Diana Wolfe spent two years in Mali, West Africa, in the Peace Corps and had a master's degree in public health from Berkeley
Grace under pressure
May 14, 2004
Jerusalem Post
by Yocheved Miriam Russo
IF you think treating leprosy, malaria, tuberculosis and making a solo dash through the jungle to deliver a baby in a remote Amazonian village sound like the stuff of historical fiction, guess again. It's everyday fare for fourth year medical students enrolled in the Ben-Gurion University of the Negev MD Program in International Health and Medicine (IHM).
In their last year of medical school, the nascent doctors spend two months in a supervised clerkship program in a developing country. About a score of this year's 35 recently returned students presented oral reports at a Gala Presentation in Beersheva on April 29, and in the process, held an auditorium full of students, professors and other interested people spellbound.
They told of treating HIV patients in Kenya - 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 told of unavoidable death, when nothing they could do could beat back the filth, poverty, ignorance and complete lack of resources they encountered.
YET a characteristic common to each of the about-to-be doctors stood out clearly: the warmth and respect for the patients and local medical practitioners they had come to know during their time in very foreign surroundings.
In these times, when medical patients in "modern" countries are forced to adjust to the bean-counter approach to the practice of medicine, their warmth, compassion and sensitivity seems unique.
ACCORDING to Professor Miki Karplus, Clerkship program coordinator, that's precisely the objective they hope to achieve.
"First of all, we select students who seem to have the qualities of kindness and compassion,"
he says. "But secondly, these students make great sacrifices of their own in leaving their home countries - America, India, Africa, Asia - to come to Israel. Over half have no previous experience with either Judaism or Israel. So yes, they learn to treat people of other cultures with great sensitivity, but they themselves are also vulnerable, immersed in a very different culture, here in Israel. It's a key part of the program."
International Program students receive a traditional four-year medical school education, a joint operation between Ben-Gurion University of the Negev and Columbia University Medical Center in New York. During their fourth and final year, after having been immersed in cross- cultural studies and practical situations during all three previous years, they are required to spend two months in a formal "clerkship" with a locally-accredited medical school in Kenya, India, Peru or Ethiopia, or in a supervised Israeli program within a distinctive community like the Bedouin, a haredi community in Jerusalem or the Arab community in Nazareth.
That clerkship working with real patients, mostly in less-than- ideal situations, is a part of the program most of the students seemed to appreciate most.
"I loved it," says Diana Wolfe, who spent her clerkship in Peru. "Working with the people I met in Iquitos is the kind of thing that keeps me alive."
Wolfe, like several of her classmates, was a globetrotter even before she reached Israel. Born in Pennsylvania, Wolfe spent two years in Mali, West Africa, in the Peace Corps and had a master's degree in public health from Berkeley when she saw a notice about the BGU-CU MD program on the Internet.
"This program was made for me," she says. "I'm interested in rural health, working with people who live very different lives than I do. The opportunity to study in Israel, improve my Hebrew, and then work in a developing country even before graduation was exactly what I was looking for.
"The focus on intercultural relations, on sensitivity, on respecting other cultures, other ways of living - all of that was important to me."
Wolfe told of an experience she had as a third year student, treating a Bedouin woman.
"The woman was suffering from several different medical problems," she noted. "She had an aortic aneurysm, but she also had diabetes, heart disease and very high blood pressure. Neither of us spoke the other's language, but as she talked and explained, I realized I understood what she was saying - not through words, but through her body language, her tone and the way she was saying things.
"What's unique about this program is that they teach us how to practice this kind of cultural communication, to understand on a different level, and to express ourselves with kindness and caring. It's a completely different way to communicate."
Part of Wolfe's clerkship was spent on the Hope, a missionary boat that travels the Amazon River treating Peruvian villagers who live in the river's most remote spots.
"We'd treat 400 people in four days," she says, noting that patients would travel two or three days through the jungle to get to the boat.
"They came with diarrhea, dysentery, respiratory diseases," she says. "Their houses were built on stilts, over the river, and we said they had the kind of toilets that never got plugged - all sewage went directly into the river. But the river was also the source of drinking water - you can imagine the problems.
"We had our own problems in treating them. Most of the equipment we had was donated, which meant that if it broke, it was almost impossible to get parts. It was all old or non-standard. There were times when we had no needles, no drugs and no supplies. But this might be the only time for a year the patient would be able to visit the ship. We had to make do and use our clinical skills - which was sometimes all we had.
WOLFE recalls delivering a baby one night.
"The woman had been by earlier in the day," she says, "but it didn't seem as though she was due just yet. But toward evening, she came back in advanced labor. I didn't have anything - no antibiotics, not even latex gloves. But she had a fine, healthy baby boy, and she named him Scott after one of the male doctors.
"They couldn't quite pronounce the name," Wolfe adds, "so they call the baby "S-Cott."
Another time, she had to stand by while a patient died.
"He was an older man suffering from advanced tuberculosis," she says, "a kind of meningitis. We couldn't treat him until his family arrived, but it took them several days, and by the time his daughter got there, he had died. She began sobbing and at the same time, singing this incredibly beautiful song. The song was the way they mourned. It was so beautiful. Moments like that I will remember for the rest of my life."
