Anatomy of the Negev

Beersheba’s diverse population and sometimes volatile security situation help prepare students at the Medical School for International Health to practice anywhere in the world.

By YOCHEVED MIRIAM RUSSO
Medical School fo International Health (photo credit: MSIH)
Medical School fo International Health
(photo credit: MSIH)
When Sakal Kvis enrolled in medical school, it became a family affair.
Once Kvis, who hails from Ft. Worth, Texas, was accepted into Beersheba’s Medical School for International Health (MSIH), there was no question: the whole family would come to Israel. Four months ago, Kvis, his wife Faith and their four children – ages six, five, three, and six months – hopped on a plane, then settled into a rented apartment in Beersheba where Sakal will study for the first three years of the four-year program.
“We could have stayed at home, in Ft.
Worth, and gone to medical school there, but we decided to come to Israel instead. It’s a great opportunity for all of us,” Kvis says. “We lived in Cambodia for three years, too, so this was another opportunity for us all to experience a different culture.”
At 31 years old, Kvis found himself one of 45 students in the first-year class, enrolled in an institution that attracts students from all over the world, then sends them out into the world as skilled practitioners of international health. The Medical School for International Health came into being in 1996 when Columbia University’s Health Sciences Division in New York joined with the Faculty of Health Sciences at Ben-Gurion University of the Negev to create an entirely unique degree program.
Graduates of this school are not only trained in primary care but also in community, preventive and populationbased medicine.
“As far as we know, there isn’t any other medical school in the world that has global health as its prime focus,” says MSIH director Dr. A. Mark Clarfield. “Others might offer an international track, but for us, this is our main objective.”
The Columbia-BGU collaboration is a two-way street, Clarfield says.
“Columbia provides certain elements of the program, we provide others: BGU pays all the salaries and administrative costs for Columbia employees who administer the admissions process from New York. When students reach the final, fourth year, Columbia helps them find their rotation situations in whatever the students choose – surgery, general medicine, pediatrics or whatever other specialty they desire.
“This benefits the students again because even though they’ll have an Israeli medical degree, they can apply for residency based on their experiences in New York. MSIH, while located in Israel, is an international school and doesn’t operate like Israel’s other medical schools. It’s patterned after American schools, where all students hold at least a bachelor’s degree upon enrollment. In Israel, by contrast, medical school comes right after high school, plus or minus army service.
Medical students in Israel aren’t required to obtain an undergraduate degree first.”
Kvis comes with several post-graduate degrees. His undergraduate degree in physics came from the University of Texas in Arlington, followed by a degree in theology from a seminary, followed by yet another post-graduate degree in medical science. After that, Kvis spent three years working as a part of a medical team in Cambodia.
“I led a team at Mercy Medical Cambodia,” he recalls. “We were responsible for disaster relief and patient follow-up for all kinds of situations. One big project came about when a whole community was burned out by fire. My responsibility was to get them food, supplies and whatever immediate help they needed, after which I coordinated medical followup.
Doctors would come to visit the village, and I’d secure everything they’d need, plus making all the medical outreach arrangements. It was in Cambodia that I affirmed what I wanted to do with my life. It showed me what a wonderful thing medicine is, what a great tool for reaching people, lifting them up, giving them hope.
“Medicine wasn’t a new idea for me – I’d thought about it before and completed all the pre-med classes in college.
But back then, it didn’t feel as though the time was right. Our three years in Cambodia put me back on the path again.”
For experienced expats like the Kvis family, moving to Israel wasn’t especially daunting.
“I’d taken the MCAP, the pre-exam for medical school. After that, medical schools from all over started sending emails, encouraging applications. I hadn’t heard about MSIH before, but when I saw what it was – a school specifically dedicated to international medicine – I was interested right away.
We’d just come back from Cambodia, and I knew international health was exactly what I wanted to do. The fact that the school was located in Israel was another big plus. When I learned that the financials would work too, that I could get the US student loans I needed, that was it. It sounded perfect.”
Even so, the Kvises had never been to Israel and had no friends or family in the country. How would they handle all the arrangements from overseas? “Ah, but we had the pioneers!” Kvis laughs. “Back in the beginning, the first classes paved the way for everyone else. They bought all the books, found the apartments, did everything themselves.
