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doctors without borders

Queen’s University student Emily Austin.Deborah Baic/The Globe and Mail

In real life, their paths would never cross. These international medical students live side by side, but come from a region so divided by conflict, they inhabit completely separate worlds.

But for a brief time this summer, their lives have collided. They share meals and classroom time in a unique pediatric medicine program run by Mount Sinai Hospital's Silverman Centre for International Health. It's designed to bring together Canadian medical students with those from Israel, Jordan and Palestine, and break down barriers in an area of "contested history, disputed entitlements and power differentials."

"As an Israeli living in Tel Aviv, I've never had the chance to talk at length with a Palestinian doctor. This is an unusual opportunity to hear the other side and see how much we have in common," says Michal Shaubi over coffee and toast at a sunny breakfast table in the downtown Toronto student residence where she and her colleagues live.

Vibrant, with red-framed glasses that match her polished toes, Ms. Shaubi, 26, is maintaining a strict kosher regimen, and carries around a pink plastic bowl and cup in her knapsack to keep milk and meat products separate. A student at Tel Aviv's Ben Gurion University, she is thrilled to meet Ghada Atallah, a Palestinian in her final year of medical school at Al Quds University in the West Bank.

The exchange, the only one of its kind in the world, is run in partnership with Toronto's Hospital for Sick Children and the Canada International Scientific Exchange Program (CISEPO).

It's the brainchild of Arnold Noyek, a renowned Toronto ear, nose and throat specialist who has forged a second career as a medical diplomat.

"We are a network of peaceful, co-operative professionals," says the energetic 72-year-old. "We stay out of politics, but we have managed to sustain the program for the past 15 years. It's a model of international medical co-operation."

The eight students aren't just learning how to suture wounds and set broken bones. The program is also a lesson in cultural diversity: They have sampled maqlobeh , a Jordanian specialty, attended Shabbat dinner in the home of a local Jewish physician, visited Niagara Falls and seen their first Blue Jays game.

And they have delved into controversial issues, including the causes of the Israeli-Palestinian conflict and the influence of culture on ethics and medicine.

"We haven't ignored the elephant in the room," says David Fahmy, 25, a second-year medical student at the University of Western Ontario. "We've talked about the Palestinian-Israeli conflict and I don't think either side has managed to convince the other. But it's incredible that people who are so heavily invested in the conflict can get along."

Their free-ranging chat over breakfast covers everything from the limited access of Israel's Bedouin community to abortion to the differing attitudes toward advanced cardiac life support.

In Canada, a patient's family is encouraged to be in the room during resuscitation, and a social worker is there to support the family. Doctors respect "do not resuscitate" orders (DNRs).

In hospitals in Jordan and Palestine, neither families nor social workers are allowed in the operating room to observe resuscitation, says Mohamad Yousef, a sixth-year medical student from Jordan. There are also no DNRs. "If it was within the law, I would always work to save a patient, even if they didn't want me to," he says.

At Al Quds hospital, the burden of breaking the news of a child's death falls squarely on the doctor, Ms. Atallah adds. "There is no support team, and doctors cannot spend a lot of time with the family because they are so busy," she notes.

One of the program's goals is to forge links between the students that will morph into professional partnerships once they return home. Ms. Shaubi hopes to stay in touch with Ms. Atallah, and plans to consult with her about patients on the phone, and accept patient referrals. "We see many Palestinian cancer patients, some in really bad condition, because they have a shortage of facilities," Ms. Shaubi says.

Founded over two decades ago by Dr. Noyek, CISEPO initially focused on bringing physicians together from this region to tackle a pressing health issue: hereditary deafness. Caused by the common societal practice of marrying within the cousin pool, the genetic disorder is 35 to 50 per cent more prevalent in Jordan than elsewhere, and 53 per cent more common among Arab-Israelis. Intermarriage among ultra-Orthodox Jews has also resulted in high rates of deafness.

With funding from Ottawa, CISEPO helped implement a universal newborn hearing screening program in Jordan in 2007, modelled after the one in Ontario. Doctors screened hundreds of thousands of newborns for hearing loss, working right through two intifadas. They now hope to replicate this program in the West Bank.

Israeli and Palestinian scientists also undertook genetic research to identify the cause of deafness, and introduced cochlear implant surgery to the Middle East. CISEPO has helped equip deaf kids for life, through hearing aids and auditory verbal training, and through outreach work about the benefits of marrying outside the tribe.

Achievements such as these help to attract some of the brainiest medical students as candidates for the elite exchange program, now in its sixth year, says director Abi Sriharan, a doctoral student in public health. One of this year's candidates is Hadas Malada, the program's first Ethiopian-Israeli. She wants to work with her community when she graduates, and has already helped create an Amharic-Hebrew medical dictionary.She and her colleagues loved having the chance to shadow emergency doctors at Sick Kids. They saw everything from the resuscitation of a two-year-old victim of a car accident, to the Children's Aid Society seizing a young child from her drug-addicted mother.

Qasim Odeh, an Arab-Israeli studying in Jordan, says the exchange has given him a voice, and the chance to express the Palestinian point of view on issues such as refugees and the West Bank.

Using health to build peace is a lofty goal, but seems more achievable as the students get to know one another and realize that their medical issues are common across borders.

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