"I get by with a little help from my friends," by MSIH blogger Tamara Kliot

With classes done and exams in full swing, we have an opportunity to reflect on what has happened over the past 5 or so months. We have learned about the important enzymes that allow us to metabolize nutrients and sustain life, the battle that occurs inside us every time we are invaded by foreign pathogens, the intricate design of cells in different parts of the body, the bacteria we should love and hate, the true meaning of statistical significance, and ethical dilemmas physicians face on a daily basis. It has become pretty apparent to me that the fact humans function so well on a daily basis is a miracle. While it’s crazy to think we have learned all this in one semester, I knew I would be studying these subjects. This is medical school after all.

I knew we were complicated creatures, but I have witnessed another level of our awesomeness these past few weeks. Finals are not the most relaxed time for students. The elevated cortisol levels tend to bring out the worst in people. However, that has not really been the case for my class. It was clear from the beginning of school, that people were interested in collaborating. Classmates would share resources they were using, notes they had compiled, or Anki flash cards they had made with other classmates frequently. When classes ended and exams began, I assumed people would be MIA and only surface on exam days, like any other exam period I had experienced in undergraduate.

Since classes have ended, I have been blown away by the amount of generosity that has gone on. People sharing notes, resources, and uplifting videos in our Facebook group. I am constantly getting notifications about this new resource or PDFs or question banks or YouTube videos or outlined notes. While it’s hard to keep tract of what I could be using at times, but its comforting to know we are all working toward the same goals together. In addition to sharing resources, people have also been sharing their time. Classmates have made a concerted effort to check in with each other to see how

people are handling the stress of finals. It’s pretty amazing to see how invested people are in our success as a group, not just the individual.

I’ve been told going into medicine is like running a marathon. You cannot sprint, you have to pace yourself. Even though running and taking exams are individual sports, they are much easier when you have a team of individuals to help keep you honest with your training.  With four exams down and one more exam to go, there is an end in sight. We are about to cross our first finish line in a series of many races and I am incredibly grateful for the team I have here in Beer Sheva.

I mean, how hard can crossing the finish line be when you have people like this in your life?

"Clown College" by MSIH first year blogger Rebecca Siegel

           On Wednesday evening at 3:47, a typical first medical student rummages through her backpack, to prepare for her next class. She sits in the break room on the sixth floor of the internal medicine building at Soroka hospital. She takes out a biochemistry textbook and put it’s on the floor beside her backpack. She takes out some highlighters, flash cards, and a binder full of printed out slides from immunology lectures. She still hasn’t found what she is looking for. She pulls out a tutu and then continues to rummage until she finds a Santa hat.  “Finally”, she mumbles. It’s time for class. 

Welcome to medical clowning. Meet Dr. Amnon Raviv, the only self-proclaimed only personal in the world to have a PHD in medical clowning. He is a clown, a real-word superhero, and the instructor of this very special course. He is a human sigh-of-relief for people battling serious illnesses all of the country. On any given day he can be found in an oncology ward, belting out an upbeat western style song about colon cancer, or in the surgery wing, helping a 5-year-old boy make a list of what dreams he would like to have during surgery (before summoning in the anesthesiologist and reading the list of dream-demands aloud).

As we leave the class three hours later, I feel a little overwhelmed by how lucky we are to have Dr. Raviv. We are students of empathy and active listening. We are tutu clad care takers. And for three hours every week, we are allowed to reclaim some of the idealism that made us want to practice medicine in the first place.

       It’s time to practice. One student is the patient, one is the doctor and one is the clown. Dr. Raviv tells us that the patient is a small child who is getting a shot, but feels quite scared. The clown tries to make bird noises and funny faces in order to distract the child from the shot. Dr. Raviv stops the exercise.“ The child is afraid of the shot”, Raviv explains “and you’re not going to help by ignoring the shot.”   They try again, only this time the clown jokes about the shot. He pretends to give it to the nurse, to himself, even to the wall. “Better”, Dr. Raviv says. Slowly we are starting to understand. 

