"Finding Family in Friends," by MSIH December blogger of the month Tamara Kliot

Studying medicine abroad is exciting! There are always new places to explore, people to meet, languages to learn, cultural norms to adapt to, and things to discover. The opportunities to procrastinate studying for biochemistry or immunology are abundant. However, with the ending of classes and beginning of exams, there has been a noticeable shift in how people are allocating their time. Priorities are shifting as that list of important information to review continues to grow.

While having fun and taking “mini-vacations” are important stress relievers, it is easy to lose sight of that when you are in the thick of studying. It is easy to isolate yourself in a study fortress and spend your time surrounded by books and watching videos on metabolic processes. It is easy to forget to be a human and spend time with friends and talk to family.

I was reminded of this when my Israeli neighbor wished me a Happy Thanksgiving. He was the last person I expected to hear those words from, but he forced me to stop and think. Thanksgiving is my favorite holiday because it's an opportunity to spend time with family and reflect on the things we are grateful for. Living in Israel, it would have been easy to forget to celebrate or even acknowledge Thanksgiving. It is just another day in Israel and in many other countries for that matter. We had had a busy week, multiple quizzes to study for, and a paper to write; the last thing on people’s minds was Thanksgiving.

But as Thanksgiving continued, it was not just another day in Beer Sheva. Some of our classmates had the forethought to organize a dinner at Butchery to celebrate the end of first semester classes and well… Thanksgiving! It was a fabulous time with delicious food (tons of meat!) and amazing company. It was fun to see our non-American classmates get in the spirit of Thanksgiving as well! The night was filled with stories, laughs, and celebration (we did just finish one semester of classes!). I learned so many new things about the awesome people I am lucky enough to call classmates. It was a great way to recharge from a long week and reminded me that I do in fact have a family here in Beer Sheva, people I call friends and accomplices in this adventure we call medical school. 

"A Very Beer-Sheva Thanksgiving" by MSIH first year blogger Becca Siegel

On November 26th, 2015, several medical students from around the world celebrated Thanksgiving dinner in the Middle East. In Beer Sheva, Israel to to be exact.  I am pointing this out because it is notable in many respects. First off, the very fact that a group of people who regularly spend upwards of eight hours a day together would want to spend their few off hours together is quite amazing. Secondly, in a little city, in one of the smallest countries in the Middle East, students from all over the world sat together and had a meal because there was a lot to be thankful for.

We had just taken our last microbiology quiz of the semester. We were a few days away from our very last class of our first semester of medical school. We had survived. We had somehow managed to move to a brand new country, learn a brand new language and start medical school, all in one fell swoop.

Together we ate delicious food and we made nerdy jokes about mycobacteria and we toasted to a circle of people who could one day be called “doctor”.

Happy Thanksgiving from the class of 2019!!!

Now on to finals.

"Lost in Translation" by MSIH first year blogger Rebecca Siegel

A few days ago, when I was walking home for class, a man asked me for directions in Russian. I know that he was asking for directions, not because my Russian was sufficient to decipher his intention but because he was pointing to a tattered map. From what I could tell, he was looking to get to the post office, which was pretty much a straight.

I tried to communicate that it was straight ahead in every way I could. I attempted in Hebrew. I attempted in English. I made a line with my finger on his map. I mimed a person walking forward and finding a post office.

Nothing worked and with each attempt he looked progressively more frustrated. I also felt frustrated because I knew what he was going through and I was powerless to help. I too was a stranger in a strange place. I knew exactly what it was like to say the simplest thing over and over again and not see a look of understanding on the face of the person that I was talking to.

            To me, this is one of the greatest assets of going to medical school in a foreign country. The very fact that we know what it is like to struggle with being able to communicate and understand basic things is what is going to make us good doctors. Not understanding is hard.

            So here’s to my classmates who have known the true horror of taking a bite of a would-be-delicious breakfast parfait, only to find they had purchased sour cream and not yogurt at the grocery store.

My very resilient classmates who have double, triple and quadruple checked the bus map, only to find they were now farther from their destination then they started.

Together, we have learned intimately what it means to need help and lack the words to ask for it.

My peers and I represent a class of physicians who will understand that it is not the responsibility of a patient to communicate in ways a physician can understand. It is on the doctor to hear a patient’s explanation and figure it out.

