Our First Friendsgiving! by blogger of the month, Jixi He

Preparation!

The third Thursday of November 2014 is not Thanksgiving, neither in Canada nor in America. It is nevertheless the Thanksgiving for this group of people in Beer Sheva, Israel: the MSIH Class of 2018.

It wasn’t very realistic for us to get a turkey because in order to get one you would have to order 2 turkeys from Tel Aviv and someone would have to spend a whole day cooking it. So we decided to go with chickens instead, a brilliant alternative. There were garlic chicken, beer can chicken, and chicken drum sticks. It was a potluck dinner at our classmates’ apartment. I brought crackers and a bowl of pumpkin spice dip, which was described as “orgasmic” by a fellow classmate. But don’t get full on the crackers; there’s more to come!

Brian and Shauna playing Shesh Besh

I wish I had fasted before the dinner when I saw so much delicious food made by my talented classmates: 3 different types of chicken, sushi, Israeli couscous, spicy Indian dish, sweet potato with marsh mellows, pumpkin pie, gluten-free diary-free nut-free chocolate cake, apple pie, and more unlisted. I’ve never been in a class as small, close and intimate as this one where we treat each other like brothers and sisters, even without the sibling rivalry part. There are only 29 of us, small enough to put all of us in one apartment. We tend to each other’s needs like it’s our own—evidence shown as below: the massage train! Who doesn’t love a nice shoulder massage, especially when you can get one in return too?

The night ended with most of my classmates going to watch The Hunger Game. I’m thankful for this Thanksgiving. Even though we’re at a place away from home, we are spending it with our classmates that are just like family.

                                                                                                             

Beer can Chicken

Everyone!  almost....

Kristina makes the best sushi

That's just round 1

Pumpkin pie with homemade whipped cream

Massage train!

Our kitty guest

                                                                                                                - blogger of the month, Jixi He 

A Quarter Doctor and a Full Clown, by blogger of the month Jixi He

Yesterday was extremely busy but awesomely interesting and fun. I was wearing my white lab coat in the morning, normal street clothes in the afternoon, and then a full-blown clown costume. The day didn’t just end there; I also had my band rehearsal in the evening. My day went from 10am to 10pm.

In the morning, a few classmates and I had our first clinical rotation at the pediatrics ER department of the Soroka Hospital. This is part of our course “Clinical and Global Medicine” which is aimed to give us clinical exposure, and gain insights and inspirations as a physician. We met at the lobby where Winnie the Pooh, Spiderman and all the Disney Princesses gather, and put on our white coats. Feeling like a quarter of doctor, I followed our instructor into the building. The whole place looked very children friendly, with a Hollywood walk of fame touch to it. There is even a cinema on the floor to entertain our little patients. We were told that there are 12 classrooms throughout the hospital to provide children with whatever class they would normally get in a community, be it academic or extracurricular.

We interviewed a young patient’s mom to know more about her son’s disease, and how the family is coping with it. She was speaking Hebrew the whole time and I was listening intently, leaning almost to her nose, trying to extrapolate as much information as I could with my pathetic Hebrew. It worked! Somehow? I felt I was able to understand 30-40% of what she said, catching familiar words here and there, and interpreting her facial expression and body language. Normally I would say my Hebrew is only 15% good. In 2 years, hopefully I’ll be able to interview patients using simple sentences and not feel like a clown.

Speaking of clown…I know…awful transition…

Probably the most fun class I’ve ever taken and will ever be able to take in med school is “Medical Clowning”. It fulfills one of the four global health clusters requirement. We had many attractive choices for the clusters and I wanted to take all of them, but as soon as I saw the description for medical clowning I knew I had to take it. This class is full of excitement, surprises, embarrassment, and inspiration. Oh, have I mentioned, laughers?  Medical clowns not only work with pediatric patients but also with adult patients, especially in the oncology wards. Clowns provide the patients empathy, and a sense of control, in addition to the endless joy they provide. Happiness is the best medicine; this cannot be more true when it comes to medical clowning.

In my medical clowning class yesterday, we all had to dress in something that we thought would make us look like a clown. I never go to any Halloween parties because I don’t have any costumes. Dressed like a clown?? I had to scratch my head for a whole week before I came up with my clown idea: hey, the once in a life time chance to be the class clown, go big or go home eh?

