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A lesson from Israel

Marshall Hertz, M.D. (second from left), Paul Quie, M.D. (fifth), and student Melanie Lo (sixth) were in the first University of Minnesota cohort to visit Israel through the Quie/Farbstein Health Care in Israel Program in 2008.

When a group of four University of Minnesota Medical School students and two faculty members visited hospitals in Israel in 2008 through an International Medical Education and Research (IMER) program, they weren’t sure exactly what to expect.

They knew not to expect the same Israel they’d seen on the news. They knew not to expect third-world conditions. They just weren’t expecting the huge, leading edge simulation center they saw at the country’s largest hospital, Chaim Sheba Medical Center, near Tel Aviv.

“The Israel Center for Medical Simulation was amazing,” says fourth-year medical student Melanie Lo, who took part in IMER’s first Quie/Farbstein Health Care in Israel Program excursion, designed to promote an exchange of educational, research, and other scholarly opportunities for students and faculty. “It was an entire building filled with different simulation equipment for all sorts of medical situations, including the clinic, operating room, and field for military and disaster relief training. We were extremely impressed by the high-end technology as well as the sheer scale of the training center,” Lo says.

Their visit to the Israel Center for Medical Simulation also made an impression on faculty adviser Marshall Hertz, M.D., who will take a second group of students to Israel in April.

“I feel like, in a lot of ways, they are technologically equal or superior,” says Hertz, comparing the Israeli hospital to those in the United States. “Yet everybody you talk to still seems to regard America as the gold standard.”

Technology and the physical exam

But as in the United States, not every hospital in Israel has all of the newest technologies. The group visited several Israeli health-care facilities, and Chaim Sheba Medical Center was among the most technologically advanced.

At Baruch Padeh Medical Center in Poriya, the community-based hospital where the IMER group spent most of its time, health-care professionals had access to some technologies typically found in U.S. hospitals—but not everything.

Instead, physicians relied heavily on taking good patient histories, performing very thorough physical exams, and having a solid understanding of the local epidemiology, especially of genetic diseases.

“They use the tools available to them,” Lo says. “The physical exam is always something you can do, even if you’re going to order a test or ultrasound or something later. In the meantime, you can still be very thoroughly examining the patient.”

An ever-present concern

The IMER cohort also noticed that safety and security precautions were part of the Israelis’ daily lives. When the Baruch Padeh Medical Center was renovated, its walls were built two feet thick to withstand potential military attacks. Another hospital moved its intensive care unit and daycare facility underground.

The University group didn’t encounter “wartime medicine” by any means, Hertz says. But “the military is around. You see soldiers with rifles. It’s just kind of a presence there.”

(In fact, IMER’s Quie/Farbstein Health Care in Israel exchange program was officially established in 1999, but because of security concerns, University student participation in the exchange has been somewhat restricted.)

Lo says effects of the long-term conflict have permeated through Israel’s healthcare system.

“A significant proportion of resources are dedicated to emergency preparedness and treatment of the physical and mental health of all victims,” she says. “But, generally, the focus in the hospitals remained on providing high-quality, culturally appropriate health care.”

And the ethnically and religiously diverse hospital staff — among them Christian Arabs, Muslim Arabs, Jews, Druze, and Bedouins — worked together seamlessly.

“It’s a real crucible of different cultures,” Hertz says. “We got a lot of cultural and religious education in addition to our medical studies.”

By Nicole Endres

The Phi Delta Epsilon Fraternity medical alumni group has provided financial support for the first two groups of four students who have taken part in the Quie/ Farbstein Health Care in Israel exchange program.
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