2.0
BLGN
THE
TRIANNUAL MSIH STUDENT COUNCIL NEWSLETTER
Fall 2013
1.
BLAST FROM THE PAST
2.
MESSAGE FROM DR
CLARFIELD
THE BLGN EDITORS
DR MARK CLARFIELD
NOAH GORELICK
THE MSIH ALUMNI
6. FROM
ASSOCIATION
DR BRIAN NEESE
3.
ATONEMENT
4.
NOTES FROM STUDENT
COUNCIL
DR ORA PALTIEL
JAMIE KLEIN
BARE(SHEVA)
5. THE
NECESSITIES
AFTER MEDICAL
7. LIFE
SCHOOL
DR JARED BRAZG
8. SHOUT OUTS TO MSIH
9. FALL PICTURES
As we start the new school year (for the
Israeli students at least), we are proud to
present BLGN 2.0 fall edition. Blast from
the Past contains, among many, articles
from the Director of MSIH, a previous
BLGN co-editor, and the President of the
new Alumni Association.
We are reviewing the past to find a path to the future: to
successful school years, courageous careers, fulfilling
friendships and more. We can’t wait for more involvement from first and second years in the making of this
esteemed student newsletter, be it as pictures, articles
or even editorship.
Enjoy this peek into
your past and your
future.
!‫יאללה ביי‬
WANT TO CONTRIBUTE? SEND AN EMAIL
TO: [email protected]
EDITORS: ARIELLA KRONES, TEEM LEE
COPY EDITOR: ADIE KALANSKY
The Medical School for International Health is a joint collaboration between Ben-Gurion University of the Negev and Columbia University Medical Center. The
Balagan is a student-run publication, and the views/statements expressed within are not reflective of the school or its administration.
THE BALAGAN
Fall 2013
MESSAGE FROM DR. CLARFIELD
2
From the Desk of Professor A. Mark Clarfield, MD
September 29, 2013
Dear students,
Once again it is my pleasure to provide you with a New Year’ s
missive; this at the kind invitation of your stalwart editors whom
I thank for all of their fine efforts in bringing this issue of “The
Balagan” to newsstands around the planet!
I began to pen these thoughts during the intermediate days of
Sukkot and just after one of the holiest days in the Jewish calendar,
Yom Kippur – a day meant to make one think both of past and
present and especially on how we will try to change for the better
in the future. To this end I can highly recommend the piece in
this issue appropriately entitled “Atonement” by Dr. Ora Paltiel a
hematologist and clinical epidemiologist at Hadassah Hospital and
who is also the head of the International MPH program of our sister
global program the Braun School of Public Health in Jerusalem.
(Disclosure: in her limited spare time Dr. Paltiel is also my wife.)
In her thoughtful article she explores one aspect of the art of
medicine of relevance to all practitioners, especially those who plan
to work in Global Medicine where cross-cultural conundrums play
such a large part.
Back to the future: I welcome you all home to B7 after your summer
holidays (which may by now seem somewhat lost in the haze of
time) and we can look forward to some interesting developments
this year. I begin with our main focus Global Medicine and the
new improved Introduction to Global Health and Medicine under
the auspices of Drs Seema Biswas and Tzvi Dwolatzky. This course
began last month with a bang: a 3 day offering involving lectures,
a stimulating debate, small group work and a shuk in which various NGOs came to B7 to offer their good offices to our students as a
place to volunteer and get some early exposure to community work
with diverse populations.
We continue to plan ways to intercalate as much GM material as we
can throughout all fours years of the curriculum without of course
compromising your ability to acquire the general knowledge and
skills required to get your MD.
With respect to the 4th year electives, we are aware that widespread and high quality clinical experiences, mostly but not
exclusively in North America, are essential for our students not only
to contribute to their training, but also to increase the chances of
a good residency match. To this end, over the past year we have
taken quite a few steps to help ensure a steady “supply” of this
invaluable resource.
A list of these will be posted on the school website and we
welcome student applications to new sites. Please note that for
various administrative and legal reasons, both at our end and on
the other side of the pond, it can take a few months to get these
agreements authorized.
As well, to this end, MSIH has now become a full member of the
AAMC’s GHLO program, to which membership for all but a few pilot
schools had previously been closed. Furthermore, in recognition by
the ECFMG of our leadership role in international medical education
our school has been chosen to be one of a very limited number
charter members of their new GEMx program meant to facilitate
student electives primarily at non North American schools. Details
will follow and 3rd year students will also be able to discuss these
opportunities at the individual meetings we will set up for each
of the 3rd year students with our electives advisors, Prof. Glick, Dr.
