordan

I would just like to give a quick mini shout out and congrats to my sister and my brother-in-law for the newest addition to our family, that’s my nephew in the picture and my new niece Kaya J. Welcome to the world gorgeous! - blogger of the month, Nicole Magpayo

Let the Adventures Continue! by blogger of the month Cherec Dickey

A few weeks ago, MSIH students had their Pesach break. Some of my classmates and I packed our bags to travel to exciting places like China, Greece, Sri Lanka, Turkey, Sweden, Czech Republic, Jordan, Korea, Romania, Italy, the USA, and interesting places around Israel.

Lacking inspiration to write something that more widely applies to the general experience at MSIH (we’re in the middle of finals right now), I chose to write about my personal adventure to Jordan during this break.  I suppose I could give you a more real-time update on life at MSIH, detailing how my classmates sit for endless hours in the Caroline house, drudging through and memorizing endless facts about microorganisms, but I thought Jordan might be a tad more interesting. J

I spent most of my break in northern Jordan at a hospital for chest diseases.  It was my first time traveling internationally, alone, and on foot; I wasn’t quite sure what to expect.  Saturday night I packed my hiking backpack with the necessary essentials for such a trip, including long sleeves, long pants, long shirts, long skirts, long . . . everything.  Pretty much just layers upon layers of clothing to cover everything but my face, hands, and feet, considering I was making my first-ever trip to a Muslim country.

All of the “long” clothing I could find in my wardrobe, 

organized into modest outfits for my trip.

In my previous travels, I had never really experienced “culture shock.”  Sure, I was “shocked” by the poverty that I saw in the developing world and the state in which I found the people around me.  It even deeply affected me as I felt compassion for the people that I met.  Moving to Israel didn’t really constitute culture shock for me, either.  Though Be’er Sheva has been referred to by my classmates as a delightful mix of the developed and developing world, it has enough Western culture for me to feel comfortable with a few adjustments.  In Israel, I can still wear the clothes that I want to wear, do the things that I want to do, and go where ever I like without feeling afraid or apprehensive. 

This time, though, I experienced the real deal.  I mean rock-your-world, make-you-feel-really-uncomfortable-in-your-own-skin culture shock, and I was only there four days. Throughout my trip, I realized that I had just walked into a place that was very different from Israel, the USA and any other place that I had been.  Honestly, I didn’t anticipate that a hop across the border would take me into another world.  On a handful of occasions, I even felt personally offended by the culture in which I found myself.  As an independent, empowered woman from the West, it was difficult for me to comprehend how things really are for women in Muslim countries.  When I started to understand how few rights women have in society, I was enraged!  For the moment, anyway, then I learned to grapple with and process these new experiences and learn what I could from them.  I had been learning about Bedouin culture in Israel, but it was from a distance.  I still went back to my Westernized community and comfortably did and said what I chose.  Learning about Bedouin culture (the majority of Jordanians are Bedouin) from within, while participating in it, was a unique experience.  It was a very real experience that this idealist will remember for the rest of her life.

The clinical and personal experiences I had with patients were the most impactful parts of my trip.  Each morning at the hospital, we had clinical hours, where we saw patients who had come from far and wide.  As I sat with the doctors during these times, I met patients from Saudi Arabia, Iraq, Yemen, and even some refugees from Homs, Syria (I’m sure you know from international news what they’re running from).  Even the Jordanians that had come to be seen were from all over Jordan.  The hospital has quite an exceptional reputation.  Additionally, the services offered by the clinic are essentially free, so combine that with the most reputable care in the area and you have all of the sick people in the Middle East lined up outside your door.

In that clinic, I got to see and hear things that I never have before.  I spoke (as in, “hello” and “goodbye,” since my Arabic is limited) with women in veils (faces completely covered except for the eyes –and sometimes the eyes, too), and then I got to see their beautiful faces when they lifted their veils for the examination.  I also watched as women loosened their head scarves to reveal their beautiful, long, henna-dyed hair and stylish earrings.  That process was astounding for me; I found it odd how different these women became to me from the person they were a few moments before when I didn’t see anything but their eyes or face. For chest examinations (which we did on almost everyone, since it’s a hospital for chest diseases), I saw the colorful and/or beautifully-sequined shirts and necklaces that many women wear under their clothing. 