Wearing a rainbow color fluffy wig with tiger ears and a tiara on top, purple sunglasses covering my normal glasses, tiger bowtie, pink toy guitar hanging from my neck, yellow black striped PJ, pink polka dots pants, and a pair of bear claw warm slippers, I showed up in my clowning class. We had to dance to the music in our clown characters and later tell the whole class who we are in our clown voice. I got used to improvisations and surprises in this class. All the activities we do in class helped us get out of our comfort zone, pay attention to people around us and not feel embarrassed. So when it was my turn, I shouted in my lowest possible voice:” Helloooo!! I am Princess Tiger Bear!! Rawwwrrrr!! I am good at playing guitar, and painting my own hair!! My name is Bumble Bee!!” I was pleasantly surprised to find out that it was slightly more comfortable to be myself, act funny, and get out of my inhibitions when I was in my clown costume. Our instructor told us that the essence of being a medical clown is to connect with patients, and help them build a fantasy world that they can temporarily escape to. So communication and authenticity is very important to a clown.

Well, this is my first time writing a blog. I never know how to end my writing. But I had a great day!  

                                                                                                          - blogger of the month, Jixi He

Thoughts on Stories, by Esther Lee

Thoughts on stories (photo by Joy Moy)

I’ve been thinking about the purpose of writing. I’ve joined a creative writing circle on BGU camps and we are meeting early this week to talk about the pieces we’ve worked on. I haven’t started yet, and I’m not sure how far I’ll get with it today. It’s been a quiet, odd weekend. The clouds were heavy in the mornings and there’s talk of rain. It’s an odd feeling when the atmosphere has yet to decide if it’s going to pour, or dry the ground underneath it.

I think the reason we write is manifold. For me, sometimes I write because I process best through writing. Most often I like to write by hand: 0.4mm black ink on firm Moleskine paper (I admit I’m a snob when it comes to paper). Sometimes I write because I have to, like these blog posts and the poem I need to start; sometimes it just comes and I write in the moment.

We have been communicating by the written form for a long time. But before words and symbols, we depended on oral traditions and story-telling. Sadly most of our oral traditions have petered out. How many of us grew up listening to stories from our grandparents/parents/relatives/that crazy uncle? How many of us remember those stories? Will we pass on our stories to the next generation? Most of us have even outgrown handwritten letters and have stopped passing notes in class (now we do the silent messaging thing on our smartphones).

All of us have stories. We carry them with us wherever we go. Sometimes they are heavy, a foggy mess of emotions vs. logic that refuse to untangle with time. Some of our stories are wondrously knitted together and testify to the power of grace. The stories we carry with us build over time. They are important to share with others. And as students of medicine and as global health advocates, I think it’s important that we care about the stories our patients bring when they come in with their chief complaint.

Most of us will have to talk to our patients regardless of our preference, our shyness, the patients’ desires etc. The charts will give us hard data, but patients aren’t a neat conglomeration of numbers and percentages. We are in medicine not purely because of the logic to it; we are in medicine because we truly care about people. Caring for people means understanding. And understanding comes from communication, and communication comes from listening to their stories. Ultimately, how we interpret data is based on how well we know the patient.

I was talking the other night with some of my peers on the topic of reading fiction (“stories”). It’s hard to set boundaries for yourself, so that every waking moment of your day you aren’t a slave to Firecracker (a question bank of sorts for med school).But I believe it’s important to make those boundaries for yourself. To do things that relate to people, whether that’s volunteering here in Israel, reading stories, taking the time to really enjoy a conversation… Part of the reason why I’m trying hard to read and write in med school is to remind myself of the power of stories and communicating them. When my patient approaches me, I want to be curious about their story. How did they get here? What’s the real reason behind the physical symptom that brought them here? What are they really afraid of? How does their culture or religion affect how they think about the illness? These are the questions we need to keep with us as we begin our lifelong commitment to global medicine, even now as students. Patients are not puzzles to be solved, or problems to be fixed. We must not forget our patients are real, walking and talking stories, just like us.  

- Esther Lee, October blogger of the month

At the museum under our noses, by Seth Morrison

History of Medicine museum, Faculty of Health Sciences, Ben-Gurion University 

It is quite remarkable what a medical student can learn simply by walking through the corridors of the BGU-MSIH medical school campus. There, a wealth of medical historical knowledge has been built into the very walls of its interior spaces. Thus, it is really an effortless undertaking for any medical student with a curiosity to understand the origins of their profession to simply walk and read through these exhibits. A total of an hour or two spent perusing them is sufficient to attain the beginnings of a well-rounded medical historical education from ancient times to the modern era. It was with this intention that I purposefully took to these corridors one day to see what I could find, and what follows here is an account of my findings.

The ancient Egyptians practiced a form of medicine in keeping with their mythology, incorporating various rituals surrounding their deities into their treatments. There are many different unique remedies that were used on patients, including hippopotamus fat and human excrement. The Nile dwellers also acquired more knowledge of bodily organs than other contemporary civilizations due to their routine procedure of embalming the deceased.