"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

Emergency medicine: killin' it without killin' anybody by first year blogger Jessie Seiler

Many of the members of the class of 2019 seem to have arrived in Beer Sheva with a wide range of skills to recommend them as friends, classmates, and future doctors. A few of us speak a bazillion languages each; pretty much everybody has traveled widely; we are all pretty great at getting out of our comfort zones. While my own total lack of Hebrew coming into this experience made me a little nervous at first, my envy really focused itself on the students who came in as EMTs or with other first-responder training. Without so much as a summer lifeguarding under my belt, I was concerned to see that we were scheduled to start emergency medicine courses immediately upon arrival in Beer Sheva. Most alarmingly, we’d be sticking our new classmates with peripheral IV catheters by the end of our third week in country. You’re going to want to poke around on the Internet for a second to see what one of these looks like. And now my alarm makes sense, right?

Anyway, orientation passed and Real Day 1 rolled around, with intensive Hebrew for several hours in the morning and emergency medicine right after lunch. After a lecture on the basics of CPR with our whole class, we broke off into four groups, each under the guidance of an advanced Israeli medical student.

“My job is to make you legit,” our TA announced. After reviewing the lecture with us, he moved on to demonstrating the basics of CPR on a mannequin, explaining each move and stopping to answer what I’m sure were hilariously inept questions, at least at first. With an hour to go in the class, he let us break into groups and begin practicing ourselves. It was pretty fun!

The drills became increasingly complex as the days passed. Some choice moments:

“I brought a friend with me. I don't want him to feel left out. So I invite him to perform CPR with me!" (Get ready to make your friend do all the chest compressions for you, because it gets pretty tiring after a while.)

“CLEAR!” (Just as exciting as in the movies!)

“Hnnnnnnrrrrrgggghhhhhh.” (This is the sound you make as a fake trauma victim to demonstrate how very much you’ve just been hit by a car.)

And then, one fateful day, just when we were allowing a little swagger to enter our step: “You are all going to place IV catheters today, and it will be fine.”

 After watching some recommended videos on the procedure the night before our big day, I experienced some quiet and thoughtful moments in which I listed all the possible ways I could potentially end my classmate’s life the following afternoon. As far as I could tell, they really all seemed like one-in-a-million chances. Some were elaborate, and even a little ridiculous, but I couldn’t stop them from swirling up: what if there’s an earthquake the second I’m getting in there and her arm gets really bloody and infected? What if I puncture and then sever the vein entirely? What if I’m concentrating so hard on not messing up (and she’s got her head turned away to avoid looking at the bloody mess I’m making) that I don’t notice the approaching tiger? I calmed myself with the thought that there aren’t tigers in medical schools pretty much ever, and that our TA (whom we had all come to trust entirely) would be hovering mere inches away.

And you know what? It went really well, for pretty much all of us. No deaths, no total failures, no tigers. I got the catheter into my classmate’s vein, she was able to successfully stick our TA (who generously offered his own veins in place of mine, which are slippery and lack team spirit), and then we all went out for a celebratory beer.

Being at MSIH means working through stuff together, and it’s not just biochem problem sets, the maze of hospital and university buildings, or the serious issue of buying sour cream when you wanted yogurt because your Hebrew is pretty bad just now. It’s also the feelings of trepidation and uncertainty that come with starting a new thing in a new place. There are obstacles, and they require a willingness to step outside of your comfort zone, a clear sense of purpose, and the right people by your side.   

And I have to say it: so far, so good. I chose MSIH because I wanted the experience of going to medical school with the type of people who would choose MSIH. And now that we’ve passed through the experience of placing IV catheters into each other, I think that was the right way to go.  

The week before exams, by blogger of the month Jixi He

Luisa's birthday

We like to say time flies when you’re having fun. Well, time flies no matter what you do especially when the exam period is coming up. I can’t believe I’ve already been in Israel for almost half a year now. I know my way around Beer Sheva. I can ask for directions in Hebrew and actually understand the answers. I refer to Soroka as “our hospital”. But I don’t think I’m ready for the exams, even if you give me another 6 months for it. I’ve learned quite a lot this semester but there’s always much more that I don’t know. So this is what we’ve been doing to prepare for the exam…


Luisa’s birthday is coming up. Don’t you dare forget about it! She is teaching the whole class about the biochemical pathways of her existence: You start with 2 substrates-papi and mami, and the enzyme-Luisasynthase, and you get an irreversible conformational change that results in our lovely product-Luisa, who is responsible for making birthday cards, giving our classmates lots of hugs, and keeping everyone happy. This metabolic pathway is positively regulated by love and negatively regulated by sickness on a gloomy day. And there you go; I should pass my biochemistry final after this review session?

