Jewish University 2019

Kesher Refuah - Reports From the Field

Kesher Refuah 2018

 

June 4, 2018

Today we visited the renown Underground Hospital - Rambam Hospital. Our visit started with learning about the history and purpose of the Rambam Hospital. Following that, our guide led us into a parking lot. As she showed us around, a realization came across all of us - THIS is the underground hospital. We saw electricity cables and oxygen and water pipes branching off in multiple directions in the ceiling. We discovered nurses’ stations built into the walls of the parking spots. We found outlets in the walls separating each parking spot. We noticed the color coding of each quarter of the parking lot/hospital. It was absolutely fascinating to see all the thought and planning that went into building this fortified hospital so that it could be used in order to protect the patients from imminent threats but still be able to continue providing medical care. I am thankful that I am now able to fully appreciate the ins-and-outs of Rambam Hospital.

    

I think we all unanimously agree that the Technion Israel Institute of Technology is a magnificent institution, both from a physical standpoint as well as a historical standpoint. As the first university in Israel, it’s main purpose initially was to educate its 17 students (1 of which was female) in civil engineering and agriculture to help build the growing State of Israel. As the years progressed, the school grew in size and departments, establishing itself as a mighty university that both Israelis and international students aspire to attend. We learned about the medical school curriculum and were able to also visit and explore the Technion’s medical campus. As we eavesdropped on a class that was in session, it was exciting to think about how the Technion has evolved into an international force, building collaborations with NYC and China.

June 6, 2018
 
This morning, our group visited the Baha'i gardens in Haifa. We were able to explore the viewing balcony on Yefe Nof and the upper two levels, which had an amazing view of the city, along with the smaller towns surrounding Haifa and also the German Colony Plaza. We also visited Stella Maris and hiked down a short path to a landing where we could see the Middle Eastern Sea. For lunch, we went to the town of Zichron Yaakov and learned about the Aharanson family. They were one of the founding families of Zichron Yaakov who are especially well known for their children Sarah and Alexander who played a significant role in the First World War because of their involvement with the Nili underground network.
 
After lunch, we arrived at the Carmel Winery and learned about its establishment more than 125 years ago. In 1882, the Israeli colonists turned to Baron Edmond de Rothschild to request his assistance in creating a winery for the country of Israel. During our wine tour, we were able to explore one of the enormous underground wine cellars that was once used to house wine barrels. These cellars were kept cool not by air conditioner but with expensive stone that Baron de Rothschild funded. After the winery visit, we visited the Galileo Druze village of Daliat el-Carmel. There, we visited the Yad Labanim, a memorial to the sons, which is dedicated to commemorating the fallen Druze soldiers who served in Israel's wars.
 
June 7, 2018

This morning, we said goodbye to Haifa and traveled towards the city of Safed in the Galilee Mountains in Northern Israel. Our first stop was Ziv hospital, a 330-bed hospital that has become known for the medical treatment of Syrians. Since beginning this venture by treating seven Syrians in February 2013, they cared for 1,000 Syrians this past February. Despite Syria being an enemy nation of Israel, the Israeli government, as well as other generous donors, provide funding to not only offer life-saving treatment to the Syrians, but give them clothes, food, and a safe place to stay. When we asked how they began this important work, they replied, “Regardless of their ideology, they are human beings, and they need our help”. We spoke with a social worker, who thanks to his ability to speak Arabic, has become responsible for addressing the social needs of all the Syrian patients. He addresses the patients’ needs and explains what the doctors are doing, the plan and prognosis, provides them with comfort in an otherwise terrifying situation. He takes the time to bond and build trust with the patients, convincing them that they are safe and that the Israelis are there to help them get better. With him, we visited a 14-year-old boy, who suffered a severe leg injury from an airplane blast in his town on the border of Israel and Syria. With the borders to all other countries closed, Israel was his only hope for treatment. When speaking with him, he said the social worker was like his big brother, and he looked forward to seeing him every morning. We were left with the parting advice that we should not lose site of the patient as a person. While the medical care we will give to our future patients is crucial, sometimes one of the most important things we can do is to ask our patients how they’re doing.