I watched as the doctors diagnosed case after case of allergies, colds, and sometimes more serious illnesses.  Chest X-rays were provided within ten minutes of ordering, so I observed as the doctors pointed out features of the lungs that indicate different diseases.

I also got some pointers on how to do medical interviews with Bedouin patients, which may come in handy during my 3^rd year.  One of those is fairly generalized across cultures, but I’ve been told it’s specifically pronounced in Bedouin culture:

“Do you take any medications?”
“No.”
“Do you take any pills for high blood pressure?”
“Yes.” *produces pills*
“I see you have asthma.  Do you take any anything for that?”
“Yes.” *produces inhalers*

In the afternoon, I followed the doctors on their inpatient rounds.  The very first patient we saw was incoherent and semi-unresponsive.  They checked her blood sugar and it was 23!  (If your blood sugar was that low, it would probably kill you.)  I watched as the doctors sprung into action to get some glucose into her, which proved a bit tricky with her tiny, evasive veins.  They successfully brought her out of her hypoglycemic coma. The following day, I got to meet her, fully responsive and awake.

Sisters from Yemen who, the following day,
told me I dress like a Yemeni woman.  (I took that as a compliment!) 

On the street the following day 

in my “Yemeni woman” dress.

The inpatient rounds were probably my favorite part of the trip.  I got to meet many very sweet, and sometimes very sick, people.  These patients had MDR (multiple drug resistant) or even XDR (extensively drug resistant – the worst kind) tuberculosis, COPD, and other illnesses that I had never directly seen before.  I got to build relationships with some women during my time there.  They loved to listen to me stumble over Arabic words and giggle when I got them wrong, then graciously correct me and teach me how to say them properly.

Fatmah, one of the beautiful ladies
I met during my stay in Jordan.

My fellow bloggers wrote in previous months, “This is what we’re here for.”  As I walked around the grounds of the hospital during my stay, that kept resounding in my head. “This is what I’m here for.”  I was overwhelmed with the unique situations I had just witnessed and the experience of an actual, tangible example of what global health might look like in my future. 

With the offenses I had taken to cultural differences and the deeply-ingrained second-class status of women, I quickly got fed up with trying to “cross cultural boundaries.”  I started to (uncharacteristically) think, “Maybe it’s better for all of us to just stay within our own culture.”  Before, as I mentioned, I was separate from the Bedouin culture in Be’er Sheva.  However, when I actually had to conform to their ways, I was quite uncomfortable.  Covering oneself head to foot and having to be constantly aware of your behavior and careful to not look at a man in the eyes wasn’t my idea of global health. However, I knew this kind of work would be difficult, and I had gotten a brief taste of what these difficulties might entail.  I got to meet and speak with others who have lived within that culture for years, doing what I dream of doing someday.  Their love for the people they serve is evident, and they do everything in their power to advocate for them.

This led me to ask myself the question that I contended with throughout the duration of my trip:

“Do I love these people enough to push through these cultural barriers and serve them?”

That was the question that went through my mind every time my jaw dropped at another cultural difference that I personally found to be absurd.  Eventually, I concluded that it truly is my heart’s desire is to work with people in such an environment.  This is my dream, and dealing with these difficulties will probably end up making the work that much more fulfilling.

Though the culture was a bit for me to process internally, I thoroughly enjoyed my time there.  It opened my eyes up to medicine in chronic diseases and developing environments.  It was also my first example of long-term medicine in global health.

So now I’m back in Israel, feeling kind of naked in a t-shirt and jeans.  For the first day or so after my adventure, I was met with the two things that always meet me after exciting travels to developing countries: 1) exhaustion and 2) the pleasant realization that I can throw toilet paper in the toilet.

This is my last post for “My First Year at MSIH”, but I keep my own blog at medinthemizraakh.blogspot.com if you’d like to follow me as I attempt to document my experiences throughout the next three years.

Shalom! - blogger of the month Cherec Dickey