CODA

After 21 hours of travel we're finally home. The funny thing about modern international travel is how the generic, sterile nature of airports and airplanes - they can all try to be different, but airports are ultimately built from the same Platonic ideal, with collections of shops, rows of chairs designed to prevent one from lying down, airplanes are also the same, the same forward-facing rows, and they vary in terms of uniforms, degrees of luxury, but they all conform to the same model - international air travel scrubs all the local from the experience. Hour after hour spent sitting in a metal tube whizzing through the air serves as a kind of brainwashing, stripping from you all of the immediacy of place that being in a place has, the smells, the sights, the customs are all the same, until where you were is dimly remembered, the only evidence the photos on your camera, and where you are going painfully far away.

That's partly the reason it feels a bit like you were never gone when you arrive back home; the crucible of international flight has melted it out of you, not with heat but with sameness.

Perhaps as testament to my compulsiveness I notice that our home smells unusually clean - getting re-accustomed to the scents and odors doesn't take long but it's jarring enough for me to realize that I must normally be really, really OCD about the way the house smells, and I only have that insight now because it's momentarily new again, as though I've walked into a stranger's house only to understand that it's actually my own.

Okay - maybe all international travel and jet lag does is make you think way, way too much. I should probably be applying all of this thought to the next Scope of Work Proposal: how to justify bringing a bunch of guys with Arabic names into the States to see how we take care of emergencies. I always love a challenge...

ENCORE!

I woke up in the middle of last night with horrible abdominal cramps and the knowledge that something wicked this way comes...

I lurched out of bed and staggered towards the bathroom, stomach roiling, sat, and waited for the inevitable. What had it been - the yoghurt, the shawerma, the seafood pizza I'd had last week, the water? I waited for a wave of sickening nausea to pass, and eventually it did, and the hot, liquid stool stopped for the moment as well. But here was something I knew very, very well - being in international medicine has, unfortunately, meant that I am all too familiar in both a professional and all too personal sense, with diarrhea, in fact, it's in some sense part of my specialty - perhaps I should put that on my business cards: "MD, FACEP, Expert in All Manner of Diarrheas".

At least I knew what I needed to do, I've been prepared for a while, I walk over to the counter and take 4-milligrams-of-Imodium-starting-dose-and-500-milligrams-of-ciprofloxacin-twice-a-day-for-five-days, only since I have 1000 mg tablets I take a bigger dose of antibiotic than I probably need. I settle back in bed and wait for another wave of cramping pain to pass - I guess this means I'm probably going to miss the tour of Jerusalem in the morning...

The alarm goes off, and I open my eyes expectantly - I feel... good, I feel... normal. I wonder at the fact that diarrhea kills more children in the developing world than anything else - what a pitiable way to die. But as for me this morning, it looks like my auto-prescription has worked.

Which is a blessing, because today, we're supposed to have a guided tour of the Old City of Jerusalem. The guide, Osama, meets us in the lobby.

"Osama", by the way, is simply Arabic for "strength", and I imagine that since 2001 he's probably changed the English spelling of his name to Usama. We take a cab to the Mount of Olives, which is where we begin our tour.

"This is the chapel of the Ascension. Actually, it's a mosque now." During the course of the day he tells us the history of the place, the ancients, the Romans, the Persians, the Crusaders, Salah ah-Din.

Osama is actually a Palestinian Christian. He's currently working on a PhD, a multidisciplinary one that involves theology, history, and strategic planning, a management field - he's working on programs to keep the indigenous Christians here in the Holy Land. Many of the young Christians have been moving away, to America, to Europe, trying to escape poverty, the conflict between the Jews and the Muslims - the monotheists live here cheek-to-jowl, if not exactly in peace, at least in temporary quiet, God's chosen children, God's other chosen children, and God's other-other chosen children.

What's the point of staying? Osama took his seven-year old son to show him the place he'd been born in the Old City and lived until he was fifteen, just as his father had shown him, and his father's father had shown him, and so on and so on. That was the way we'd known so many of the places Jesus had been, the early Christians had shown their children where he'd been, who'd shown their children, and so on and so on.

"Emperor Hadrian built this arch... the city has been totally destroyed seven times..." I wonder during the day if Alexander the Great, or Salah ah-Din, or Genghis Khan, had ever been laid out with diarrhea during the course of their conquests, and try to imagine them dizzy and squatting over a camp latrine, thinking to themselves that they probably should have waited for the goat to finish cooking, but it'd been a long day and they were so hungry...