Zimmerman and David Arnstein.
Also on the electives front (for reasons obviously unconnected
in any way to MSIH per se) Columbia University and St Luke’sRoosevelt Hospital have decided to part ways, as far as we know
at the end of this calendar year. Please note that this change will
not effect our present 4th years. However this development, as
well as CU’s decision last year also to cease affiliation with Harlem
hospital, may impact our present 3rd year students’ ability to
utilize CU as their main site for NY State-based electives. However,
we want you to rest assured that CU will still continue to supply a
large number of electives to MSIH students. As well, unrelated to
the issue of the specific MOUs negotiated with individual students
alluded to above, we are in advanced negotiations with other sites
both within and without NY State to ensure that our students will
continue to enjoy a broad choice of high quality clinical electives.
Details to follow.
In closing, please allow me to wish you all a fruitful year and
repeat a mantra which I hope is obvious to you all: our students’
success is the school’s success.
All the best and ‫בהצלחה‬,
A. Mark Clarfield MD
Firstly, we have after much work now found a way to increase the
number of such individual Memoranda of Understanding (MOU)
signed with various medical schools in North America to facilitate
additional specific elective opportunities.
THE BALAGAN
Fall 2013
Atonement
3
Atonement
Written by Ora Paltiel, MDCM, MSc, FRCPC
1 September 1996, Annals of Internal Medicine
I trained in a large university teaching hospital in Montreal. Our patient population was cosmopolitan. We
learned how to interpret the silence of one ethnic group, the screams of another. The atmosphere was a tolerant one. Empathy abounded, yet patients had to adapt to us, come on time, wait their turn, and accept any
piece of information or advice that we, with our white coats, had to offer. We supplied them with the facts,
often without being asked. Although patient autonomy was respected, there was no question about who had
the upper hand. Medicine and its practitioners were from the dominant culture.
Recently, things changed for me. I have become an immigrant physician, having moved to Israel 3 years ago.
Knowing that I had come to an advanced medical system, I nevertheless felt that I had something to contribute. I brought my own brand of “good medicine” with me, hoping, of course, to do good.
A 70-year-old man came to my hematology clinic in September with a new diagnosis of lymphoma, only he
didn't know that. Mr. D came armed with a discharge summary stating that he had had laparotomy for intraabdominal adenopathy. The pathology report showed that he had diffuse large-cell lymphoma. I asked him
what he knew of his diagnosis, and he answered that he had been told that he had an infection.
I searched his face for signs of dissimulation, disingenuousness. Mr. D did not seem to be the kind of man
who would mislead himself or want others to mislead him. Nearby, his son sat and smiled knowingly. I took
this as a sign that I might speak the truth. I did. I gently told Mr. D that he didn't have an infection, that it
was a tumor, a tumor with a name: lymphoma. I explained to him that there is an effective treatment and that
many people do well with this disease. I believed in what I was saying. I thought that he did, too. We talked
some more. He was neither naive nor primitive. A 50-year veteran of Israel, he had worked in the university
for several years. I assumed he understood. We made plans for further tests and for the start of treatment.
A week later, I received a phone call from Mr. D's family physician, an immigrant like myself but from Russia.
He informed me that our patient was in a deep crisis, a broken man, pessimistic and refusing treatment. The
physician asked me about the prognosis, and I replied in optimistic but realistic terms. He said he would try to
convince the patient to return to the clinic.
Later, I heard that Mr. D had canceled his appointment for treatment. I asked the social worker to intervene.
When she reached him, he told her that he was weak, that his fate was sealed, that there was no point. His
son subsequently disclosed to her that I had been too blunt, too direct. Distressed by my miscalculation, I
called Mr. D myself, asking him to reconsider. He repeated that he was too weak and would not tolerate any
chemotherapy. I told him that we could tailor the treatment to him. I suggested that being a newcomer, perhaps I had not explained things clearly, and maybe he had misunderstood the message I had tried to convey.
He agreed that this might have been the case. I wondered to myself whether the fact that others had not been
truthful with him made him suspicious of me and my optimistic forecast. I invited him back to the clinic on
Wednesday, just to talk. He said he would try. His tone was noncommittal.