Since then, every class afterwards has benefitted. The pioneers created a book room for communal books, they found apartments, they bought – and then many sold – furniture and other things to those of us just starting at the school. While we were still back in Texas, we were connected with a family who had a four-bedroom apartment.
They were leaving, so we made arrangements to just take over their old apartment. They even left some furniture for us to use when we first came.
The furniture was sold, but they let us use it for our first three weeks. That gave us enough time to get to Ikea to buy what we needed for ourselves.”
Unlike many families permanently immigrating to Israel, the Kvises didn’t send a lift.
“Just our luggage, whatever we could fit into checked baggage – plus my carry-on bag, which wasn’t weighed. I must have had 100 pounds of books in that pack. We bought clothes before we came – something we didn’t do for Cambodia. In Cambodia, we knew we could get what we needed but here, we weren’t sure.
“Funny thing is, though, how many things in Israel are similar to Cambodia – not in the ‘third world’ sense, not at all. But here, just like in Cambodia, the houses are all concrete, the floors are all tile. People here dump water on the floors to wash them, just like in Cambodia. What did surprise us was to see how many cats are roaming around. That was new.”
And of course the intermittent missile strikes were new.
“That was funny, how that worked out,” Kvis recalls. “We knew about the sirens, the missiles, we knew that could happen, so we prepared the kids in advance, explaining everything. Of course we didn’t know what the warning siren would sound like, so that caused a little bit of confusion. In the middle of one of the first nights we heard what turned out to be a car alarm, and thought that was it. We all woke up, but I couldn’t see anyone else running around, so we figured maybe it wasn’t. We decided, though, that we should have a trial run with the kids, so we’d know what to do and could walk to the bomb shelter, right next door, in an orderly way. We practiced and thought everyone understood.
“But of course when the real siren went off, things fell apart. That first alarm was in the middle of the night, but Faith is kind of a night owl and happened to be up. I jumped out of bed and ran out the door just as Faith was running in, so we crashed. Then we rushed to get the kids. I picked up the little one, we both woke up the others, who were sleepy, wondering what was going on. But they were pretty good – the baby cried a little, but that’s all. We finally got the whole family into the living room, but then I looked out the peephole and saw a neighbor out in the hallway. I was confused.
The siren had stopped and it was quiet, so we thought it was all over – I’d thought the siren would stay on until it had actually hit somewhere. We learned that it didn’t – so the bottom line is, we didn’t make it to the shelter that time. The next time the siren sounded we did much better. We did it three ways: a practice run, a foul-up and then a success.
“All in all, it wasn’t bad. You know, coming to Israel, these things can happen. Getting everything we wanted in Israel far outweighs the problem of the rockets. There are so many good things here – Israel is the cultural and geographical center of the world. It’s where Jesus walked, and right now, it’s at the focus of world attention, a good place to be.
We love to t r a v e l and this is the perfect opportunity.
“What do we miss? Well, Faith is originally from Minnesota and lived in Arizona, so she’s not as Texan as I am, but we miss restaurants like Chipotle and Chick-Fil-A, but we’ve learned to love humous and pita. Our loan disbursements didn’t come right away, so for the first month, we ate a lot of humous. It’s wonderful! Humous works as mayonnaise, as a dip, it’s great on everything.”
Even schools don’t present much of a problem.
“Faith is a teacher, so she’ll most likely homeschool the children. We looked into several different options, but we’ll probably homeschool again as we did in Cambodia. Hebrew? I speak two languages now, Cambodian and English, and I’m learning Hebrew as part of the program. Faith speaks three languages.
At home, our kids mostly speak English, some Cambodian. We’ll all learn Hebrew.”
The diversity of the students at MSIH is one of the things that attracted Kvis, and in turn, one of the elements that made him an ideal student.
“In making entrance decisions, we look to several factors,” director Clarfield says. “First, of course, is to see whether the student has the academic rigor to do well in medical school. You don’t need to be a genius to be a doctor, but it helps to be reasonably intelligent.
Second, we interview – two separate interviews for each applicant.
We’re looking for personality, working to assess their emotional quotient, empathy, their sense of social responsibility, that kind of thing. All classes are conducted in English. This year, in our first year class, 90 percent of the students are from the US, 7% from Canada and 3% from somewhere else. We don’t track to see how many are Jewish. The school is in Israel, but it’s an i n t e r n a t i o n a l school, not a Jewish one.