Sleepy chaverim (friends)

Sleepy Sam!

How to prevent yourself from falling asleep in class? Fall asleep between classes! Just like how my dear chaverim (“friends” in Hebrew) have demonstrated: a short power nap during the break can improve attention in class and retain 50% more knowledge because you’re not constantly dozing off. Phase II clinical trial pending.

Food before

Food after!

It is absolutely essential to have good energy for better and more efficient studies. The brain takes up only 2% of the body weight but uses more than 20% of our daily energy intake. Let’s take care of that little commander on top with some delicious cafeteria food from the hospital. Beef, carrots, and chicken soup; tastes just like the food I had in China. “It tastes like Chinese” is the best compliment I can give to food. We all might have noticed that we get a little grumpier when we’re hungry. That’s because when we’re hungry the serotonin level drops and this is an important hormone that helps regulate behaviors like anger and aggression. I can definitely tell you that I feel like the happiest person on earth whenever I finish a good meal after a state of starvation. My almost empty plate can tell you that too.

Rainy B7

When you’re busy preparing for exams don’t forget about the little things that can make life beautiful. It’s been pretty rainy and cold in Beer Sheva this past week. Even in this gloomy weather, I still spotted the most beautiful scene at the hospital helicopter field yesterday: a golden sunset against the backdrop of the heavy grey clouds. It brightened up my evening as I walked back home, tired from a whole day of study.

Falafel for Thanksgiving

It’s the 4th Thursday of November. What’s Thanksgiving in Israel like? Falafels! In this cold winter night at the Black Falafel stand, we gathered our friends and family and took turns saying what we were thankful for this past year. I am thankful for my mom, all my friends, this falafel and the fact that I’m in Israel. - blogger of the month, Jixi He

"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

Research and Medical School, by blogger of the month Aaron Dobie

Loading cDNA into liquid nitrogen trays for long term storage.

A cool and unexpected part of my first year in medical school has been participation in new types of medical research. Since arriving in July I’ve been able to participate in two different research projects – one qualitative and one quantitative. The first was an ethnographic case report on in-home quadriplegic care in the Golan, a region roughly three hours north of Beer Sheva.

            Early on in the fall semester, Dr. Seema Biswas (referenced in Jonah Kreniske’s 24 September 2013 blog post) arranged for eight students in our first-year class to visit one of her colleagues in a community health clinic in the Golan. The doctor in the Golan had a number of patients whose stories and conditions cast interesting lights on different topics in Global Health. Fellow classmate Baila Litwak and I interviewed a quadriplegic man whose parents quit their jobs six years ago to be his full time caregivers. We performed the interviews in their home and we were able to see the man’s medical setup – respirator, feeding machine – and talk to his parents about their story. The community doctor had trained the family how to use all of the equipment and it was powerful to see the well-functioning links between a robust primary care system and the people it’s designed to serve.

The liquid nitrogen tank

            My other research experience was more quantitative. In college I never had the chance to do any hard bench science research but was always interested in learning some of the lab techniques that I learned about in various classes. One morning in the fall semester I got to talking with our biochemistry professor (emeritus) Dr. Nava Bhashan (who, as a side note, wrote MSIH’s problem-based-learning biochem curriculum with actual cases she’s encountered over the years as a clinical biochemist). I knew that Dr. Bhashan used to do research on the cardiovascular effects of HIV antiretroviral therapy and I asked her if she knew of any similar research projects going on at Soroka Hospital. Without hesitation she whipped out her phone, made a couple of calls, and arranged a meeting for me the following week. I ended up talking with Dr. Ran Taube who runs a lab looking at the molecular mechanisms of HIV transcription. With no HIV vaccine visible in the nearby future, his research elucidates and proposes ways in which latent HIV within the body can be re-activated so that the body’s immune system (along with concurrent antiretroviral therapy) can actually “see” and clear HIV infected cells. Dr. Taube was fine with me shadowing in the lab and during January I put in four 20 hour weeks after school in which time I learned many lab techniques: cell culture, lentiviral gene transfection, RNA extraction, cDNA reverse transcription, and PCR.

