Vacation! by Angel Eads

The goat farm

One of the best parts of going to school in Israel is the holiday schedule.  Next week, Passover starts, and we get a ten day break from classes.  I’m hoping to use those ten days to travel to Jordan, catch up on studying and rest up for finals.

A few weeks ago, thanks to Purim, we had a three-day weekend.   Purim is the Israeli version of Halloween, only with more alcohol.   It's a chance to wear a fun costume and drink until you can't tell the difference between Mordecai and Haman.

Turkish aqueduct

It also ended up being a great opportunity for some classmates and me to get out of town and go exploring.  We spent 3 days walking the Jesus Trail, a 60 kilometer footpath that stretches from Nazareth to the Sea of Galilee.   On Thursday we took a bus to Nazareth, spent the night in a convent and started our journey bright and early the next morning.

Trail

The trail ran through wilderness, fields of wild flowers, construction sites, pasture lands, orchards, cities, along major highways, quiet country roads and through many historic and religious sites.   It was a great journey and there was always something new to see.

Mount Arbel

We stayed at a convent, an organic goat farm and a bed and breakfast.   We said hello to lots of friendly locals in Cana who were remarkably accepting of the sweaty strangers wandering through their town carrying backpacks.  We ate our weight in falafel, fries and trail mix and enjoyed a fantastic meal at a small restaurant in Moshte Arbel.  We saw ruins of ancient synagogues, holy churches, a Roman road, a Turkish aqueduct, a Bedouin castle and more cows and sheep then I can count.   We ended our three-day trek sitting by the Sea of Galilee near the ruins of Capernaum.

A shirut took us to the Haifa train station, and the next day I went back to classes, studying and the sometimes tedious life of a medical student.  It can be difficult to remember, amidst all the day-to-day tasks, what an amazing country exists outside of our classroom walls.  Fortunately, holidays like Purim provide a chance to see all the things this country has to offer.

Wildflowers

The Sea of Galilee

Bedouin castle

Forest on trail

Capernaum synagogue ruins 

(Many thanks to the awesome and talented Casey and Jonathan Ditty for all of the pictures!) - blogger of the month, Angel Eads

My volunteer weekend with PHR, by Sarah Humphreys

Sister Aziza

Last weekend I volunteered with Physicians for Human Rights (PHR) in the West Bank. Early Saturday morning, my friend Julian and I met two Sackler students in Tel Aviv and took a taxi to an Israeli town called Tayibe where we met up with a larger group of about 4-5 doctors, a couple of nurses, a speech therapist and a physical therapist. After introducing ourselves, we all piled into a large van and drove about 45 minutes into the West Bank to a town of about 6000 residents called Qusra. Qusra is in what they call Area C of the West Bank, meaning it is under full Israeli civil and security control. There is no government medical facility in Qusra and when we rolled in at around 9:30am, there were already a few hundred Palestinians gathered in a school parking lot (men on one side, women and children on the other), waiting to receive medical care.

We all gathered in a central room where about 9 official-type men spoke to us in Arabic (a female doctor nicely translated for us) about the violence that defines life for the Palestinians in the region, as the village is surrounded by illegal outposts and has been repeatedly attacked by settlers. They called for an end to the occupation and thanked us for coming.

I spent the day shadowing a doctor named Mitch and hanging out with the amazing Sister Aziza—a Comboni missionary from Eritrea, who has basically had nine lives as far as I can tell. She has been trained as a nurse, a midwife, and a doctor, speaks six languages and served as the only doctor in some region of the Sudan for twelve years. Last year she received the 2012 Hero Acting to End Modern Day Slavery Award from Hilary Clinton regarding her advocacy work aimed at exposing the systematic trafficking, kidnapping and slavery of refugees in the Sinai desert before they enter Israel. On top of it all, she has a wicked sense of humor and an intense empathic warmth that literally bathes anyone she comes into contact with.