Medicine in biblical times drew on the religious traditions in the Bible and Talmud. The Hebraic practice of medicine was fascinated with life and death, a result of the veneration of mankind imbued by its creation in the image of God. The basis of Hebraic treatment was mainly social and personal hygiene: 213 out of the 613 mitzvot (precepts of God) are related to health in some fashion. Some of the surviving rabbinic texts, like the Mishnah, reveal a stark similarity of issues to the ethics of modern medicine in the polis: the rabbi criticized physicians for over-commercialization of their services and failure to attend to the poor, and drew a hard line by saying that refusal to attend to the poor is tantamount to homicide.

The basis of Greco-Roman medicine was Galen’s Four Humors. A “humor” is not a joke or jest, but the term applied to a bodily fluid. On their account, an imbalance of these humors was the etiology behind every disease, and they determined each person’s temperament: either melancholic, sanguine, phlegmatic, or choleric. Additionally, Hippocrates was the leader of a rationalist school of medical thought in Rome, and the Hippocratic corpus descends to us from this period. This corpus, we know, provides the ethical foundations for our modern practice of medicine in the West. And have you ever wondered where the medical symbol of a serpent wrapped around a staff derives from? It comes from the myth of Asclepius, the Greek god of medicine, who apparently carried such a staff.

Medicine in the Islamic world was also heavily influenced by Galen and the Roman rationalist school. The best hospitals in the world during the Middle Ages were said to be in Cairo, Baghdad, and Damascus. Many brilliant thinkers emerged from the Islamic world. Rhazes (d. 925) wrote the first accurate clinical description of measles and smallpox. Avicenna first suggested the contagious nature of tuberculosis. Maimonides, a prominent Jewish philosopher and physician, was a physician in the court of Saladin in Cairo in the late 12^th century and his fame extended into every great civilization of the time.

In medieval medicine, the term “physicus” began being applied to the academic doctors who philosophized about medicine more than they spent time treating people. Galen’s theory of humorism remained the dominant one, although there were many elements of folk medicine brought into the mix during this period. Observation of the characteristics of urine was the primary diagnostic test, and bloodletting was used as a treatment for a variety of ailments. Many odd elixirs, balms, tinctures, tonics, pills, and potions were given to patients to take, one of the most common being theriac, which had a long list of ingredients including viper flesh. Medieval doctors were not known for their effectiveness in healing. In fact, they were often derided for their impotence in jokes like this medieval poem:

Said time to the fool, be a physician,

and kill people for their riches.

You will have an advantage over the angels of death,

for they kill mankind for free.

This history may seem dry to some, but meaning always follows from reflection. It is given here merely to consider that there are many things to discover about the medicine of the past, and understanding where we came from is not a trivial pursuit. In reading these exhibits and inspecting their historical artifacts, I was reminded of the Hunterian anatomical gallery at the University of Glasgow and seeing its cadaverous collection of centuries-old anatomical specimens. It was there that I first became interested in the early roots of modern medicine.

In the end, it is unlikely that any hospital department head or patient of mine will ever be dissatisfied with me as a physician if I don’t know something about Vesalius or Boerhaave, Galen or Willis, Harvey or Hunter. Nevertheless, even though these things are inessential, I would think myself to be missing something vital if I was completely oblivious to the fact that, as Newton admitted, “if I have seen further, it is by standing on the shoulders of giants.”   - blogger of the month, Seth Morrison

for more information on the MSIH, visit our website at http://www.cumc.columbia.edu/dept/bgcu-md

Happy belated Valentine's Day!, by blogger of the month Amanda Norwich

How can you say "no" to that face?

Happy belated Valentine's Day! Although this is not a holiday generally recognized in Israel, being it is devoid of any Hallmark cards, we still find ways to celebrate. Yes, there is love without Hallmark. I know, unbelievable! For instance, while taking a break from Virology lab one of our very best class bakers (ehem Kiki Fabian) handed out an amazing batch of homemade brownies shaped like hearts! Delicious and gluten-free. Not to mention we just learned that chocolate is healthy for your heart, so really what more could you ask for?

Alert! Medical students having fun.

Just to catch everyone up to speed on the rest of the week, we did have a Zumba/dinner party, in that order if anyone was curious. It was really a great time and an awesome workout if anyone gets the chance to shake it like a polaroid anytime soon. After sweating it out we went upstairs to taste the dishes each group had made based on heart-healthy diets like DASH and had a proper feast. The next day we had a poster session in the amazingly warm Beer Sheva sun and completed the week with a wrap up session. All in all the entire week was a great opportunity for me to grow, both as a medical student and a temporary resident of Israel. Things are not so different here, despite the language barriers.