“I’d say that this year, there appear to be a few more kippot in class than usual, but it’s not the result of a policy decision, we don’t advertise for Jewish students. Our sole focus is on people who are interested in international health.”
EVEN SO, as in the case of third-year student Talia Lewis, there appear to be advantages to being Jewish. Lewis had already spent considerable time in Israel, spoke Hebrew and has family here.
“More of my friends from college are here than in America,” Lewis smiles.
“During high school I spent a semester here and then later, a whole year. That said, I didn’t set out to go to medical school in Israel. What attracted me was the MSIH program, which was exactly what I wanted. I also knew it would offer a totally different Israel experience than what I’d had before, when I’d been part of a modern Orthodox Jewish group. And this would be Beersheba, completely different. I knew I’d find a very different religious, political and spiritual atmosphere than anything I’d experienced before.”
Lewis was right about that, she says.
“It’s been wonderful to experience Israel with people who didn’t grow up being interested in it. I usually invite people over for Jewish holiday meals, not because I’m trying to bring them closer to Judaism, but because it’s wonderful to share these experiences. I really appreciate the fact that I’m getting to see the politics and religiosity of Israel in a unique way. One of my classmates is an evangelical Christian who wants to be a medical missionary. To experience Israel through her eyes has been fascinating – she even invited me to go with her on a religious retreat. I’d never done that before, so I went. I’d never put myself into someone else’s faith experience that way before.
“This is the sort of thing I would never have been able to do in the States – I just wouldn’t have done it. But here, I could allow myself to go and to learn from it. Seeing their Bible study, their worship, just being the only non- Christian was an experience in itself.”
Why international medicine? “I wanted to be doctor since early in high school. I started by asking myself, ‘What’s the darkest situation I could encounter?’ I’m pretty adaptable and flexible, and I figured not everyone would be comfortable doing that kind of work, but I knew I would. Ever since I was little I’ve wanted to bring light to dark situations, so my first thought was to go into oncology. Then in college, I began to consider third-world countries.
After taking a couple of courses, I discovered that this was my new ‘darkest’ opportunity.”
In terms of specializing, Lewis says she’s considering two different fields, rheumatology and psychiatry.
“Believe it or not, there is a common thread,” she laughs. “In rheumatology people suffer from many different kinds of chronic or debilitating pain, but no one can really figure out why.
They go to doctors, the doctors can’t find what’s wrong, and the patients become frustrated. There’s so much validation that’s needed, and I’m a validating kind of person. I can contribute in dealing with people with chronic pain. Much the same is true of psychiatry – so much is unknown. Both of those specialties have huge gray areas, unknowns, which can prove frustrating for some, but I love it. In both areas, validation is needed.”
Lewis sees her future as being a family doctor in an underprivileged area somewhere.
“I’d like to spend some of my time in the States, part of my time abroad. I’d love to have a clinic in a developing country, a center to attract people in the region by offering medical care, but that would also provide all kinds of other developmental programs like education, social security, and general health.”
MSIH graduates practice all over the world, Clarfield says. Some even come back to Israel.
“There’s been a change in that,” Clarfield explains. “When we first opened, back before my time, we were informed in no uncertain terms that our program could not be used to add doctors to the Israeli system. At that time, it was thought that Israel had too many doctors. Even so, of course, a few came back – it was rare, but a few did.
They were perfectly qualified to do so, and obviously were free to do whatever they wished with their lives. Now that policy has changed.
“In the past three years, officials have come to understand that we actually have a shortage of doctors here. So now we’re quite open about welcoming students to come back to Israel. Every year, a few do. This year, three are interning here. They may or may not go back to the US to do their residency, but for those who want to stay, we welcome them and we help them.”
NOW IN her second year at MSIH is Santa Barbara, California, native Adie Kalansky, 26, wrote a telling account in her blog about how her class got to the heart of things, literally. Cadaver dissections, she writes, are a rite of passage.
“I was apprehensive about it,” she acknowledges. “For the first day, our class was divided into two groups, I was in the second. My good friend Julia had been in the first group, and she’d been the first person to leave. The uncomfortable look on her face gave me a woeful feeling and made me nervous, but when I went into the lab, my strongest reaction was to the sharp smell of formalin, the preservative.