Mitch, Sister Aziza, Julian and I probably saw between 30-40 patients that day (PHR in total saw around 270). Most of them were women, and the complaints were varied. The main message that Mitch kept driving home is that a lot of the ailments we observed were pathologies of oppression. Kidney stones because the water is poor and unmonitored, cluster headaches and other nonspecific complaints due to chronic stress and violence, unfilled prescriptions and unmonitored diseases due to lack of health care. One woman came in and looked straight in our eyes and told us her 37 year-old husband and one of her sons had been killed recently in the conflict, and she was at home trying to raise her remaining 5 children on her own. Another broke down on the examining table, and while we were unable to understand exactly why, it had something to do with conflict at home and perhaps the burden of being a woman in a society where you are expected to bear as many children as biologically possible throughout your reproductive life and the stress of having such little control over how your life unfolds. Basically, what we saw that day was evidence of disempowerment, in all arenas, and the toll it takes. It did not escape me that some of the patients seemed to receive some healing, or therapeutic benefit, from just sitting in front of us, and having a modicum of attention paid to their life experience.

Kids

Again and again, Mitch repeated that the medical care he was doling out was not what we would ever consider good care by Western standards. If a woman comes in with kidney pain, and blood in her urine, she needs scans and further work up. In a town with no access to health care, where the closest clinic is many kilometers away, and transportation and life circumstances unpredictable, she isn’t going to get that. It’s unrealistic. There were over a handful of patients who said that they weren’t going to seek out a specialist, or follow up on the visit. And so they walked away with antibiotics and painkillers instead, to tide them over, essentially until PHR comes to town again.

In class this week, we had a lecture by the amazing Seema Biswas, a surgeon who has worked all around the globe in under-resourced areas. She echoed the same sentiment—that there have been many experiences in her life where she has had to do surgery under circumstances that would essentially amount to medical malpractice in the States. She said that for those of us hoping to do global health in the future, there will be many moments where we will find ourselves doing things that we would, in other settings, deem to be “heinously wrong,” but that might be right and appropriate under these new, different, non-Western circumstances.  The overall message was that it’s naïve to think you can change the world-- the best you can do is try and change yourself. This is truly a message that can be applied to any area of one’s life. Apparently the message resonated with my whole class, as Jeremy (another classmate) emailed us the following quote by the ever-sage Rumi:

“Yesterday I was clever, so I wanted to change the world.

            Today I am wise, so I am changing myself.”

                                                -Rumi

Today, After Four Posts, I Am Announcing My Retirement, by blogger of the month Nathan Douthit

The time has come for me to retire from the game of first-year blogging. I'd like to thank my coaches, my teammates, my fans, and everyone who helped me get to the point I am today. Especially my wife, without her loving support and gracious editing, I would never have been able to write four of these. What am I going to do now? I've always wanted to try to play baseball. Lots of people have made that switch successfully, with all due respect to His Airness, so I'm hoping to sign a minor league contract soon. Maybe I'll save the Looney Tunes from aliens. We'll see. If not, I've been assured MSIH will allow me to come back from retirement multiple times to help boost their ticket sales.

            All joking aside, I have been very glad to write these posts, and thankful for everyone (I'm talking to all three of you) who read them. This was helpful for me in considering the things Kate and I have been through in the past few months, and what we've learned from them. Hopefully they've helped you to think too.

            In my head, there's all kinds of pressure about this final post. In reality, y'all probably don't care. But I decided to write this last post about a question I was asked by a professor at a Shabbat dinner. "What does it feel like to move from the majority religion to the minority?" 

            First, a caveat. Kate and I are evangelical Christians. As such, we believe that following Jesus is more than checking a box marked "Christian" on your census form or medical school application. So, in the good old US of A, we would not consider ourselves a majority, although many people would, which is fine. Either way, when we came to Israel, we knew we were moving to a place with a much smaller percentage of our religion.

            Now, there are many aspects of answering this question, including explaining how we relate to our classmates (both Christian and non-Christian), or how we relate to the Israeli culture at large, or a variety of other things. But what I will write about today is how we relate to the other Christians in the community, specifically, our church.

