Secret genius in the desert

This year marks the 20th anniversary of the founding of a unique English-language medical school, the Medical School for International Health (MSIH) of Ben-Gurion University of the Negev. Though it is the only medical school of its kind in the world, with a four-year global health curriculum for all students, its existence seems strangely unknown in its home country. This “secret genius in the desert” now has 570 graduates serving as doctors all over the world. Global medicine means many things: refugee medicine, disaster medicine, working with underserved populations, international preventive medicine and health systems, tropical medicine, or all of the above. But what the students and alumni appear to share is the desire to have an impact as medical practitioners on social justice issues, and compassion for others whose cultural world is different from their own. Graduates of the rigorous and challenging curriculum have worked as physicians in Papua, New Guinea, Ethiopia, Botswana, Haiti, Tanzania, Kenya, Angola, Uganda, Liberia, Jordan, Chad, and more. Many continue working in underserved populations. The cross-cultural experience at BGU “has shaped and had a transformative influence on what I do,” says Dr. Javeed Sukhera, assistant professor of Psychiatry and Pediatrics at Western University, London, Ontario, Canada. “It's about the bigger, broader issues on how we challenge ourselves every day to get outside our comfort zones, thinking about health disparities and issues of access,” explained Sukhera, speaking by phone from Canada. Although Israel wasn't an obvious choice for a North American Muslim of Pakistani background, Sukhera, who graduated in 2005, relates that Israelis “accepted and welcomed me with open arms.” Now, years later, he says, “For me it's how we treat people with mental illness, how stigmas have an impact in health care. Without being in Israel, having that experience I would never be doing what I am doing now.” “I think that I live and breathe that spirit of community focus at BGU in my practice now,” continues Dr. Sukhera. “I see this is in myself, including my work with indigenous people with mental illnesses who are systematically marginalized.” When it was first founded 20 years ago, the school was a collaboration between Ben-Gurion University Medical School and Columbia University Medical Center (CUMC) in New York City. Faculty members at both institutions conceived of the idea of a school in which international health and medicine would be required. Their concept was to train a new type of physician skilled not only in practicing internationally, but who would also have special skills that would help in dealing with multicultural populations, particularly those in the United States and Israel. The idea turned out to fill a niche in the world of medical schools. Though MSIH is still the only school with all four years dedicated to global medicine, some schools around the world have since introduced global health tracks. For several years the school was co-run by Columbia and BGU, but this proved a somewhat clumsy arrangement. Columbia's name was on the diploma, even though it was an Israeli MD degree. “At some point the dean finally said this is inconsistent with Columbia University policy,” explains Dr. A. Mark Clarfield, the outgoing director of MSIH. “They said, 'You'll run it alone, but we will maintain a very robust relationship.'” Columbia is our best friend, but we now run the school independently,” says Clarfield, pointing out that MSIH students do their fourth-year electives at Columbia, and Columbia medical students have access to BGU's international clerkship sites. As every year for the past 20 years, last month 27 first year MSIH students – the class of 2022 – dressed in white shirts and dresses, filed into the Ben-Gurion University Medical School auditorium to take what is known as the Physician's Oath. The White Coat Ceremony entails a specially crafted version of the original Hippocratic Oath that doctors worldwide take committing to provide the best care without harm. This was traditionally done at graduation from medical school. It was the BGU Medical School that introduced the ceremony in the students' first year when the school was founded in 1974, with the then revolutionary idea that students should begin interacting with patients almost immediately, and thus should take the oath at the beginning of their studies. (The idea has since been adopted by many American medical schools.) The MSIH curriculum has in many respects adopted the philosophy of the Hebrew language medical school at BGU founded in the 1970s, which saw its mission as being dramatically different from that of conventional institutions, namely in its outreach to the community. MSIH students are themselves from a variety of cultures and backgrounds. Many have already earned advanced degrees and have spent time working with underserved populations abroad. By definition they're more altruistic and idealistic. “People who go