What Should You Bring on Your International Medical Elective?

Alex Berger, MS4, OB/GYN

Alex Berger spent 5 weeks in Tel Aviv Israel conducting maternal health research as an International Fellow at the Gertner Institute. He wrote this reflection during his time in Israel.

February 27th 2013 Tel Aviv, Israel

Passport, white coat, stethoscope, vaccines.  For most doctors/medical students going abroad on an international health initiative, these are the items that are required.  In preparation for my international medical fellowship, I collected these items and went through many standard steps.  I found a faculty sponsor (Dr. Adam Goldstein at UNC), arranged for a local physician/mentor and site (Dr. Liat Lerner-Geva, the Gertner institute), submitted a proposal to the Office of International Activities, developed a project and aims (on improving maternal outcomes), and applied for funding.  I found local contacts, created a packing list (including my passport, white coat and stethoscope), and picked up local guidebooks. But in addition to all of these basic preparatory steps, I had additional challenges because of the location of my fellowship.

Israel is a complicated country whose history, religion, politics, and geography make it a lightning rod for conflict.  Navigating this conflict on a medical mission is challenging and my presence in Israel would require extensive planning. Back in the summer of 2012 when I was preparing for the fellowship I submitted an extensive statement of purpose with faculty sponsor and mission statement to apply for a special travel waiver from UNC.  After I received permission, I worked with the U.S. State department and U.S. Embassy in Israel to ensure proper contingencies.  At each step I was thoroughly warned about the risks and liabilities of living in Israel.

Despite the challenges of getting here, my experience in Israel has been profound and I am so grateful for the relative peace that has sustained throughout the month.  During the conflicts in November, this peace was far from assured.  In the winter, rockets arrived daily in Tel Aviv and surrounding cities from the Gaza strip.  Jeremy, a close friend from college and current medical student at Sackler in Tel Aviv, recalls his time in the hospitals then, struggling to ignore the sounds of rockets. "There was a feeling of helplessness,” he says “We often only had a minute warning before the rocket would land, and moving our patients would have been futile."  Jeremy, like the thousands of health professionals in direct line of the Gaza missiles, felt a duty to protect and serve his patients, whether from their illnesses or the rockets.

Pedram, an Iranian-born medical student at Sackler, remembers his experience outside of the hospital.  Those that have been to Tel Aviv have warm memories of the beaches that cover the cities’ coast line.  Young couples, families, and groups of children frolic in the waves, play Frisbee, and enjoy picnics on the pristine sand. One day in November, Pedram was walking with a friend along the beach when he heard the missile siren go off.  He and the other beachgoers snapped their heads as a rocket came into view not more than 100 yards in the air.  As it arced menacingly toward the beach, a second projectile coming from the opposite direction came into view and intercepted the first, causing a loud explosion.  This sight would be repeated an estimated 1,456 times in Tel Aviv and throughout Israel that winter as the Israeli missile defense system (Iron Dome) would intercept and destroy many incoming threats (reports cite 421 interceptions over Israel, 142 rockets which fell in Gaza, and 875 which fell harmlessly in open areas) .  Some (58), it did not.  Six Israelis were killed and hundreds injured from the rockets that made landfall in populated areas. A commuter bus was bombed, injuring 28 Israelis on the way to work. Israel responded forcefully in Gaza. In an incursion known as Operation Pillar of Defense, some 133 Palestinians were believed to be killed with hundreds more injured.  During the past month, I have met colleagues who cared for the injured on both sides.  They have watched as countless more have been lost. As physicians, we are bound by an oath to do no harm, and often, in Israel, we are repairing the harm caused by others.

During the violence in November I worked with my UNC and Israeli colleagues to develop alternative plans in case the violence continued. More importantly, I prayed for peace.  Lani, a dentist and close friend from UNC, was to be in Israel providing free dental work while I was there.  We spoke often over those weeks, sharing our fears and hopes for a resolution to the conflict.  While a tenuous ceasefire was being held, I reconfirmed my visit and mission for the fellowship.  The peace held and I arrived in Israel safely, finding purpose in my work and gratitude for peace.

Over the last week this peace has been shaken.  Protests in and around Jerusalem have led to violence with Palestinian youths throwing homemade rockets and Israeli soldiers firing back and severely injuring protestors. Last week I was at Hadassah, the premiere health care center in Jerusalem, working among those that cared for the young Palestinians who were injured.

Yesterday evening I took a long run along the Mediterranean after work. I ran on the beach, going south towards the ancient port city of Jaffa.  As I ran in the sand, I caught the sun setting over the tranquil blue waters.  When I got home, this peace was rattled by news that a rocket had landed in Ashkelon, a small town 100 km south of Tel Aviv.  This was the first such rocket attack since the November ceasefire.

I was to meet Jeremy later in the evening and as I walked the block to his house I got lost.  It is a route I have taken at least a dozen times since arriving in Israel.  But this night, I was lost in my thoughts.  I wandered a few blocks down the busy central district of Tel Aviv as I considered the rocket attack that day, the young Palestinians at Hadassah, and the lives lost in November.  I passed happy couples walking by hand-in-hand, a group of school children enjoying ice-cream by a large colorful fountain.  I leave in 10 days.  People that know me well know that I am always optimistic and upbeat.  I leave Israel hoping for lasting peace in 10 days, months, or years.

So this all brings me back to my question: what to pack? How do you prepare for this experience?  The standard list is vital, but so much more is needed. Of course you need a stethoscope to help you hear hearts, a white coat to identify yourself, a passport to get you into the country, and vaccines to keep you well. But what should you bring with you, really? First, bring your stethoscope, but also bring your heart.  You will need it to guide you during the challenges and successes of your experience.  Second, bring your white coat, but also bring your identity.  This is who you are, your principles, and it will center you during your journey.  Third, bring your passport, but also bring a curiosity to learn.  This curiosity will grant you entrance to places and ideas you would never have imagined.  Lastly, yes you should get vaccinated.  But don't be immune to new ideas and experiences that will help you grow into the compassionate doctor you are meant to be.  During your career you will bring life into the world, you will save and you will see lives lost.  But don't forget to bring along what got you there, and have an open heart and a curious mind to discover what lies ahead.