"A Guide through Dissonance: 2015 Physician's Oath Ceremony," by MSIH first year blogger Jay Berkes

MSIH Physician's Oath Ceremony 2015

The fact of medicine as an institution has not been lost on any that have passed through its doors. The least of which are first year medical students, whose ambitions of practicing medicine have not yet been co-opted by the demanding processes of the education and the career. Our view of medicine is still one of reverence, the ideals of which don’t just sit propped on one mountain to be climbed, but on peaks and in valleys throughout an entire range of challenges. They remain there, revered, and in places of importance because we are the type that enjoys challenge.

A good challenge, though, must be accompanied by its goal. Or some reminder of its goal. For me, this reality was the highlight of the master’s degree I completed shortly before coming to Israel. I studied business administration, the result of which is a ticket to business ownership or organizational management in some form. In one class we discussed whether or not management was a true profession, bound by a code of conduct, a license to operate, a professional governing body, a foundational education, and a duty to serve. These requirements are necessary to generate a fairly explicit agreement with society, one in which the members of a profession will exercise trust and control in the provision of their service, maintaining equity within that societal agreement. Of course, the field of management isn’t bound by these requirements. So do they not have a place within a societal agreement? Of course they do, and in the absence of a professional governing body or a license to operate they must rely solely on their education and their duty to serve. Those two things, and especially that duty to serve, become the daily reminder of the daily challenges offered in management.

So where does that leave me, three months into my medical education, still wrapped in the importance of the pursuit of becoming a physician? And what is the guiding reminder of that goal?

First and foremost, I hold onto that duty to serve, a fundamental part of my interest in medicine, and a fundamental part of my future profession. And while that should be enough, the rigors of the educational process provide more than enough distraction from the foundation. Every pursuit of knowledge is wrought with that dissonance, the dichotomous fight between awareness and ignorance. Awareness to the details of root memorization, creative processing, and the larger end goal of application. Ignorance to the discomfort of effort, in the trenches of detail and the finality of that big picture. The difficult realization, of course, is that merely surviving such dissonance isn’t enough. Surviving on the merit of scientific knowledge, and graded application, will produce competence, and at the every least it will have produced a physician that has succeeded in entering into that fairly explicit societal agreement (complete with licensure, a code of conduct, and the acceptance of a professional governing body). But a code of conduct is not an oath, and medical competence is not the only goal. Something else is needed.  

At MSIH and Ben Gurion University, like hundreds of institutions around the world, we take a Physician’s Oath at the start of our medical studies to guide us on a path through that dissonance. With Dr. Shimon Glick, a founding member of BGU’s Faculty of Medicine and a leader in the practice of medical humanism and medical ethics, we learned that this oath and this ceremony is in place to bear on us the responsibilities and duties, and not just rights, of medicine. Started over 40 years ago, at this school, this practice aimed to make “change agents” of the BGU’s first medical students, working to upgrade the medical care and health of patients and communities, from the very start¹. 

For those of us that have chosen a foreign country to enter into a difficult profession, with a focus on a discipline (Global Health) that is not widely understood, the Physician’s Oath is a guiding hand, a statement of our duty to serve, and a reminder to be agents of change for the benefit of our patients and our communities.

I’ll use it as my guide when the dissonance gets too loud.

Reference:

1.      Glick, S. M. (2003). White coat ceremonies—another commentary. Journal of Medical Ethics, 29(6), 367–368. http://doi.org/10.1136/jme.29.6.367

"Every day is Valentine's Day at MSIH", by blogger of the month Shauna Dunton

Valentine's Day

The middle of February marks our 6th month of attending the Medical School for International Health, of living in Be’er Sheva, Israel, of knowing and growing very close with our classmates, and of being far away from our loved ones at home.

Our time here is truly flying by.  We have learned so much and we have gotten so close to one another in such a short time.  In fact we have become so close as a class that we find any excuse to spend more time with each other which is quite incredible considering we spend eight hours a day with each other at school already, not to mention that most of us live together. For example, we recently celebrated Valentines day together as a class by having a “breakfast for dinner” Valentines Day Feast complete with card signing for each and every student in our class. There were heart shaped pancakes, french toast dyed pink, and loads of loving glances at one another as you might expect at such an event.