into medicine really do this as a service, people who go to MSIH are even more so dedicated. They go to this school because of their desire to help those the most in need. They're very outward looking and a very special group of people,” insists Dr. Tiffany Pierce Schatz, class of 2010. Today a general and thoracic surgeon at Doctors Community Hospital in Lanham, Maryland, she cautions that “not everyone would have the grit to handle the hard parts, but our medical school was a real life experience; the learning was the easy part. You get to be with so many different people who have a different perspective on the world, on medical education; that was a major plus.” The international medicine track already begins in the first year. Esther Levison, a first year student from Perth, Australia, has advanced degrees in medically related sciences. In 2015, she volunteered as an international aid worker in Mother Theresa's Mission in Calcutta, which provides homes for the impoverished and the sick. It was an experience Levison calls “demoralizing and formative.” The [nuns'] intentions are good, but I was a bit naïve,” she recalls. “I wanted to provide medical care to make people better. The Missions of Charity get huge donations, but it's not manifested in any way with medical facilities or training or nurses. There's very limited medical care; this was a shock and disheartening.” She says she returned to Australia determined to find a way to provide medical care to needy children. “I feel an obligation. This school is focused on global medicine, on populations that you don't find anywhere else in the world.” Levison, who has also worked with refugees in Australia and Greece, has already joined MSIH's Global Health Working Group and become involved in activism against contemporary slavery in the Middle East. Aerin Philip's two and a half years in the Peace Corps in Nepal was an intense education in cross-cultural aid. During his stint, the 25-year-old second-year MSIH student from Houston, Texas worked in the health section, giving nutritional and agricultural advice in a remote rural village 24 hours away from Kathmandu by bus and on foot. “Electricity was off and on, and I had to carry water to my house,” he relates. He was there during the 2015 earthquake. “Everything was wiped out; it was chaotic with no means of communication.” “When I decided to become a doctor I saw an ad for MSIH. I liked the idea of studying medicine in the global context, and not at a traditional medical school. In a way, this is like the Peace Corps, living in a place I have no ties or heritage to, and I'm absorbing things as I go along.” Philip's parents are Orthodox Christians who immigrated to the US from India. (The name “Aerin” is an unusual spelling of the name “Aaron.”) As part of his community outreach, he's involved in a project with Bedouin teens in a local village. “I love meeting people of different backgrounds, I find it fascinating. The whole Negev population is so interesting. That what makes this school so special,” he says, commenting that he also gets a kick out of constantly being mistaken for an Arabic speaker. “I love it. I've learned a few words now, so I can say I don't speak Arabic!” “MSIH really opened my mind to global health and applying medicine outside of the hospital,” says 27-year-old Jonah Cohen, a fourth-year student now doing his rotation at the Long Island Jewish Medical Center and North Shore Hospital in the US. In his first years of medical school he did a project on emergency medicine in the unrecognized Bedouin villages, and wrote a research paper on the Ethiopian community in Israel, focusing on the issues of integration, higher rates of mental illness and diabetes. In addition to fourth-year electives and clerkships in medical centers in North America, a key requirement of all MSIH students is an internship abroad in their fourth year. In the past, the sites have been in India, Nepal, Peru, Mexico, Vietnam, Sri Lanka, Ethiopia, Uganda, and Ghana. Organizing these sites, which vary from year to year, is always a challenge, explains Michael Diamond, the MSIH Global Health Education Coordinator. “Every year something happens to upset a very delicate balance of the projects: strikes, civil/military disturbances, visa problems, connecting flights missed with students stranded in remote places,” he relates. “For the last couple of years we haven't sent students to Ethiopia because of fears for safety. Sri Lanka was canceled at the last minute once because doctors went on strike. We once had a site withdraw from the program as our students were en route to the airport because the dean and senior administration had been taken hostage.” That said, adds Diamond, “this is true global health. Always expect the unexpected and be able to improvise overnight. We've become true experts over the years.”

Secret genius in the desert

BGU’s Medical School for International Health seeks to make an impact on global medicine.

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