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Background: Papua New Guinea (PNG) is a young nation. It has been independent since 1975. It consists of more than 290 inhabited islands, and its people speak more than 800 different languages. The GDP per capita is $2100, and only 4.3% is spent on health care. Government services are scarce in remote islands. It is a tropical country, with many tropical diseases. YWAM Medical Ships - Australia is a Christian charity that is actively developing communities by addressing health care and training needs in PNG in partnership with the relevant national and provincial government administrations. The program is guided by the PNG's National Health Plan: 2011- 2020., Methods: As part of this effort YWAM runs the YWAM PNG, a large hospital ship that serves the remote parts of the country. The services provided include mentoring and support of local health care teams, eye surgery, dentistry, and three mobile teams that include primary health care, mother and child care, childhood immunizations, physiotherapy, optometry and health education The Israeli Ministry for Foreign Affairs signed a joint declaration of intent (DOI) with YWAM last year. The DOI outlines the Ministry for Foreign Affairs commitment to encourage Israeli medical professionals to volunteer onboard the MV YWAM PNG, in rural and remote areas of PNG., Results: This paper summarizes the experience of four infectious diseases specialists on board. The main infections observed were malaria, tuberculosis, tropical ulcers and filariasis., Conclusions: The exposure to primary care in a remote part of the world is an emotional, personal and professional experience which can benefit the population the ship serves, as well as the volunteers, for whom the outreach on the ship is a memorable experience.

Unlabelled: In the majority of cases upper respiratory tract infections (URI's) are caused by viruses. Nonetheless, in many instances, patients with URI's are over-treated with antibiotics. In order to evaluate the use of antibiotic therapy in patients with URI's, we recorded medications prescribed for URI's in 394 young adults seeking care in a primary care clinic. The following parameters were assessed: rhinnorhea, cough, sore throat, dysphagia, tonsillar exudates, tonsillar enlargement and cervical lymphadenopathy. Throat cultures were taken from all the patients., Results: Antibiotic therapy was prescribed for 99 of the 370 patients (26.8%) with URI's and negative throat cultures. Among these patients, a high prevalence of the following findings was evident: tonsillar enlargement (66.7%), tonsillar exudates (48.5%), cervical lymphadenopathy (42.4%), lack of rhinorrhea (40.4%), lack of cough (32.0%) and fever (31.3%)., Conclusions: Excess antibiotic therapy was prescribed for patients with URI's. Possible explanations are: clinical findings that suggest a diagnosis of follicular tonsillitis, early antibiotic treatment that is not based on throat cultures or antigen detection tests, and multiple treating physicians., Recommendations: We recommend that in cases of patients with URI's, antibiotics should not be prescribed unless diagnosis of a streptococcal infection is supported by results of throat cultures or antigen detection tests. Furthermore, in primary care clinics with a number of physicians, treatment should guarantee appropriate medical follow-up.

Bordetella bronchiseptica rarely causes disease in man, and is an unusual pathogen in animals. It causes a pertussis-like syndrome, but pneumonia and sepsis have been described in the immunocompromised as well as in the immunocompetent. A 53-year-old man with adult-onset diabetes and healed pulmonary tuberculosis presented with lobar pneumonia and rapidly developed septic shock with adult respiratory distress syndrome. He responded well to the combination of piperacillin-tazobactam.

8 cases of acute mental disorders among Israelis travelling in the Far East are presented. The most common symptoms were hallucinations, paranoid delusions, agitation and depression. The important precipitating factors were drug abuse, reaction to the foreign environment and malarial prophylaxis. Treatment included creating a nonhostile environment, the presence of a Hebrew-speaking physician, psychopharmacotherapy and prompt evacuation to Israel. Most patients improved markedly and returned to normal functioning.

In 1991 the deans of the 4 medical schools in Israel decided to institute a national qualifying examination in internal medicine. This marked the beginning of the process of unifying the qualifying examinations in all major medical fields. We describe the development of the examination, experience with its administration to 720 students in 1992-1994, and the outcome of this initial effort. The examinations were prepared by a committee of senior faculty from the 4 schools, representing all the relevant clinical areas. Professional consultation was provided by the Unit for Medical Education of Tel Aviv University. Each examination consisted of 180 multiple choice items, reflecting an agreed representation of the various medical specialties, and was designed to test both comprehension and problem-solving ability. A syllabus was published by the committee and distributed to students and faculty in preparation for the examination. In composing the examination, the committee took into consideration differences in general policy and varying emphases in the curricula of the 4 schools. Analysis of the results of the 3 annual examinations showed both a high level of reliability and high quality of the majority of the individual test items. There was a trend with time to slightly lower average scores, and fewer passed the exam last year. There was improvement in the results after the first 2 years in the area of problem-solving related to interpretation of imaging, blood smears and clinical photographs, but this trend did not continue into 1994. The introduction of a high level examination based on a common syllabus provided important feedback, improving both student motivation and clinical teaching. For all schools, the outcome of the examination served as an important external indicator of teaching standards. Following this positive experience, uniform examinations in surgical subjects and pediatrics were introduced for the first time in 1993. The committee recommends that Israeli medical schools gradually introduce a comprehensive qualifying examination based on a mutually agreed list of objectives and syllabus.