In other news, this past Thursday, two of our classmates played in Light Opera Group of the Negev’s production of Fiddler on the Roof. It was an amazing production and about half of our class came out to support them in this great endeavor. The acting and the dancing were spot on and I know we’ve all got those catchy tunes still stuck in our heads a week later.

Fiddler on the Roof

Last but not least, on Monday night a group of woman from all years of MSIH put on a spectacular production of the Vagina Monologues. I had watched a production of the monologues performed at Colgate University where I went for undergrad, but as another student in our program pointed out, it was quite powerful to see this production done by an array of multi-talented women that are all going to become doctors.

Vagina Monologues

You might think at this point in my blog post that we may not realize that we are here to study medicine, but believe me, we do! I will elaborate on all the things we are doing in the classroom in my next blog post.

Until then, lehitra’ot!                                                 - Shauna Dunton, 1st year blogger of the month

Exam week trivia, by blogger of the month Jixi He

I thought I might not have much to say for this last week of blogging due to the exams. We had a bacteriology exam and Hebrew final on Sunday, and biochemistry final on Thursday. However I realized that the excitement of life doesn’t go away during exam’s week as long as I keep my eyes open. Hence I’ve slowed down to smell some roses and gathered some trivia from the past week that’s not related to biochemistry. You know how hard it is:

Photos:
1. We finally got our ASRAN cards – proof that we’re medical students!

















2. My desk before the biochemistry final. Yes, I was multitasking all those books.


















3. Can you guess what is this strange looking UFO building, where I spend most of my daytime before an exam? I bet our library is cooler than yours.















4. The library’s got a great view too: the helicopter pad. A helicopter landed one morning and some soldiers came down with a stretcher just like in a movie. What better place to learn emergency medicine than in Israel?















5. Before the biochemistry final, I spotted the most beautiful sunset on my way to school. Thanks to our NBME exam time (5pm in order to be in sync with North America) I was able to witness this beauty of nature that not everyone can see everyday.

6. After the biochemistry final, my breath was again taken away by the mesmerizing sky with the cotton candy like clouds and an almost-full moon.

7. I found this Chinese rice snack I had always loved as a kid in a nearby supermarket. The excitement was comparable to seeing a long lost childhood friend on a lonely island, and knowing that my friend now speaks Hebrew too.

       8-10. A Shabbat dinner with Chinese food is the best! I’m pleasantly surprised after coming to Israel that I’ve had way more frequent Chinese food gatherings in the past 6 months than my past 6 years in the US. We have much less Chinese students here but probably also because of that; we are a much tighter community. Whenever I get to taste Chinese food I feel like I’m on an express plane back home.

"Why is this August different from all other Augusts?" by blogger of the month Aviva Friedman

I was going to start this blog post with a pun about rockets, but, when google failed me and that plan imploded (har har), I decided instead to write an ode to the craziness of this past August. A slow start to the school year meant that, while our friends across the ocean were tucking into neatly pressed white coats and embarking on their first few weeks of medical school, we were holed up in classrooms doubling as shelters (not to mention meeting the neighbours in the middle of the night wearing nothing but a towel…), cramming 5 weeks’ worth of Emergency Medicine and Hebrew lessons into 5 days while sirens occasionally blared in the background to remind us of the current state of affairs. It also meant an ensuing scramble to set up apartments and phone lines as things began to settle, exposing us to the balagan of Israeli culture, starting at the grocery store, where we stood in something that sort of resembled a line, wondering whether we were actually buying yogurt or sour cream and if we would make it to the bank in time before it closed at 1:30 for a four-hour long mid-day siesta. 