             The church we are involved in is one of the very few options in this city. We gather either Saturday morning or Friday night to worship together, pray together, fellowship together, and sit under the teaching of the scriptures together. On Tuesday night, there is a group of students (both MSIH and Israeli) that gathers together to study the scriptures and fellowship.

             In the church, there are Russian, English, Spanish and Hebrew speakers. We come from all walks of life, all parts of the globe, but are united together in Christ. As such, I have had to learn many things, not the least of which is flexibility. There are different styles of teaching, different concepts of time, different types of music, and even different languages spoken, but we trust in One God. This can be at times difficult, but the question arises "What other church will we gather with if not this one?" God has given us the local church as a means of sharing in the riches of his grace, and cultural difficulties do not change that. We have been blessed by getting to know the hearts of the leaders and members of this congregation, and we are thankful for it.

             Being the minority is teaching us what we truly hold to be a secondary, cultural thing and what truly knits our hearts together in love with brothers and sisters in Christ. Being a minority is teaching us to love each other and other believers, despite what may rub us the wrong way. Being a minority is teaching us when to speak and when to stay silent. Being a minority is teaching us to be truly and deeply thankful for Jesus and His global Church, whatever form that may take in local churches. 

            I could go on, as God has been faithful to us through this community in many ways, but I think I'll stop for now, for fear of boring many readers. For those of you who read this, and my other posts, thank you. If you're an incoming first year, Kate and I look forward to meeting you, and good luck in all your preparations! Packing note: bring anti-perspirant. It's expensive here, but necessary.

             Let me close with one last statement: there are difficulties attached to attending this school, but as I look back on the last year, I wouldn't change my decision to attend. I will not paint a picture that says the school, teachers, faculty or system is flawless, but I hope and think that it is worth it. I'm glad I am a student at MSIH.  - blogger of the month, Nathan Douthit

Embracing Helplessness, by Nathan Douthit

My classmate Sarah wrote an excellent post on our clinical rotations just last week. If you have time, you should go read it (seriously, go now, this post can wait). The day she is writing about I was in the same group, forced to speak Hebrew with a patient who did not know English. It was kind of a random draw, nobody knew who was going to interview whom, and I ended up with a Bedouin woman who spoke only Arabic and a little Hebrew. During this rotation, and through the course of my Hebrew learning, I have learned a very difficult, but important lesson for all who wish to be medical professionals.

            First, a word about my Hebrew speaking proficiency. There are many students at MSIH who grew up with Hebrew speakers in their families, or went to day school and learned when they were younger, or had some type of connection to Israel that caused them to learn the language early. They came in July, and were able to settle in, shop, look things up online, figure out their bills, etc. I am not one of those students. When I arrived, I could barely distinguish between an aleph and a tav. Transition to life here was not smooth, but jarring and difficult, and in many cases, very lengthy. As a matter of fact, after several frustrating hours in a government office and on the phone (Most important phrase I’ve learned: “Eta medebear anglit?” or “Do you speak English?”) I just secured a student discount for our apartment tax, 8 months after we arrived.

Anyways, back to my story. I slogged through my interview, struggling with grammar, syntax and appropriate wording (asking some inappropriate questions on the way, quite by accident) and struggled to understand her answers (thankfully she occasionally shifted to Arabic with our translator, who then told me in English). Afterwards, I was exhausted from the mental effort. Once the woman had returned to her son’s side, the translator told us a little more about her. She lacked significant formal education, and her son was one of her four children. When he was young, he was diagnosed with a rare genetic disorder, in which he can’t feel pain. When she first came to the hospital, this woman spoke no Hebrew. She learned what she knew through her many repeated visits. I tried to imagine myself in that situation, and shuddered to think of it. I remembered all the difficult situations I had been in as I was learning Hebrew, and realized they paled in comparison. As helpless as I felt at the market, or the post office, or any government building, this woman must have felt it a million times more. Watching doctors measure her son’s symptoms and ask her unintelligible questions I realized that was no game for her; she wasn’t trying to buy cheese or pay bills, but to have her son healed. What a nightmare that must have been. What unimaginable helplessness.