Working with the bodies wasn’t actually so bad. It’s a helpful educational tool – it’s not my favorite, but I don’t mind it. Sometimes I’d glance at the hands and see that a woman had painted her nails. It gives me pause. It humanizes the whole experience for me.”
Kalansky, like Lewis, is also Jewish and has visited Israel many times.
“In that sense, it’s not as big an adventure for me as for some of the others,” Kalansky notes. “I was exempted from the Hebrew-language class. I was a little jealous about that, actually – I didn’t want to be exempted, but now I’m learning medical Hebrew, and that’s new. One day in class I was trying to describe ‘ovaries.’ I couldn’t come up with the Hebrew word, so I ended up describing them as ‘the balls of the uterus’ – I don’t think the class will ever forget that one.
“Coming here without any Hebrew at all must have been difficult for my classmates. You have to do so many things, opening a bank account and everything – I had trouble with that myself, and I speak reasonable Hebrew.
I can’t imagine how the rest of them managed.”
Kalansky spent some years considering medicine as an option.
“I’d wanted to be a doctor for a long time, but it took me quite a while to fully commit. In college, I studied psychology, and we did a lot of research about the brain. Again, I was interested, but not all that sure. Finally I decided that if I didn’t try it, I’d always regret it. There wasn’t anything else I wanted to do, and now I’m really committed.”
Needing to take out sizeable loans to pay for her education doesn’t scare her, Kalansky says.
“No,” she laughs. “There are so many other things that scare me I don’t get to that one. Like the rockets! It was very nerve-wracking at first. Last year, our classes started in July when there were lots and lots of rocket alarms in Beersheba. One night 10 rockets hit all at once, and then the next morning, we had them at 8 a.m., then at 9 and 10 – and that was the day we had to learn to insert IVs on each other! Finally that day they moved us into a hallway for class, so we wouldn’t have to run to the shelter each time, so there we were, in the hall, hands shaking, trying to get an IV line in.”
But “you get used to it after a while,” she says. “For the first few days, anything can set you off – an ambulance siren, a motorcycle accelerating, someone whistling, anything like that can start your heart pumping. I still don’t like to be awakened in the middle of the night, but now I’m used to it.”
ONE OF the advantages of coming to Israel to study global medicine is living in Israel itself, Clarfield notes.
“Our objective is to train people who will be able to practice medicine in any part of the world,” he says. “So for most of these students, living in Israel is an education by itself. Here, they’re exposed to one of the most multicultural societies in the world; Ethiopians, Beduin and regular Israelis are a very diverse group. Coming here – especially to Beersheba – constitutes a global experience all by itself.”
In her blog, Kalansky discusses a day last semester when her clinical group accompanied a nurse and social worker to visit two Beduin patients in their homes.
“We drove through a nearby Bedouin town, around it and then right into the desert,” she writes. “No roads, no signs, just an occasional wet patch of mud, and sometimes a wee sand dune. We pulled up to a flock of sheep where we met by the patient’s son. He welcomed us into the home, seated us on floor cushions and hot sweet tea was served.
The nurse began talking about proper insulin administration with the family in both Arabic and Hebrew. Several times, the father had been hospitalized due to complications of diabetes.
When he’d been in the hospital, the nurse realized that the man had poor vision and wasn’t able to read the numbers on his insulin injector, which meant that he wasn’t getting enough.
“Here in the home, the nurse was able to spend more time with the family, answer their questions and work on a better eating plan. Driving away, the social worker who was with us told how he, too, had grown up in a Beduin tent, and described another advantage of home visits, something he does virtually every day. In explaining why, he told a story about a very conscientious doctor he worked with, and a patient the doctor had been seriously concerned about.
“The doctor had asked the patient to come into the clinic every week to be checked. He also asked the social worker to visit the man in his home so they could see how he lived. The social worker went, and discovered how difficult the trip to the clinic was – not just long, but rough, sandy and bumpy. Returning, he told the doctor about the arduous trip the weekly visits would cause the patient [to make], and the doctor was surprised.
He’d had no idea of the burden he was placing on his patient.”
“It was an engaging day,” Kalansky concludes. “We learned things we never could have seen inside hospital walls. As we drove away, with the dusty Beduin village disappearing into the background, one of my classmates looked out the window.
“If ever there was any doubt as to why I came to MSIH for medical school , now I know,” he said. “A day like today tells me why.”