 No matter what diabetes is called it's always high blood sugar and heart disease scares most of us out of our pants. What was really eye-opening was getting to see the emotional pain the patients who were willing to talk to us went through. At the wrap up session the professor in charge of coordinating the week said if all we got out of our activities was the ability to empathize more with patients suffering from heart disease he was happy. If that's the case, he succeeded in my eyes. Even though it seemed like at times my level of emotional involvement with the patients was extreme, perhaps far beyond anything I would allow myself normally, I don't have any regrets. 

During one particularly hard interview one of my classmates from Goldman (BGU's medical school) allowed herself to openly cry, while I found myself tearing up as well. Even though I know it would be impossible to feel this kind of connection with everyone throughout my career, there's no better time to do it than now when we don't have any direct responsibilities or life-changing decisions to make. And now the naive sentence I'm sure every medical student says at some point - I hope I never become jaded. That I let myself feel connected to patients even though it can be hard. If there's anything I've learned this week from the marathon runner who had a heart attack with no apparent cause or the woman who came in for a simple test and was told she had to go into open heart surgery, it's that sometimes medical tools are fallible at best. And often there's little to nothing we can actually "fix." So the best tool we have is to listen and sometimes that's enough.

Shabbat soup.

On a less serious note, we ended the week with possibly my favorite part of being in Israel - Shabbat dinner. It started out as an attempt to host a group of students from both classes, but since they're in finals right now that didn't work out. However, the night was still amazing as we shared soup, pasta, cheese and brownies over candle light. Perhaps not a meal with the healthiest glycemic index, but I've also learned you have to indulge yourself a little every once and a while. Because life is short and really, who doesn't love chocolate? - blogger of the month Amanda Norwich
PS - Happy (belated) Anniversary to Mr. & Mrs. Kalansky from MSIH Class of 2015!

Finally settling in, by September blogger of the month Chris Brown

One of the many trips of carrying belongings from one apartment
to another in 97 degree heat, I am so very,
very tired of moving. I really hope this apartment works out.

So after a successful first week of real classes it’s on to moving day. A day where hopefully I’ll be able to settle in a bit and really feel at home, an event that has been a long time coming after having spent  a little over two years living in a hut in rural West Africa.

My name is Chris Brown, no not the singer Chris Brown, and I get the opportunity to share a little bit about life here in Be’er Sheva and experiences in the MSIH program. A little about myself; I grew up near Seattle Washington, and graduated from the University of Washington, then after a brief break, about three years, working as a phlebotomist, doing construction, and  teaching French on a volunteer basis, I went back to school to get my Masters in Teaching at Seattle Pacific University. I worked as a high school science teacher (mostly chemistry, with a little physics and biology thrown in to keep things interesting) for about 3 ½ years before deciding, though albeit an extremely honorable and important profession,  I found it to not be an ideal fit for me. It was a great opportunity and experience, one that I will always treasure for the rest of my life. Hopefully helping people learn about health and prevention will allow me to exercise the skills that I learned while teaching on a daily basis and I hope to also one day integrate teaching into my medical career at some point in a more formal fashion. After leaving teaching I left to serve in the Peace Corps as a health volunteer in Senegal, West Africa. I finished Peace Corps about 3 months ago and now I am on to my next adventure, medical school in Israel. As a side note I am also the oldest student in our class at 33 years old despite Avi’s generous 21^st birthday wish in the August blog entry or the bar mitzvah card from the whole class for my birthday last month, stating that I’ve finally became a man, at least now I have it in writing.   

          

One of many beautiful flowering trees
around Be’er Sheva.

Despite the rather “rockety” start to being here in Be’er Sheva, things are going rather smoothly. The school did their best to give us the most up to date information and even changed our classes to a more secure location, including having class in a bomb shelter for a short time, always up for new experiences... Granted some things have not gone as well as they might have gone in the US, the staff is doing well, despite what must be for them and their families a very nervous and stressful time, they still were able to deal with concerns that many of us were feeling.

The raging river in Be’er Sheva,
has a bit of silt in it at this time of year.
It’s the gray thing in the middle…

As conversations within the first year class transition from talking about what we’ve done before medical school, to getting cell phones, to furnishing apartments, to now talking more about classes and the impending deluge of information that is beginning to swarm around us. It feels good to be here, working towards something great. Professors and upperclassmen have been extremely welcoming and one week into the education, granted I was a teacher and am critical how the subject matter is taught, has been going well and I am looking forward to the next week. Well that’s it for now.  I need to go study for Immunology, Biochemistry, Microbiology, Molecular and Cell Biology, Histology, Hebrew, Global Health, and Biostatistics, that’s a lot of classes…

Interesting fact about life in Be’er Sheva: If you don’t like/want or need a piece of furniture you can simply take it outside and place it on a corner or the side of the street (preferably near a garbage or recycling bin) and it’s gone within 30 minutes to a couple of hours, off to be part of another person’s life. - blogger of the month, Chris Brown