View of Soroka Hospital one night after leaving lab

In the end I decided that simultaneous research and medical school wasn’t going to work for me but it is definitely an option for so-inclined future students. There is a lot of interesting research happening around the BGU campus in Beer Sheva and I think both of my experiences illustrate the close knit community of students, professors and researches at Soroka Hospital and MSIH. 

-blogger of the month, Aaron Dobie

What matters most, by Jonah Kreniske

A gentle breeze wafts in from the balcony, sliding through my open door and bringing a welcome chill. I step out and rest my hands on the iron banister. In the distance I can make out the hills of Ramot, barely lit by a low, rust colored moon.  My neighborhood, Gimmel, winds out below me. Undulating Hebrew and Arabic beats from nearby apartment complexes mix with the usual classic rock standards from Coca bar up the street.  If it were daytime, you would hear the Ethiopian children across the street playing in the yard of the New Immigrant Absorption Center. But it is almost one in the morning, and they are sleeping now. I should probably be sleeping too. Instead, I’m standing here, breathing in the city. From my balcony I can see Soroka Hospital. A shining invitation to the unwell of the desert night, it is a slice of sleek modernity in the dusty streets.

The past month, in that hospital, has been a whirlwind introduction to our new lives as physicians in training. We have met our classmates and together we have absorbed myriad lectures, and trudged through hours of intensive Ulpan. Now, in this rare moment of relative calm, I look across at the maternity clinic, and I wonder if someone is being born behind those walls. It’s comforting to remember that life begins here. On Monday, walking past the ER to my first class, a weeping woman swept past me. Glancing towards the ER doors she had burst out of, I saw another woman writhing on the floor. An ambulance had just arrived. Never have I heard so much pain in the voice of another human being as I heard in the cries of that woman outside the ER, on my way to 8am class.  At Soroka we see what we might push to the back of our minds in another context. We see illness and death, birth and health, side-by side, tipping weights on a human scale.  

“Good medicine is not about killing microbes, it is about keeping human bodies in balance,” one professor reminded us. On the hospital campus, in the tireless work of the physicians and nurses who pace its halls, and in the aspiring faces of my classmates, I see the will to maintain that balance. In the struggle to provide care, I see the physical manifestation of the compassionate instinct that I would like to believe is somewhere in all of us. As I step back into my room for the night, I know another long day of classes awaits us in the mounting heat of the morning, but I also know that this day will be another small drop on the side of the scale that matters most. - Jonah Kreniske, September blogger of the month

A Day Twice Reflected, by blogger of the month Elon Richman

Today was long.

I woke up at 7:30 am to attend three and a half hours of intensive Hebrew language where our teacher drills us and drills us with verb conjugations and nouns. Its a steady barrage of “what the are you saying” and “will I ever really be able to have a conversation with someone in this bizarre language without sounding like a child.”

After a short lunch, I am warmly greeted by five hours of “this is how you treat the absolute worst case scenario that ever could possibly happen to a human being” and a repetitive series of mouth to mouth resuscitation with age old alcohol wiped plastic dolls.

When I think about the work that awaits me over the next four years of medical school, I begin to tremble.

I’m walking home from yet another ten-hour day and look up at a fiery bright orange sky remembering that momma said there’d be days like this. Days of stress and uncertainty. Days when I didn’t wake up on the right side of the bed or I’m just having trouble seeing the big picture.

So I think I’ll try today again.

I wake up to a cool morning. The light is shining gently on yet another peaceful Be’er Sheva dawn as the city churns and people leave for work. I sip green tea, eat fresh bread and look off my balcony at the doors of Soroka who readily await my arrival.

On my way in, I take a detour towards Coffee Time where the barista knows me and doesn’t need to ask my order. We smile and greet each other with a cheerful boker tov and I’m off with my warm coffee. That first cup of muddy black Turkish brew hits my lips and blesses me with the gift of God’s strength and energy.

I’m ready.

It’s now Ulpan time and Nava, our charismatic and oddly humorous teacher, gives us the tools to describe our world around us (both in the streets and behind hospital doors).  I notice my language progress from the last few weeks and smile at the entirely wide and new array of people I can communicate with because of this tongue.