But despite the war-time hoopla, we finished orientation. Most of us moved in to new apartments, began kindling friendships, and spent our first gluten-free, sugar-free, dairy-free shabbat together as a first-year family. We made friends with the local cats and danced salsa (taught by Israelis?!). We conversed in broken Hebrew to our cab drivers and landlords, and experienced a night out a dance club where we were the only ones dancing. We explored Be’er Sheva’s Little India and ate “authentic Chinese food” in the middle of the desert. We sat through our first week of Histology and Immunology, Biochemistry and Global Health (oh my!), then built bridges over pizza with our Israeli equivalents in the Hebrew medical school. And of course, who could forget Hebrew, where we served each other falafels in the Beginner class and, if somehow like me, you ended up in the Advanced class, we were already having discussions (IN HEBREW!) about AIDS and overmedicating our children and the ethical implications of posthumously utilizing someone’s gametes to produce a grandchild. In Hebrew. Yep.

Medical school in Be’er Sheva is anything but traditional. We are adjusting to a new language, a loud - but exciting! - culture, and life in what is essentially a convection oven. Thankfully, the sirens have ceased to blare, replaced instead by the shrill voices of Israelis on their cellphones and the cries of stray cats trapped within the halls of our school. Our fears have now shifted from dodging rocket fire to the seemingly impossible task of juggling nine classes and finishing up our homework before a dynamite (see what I did there?) camping trip this weekend in Tel Aviv, because as any Israeli would tell you, life carries on…. 

Updates to come!

- Aviva Friedman, blogger of the month

Yom Hashoa:Holocaust Remembrance Day, by Baila Litwak

יזכור = remember

I arrived in Beersheba with 36 classmates in mid July and at this point have been living here for nearly 10 months. Yesterday I heard my first siren that was not a drill. Yesterday was Yom Hashoa, Holocaust remembrance day.

According to Jewish law holidays begin at sunset and last until sunset the following day. I realized Yom Hashoa had began when I was studying in my apartment, listening to the radio, and it suddenly dawned on me that they were no longer playing happy, upbeat music. On Yom Hashoa every radio station plays slow, somber music, every TV channels broadcasts either documentaries or discussions relating to the Holocaust. As I was studying for my pathology final I felt too tired to make dinner and too busy to go out to eat so I decided to order pizza. When I went to the dominos website I found that they were closed for Yom Hashoa.

“Dear customers, On the eve of Yom Hashoa Dominos will be closed...”

On Yom Hashoa there are ceremonies throughout the country held at schools, public squares, military bases, etc. I, along with a number of my fellow classmates, attended the Yom Hashoa ceremony at BGU. It was outside in the 90+ degree weather under the scorching sun, yet hundreds of students were there to remember the millions who were “exterminated” during the Holocaust. There were nearly as many students in attendance as there were last month for Purim, which is one of the most fun parties on campus all year. At the ceremony there were speeches, a modern dance piece, a choir that sang two beautiful songs, and six people from the community who told stories of their family members who were killed and those who survived the Holocaust. Each of the six people who shared their family’s story lit a candle in commemoration.

At 10:00 in the morning of Yom Hashoa there is a siren that blares throughout the country, loud enough so that people can hear it where ever they might find themselves at that moment. The siren lasts for two minutes and for those two minutes everything stops.  Every person at every ceremony stands in silence. People stop driving in the middle of the highway, get out of their cars, and bow their head in honor of their brothers and sisters who were killed.

https://www.youtube.com/watch?v=OeozUSWdoQA

Israel was established to be a place of refuge for Jews being persecuted across the world and a state where Jews could feel independent and safe. Today Israel is still such a place and not only for the Jews. Every year On Yom Hashoa Israel remembers those who were not safe where they lived and were forced to endure persecution, murder, and true hatred. - blogger of the month, Baila Litwak

MSIH Passover, by Baila Litwak

            Passover break could not be at a better time, the weather is warm and beautiful and it is the perfect time to explore. Since the holiday began the country seems to be more alive with people, from Israeli children on break to tourists from all over the world. So far in the week of break I have visited family, saw live music in a town square of Yafo, and I have spent a few days soaking up the sun and arctic (Israeli ice pops) at the beach in Tel Aviv. While there I was able to see friends living in Israel, friends visiting from home, and I ran into other MSIH students enjoying their time off as well. With such great public transportation in this country it is easy to go from Beer Sheva to Tel Aviv or anywhere else whether it be for a few hours our a few days. I hope to take advantage of this fact and travel more of the country during the rest of this break.

