Residency Programs for Palestinians

Augusta Victoria Hospital (AVH) – one of the referral centers for the Palestinian population in Jerusalem. In fact, many of the hospitals have become somewhat specialized each primarily working with a specific specialty. For example, AVH specializes in oncology providing chemotherapy for adults and children and recently acquiring a new radiotherapy machine, in large part due to Dr. Faramand’s hard work in the region. Saint John’s Hospital specializes in ophthalmology, the Makassed Hospital is a general hospital and does a wide range of specialties. The interesting things about Makassed Hospital is that it has been running a residency program from 15+ years but the rest of the West Bank has only recently began residency programs throughout various major hospitals. They have exponentially been improving year to year and I look forward to contributing in some way in 5 years or so. As I mentioned, AVH specializes in oncology and provides services to adults and children ranging from leukemia, brainstem gliomas, beast cancer, and the list is continues. The typical format being morning report for the new patients, followed by rounding on the patients to determine the plan, then residents continuing on to various assignments such as outpatient clinic, inpatient services, chemotherapy units, and so forth.

After visiting various hospitals and working with a number of residents and interns, I wanted to discuss differences I noticed with the responsibilities of residents but also general managements – in particular, palliative care. More advanced residents work overnight calls, but not as many as resident would in America, as I understood it. But now that all changes as residency programs in America are restricted to 16 hour shifts. I noticed that while rounding it was more of a group effort to present the patients and review the lab results as opposed to the American system of knowing every single thing about a patient in the event that the attending asks some random question.

We also discussed palliative care and its non-existence in the Palestinian Territories. The issue arose while working at AVH since a significant portion of patients have advances stages of cancer. It seemed that patients were more or less not completely aware of their status especially if they were older patients. Families were more involved in patient care and even in decision of life or death. The American healthcare system is strongly patient centered with all decisions revolving around what the patient desires. This was not the case in certain circumstances here – but I’m not sure which I would declare as the correct approach, rather each has pros and cons.

After finishing up my own Internal Medicine Residency Program at the Cleveland Clinic, I hope to translate what I learned there, both medically and regarding residency programs, to the residency programs here.


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