From Ziv Hospital, we went to speak with Dr. Lilach Malatskey about Lifestyle Medicine at The Azrieli Faculty of Medicine in Bar-Ilan University. We learned that by the year 2020, the World Health Organization estimates that two-thirds of all diseases will be the result of unhealthy lifestyle habits. Lifestyle Medicine attempts to address this by focusing on good nutrition, physical activity, stress management, and forming healthy relationships to prevent and treat chronic diseases such as diabetes and heart disease. Dr. Malatskey and her colleagues aimed to incorporate these lifestyle interventions as a class offered to first-year medical students at their university. They introduced ways that the students could live a healthier lifestyle through both classroom work and interactive sessions, including a healthy cooking demonstration, exercise classes, yoga, and meditation classes. The students were very receptive and greatly enjoyed this class, but a year into medical school, the students were still more stressed, and had overall less healthy lifestyles than when they began. Since then, Dr. Malatskey and a group of motivated students aimed to further address this issue by promoting positive changes in the university, such as encouraging the cafeteria and vending machines to have healthier food options, hosting regular exercise classes, and even organizing a smoking cessation class for students and faculty. They faced many challenges as they tried to incorporate these options but made some important progress. We spoke about ways we could learn from their work and incorporate a similar program at Stony Brook, which we think can bring about some promising results.

After saying goodbye to Dr. Malatskey, we explored the Old City of Safed, where we admired the beautiful architecture and visited shops with some amazing local artwork. We also saw a wonderful view of the Galilee mountains from atop a group of shops! And of course, we stopped for a delicious falafel before we left. Today, we learned the importance of taking care of our patient’s emotional, social, and spiritual health, and how this journey often begins with taking better care of ourselves. Certainly, the rest of our trip with Kesher Refuah will help us achieve this goal, which is just what the doctor ordered.

June 8, 2018

Visiting Yad Vashem was an eye-opening experience that allowed us to reflect on the incomprehensible struggles that the Jews have faced and their ability to overcome them. Peppi, our tour guide, emphasized the history of the Holocaust, reminding us that being Jewish was seen as a race more than a religion and that “any trace of Jewish blood” in your ancestry meant that you were executed. German doctors like Josef Mengele sent Jews to the gas chambers so that they can be used as guinea pigs to study the body’s reaction to hot/cold temperatures, the effects of starvation, and the response to pain. It is inconceivable to think that a physician who is supposed to advocate for his patients and “do no harm” actually performed medical experiments on children and young twins to prevent the birth of future Jewish generations. We also learned about a French doctor named Adelaide Hautval who is recognized as Righteous Among the Nations for her outspokenness and protests against the maltreatment of the Jews. She was punished and sent to Auschwitz to work as a doctor, where she continued her activism and hid a group of women who were ill because she knew that the Nazis would kill them otherwise. Yad Vashem reminds us that as future physicians, we have an obligation to recognize the medical atrocities of the Holocaust, never forget the victims’ stories, and honor the health professionals who remained true to their healer’s oath. Additionally, we must appreciate our roots, be strong about our identity, and never forget our values even in the worst of circumstances. After Yad Vashem, we decided to stop by Mount Herzl to commemorate and pay tribute to Israel’s fallen prime ministers, prominent Zionist leaders, and soldiers who were killed in battle.

Next, we explored the Machane Yehuda shuk (market), where we got to see the preparatory rush before Shabbat. It was full of locals and tourists who were shopping from vendors selling all types of fruits and vegetables, fresh fish and meat, cheese and nuts, and spices. It was a sensory experience with an array of sounds, sights, and aromatic smells. For lunch, some of us tried a new Yemenite food called Malawach which is a tasty puffy pan-fried bread that is served with egg and tomato dip. Others enjoyed a savory Israeli beer over conversation. Finally, as Shabbat loomed, we were welcomed by Gal and her family for a delicious meal. After a busy workweek, it was beautiful to see how a family comes together for Shabbat to sing songs, exchange stories and jokes, and of course, to eat great food! The food that Gal’s mom prepared was outstanding and we really enjoyed spending time with her family. We thank them for their hospitality and for making Shabbat in Israel feel extra special.

