IFMSA decides: A Disservice to Medical Students

I was disappointed when I read that the international association of medical students was going to ban Israel from taking part in matching students to experiences in other countries. The newspaper headline announcing this read, “Israel suspended from international medical student’s association amid accusations of genocide in Gaza” I asked myself, what do medical students have to do with the war between Israel and Hamas? Why should students whose focus and careers are directed to help people, irrespective or race, creed, religion or nationality? Is this punishment for Israeli medical students? Is it believed that by punishing medical students Hamas will agree to a ceasefire and return the hostages or that Israel will not pursue their quest for protection of its citizens after the massacre on Oct. 7, that included murder, rape, incineration and kidnapping at the Israeli border and at the Nova music festival? Is it believed that international medical students who want to visit Israel for a placement will be tainted and turned into genocidal proponents by being taught by Israeli doctors, whose political beliefs may not support the current Israeli government?

I am a beneficiary of the IFMSA (International Federation of Medical Student Associations), during my medical education in Scotland at the University of St. Andrews. As an American I chose to study abroad because I wanted to travel and learn as much about medicine as practiced around the world as possible. I took advantage of the opportunity: a student could choose a country, city and medical specialty and be placed, trying to meet those criteria. For me each of my choices were met. During my five years of medical education at the Dundee campus of the University of St. Andrews I did the following: Surgery and midwifery in Northern Ireland (Londonderry), where I experienced the hostility that existed between Catholics and Protestants, as because I was Jewish, staff members seem to feel comfortable explaining the reasons for the animosity; financial, historical, cultural and religious. When I was assigned to look after a bishop in for a surgical procedure, when he discovered that I was Jewish, he said, “Oh, the chosen people”. My Lithuanian survivor of the pogroms that propelled her and her family to America would never have believed it. I also learned that on Friday night, when I worked in the emergency room, one of them most common requests for care were for the removal of fish bones caught in a patient’s tonsils.

In Denmark, where I had visited prior to my starting medical school I was placed at newly built hospital on the outskirts of Copenhagen. It was because of the month I spent in Copenhagen as a university student at Brooklyn College, who was at the tail end of a six-month travel foray through Europe, that a group of female medical students “adopted me”. I attended their classes and was amazed that the so enjoyed studying medicine, in contrast to the American medical students who I had met who always seem to carry the weight of the world on their shoulders. That propelled my quest to study abroad. I was on a surgical unit. The chief surgeon was almost a foot taller than me and towered over the operating table. He was a specialist in breast surgery but was also a general surgeon. He explained to me the rationale behind a total mastectomy and lymph node dissection. This was years before it became evident that a lumpectomy and radiation would be as effective without the disfigurement that often followed the standard radical mastectomy. He had enough faith in me to allow me to take the lead in a routine appendectomy, with his careful supervision, something I would never have been able to do at that stage of my training in Dundee. One of the things that really amazed me was the fact that beer was served at meals for those who did not have any reason not to drink. The surgeon confided in me that there was a great deal of chronic liver disease (cirrhosis) because of alcohol use, and he was working on a surgical procedure to relieve the venous pressure to decrease the risk of esophageal vein bleeding which was often fatal.

In Greece I worked with an orthopedic surgeon at the Athens city hospital which was in the public domain. Unlike the private tier of hospitals, as in the United States served those who could afford private insurance this hospital was akin to the large American city hospitals like Boston City and Belleview in New York or the broken-down Coney Island Hospital as which my late mother died many years after I was a qualified physician. It was a time of great political upheaval in Greece (1964-65), and there were protestors in the streets. I was called at one point to explain to an American student who received a deep wound during a confrontation that he would need a penicillin injection which when given unfortunately impinged on the sciatic nerve. The anxiety from the pain needed some soothing in English which is why I was called upon. I watched the surgeon who was my supervisor put in pins to broken hips in what would have to be called a relatively “bare bone” primitive circumstances. The surgeon explained the method due to a shortage of proper equipment.

My visit to eastern Europe was important for me as that was from where my grandparents came. It was a summer in Warsaw, Poland, working at a pediatric hospital. Not in the Lithuania of my grandparents but close by and also a victim of the second world war’s attempt at extermination of the Jews. I was able to travel there as a British medical student, despite my American citizenship. I along with a dozen other students from various countries including Finland was housed in a female medical students’ dormitory. We were a major curiosity to the students who were eager to meet with us. I learned some Polish prior to my arrival. The head of the department was a Jewish man who had spent the war in Switzerland where he had been studying at the time of the invasion. He returned to Warsaw to help revive the medical system. Another doctor revealed to me that she was Jewish after she realized that I was. I saw evidence in the children of the ward of advanced rheumatic heart disease (cor bovinum-enlarged heart) due to the lack of penicillin to treat rhematic fever when they were youngsters. I was able to communicate with them in my basic Polish and the relished hearing their own heart murmurs when I placed my stethoscope in their ears and put the diaphragm on their heaving chests. I was amazed at the fact that they did not have disposable needles and sharpened them after use and before sterilization on a sharpening stone. I also witnessed the machinations of a robust black marked where people comfortably approached foreigners to exchange money at four times the official exchange rate- the problem was there was not much to purchase as stores had limited stock. One luxury was chewing gum and a package of five sticks of America gum was worth about $5 in Zloty. Coffee was a luxury, and the usual morning drink called kawa z cykori (chicory coffee). It was brown in color, had lots of warm milk and was better than nothing, unless you liked tea which was readily available.