Osama is a thin man, short, about my height, but he somehow manages to well out-pace us - he doesn't break a sweat during the course of the day while perspiration pours off my forehead, and my neck, and my chest, my underarms, my legs - you get the point. He says that he once had a group that measured the number of steps they'd taken on a pedometer, and it worked out to about 7.5 miles total.

I can't imagine Genghis walking 7.5 miles, much less one, with diarrhea. Perhaps I can reformulate the taunt: physician - healed myself. Thank goodness for modern medicine!

FINAL ASSORTED OBSERVATIONS FROM ABROAD

We leave tomorrow; today is my last day at work here in the West Bank, and for my last trick:

We had dinner last night at a restaurant called Shalizar in Jerusalem, which advertised itself as a dining establishment that served Oriental cuisine. Recall, please, that the "Orient" in classic use referred to the Near/Middle East, Persia, Afghanistan, etc., which is not to be confused with the Far East, i.e. eastern Han China, Korea, Japan, etc. The food, which was excellent, turned out to be what is to me now very familiar and much loved Central Asian party food - lamb or chicken served on rice with oil and garnished with almond slivers with bread, sour yoghurt, relishes, and assorted other items. This meal has become comfort food, and the flavors bring to mind being a guest in all manner of rugged places I've been wherein men with guns serve the meal with all gentility while you sit on cushions. Flashbacks, I tell you. By the way, even in the Muslim quarter of Jerusalem kids still call out "hey, China!" and "nihao!" From now on, instead of telling them I'm an American, maybe I'll tell them I'm Genghis Khan...

If I were king of English I'd do away with corporate-speak, all of the syntactic shortcuts that function as a kind of shorthand, sure, telegraphing certain meanings in a compact way, but they can allow people to get away without actually thinking about what they're saying. Words and phrases like "synergies", "stakeholders", "paradigm shift" - I don't think they mean what they think they mean. I would love to encourage a paradigm shift for these stakeholders away from these synergies.

I've been commuting from Jerusalem to Ramallah for the last few days in the office. It's only about 15km (or about 8 miles) but it takes about 40 minutes or so - there are two checkpoints between here and there, staffed by armed Israeli teenagers, bored, hot, maybe a little scared or more bored, armed with American made weapons, M16s, M4s, looking in the car, checking out the occupants (our cab driver going to Bethlehem was all over the place, could never find a good volume for music, I felt a little embarrassed for him while he tried to flirt unsuccessfully with one of the office women, but he was canny: every time we'd roll up to a checkpoint he'd start blasting the music to an obnoxious level and looking like he was having fun; I realized that someone driving a vehicle bomb would probably be the opposite, really quiet, sweating bullets, serious as cancer, and since he was purposefully acting silly the soldiers paid him no mind at all). This morning, on the way to the office, we rolled by a checkpoint, and at first I just kept looking out my window, until I realized that there were two Palestinian Red Crescent Society ambulances parked with their lights flashing, and then I saw an enormous crowd of men and covered women thronging around two Palestinian policemen who were standing on the hood of their truck, arms outstretched and trying to direct the mob. "What in the world is going on?" "They're trying to get to Jerusalem for Friday prayers, but there are many road closures." It is a mad press of humanity, men, women and children shoving up against barriers erected by the Israelis. Crowds, or maybe more accurately, mobs, scare the hell out of me; the last angry mob I faced was in Afghanistan, and like a rabid dog, it is an entity that is not to be messed with, you either run or you put it down, but we cruise by and they fade into the rearview mirror, and they are still there when we return to Jerusalem in the afternoon...

"Today is your last day?" "Yes, today is my last day." "And you're leaving tomorrow night?" "Yes, I'm leaving tomorrow night, but I hope I'll be back, Inshallah." "Yes, Inshallah." I wonder if Genghis Khan was ever invited back? By the appropriate stakeholders?

FURTHER ASSORTED OBSERVATIONS FROM ABROAD, A POTPOURRI, IF YOU WILL

In other countries people are always driving like it's stolen - jackrabbit starts with rocket-sled acceleration to speed, hard stops with tires a-smokin', rally-car style drifts into curves, all very exciting. I catch myself looking back to see who's chasing us.

Many people speak English not just well, but very well. So many, in fact, that it's almost more surprising when someone doesn't. Which doesn't mean that we as Americans shouldn't at least try to learn other languages; as the saying goes, you speak three languages, you're trilingual, you speak two languages, you're bilingual, you speak one language, you're an American.

Everybody smokes. As a result, you smoke too.

Dignity isn't related to what you have, where you are, or even necessarily where you come from, but from accurately knowing who you are relative to the rest of the world and accepting it.

