Sara Alsaraf spent her elective in Beirut. She tells us about this beautiful city and the contrasting medical experiences she had there

Beirut, the capital of Lebanon, is an ideal summer elective location because of the wonderful nature. This tiny country has Mediterranean coast along the whole of its western side and the stunning Lebanese mountains look down at you from the east. The unique and varied geography runs parallel to a turbulent political history. Some of you may associate Lebanon with the civil war that ended in 1992.

Reminders of the war can be seen all over Beirut--bullet pricked and demolished buildings--but, slowly, the city is returning to its former glory as the "Paris of the Middle East." Downtown Beirut has been totally rebuilt and now rivals the Ramblas of Barcelona or the Piazzas in Rome in its architectural beauty. Large crowds are drawn night after night to visit the markets, clubs, and smoky cafes where people relax and puff on their apple flavoured tobacco through bubbling water pipes while sipping mint tea.

I arrived on a hot July night, preparing to face a month of obstetrics and gynaecology at the American University of Beirut Hospital. I organised the exchange through the Medical Students' International Network (MedSIN)--the UK branch of the International Federation of Medical School Associations--and the Lebanese Medical Students' International Committee (LeMSIC), which offers exchange programmes lasting four weeks throughout the summer months. I had to book several months in advance, as Beirut is a popular exchange and elective destination with limited places.

Up all night

When I arrived, Kareem, my contact, met me at the airport and drove me to my accommodation. I discovered the next morning that although I was living on top of Super Nightclub, which can only be described as a glorified brothel, I was in the bustling heart of Beirut--the old town centre, littered with shops, cafes, restaurants, and hotels.

In the first week I met many other exchange students, who were friendly and easy to talk to. This was partly because we were all medical students in the same situation; it was also because the exotic and passionate heat of Beirut and the fusion of Eastern and Western culture kept us awake in coffee shops smoking the pipes, in clubs dancing to a mix of Arabic, French, and English music, and most often in the restaurants eating and relishing delicious Lebanese food. All this fun, you may think, left little time for the hospital.

In my first two weeks, this assumption would be correct and although I had familiarised myself with the hospital, it hadn't exactly been my most regular destination. Realising that I didn't have much time left,
I extended my stay for two weeks and was in the hospital from 8 30 am until around 4 30 pm every day.

Medical education

The American University of Beirut Hospital is a large and, thankfully, air conditioned hospital with a private and a public side. The students are graduates of the American University of Beirut and the teaching is officially in English, although Arabic is often used.

As a third year medical student, it was great to see how medicine is taught in another country as it makes you aware of what is missing and what is good in your own education. At the hospital they use the US medical education system and so the students already have a degree as well as two premedical years behind them before being finally allowed on to the wards.

Students are required to clerk a patient thoroughly, write the notes, discuss their diagnoses with the interne (house officer) or resident (registrar), and go on to filling in the investigation and prescription forms, which the doctor then signs. The system is similar to the United Kingdom, but the student centred approach of the whole hospital is striking. After every clinic, the consultant in charge would come for an hour to ask about the patients and discuss any queries a student had. I learnt a lot not only about obstetrics and gynaecology, but what it is like to be taught consistently by doctors whose priorities are to develop their students' thinking and maturity. It was certainly a welcome break from the tension felt between consultant and student in the English system.

This kind of education comes at a price, however, and the students regularly complained to me about the enormous fees they pay. The students at the hospital are privileged--they know it and most of them work hard. Lebanon is, however, home to poor people as well as rich, and this was not my only medical experience. There are many Palestinian refugee camps scattered in and around Beirut and LeMSIC also organise a programme in one of these.

Contrasts

Only five miles away from the hospital, I visited the overpopulated and devastatingly poor Bourj Al-Barajnee refugee camp. There are some 10 000 Palestinians crammed into this rat infested camp. The hospital, only in existence due to charitable groups, is a salient building, modern and clean in the midst of crumbling and dirty buildings. Inside, however, I was struck by the reality. The doctors here are working on a tight budget; every set of gloves is accounted for, cannulas are only used when totally necessary. The sparse equipment and meagre supplies of this depressing camp were in sharp contrast to the well supplied hospital. The wonderful friendly personalities of these devastatingly poor people and the doctors' positive attitudes in spite of their inability to practise medicine effectively is something I will always admire. It made me realise that even though the NHS in the United Kingdom is not up to scratch, it would be considered more than luxury for both the doctors and patients I encountered in Bourj Al-Barajnee.

As well as visits to these camps, LeMSIC organised a diverse social programme for us. Every weekend they would take us to visit the many and splendid wonders of Lebanon from the north to the south, all of them intertwined with history and politics. I spent many days idly lying on the clean beaches, and others hiking on the mountains.

Beirut holds so much for a medical student to explore and the well organised exchange programme, the friendly Lebanese students, and my wonderful roommates provided a home to me for six weeks, which I can only hope to return to in the future.

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