My most impactful visit was in my next to last summer before final year. It was to Israel which followed my month in Greece. I tried to make my plans geographically compatible. From Greece I took a boat ferry to Israel, which stopped over in Rhodes. I had asked to midwifery (obstetrics) and gynecology in Haifa, in the north of Israel. Rambam hospital was right near the Mediterranean Sea, and I was provided with a small cabin that I shared with a Canadian Dental student. Professor Aharon Peretz was my supervisor. At the time that I met him I did not realize how our lives in some way intersected as he came from the same region of Lithuania as my grandparents. He allowed me to do whatever I was interested in. I was eager to assist at surgery and births. The assigned residents were happy to allocate their duties to me, especially holding retractors during surgery for cystoceles, which were tedious to them by very exciting to me. I had some very moving experiences as when Peretz ran a clinic for women who were infertile or had multiple miscarriages and were applying for reparations from the German government as they were survivors of the Holocaust. He explained their problems to me and then signed all the applications. When I asked if their problems were related to their incarceration or starvation during the war he said, “yes” emphatically, “every one of them”.

I had some exciting moments with some of the Arab patients of which there were many. One pregnant woman was brought in screaming with her husband right behind the stretcher. Examination revealed a likely ruptured ectopic pregnancy (outside the uterus) which required rapid surgery and blood transfusion. The senior resident asked to have intravenous prepared on O positive blood ordered. She handed him a device in a cellophane package. He looked at it and asked, “what’s this?” She replied, “it’s the new intravenous catheter which when put in is not likely to come out which is always a problem with the needles we usually use.” “How do you use it?” He looked around as the intravenous was set up and a unit of blood had arrived. “I have used them in Scotland”, I said with some degree of confidence (I had put in two of them before I left Aberdeen where they had just come into use). The resident gave me the cellophane package. I put the tourniquet on the arm, but the blood pressure was low and a took awhile until a vein at inside of the elbow became visible. I put on the iodine, wiped it off with alcohol and with a rapid thrust of the needle into the vein, I could see the blood flowing backing into the plastic catheter which I threaded into the vein, and we hooked up the saline fluid and the blood line was piggybacked into a port in the intravenous line. She was then whisked into an elevator. I sat with her husband and oldest child while an Arab-speaking nurse translated my words to them. “You brought her here just in time. With a little luck she will be fine. The surgeon is one of the best in the country.” He wept as he held my hand. His daughter but her arms around her. Two hours later Pertz came out of the elevator and said with a smile on his face in Hebrew and the Arabic, “She fine, you can visit her in an hour or so.” The husband took Peretz’s and shook with his two hands, then shook the hand of the nurse and mine, all the time saying “Shukran, Shukran” . She went home two days later.

When I was preparing to return to Scotland, Peretz took me aside and told me that if I wanted to return to Rambam he would be happy to have me as a resident. At the time I did not know how that might happen. His second in command told me while I was saying goodbye and how much I enjoyed working with everyone, and said, “especially with the professor.” “You know he is very famous, not just as a physician but he was a key witness at the Adolf Eichmann trial, as someone who witnessed him in his role at the Dachau concentration camp. When he was in Kovno Ghetto, he witnessed and then described during the trial, they threw the children into the truck. The mothers shouted desperately. One said, “Give me back my children.” When the guard offered to give her back one of her three children, she could not choose, and she left the truck which she had mounted, empty handed.

The result of the Rambam and Peretz experience resulted in my returning after my training to do six months internship with Peretz and years later, made Aliyah with my first wife who I met during those six months who was Israeli.

Although the goal of the IFMSA is clinical experience in other countries. The impact is likely much greater than the clinical experience. I learned about health care systems, various approaches to medical care that were novel to me, insight into various cultures and people that I would not have otherwise experienced. I believe it has made me a better clinician but mor important a more attentive physician. It is not only very short-sighted for the IFMSA to boycott Israel and Israeli physicians, but in the long run is doing the whole medical profession a disservice.