American participants in Ben-Gurion University’s M.D. Program in International Health and Medicine.Global medicine means many things: refugee medicine, disaster medicine, epidemiology, international preventive medicine, international health systems, tropical medicine, medical anthropology, or all of the above. But the essence of global medicine, declares Dr. Carmi Margolis, director of the Ben Gurion University Program in International Health and Medicine is compassion for another human being whose cultural world is outside your own.
That’s the message that’s being taught to a group of 26 young American men and women who have already completed four years of undergraduate pre-med degrees, who arrived in Israel during the summer to begin a rigorous and challenging global health and medical care program at the university.
“If the patient or the community you are trying to help exists in a different cultural world, then you must have skills, attitudes and knowledge that will enable you to communicate and treat effectively,” Margolis told ISRAEL21c.
Although Ben Gurion University Faculty of Health Sciences (BGU) in Beersheva and Columbia University Medical Center (CUMC) in New York City are thousands of miles apart, faculty members at both institutions conceived the idea of creating a new medical school in which international health and medicine would be required. There was strong interest in both schools in attempting to create a new type of physician who would be skilled not only to practice internationally, but 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. The question of how to practice cross-cultural medicine had become an important issue. While many medical schools offer electives in international medicine, the BGU M.D. Program in International Health and Medicine in collaboration with Columbia University Health Sciences (its formal title) – established in 1997 – is the world’s first medical degree program designed to train doctors for the practice of international health and medicine. The study of international medicine is required for graduation (BGU-CU M.D.).
The re-emergence of infectious disease, the rapid spread of chronic and lifestyle-related diseases beyond the industrialized world to developing nations, and the inability of governments and international health organizations to respond to international health crises in an era of rapid globalization were all issues that inspired the BGU-CU M.D. program.
When the innovative collaborative program was still on the drawing board, it was called the ‘Medical Pioneers Program’. Indeed, these students are in a very real sense pioneers.
The program, now in its seventh year, draws highly motivated students who want to study cross-cultural medicine. “We couldn’t have started this program without Columbia,” explained Margolis, director of the program in Beersheva. “There is no place in the U.S. that doesn’t have a large diverse cultural population, and the Columbia faculty saw this collaboration as a way of addressing this need.”
In Israel all four medical schools have top-flight seven-year medical schools. Three of them – The Technion, Tel Aviv University and Ben Gurion in Beersheva also operate U.S.-style four-year tracks in which the language of instruction is English. The BGU Program in International Health and Medicine is the only one specifically designed to train clinicians to practice medicine outside the culture in which she or he grew up.
The skills taught in the international track include communication skills, such as competence in foreign languages and in using translators; knowledge of other cultures, and how cultural factors influence medical decision-making.
The students who take part in the program are themselves from a variety of cultures and backgrounds. Most are non-Jews. “These are not the same kinds of students that are applying for residency programs at Columbia,” said Margolis. “They are more altruistic and idealistic, by definition.”
The international medicine track already begins in the first year. In the third year when students are doing clinical work, they take part in a workshop in cross-cultural medicine, using professional actors simulating situations, an approach refined at BGU.
In the fourth year the students are sent off to various foreign countries for two-month international clerkships. Each site is covered by a local university: in Kenya, Moi University; in Ethiopia, Addis Ababa University, and in India the Christian Medical College in Lahore. Students have also done their clerkships in Peru and Nepal.
At a presentation last spring returning students told of treating HIV patients in Kenya where there are two or three people to a single hospital bed. They described reconstructive surgery for leprosy patients in India, of patients suffering from malnutrition, dysentery and exotic parasitic infestations in Ethiopia. Several students told of unavoidable death, when nothing could overcome the filth, poverty, ignorance and complete lack of resources they encountered.
One characteristic stood out clearly in each of the about-to-be doctors who related their experiences: the warmth and respect for the patients and local medical practitioners they had come to know during their time in very foreign surroundings.
In his Ethiopia Journal, written during his first international clerkship, Harrison Levine describes both his distress at seeing awful poverty, and his elation at experiencing effective community care under impossible conditions.
We went to see four of the women’s homes in the shantytowns. These were truly sad. A tiny square room with newspaper or burlap or something to keep the rain out, cockroaches everywhere, a tiny brazier for cooking. There are communal latrines, and all the houses are cobbled together from strips of rusted corrugated steel sheets. The houses are constructed in an impossible maze with streams of dirty, muddy water running along the rock-strewn pathways. We have all seen these things on the commercials for Save The Children, but until you been there you cannot possibly appreciate the poverty these people suffer…
A few students who are unable to leave Israel for personal reasons do their clerkships in a program dealing with the Arab population in the north of the country. Of course, all the students meet many Bedouin patients in the Beersheva area as part of the regular program.
Because Chris Wagner and his wife Kristin are expecting their first child, he decided to remain in Beersheva, rather than going to Africa or India for the 4th year clerkship. Instead, the 28-year-old 4th year student will be working with Bedouins in the Negev.
Wagner first heard about the program when he was studying for a master’s degree in Biblical studies at the Jerusalem University College. “I met someone who was in the charter course at BGU and I thought, ‘what a crazy idea. Why would anyone come to Israel from the US to study medicine?’ But two years later when I decided I wanted to go to medical school, I looked up the program. It was the international aspect that appealed to me,” he told ISRAEL21c.
Wagner says that his Christian faith was a definite factor in his decision to attend the international program. “My belief in Jesus, in his call to serve the poor and needy and to minister to the whole spectrum of needs, and the under-served, certainly motivated me to want to study international medicine. A lot has to do with prayer. To know that God was calling us to be here.”
Wagner adds that the experience of living in Israel has been the most exciting part of the course for him. “The second you step out of the classroom you’re facing new situations in a foreign country and culture. Just daily living is a cross-cultural experience.”