During lunch I talk with my classmates and we laugh over food and more coffee. Conversations vary and I’m thankful to rest my mind for an hour and change before going to the next series of lessons. As we walk to Emergency Medicine at around 1 o’clock, it’s hot, but my body thanks me for the warmth after being inside for so long.

We arrive. It’s time to start pumping adrenaline as information is hurdled at us and we’re encouraged to think on our toes.

“Head trauma? Infant Foreign Body Obstructions? Safety first!”

I arm myself with knowledge. What pleasure it is to feel readiness and confidence as I imagine jumping at the chance of aiding those in distress. Bring it on.

6:00 rolls around and I’m off school. I swing by the pool and lunge head first into the engulfing waters. The intensity of my workouts keeps me alive, pulling at the water and pushing the limits of my body slightly further every time. I sense the resistance against me as I glide through. Even better is the clear mind and feeling of euphoria after a full hour of intense swimming. It’s like meditation, concentrating so fiercely on my activity until the release, when tension is put to rest.

I’m walking home now against a fantastically beautiful Be’er Sheva sunset. I smell the plants. I touch things. I feel my feet steadily kiss the sidewalk as I walk home with a clear mind.

I reflect on my accomplishments from today and excite my nerves with tomorrow’s prospects. What new Hebrew words will I learn? What new restaurant should I try?

I think about this weekend. What will I do? Who will I see? What new place can I discover?

There are so many ways we can view our day to day lives in medical school. It can be a stressful rush of chores and appointments, or a beautiful array of sensation and life. It’s easy to lose sight of why we’re here.

My advice? Smell more plants, touch more things, talk to more people. When you find your balance starting to sway in the wrong direction, take notice and readjust. Bring everything back to the present time.

Don’t dissolve the day’s powder in a glass and drink. Instead, let her breathe. Smell the essence, taste the bitter and sweet, and live forever in the infinitesimal granules of every moment.

The late Israeli comedian Talia Shapira once said wisely:

.התחילה כבר החיים ,לב שמת לא אם

If you haven’t noticed, life has already begun.  -Elon Richman, August blogger of the month

A picture speaks a thousand words....photoblog by Jonathan Ditty

Words can only go so far to describe the wonder that is Beersheva. Therefore, I have provided a sampling from her majestic scenes. Behold, a photo blog.

Home, by blogger of the month Jonathan Ditty

Our first year is winding down and there are less than two weeks until our last exam. Many of us are going back home for the summer, others will be here in Beersheva making a lot of vitamin D, and some will be exploring other parts of the planet. I will be heading back to California for a wedding; it’s the place that it all started a year ago.

I remember this time last summer very well. I re-read all of the MSIH emails that I had skimmed (skipped) and did some last minute I-don’t-want-to-pay-crazy-taxes-on-shoes-in-Israel shopping. But most of last summer I spent preparing for my wedding. Casey and I were engaged for three months and were married for three days before leaving for Israel.

Some students had spent time in Israel before, some spoke Hebrew fluently; others (like myself) had never been to Israel and knew some of the alphabet at best. Aside from wondering if I would survive the first year of medical school, I was wondering if I would survive Beersheva. Then there were questions like "what will marriage be like?" and “what is it like to be a husband and a student at the same time?” and "what will my wife do there?”

Transitions are usually not easy, and last summer was certainly no exception. We loved Los Angeles and never thought we would stop reminiscing about the ‘gold ol’ days.’ And yet somehow, Beersheva has become a lot more like home than I ever expected.

To the much anticipated MSIH class of 2017: the adjustment to life here is different for everyone - and yes it is difficult - but it does happen. Be patient, ask for help, and drink lots of water.   - blogger of the month, Jonathan Ditty 

