Lorna Cowan

Medical Intern from 14/07/19 to 08/08/19

Having just completed my third year of medicine at the University of Glasgow, my internship with Save a Child’s Heart (SACH) would be both my first encounter with pediatrics and my first time in Israel. I had been advised by an older student that paediatrics was like learning medicine from scratch and I quickly began to see how true this was!

A recurring theme throughout the duration of my internship was language and the congregation of many cultures in one location. A key part of my experience was staying in the legacy children’s home with the children receiving treatment, as well as their mothers and the nurses from each of the different countries. With children from countries ranging from Rwanda to Iraqi Kurdistan; Tanzania to the Solomon Islands; Uzbekistan to Ethiopia, there were myriad languages being spoken in the home at any one time. One memorable evening was spent with the kids demonstrating their perfect newly acquired English and Hebrew vocabulary while laughing at my pitiable attempts to pronounce the Swahili, Kinyarwanda and Kurdi phrases they were teaching me.

One aspect of the work of SACH is to train physicians from developing countries in Israel in order that they may then return to treat children independently within their own communities. I was very fortunate to shadow some of these doctors during my stay: Dr. Alex Loth from Tanzania and Dr. Tolesa Waktola from Ethiopia, training in cardiac anaesthesia; Dr. Stella Mongella from Tanzania, training in paediatric cardiology; and Dr. Mudaniso Kumani Ziwa from Zambia and Dr. Yared Agidew Awano from Ethiopia, training in cardiac surgery.

Comprised of Dr. Alona Raucher, Dr. Sagi Assa, Dr. Akiva Tamir, Dr. Hanita Shai, Dr. Sivan Elkarat, and Dr. Stella Mongella, the paediatric cardiology team held ward rounds of the ICU and the paediatric surgical ward several times each week, on which I was able to accompany them. A weekly clinic was held for children from the Palestinian Authority, during which I observed echocardiograms be performed and was given the opportunity to examine patients. I was also privileged to Dr. Basher Abu Jarad, a cardiologist from Gaza who works in association with the organisations Shevet Achim and SACH to bring children from the Palestinian authority to Israel for treatment. The doctors would generously provide tutorials in English on a multitude of topics: from the events of cardiac surgery to the clinical presentation of tetralogy of Fallot; from Marfan syndrome to rheumatic heart disease; and from the Fontan circulation to the Hebrew alphabet!

As a medical student, the importance of mentorship and positive role models cannot be underestimated. The weekly multidisciplinary team meeting involving the paediatric cardiologists, cardiac surgeons and intensive care specialists was an excellent opportunity for learning and highlighted the importance of collaboration in order to provide the best outcomes for patients.

One of my favourite weekly activities was observing interventional cardiology procedures be performed in the catheterisation lab led by Dr. Sagi Assa. Here, I was able observed the repair of conditions such as atrial septal defect and coarctation of the aorta that would formerly have required open heart surgery. The benefits of this are numerous: an expedited recovery time, greater cost-effectiveness and a lower risk of infection. My time was made particularly enjoyable due to Tal Sela – a cath lab technician – who explained and encouraged critical thinking about the procedures, not to mention the delicious figs he smuggled in for me from his garden or the plentiful coffee breaks he urged me I needed to take.