Patients have a variety of complaints against doctors. They have no time, they use words I don’t understand, they don’t listen, etc. But as I listened to the difficulties this mother had faced and overcome, I realized that these complaints can be summed up in one. Doctors don’t speak the language of their patients. By the time we battle for medical school admissions, spend four years filling our heads with knowledge and then 3-10 years filling our hands with work, we’ve left behind the most important experience of all. We have forgotten what it is like to feel helpless. We feel no compulsion to slow down, listen, and speak to our patients. We feel no obligation to immerse in their culture, to understand their hopes, dreams and fears. We have the answers, and  we can just shove them down their throats until they feel well. We act as those who have no vulnerability, who possess no weakness, who fear no thing.

            I reflect on the times when I’ve struggled in my language learning, and see the many times I have felt helpless, and realize that the simplest kindness from any stranger has helped me so much. It is, in my opinion, valuable for doctors to experience this, to remember their own frailty and so have compassion on the frailty of others. Learning Hebrew is difficult and continues to be a challenge, but it is good for me, and for all future doctors, to embrace helplessness in a situation. In so doing, we may learn empathy when we are the ones who can bring comfort or affliction, peace or unrest. - Nathan Douthit, blogger of the month

Clinical and Global Medicine rotations, by Sarah Humphreys

First-year medical students at Soroka Medical Center

Each week, we are divided into groups and dispersed to various settings throughout the city and in Soroka hospital for our clinical and global medicine interview rotations. They were supposed to begin last semester, but as classes were put on hiatus due to Operation Pillar of Defense, we are currently making up for lost time. A couple of weeks ago, I joined my group in the pediatric emergency department where a social worker took us on a tour of the facilities before we convened in a small room to meet our patients and interview their parents.

            Oftentimes when we do these interviews, the attending, or whoever our supervisor is that day, cherry picks the few English-speaking patients on the wards so we can talk to them in our native tongue. On this day, the social worker explained, she had been unable to do this, and more to the point, she expected us to interview the patients in Hebrew, and if we got really stuck, she would help us translate.  A slight vapor of unease wafted throughout the room, as some of us shifted in our seats and mumbled aloud about the fledgling state of our Hebrew skills, but we knew that this was the deal and that we had signed up for precisely this when we came to medical school in Israel.

            As the interviewees came in, we took turns taking a patient history and inquiring into the family and social history of the parents themselves. The point of the exercise was really about communication, and honing our listening skills, as all the medical knowledge in the world is completely useless if you lack the ability to elicit, and pay attention to, the story your patient is telling you.

We learned so much that day, about Bedouin culture, and how it may not be appropriate to ask a Bedouin mother if she is married (because it is unacceptable to be a single mother), but it is medically relevant to inquire as to whether her husband is also her relative (as consanguineous unions are extremely common), and how many other wives her husband has (as polygamy is the traditional norm), and if she is the first, second or third wife (as her rank may affect her social standing, which may in turn affect her health status). We also learned how important it is to be present with your patients, and to actually make eye contact and listen, without trampling them with a million questions before they’ve had time to answer, and without filling the awkward silences that often lead to valuable truths. In many ways, I found that speaking in our non-native tongue was helpful, as it naturally slowed the pace of the conversation, although we all found it doubly challenging to conjure the right mix of empathy and presence while constructing our next questions in the correct syntax.

 At the end of the day, I had a newfound appreciation and respect for my classmates, all of whom I found to be immensely empathetic, kind, curious and compassionate in their interviewing skills. I also had a newfound appreciation for what a privilege it is to be in a position where random strangers are willing and able to let you in to the details and vulnerable spaces in their lives. It’s a cliché at this point, and everyone says it, but this is why we are here. Now back to learning Hebrew (and Russian, and Arabic, and Amharic . . .).  - Sarah Humphreys, blogger of the month