I realized that this was not the first time my way of involving patients with their illness and treatment had
backfired. My own set of ground rules (“Thou shalt not administer chemotherapy without informing the patient
that he or she has cancer”) was being questioned. I considered it honesty, an absolute value. Here, it was
called being too direct. I had sometimes observed a conspiracy of silence between the physician and family.
But I could see now that the patients might also collude. I had so deeply internalized “the patient's right to
know” that I never even considered an equal and opposite right not to know.
I sat at my desk and considered euphemisms that I could have used. I understood that on the edge of the
cultural gap on which I stood, I no longer had the upper hand. When I had moved to the Middle East 3 years
earlier, I brought with me my household belongings, my children, my McGill University diplomas, and my
Royal College qualifications. They all found their place. But I also brought my culture, my professional style.
These had not yet found their place. All of the drugs and the doses were the same, but some of the norms
were different. Friends of mine had worked in unusual places—with native Indians, in Africa. They were
forced to adapt. So would I.
I recalled his imagery.
His fate was sealed.
Yom Kippur lay around the corner, and he believed it applied to him.
Reprinted with Permissions from the author and from the original publisher, Annals of Internal Medicine
THE BALAGAN
Fall 2013
FROM YOUR STUDENT COUNCIL CHAIRPERSON
te
o
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Your Student
m
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It is almost as if there was no summer vacation.
Third years running around with stethoscopes
doing blood draws galore. Second years eating,
sleeping and dreaming of USMLE step 1. And who
could forget the oh so lively First years, diving
head First into this crazy experience we call
medical school!
As the cool weather creeps into Beer Sheva,
student life continues at full speed. The third
year class just completed an inspirational week of
cardiology during their Internal Medicine rotation.
meanwhile the second year class has also been
enjoying a hearty month of cardiology lectures :)
Just before Sukkot vacation, the First year
students enjoyed inspiring presentations at the
Introduction to Global Health seminar, organized
by Dr. Seema Biswas and a cohort of second and
third year students. The First years also participated in the inaugural Global Health Shuk, where
they interacted with a variety of local NGOs.
On behalf of the MSIH Student Council, we are
looking forward to all the exciting and memorable
moments this year has to offer!
Until next time.
Jamie Klein
student council chairperson
photoby www.toasto.com
THE BALAGAN
Fall 2013
5
THE BARE(SHEVA) NECESSITIES
The Bare (Sheva)
Necessities with Noah Gorelick
volume one:
high yield definitions
“the most advanced online learning platform for
aspiring young gunners”... unless there’s a wedding, birthday, goat-naming or other random
Be’er Sheva celebration in your ‘hood - in which
case it’s likely an actual firecracker
Note: from the Hebrew “‫”אזעקה‬
The realization - once you’re already halfway
to the bombshelter - that the low frequency
siren thats stimulating your sympathetic nervous system is just another damn motorcycle
revving off in the distance.
Note: Also referred to as S. cafetereus or, colloquially, as “Staph caf”
The greatest hospital-aquired meal that eleven
NIS can buy. All-you-can-eat so be sure to
grab as many Petri dishes as you can carry.
THE BALAGAN
Fall 2013
From the MSIH Alumni Association
6
From the MSIH Alumni Association, representing the 400+
MSIH trained physicians who have gone before you, Shalom!
In its first year of existence, the MSIH Alumni Association is building up a
social and professional network that we hope will serve you all as students,
and later as physician alumni. We have laid out a clearly defined Mission and
Vision, a guiding set of Core Values, and Policy & Procedures that define how
we operate. We have also elected an Alumni Council to ensure the organization succeeds in meeting these ambitious goals.
The MSIH Alumni Association connects and communicates through a secure
cloud based website (called Alum.ni) designed especially for us. This has
taken us out of the email-list-serve age and put us squarely in the anytimeanywhere potential of social media.
So what does all of this have to do with you? First and
foremost, our core mission is to connect with current
students. We want to support you in the many facets
of your lives and careers, starting from the first and on
through your fourth year.
In that regard, I’d like to share with you our two cornerstone programs: Student Mentorship and Residency
Advising. These are two separate programs meeting
needs at very different stages of your medical schoo
progression.
The Student Mentorship Program matches up alumni with a
first or second year student based on a variety of factors (specialty interest and geography among others). We expect these
pairings to lead to long term, mutually beneficial relationships
that allow students to glean personal and professional guidance
from a physician they trust and who understands the unique
challenges of the MSIH experience.