Beer-sheva's "Beach", by Sakal Kiv

On those occasions I am not drowning in Endocrinology and learning about hormones that gush out of our glands and flow down lymphatic or hematogenous course ways, I try to take a walk with my family to the “Beach,” an affectionate nickname given to the fountain park that has recently opened in the neighborhood. It is a nice place where our family can go and enjoy ourselves. It is just as much fun to the kids (and a lot less expensive for us!) as any water park. It is even better at night, when all the gushers light up with lots of bright colors. It is such a contrast to the hot summer sun. I like to hear and feel the cool, crisp water. It shoots up and down. It rains all around. The lights seamlessly morph from one mesmerizing color to another. Everything is synced to create this cool dancing effect. Majestic palm trees line the way and plenty of leafy plants and flowers bloom in the perimeter landscaping. Adults chatter away as they sit under the wooden shelter made to look like an impressive giant wave. All the kids are laughing, playing, and splashing. Some try to sit on a jet of water. Others try to run through as many as they can. Another group is playing tag in the middle of the pillars of water. Parents are snapping pictures while others are gently coaxing some of their shyer and younger ones to brave the water. Some walk their dogs along either the boardwalk or the path made to look like a sandy beach. Aside from actually being at the Mediterranean, this is not a bad place to be, especially since it is only a few blocks away. Of course, we often come home with our children soaking wet. Faith and I rinse them off in the shower, change them into dry pajamas, and sing a bedtime song like this one:

I've got river of life

Flowing out of me,

Makes the lame to walk

And the blind to see;

Opens prison doors,

Sets the captives free,

I've got a river of life

Flowing out of me.

Spring up, O well

Within my soul,

Spring up, O well

And make me whole.

Spring up, O well,

And give to me

That life abundantly.

-blogger of the month Sakal Kiv

What is keeping me up at night, by Sarah Humphreys

When deciding what to write for my fourth and final blog post, I thought about the hedgehog and stray kitten that hang out together by my doorstep every night, how this year has almost flown by and what a crazy year it’s been, in so many transformative ways, and other random musings on life in Beer Sheva and medical school in Israel. 

I feel compelled to write, however, about the thing that’s been keeping me up at night for a week.

Last Tuesday, as friends and I were leaving the hospital after class, we saw an African immigrant being escorted out of the building barefoot, and shackled at his wrists and ankles. My heart sank, and I’m ashamed to admit that my immediate impulse was to avoid looking up at his face because I was afraid of what I would feel, and what I would be forced to confront. I did look at him, however, and I have no way of describing what I found, except to say that the man seemed dead inside—completely void of emotion and life, gaunt, like a ghost crossing the river Styx in the fifth circle of hell.

I parted ways with my classmates and that night some of us went to a concert but I couldn’t shake the image of what I had seen.

The next day I went for a run, and maybe for the first time in my life, gave thanks for the fact that I have two legs that aren’t shackled together, that let me run and travel to new countries and seek out new adventures and pursue a better life for myself. Of course, days later, when I couldn’t stop talking about it to those closest to me, and couldn’t shake the image that haunts me, I began to do some very superficial research into the topic and struck up an email correspondence with Len Rubenstein, the ex-president of Physicians for Human Rights, with whom I worked on a project prior to enrolling in medical school.

Here is what I found: Israel currently keeps about 2000 Africans asylum seekers from the Sudan and Eritrea in detention centers in the Negev, close to the Egyptian border. The majority of those currently detained entered Israel after June 2012 and are being held under Israel’s Anti-Infiltration Law that allows the state to hold, without trial for up to three years, anyone who has entered the country illegally, and I believe longer for refugees from countries considered enemies of the state, such as Sudan. It isn’t my job here to talk about Israel immigration policy—a simple google search will tell you all you need, or you can read about it here: http://www.hrw.org/news/2013/03/13/israel-detained-asylum-seekers-pressured-leave It is also important to point out that Israel’s struggle to maintain a national identity in the face of mass immigration is not unique to Israel—the United States and much of Europe are dealing with similar issues.

What I can’t stop thinking about is how the man I saw was probably trying to escape a life of persecution for the promise of a better life in Israel. And after experiencing the (well documented) kidnapping and torture while crossing through Egypt, he is now stuck in a desert detention facility indefinitely. And how, with the detention facilities currently being expanded, and located so close to Soroka hospital, there is no doubt that we will encounter these shackled asylum seekers as patients on the ward.

How do you treat someone when the least of his problems is medical? How do you treat someone when he is shackled to a hospital bed for trying to find a better life? How do you heal someone’s body and then send him back to a place of no hope? Why aren’t we talking about these things?

And then I remember that this conversation applies to all areas of civilian life—what is our obligation to other people? How often do you turn away when you don’t want to deal with the repercussions of witnessing an unsavory event? How do you cope when you witness something horrible and there is literally nothing you feel you can do, except write?

I don’t have any answers.

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