There is no word for "dignity" in any language when you're car sick.

We arrived in Jerusalem today! Just a few more days before we get home, but checking out from the hotel that's been my home for the past 17 days, I remember something from earlier...

I met with the physician responsible for EMS at the Palestinian Red Crescent Society today. The PRCS is the Middle Eastern arm of the International Committee of the Red Cross. A major sticking point in working with them is that they won't sign M.O. 21, and for good reason: "if I see someone hurt I'm going to help them, whether they've signed the Anti Terrorism Certification or not! That's not providing 'material aid' to a terrorist, as though we're giving them weapons or teaching them to fly in to buildings."

He's got himself a point. It's taking someone from the PRCS to remind me what Jesus taught about our "enemies"...

Walking through downtown Ramallah, you hear some of the following:
"'Ey! 'Ey! Jackie Shchan! Where is Jackie Shchan!"

What - these punk kids have already forgotten about Bruce Lee?!

You would hardly recognize me: I'm sitting in this lovely, air-conditioned office, wearing - get this - khakis, a dress-shirt, a tie and a blazer! Compared to the way I look at my day (and night, and weekend, and holiday) job, I seem almost civilized - no blood, no sputum, no vomit on the shoes, I do not reek of sweat and fear, I have not had to threaten anyone with bodily harm. Of course, this is day 17 of my sojourn into office life so some of the shine has worn off. Actually, kind of a lot:

I've done a ton of sitting at various desks typing on the teeny tiny keyboard of the mini-laptop I've brought, putting out reams and reams of stuff entitled Master Plans, Draft Action Plans, pages of deliverables which need to be in a deliverable format in order to be delivered. The past couple of days have been spent with the hammer down, nose to the grindstone, shoulder to the wheel, butt in the office chair, putting out these documents in which I recommend things like universal BLS training, repainting and hanging new curtains, collecting disaster caches, establishing emergency medicine as a recognized specialty. I am also experiencing something called "filling out one's time sheet." Some of the people here call it nation-building, which seems to involve a lot of sitting on one's behind, who knew?

I just hope that all of this work gets a wing of the hospital named after me. Or like something academic, at least a named chair. Maybe the one I'm sitting on.

GOING NOWHERE

By the time I snap the lid of my little laptop shut, dusk is falling; my neck is stiff and sore, my back aches, my knees are stiff, my eyes are watering and my wrists do more than twinge.

I have spent the day in my hotel room at my little desk, tapping out what I hope will be more than a memo, it will be a mission statement, a manifesto, a document to chart the course for the future of emergency medicine in Palestine. But it's going to be dark soon and I've done nothing but sit on my duff all day - I am restless.

I get up and decide to go for a walk, it doesn't matter where. I walk by Pronto, the little Italian restaurant that happens to be one of the few places open during Ramadan, recognize nobody, and walk up a side street. I'm finally becoming familiar with some of the shops and landmarks, and then I realize that there are a lot of people here I don't know, looking up quickly when I pass by, then returning to whatever business they were about, closing stores, carrying things in plastic bags, draping sleeping children over their shoulders.

There are groups of young men walking in clusters down the street, and since I am walking alone in a strange place I remember that I should be careful, I think. I remember what was probably the dumbest thing I'd done, walking by myself through the oppressively hot, dusty streets of Konduz in northern Afghanistan in the gathering twilight obscured by more dust, dim figures of men in the distance, in June of 2002, shortly after the Taliban had fled, and I understand that this dark, this heat, this fear, this must be what hell is like. In the process of getting lost I began to understand how stupid I was, how alone, how away.

It's nowhere near as bad here, though; the locals are mostly disinterested, accustomed as they are in this fairly cosmopolitan city to seeing foreigners. I do get the occasional "welcome to my store!", interspersed with some "nihao!"s or "konichiwa!", to which I give a half-smile and reply, "nope - Amreeka." That seems to throw them in some confusion, so I keep walking.

That confusion is probably a good thing; I am a single foreign man alone in a city, I'm wearing cargo pants and flip-flops, which probably were not the brightest thing to wear, self-defense wise, but what do these people have to know? I try to project cool strength, I'm bad, I'm Bruce Lee for all you know, while I try to remember what the movies tell you to do in these situations, I can never remember - do I sweep the leg? Do I not? Which was it?

I walk past street vendors with funny hats and bottles of juices, big metal pots with frying oil and felafels ringing their rims, there is some dust in the air, mingling with the scent of Arabic coffee, unknown fluids on the ground to which scraps of newsprint stick. It is a wonder, I tell myself, that I was born like this, born in a place like this, with smells that I now find too strong, streets that seem too dirty, how did I come from this to what I am now, Amreeka.