chag sameach = Happy holiday

            Passover is a week long holiday that starts with a seder, a festive meal that follows an order of activities and readings (seder=hebrew word for order) and is filled with songs, food, and wine. Every year my family makes a big seder where family and friends come to enjoy the evening and traditions until the wee hours of the morning. This year, like every other, my family held a large seder but for the first time I was not there. Instead this year I was in Israel where there is only 1 seder instead of 2 and I had a seder with part of the MSIH family rather than my family at home. A gracious second year opened his house to the extended MSIH family and invited every student to the seder. Every day it seemed more and more people were saying they would be going to this seder and by the night of there were 21 of us. The seder was a great opportunity to hang out with fellow classmates, learn other people’s traditions, and was a lot of fun!

            As someone who observes Passover and does not eat bread or other food items that are prohibited for the duration of the holiday I have fallen more in love with Israel through this holiday. From what I have seen, most restaurants here have a Passover menu which even includes kosher for Passover bread! The food is always terrific in Israel, and that remains true during Passover.

            At this point in the year we have taken two finals and have three more before completing our second semester of M1. We are half way through our Passover break and last night we had a big BBQ for our class where we shared stories of our breaks so far. We had classmates all over the world this break, in Denmark, Austria, Romania, Jordan and there are some still traveling in Turkey, England, Ukraine, and Mozambique. Israel is a beautiful historical country with countless numbers of things to see, it is also an easy place from which one can travel to other parts of the world. -Baila Litwak, blogger of the month

Goats, Garden and Graves, by Sakal Kiv

The desert surprises me, particularly the Negev. You find so many things that you would not expect to see here. Who would have known that people drive out to the middle of the desert for fresh farm-raised tilapia or goat’s cheese? When we stayed for a week in a desert farming community, we saw red-ripe tomatoes (yum!), crispy bell peppers (mmmm!), and beautiful flowers being grown out there. The Cambodian agricultural students there told me, “It is amazing the skill they have to make things grow out of the desert, in our country, we just defecate on the ground and something grows, yet we haven’t really learned to fully take advantage of even that.”

A few days ago, we had another unexpectedly pleasant time in the desert. On the way to Sede Boker (which, until this trip, I had incorrectly heard and thought of as “Stable Care”), our friends took us to a kibbutz where they raised goats for cheese and milk. The kibbutz even gave out samples for us to enjoy! My kids especially liked watching the goats being milked. I had expected that they would be milked by hand, but instead, they were all hooked up to a milking machine like the ones used for dairy cows—a real-life Mister Rogers Neighborhood experience.

At Sede Boker, we walked around the garden where David Ben-Gurion is buried next to his wife, Paula. Our kids had a wonderful time walking and playing with each other there. It was a beautiful place to be, quite shaded and cool and full of lush, green things growing out of rock. On our class hike when we first arrived, I remembered looking up from the valley of Wadi Chaverim at night and seeing the lighted garden and wanting to visit, so it was good to have the chance. It is a very fitting resting place for Ben-Gurion, a visionary leader who looked beyond the desolation and saw its potential, something that is becoming more and more a reality today.

After our walk, our kids played at the playground (I love it how there’s one of these everywhere!). Then we finished the evening with a dinner and conversation between friends. Sometimes it astounds me, especially when I take time to think about it, of all the momentous events that have taken place here. This desert is where Abraham raised sheep and received divine promises, where Elijah sought refuge in a cave and heard the Whisper, where some of the last great cavalry battles took place in the Sinai-Palestine campaign against the Turks, where David Ben-Gurion kept a home and lived and worked, and where some of the best medical students the world has ever seen are being trained. When I think of all these things, I feel blessed to be here in the Negev desert with family and friends. - Sakal Kiv, blogger of the month

Small Victories, or How I Learned to Stop Trivializing and Love the Travail, by Seth Morrison

This past week was a week of small victories. These undersized accomplishments demand no recording in the great history books of noble deeds, and I myself will probably forget about them entirely within a single trip around the sun. In other words, it was an average week. But, I have been learning over the past several years and up to now not to trivialize these small victories. One must grow to love the ongoing travail of life that together they comprise.