June 10, 2018

Today we started out at Hadassah Hospital in Jerusalem. Right away I could see how big and bustling this hospital is. It reminded me of the big NY hospitals. There was so much to see there. First we saw the heritage room there, which was an excellent starting point. I was particularly amazed by two things I learned there. One was that all of the presidents of the hospital are women and that is a rule of the hospital. When the hospital was created in 1912, women did not have the right to own property or vote, but Henrietta Szold was elected president of Hadassah Hospital. They are proof of the power of women in medicine and are an inspiration to me and other female doctors in training. The other amazing information I learned in the heritage area is that they used preventive medicine before it existed. They established camps and playgrounds all over Israel where they would teach children of the community about good hygiene and healthy lifestyles. They children would then teach their families and other communities members. We then toured the emergency and trauma department. Both areas of the department were very impressive. The trauma unit was so organized and prepared for any situation. They even had an X-ray machine on tracks able to go from bed to bed if need be. After the trauma area, we visited the below-ground Pre-Op area. The tour guide told us about how the operating rooms are themed with different colors and nature-themes, which is actually for the doctors. Then we saw some of the patient rooms and family rooms. They believe in having spaces for family to be together and patients rooms that are not “sterile white.” The ideals of patient care certainly transferred to pediatrics. The children’s hospital was beautiful. It barely looked like a hospital. It was colorful and bright with activities for the patients. The most amazing part of the children’s hospital was seeing someone teaching the children’s about IV’s and how they are done. They are reducing pediatric patients’ anxiety and fear through education. Lastly, at the hospital we saw Chagall’s painted windows in the synagogue there. Each pane of glass was gorgeous and full of symbolism, representing a son of Jacob.
 
 
After Hadassah, we explored the town of Ein Kerem and had lunch there. It was very pretty town with an amazing view and great food.
 
Lastly, we visited the facility of Zichron Menachem. Zichron Menachem is a truly amazing facility that cares not only for the pediatric oncology patient but the parents and siblings as well. We got a full tour of the place. They have everything a child could imagine wanting. From medical rooms to music rooms to play rooms to a gym to a green house to a petting zoo, they have everything to help heal soul and body. They even have camps where they travel abroad with patients, doctors, nurses, and volunteers. We had one of the National Service workers speak to us about her experiences with Zichron Menachem. This service has clearly had a positive impact on her life, further showing how wonderful the institution is. As someone interested in oncology, this was an inspiring facility.
 
   
 

June 12, 2018

This morning we were given the opportunity to visit the Soroka genetics institute.  We were greeted by the head of the institute, who explained to us why it was established and what its goals are.  The laboratory provides many services to the people of Israel, no matter what race religion or creed followed, all free of charge to them.  We were told that, like Ashkenazi Jews in particular, the Bedouin population has many genetic conditions due to their small gene pool.  This leads to the coupling of recessive alleles and results in a variety of conditions that affect morbidity and mortality of offspring.  In addition, because many very religious Jews don’t see abortion or forms of birth control as acceptable, the clinic provides prenatal testing to see if a couple could produce viable and healthy children.  This occurs even before the process of arranging marriages.

After this brief introduction we were shown the lab where techs do the karyotyping of genes.  It was at this point that we were shown some common genetic illnesses that we had only learned about.  Despite learning about these diseases in the classroom and the clinic, none of us have actually seen a genetic karyotype in the lab!  Seeing the process of discovering a trisomy, or a translocation, brought a new life to these diseases.

In Soroka’s children’s ward, where we visited next, we were given a very thorough talk by some of the teachers who instruct the hospitalized children.  Unlike the system in the US, they explained to us that every children’s ward had a school associated that hospitalized kids would go for education.  They showed us the impressive learning facilities, as well as the recreational center where they had board and video games as well as a number of computers and 3D printers.

June 13, 2018

This morning we toured Rabin Hospital located outside of Tel Aviv, where we were greeted by a pediatrician who gave us a brief but fascinating presentation about the Israeli healthcare system.  This overview compared the US and Israeli systems side by side in terms of healthcare dollars spent per GDP, life expectancy, number of healthcare workers per capita, and many other data points.  It also included a detailed explanation of Israel’s tiered national health insurance programs, as well as the four options for plans offered to all citizens.  These explanations were eye opening and gave us an excellent idea of how our system differed, both for the better and the worse.  

In the afternoon, we visited Save a Child’s Heart, a program that was established by a cardiac surgeon to fly in children with congenital and acquired heart disease and provides lifesaving surgical intervention at no cost to patient’s families.  The children are typically flown in from low income countries and either have no access to high quality healthcare, or are unable to afford such care.  The program is aided by a number of volunteers with a variety of healthcare backgrounds that aids in getting down the average cost of a procedure to 15K dollars.  This amount is, in turn, paid for by the Israeli government.  After a presentation about the program and its mission, we were given the wonderful opportunity to play and interact with the children who were currently being treated.  It was a joy and an honor to elicit a laugh or smile from these kids who have traveled so far for their care.  Neither the program’s mission, nor the experiences interacting with the kids will be lost on any of us.

 

Kesher Refuah 2018 Cohort:

Rebecca Anderson, MS1

Justin Charles, MS3

Annie Chau, MS1

Jonathan Dounel, MS1

Natalie Jarahzadeh, MS1

Bennett Wechsler, MS3