The Residency Advising Program is less formal, but has led
us to open our Alum.ni website membership to rising fourth year
students. Your c/o 2014 colleagues are already up and active
on the site, requesting (and receiving!) information on specialties, residency programs, electives, and insights regarding interviews.
In addition to the programs above, you will see alumni showing up at various
times throughout the year. Eric Barna was just in town delivering your White
Coat Ceremony keynote speech, and I know that other alumni have stopped by
in months past to provide lectures and Q&A sessions with all of you.
This is only the beginning of Alumni engagement. Your success is our objective and we will pursue all avenues of support to make that a reality.
And when you become alumni (oh, that glorious day!) we hope you will become
a part of our organization, and give back to your colleagues in the same way.
THE BALAGAN
Fall 2013
Life After Medical School
7
Life After Medicalschool
by Jared Brazg, MD
Class of 2013
On a brilliant summer night last May, surrounded by good friends
and family, mentors and colleagues, I was handed my medical degree – marking the culmination of my efforts at MSIH in
B7. Immediately following, I posed for a picture with the dean of
the faculty, enjoyed a tasty dinner on the lawn outside the main
campus, and then, like so many times before, I crossed the street
to Einsteins and danced my little heart out.
Wearing a moderate sized hangover the next morning, I packed
my bags one last time and said goodbye to Beer Sheva. Driving
north on Highway 6, through my rearview, I watched Bash slowly
fade away into nothingness. And I couldn’t help but feel sad.
Because the truth is, the last four years have been some of the
most life altering, fun, intensely challenging, and transformative
years of my young adult life. I will likely never have any other
chapter quite like it. And it’s hard to believe that it’s over.
Now I feel a world away as I settle into a new life in New York.
Everything has changed. Some things are better, some things are
worse, and some things are just different.
My days as a professional student are over. I get a paycheck. For
doing something I love. It’s crazy.
The city is loud. It’s fun. But it’s so loud. Saturdays in NYC blend
into every other day and I often find myself nostalgic for the
peace a Shabbat morning brings in Beer Sheva.
My Soroka scrubs are pajamas. My tan has faded. And I can’t
find a decent shwarma spot for the life of me.
There is no doubt that the next three years will be full of their own
unique set of challenges as I begin my residency in Emergency
Medicine. I’m expected to take full responsibility of my patients’
care, adjust to another medical system with it’s own flaws and inadequacies, and to build a new community of family, friends and
colleagues in an effort to replace the one I’ve left behind in Israel.
But to be perfectly honest I feel ready for it. Because I don’t know
if there is a better place to learn how to be a doctor, to develop
a strong sense of character than in the dusty desert town of Beer
Sheva. Simultaneously war-torn and peaceful, dirty and beautiful,
exhausting, yet somehow revitalizing of both body and soul, there
is simply no place in the world quite like it.
And for that I will be forever grateful.
THE BALAGAN
Fall 2013
SHOUT OUTS TO MSIH
8
Dear Classroom,
We’ve had a great run, but I think I’m ready to move on. Someday
I will return to once again rest in the glow of your fluorescent
lights and to freeze under the icy winds of your air conditioner, but
right now I need something more. I am moving on to bigger and better
things. Know that I will always hold dear our times together, but all
good things must come to an end.
Your friend,
Becky
e door
(in respons
et
middle nam o why dont you have
e?)
a
Shout outs to
you’re welcome
love,
msih 2015
dear macklemore,
MSIH
THE BALAGAN
To Zebra,
Why do you torture me?
Sincerely,
Angry Goat
,
Dear lab coat ladies
chines are
ma
g
Though the vendin
we miss acting
much more efficient,
eded.
out what size we ne
KIT. BFF. xoxo.
Bescrubbed students
Made
it
sunri to the to
s
p
is lik e...is this for a beau
what
t
e?
med s iful
chool
we ch
oose
t
his!
Dear Hubby,
Glad you finally showed us a big one.
Sister wives
Let’s get
hummus!
- Kady
lilmod ivrit ze kmo hatul
sh’ochel melafafon. ze kashe.
- dr. ashkelon
h
close t
o
t
e
m
want
s?
Do you ff the light
o
s
n
and tur radiology clas
In
I put my J
in with my
Seung.
-The Sooj.
msih
2017
DEAR TIM,
HOPE YOU’RE STAYING WARM IN
YOUR BOX UNDER THE OVERPASS.
-YOUR MOM
Fall 2013
9
THE BALAGAN
GOT PHOTOS? SEND THEM TO:
[email protected]
Fall 2013