If you care to know what these victories were, read on from here. If not, skip to the paragraph beginning with, “As you can see…”

During the week I…

Was pleased that I owned a wool coat for a stretch of some wet, chilly weather in Beer Sheva,

Answered a question about the wet, chilly weather in Hebrew to a neighbor who asked me as he was leaving his apartment,

Saw a different neighbor, Meir, in the Soroka Hospital cafeteria during lunch and understood (mostly) what he was telling me in Hebrew about visiting his elderly mother in the hospital,

Found out that I escaped the first semester of medical school without failing any exams,

Cooked a three-course dinner for a group of six, the most people I have ever prepared a dinner for by my own efforts,

Improved my tiny apartment room by installing several hooks in various places to increase its storage capacity, and bought a desk lamp to prevent premature eye damage from late nights studying with insufficient light,

Finally got working cell phone service again after the first company I used cancelled my account with them, for no apparent reason, back in December, and called family members in America for no extra charge,

Received a compliment on work done on a scientific literature review project that I thought would surely be disappointing, at best, to the professor,

Learned a bit about childhood development at clinical observations in a pediatric specialist’s office,

And, I finally came to understand the overall treatment regimen for patients infected with tuberculosis—a subject that had perplexed me—thanks to a stirring lecture by Dr. Alkan.

As you can see, I won’t be winning prizes, grants, medals, or any other accolades for my doings in the week of January 27, 2013. but, the beauty of that lies in the fact that I still thought it was a good week despite its ordinariness and not receiving any exterior recognitions for it.

I think it is all too easy for a medical student to go down the well-trodden path that many people of letters end up on. They come into their education like children—idealistic, wide-eyed, empty vessels ready to be filled—and many leave like Faust—devoid of the purpose and ideals with which they started, floating on the breeze toward they know not what. They leave laden with knowledge they have not a clue how to most meaningfully employ toward good ends.

Here is what Faust said after he’d finished his course of study:

[Night: in a narrow high-arched gothic study

Faust, sitting uneasy at his desk.]

Faust:  Have now, alas! quite studied through

Philosophy and Medicine,

And Law, and ah! Theology, too,

With hot desire the truth to win!

And here, at last, I stand, poor fool!

As wise as when I entered school;

Am called Magister, Doctor, indeed—

Ten livelong years cease not to lead

Backward and forward, to and fro,

My scholars by the nose—and lo!

Just nothing, I see, is the sum of our learning,

To the very core of my heart 'tis burning…

What then? all pleasure is fled forever;

To know one thing I vainly endeavor…

And then, too, nor goods nor gold have I,

Nor fame nor worldly dignity—

A condition no dog could longer live in!

And so to magic my soul I've given,

If, haply, by spirits' mouth and might,

Some mysteries may not be brought to light;

That I may know what the world contains

In its innermost heart and finer veins,

            (from Faust, A Tragedy, by Johann Wolfgang von Goethe, 1808)

Perhaps I have no authority to speak of such things, as I am yet at the incoming end of the educative transaction, but then again perhaps thinking about them now will deflect me from this regrettable path. It helps me to remember the words of Dr. Viktor Frankl, who wrote, “Man does not simply exist, but always decides what his existence will be, what he will become in the next moment.” So, my prayer for the class of 2016 is that we would not get lost in the directionless mire of the daily grind, that we will learn to appreciate and act on the insights that even the most mundane of weeks can bring, and that we will not succumb to the Faustian temptation of narcissism by the time we’ve reached the home stretch. Amen. - blogger of the month, Seth Morrison