I finally realize that I am getting lost, I turn around and walk until I find some landmarks I recognize, a bad-ass Brea ninja who just wanted to walk down this street and then turn right around and walk back, no big deal. I've stretched my legs enough, I suppose, so I walk down the hill towards the hotel, to go tap tap tap on my laptop some more.

MY FIRST TIME BEHIND THE VELVET ROPE

"I am looking for the priest, Bandak." "I am he." "Oh, I am your cousin!"

We are standing in the Church of the Nativity in Bethlehem; we can hear an Armenian quintet of priests holding their service in the back. Amal, a PhD nurse who is originally from Bethlehem, has just found her cousin, whom she has not seen in 25 years; they do not recognize each other at first.

"Come, come!" Somehow Amal has been able to shepherd us past the thronging lines of pilgrims who have queued for hours, from Spain, from Senegal, from Brazil, from Canada, to see the place where Christ was born. She holds back what looks suspiciously like a velvet rope and ushers us in to what is supposed to be the most inclusive club in the world - Christendom. Amal's cousin, a large, grave looking man in maroon robes, is flipping car keys around his forefinger like prayer beads - welcome to the modern world - whom we pass to enter the 4th century AD.

The Armenian monks swing their censers - the birthplace of Jesus makes me feel light-headed. A guard lets us pass in trios the wrong way in to the grotto where Christ's birthplace and the manger is supposed to be housed. A large, African woman is kneeling in front of the star on the floor that marks Jesus' birth - she has to be helped to her feet, and assisted up the stairs where she sits heavily upon what looks like a school chair, overwhelmed. There are the voices of the pilgrims, French, Russian, American English. The men, believers or not, speak in hushed and gentle tones.

We ascend back in to the chapel, where Amal's closer cousin, Linda, serves as our local tour guide. "You know, I am sorry - having lived here all of our lives, we don't know much about the history of this place! We have one cousin who has become an official tour guide, but he is too busy today!" She says this, leading us past a line of Nigerians who are waiting to enter the basement with the manger. "Come quickly!' She ushers us up a set of curving stairs to a quiet square on the south side of the church. She holds a set of keys and unlocks a gate - "come down here!" It's another grotto, but one that's not in the Lonely Planet guide. "This is where the bones of the children who were killed by Herod are kept when he tried to kill all the boys." It is cool and dank in this catacomb. We can see the bones through the gates that keep us from touching them. Like the morgue-man, I feel nothing. After a few minutes, Linda leads us back up the stairs and locks the gate behind us, returning the key to their cousin. We walk back through the church, exiting through the entrance door, violating every possible rule, but somehow we are excused.

They take us to the Milk Grotto, then through some more streets. "See? This is where Amal's grandparents lived!" We take pictures, and then try to pass through a gate that seems locked. Linda calls up in Arabic, and the window opens to reveal another family member, who drops money down to Linda; another older woman comes around the corner and embraces Amal. "We haven't seen each other in 25 years!"

Amal has been away, working; she received a PhD in America, and then worked in Jordan. She's back in Palestine now with the hope of reshaping the future of its healthcare. "Aren't you going to stay for tea?" Amal doesn't cry - we move on because there's no time. We come upon her parents' old home - "there are unpaid electricity and water bills stuck in the door!" We laugh and take pictures. Linda's son is graduating from a Jordanian medical school this year. "I hope he stays here, because so many of the young people are leaving to try and make a better life - but what do we have besides our land?" I try to tell her that that's what we're trying to do in Ramallah, make a place where a young, talented physician can excel in this country, but she doesn't hear me - she's trying to figure out where Amal has gone so we can get to the souvenir shop she knows.

It is dizzying, being here where Christ was born with someone else who was born here as well.


What's up, cousin?

Is it really the end of my second week here? But there's so much bureaucracy to cut through, so many politicians whose image we have to burnish, so much not fasting to do!

Which reminds me - I wonder where my pizza is?

The buzzer sounds. I get the door; it's the skinny kid with funny hair and a high voice. That's how I know I'm getting older - his hair looks funny to me. "Why were you not at the buffet tonight, sir?" he asks - we were in the dining room earlier when he told me about the Iftar banquet available. I grin and reply, "I'm tired."

He's a nice kid. Earlier in the week, I forget why, but we were all talking about how much we liked Palestine, and somehow he ended up laughing awkwardly and agreeing, "yes, we are all one family!" I wonder if people here make fun of him for being different.

"Hang on a sec." I run over to where my change is; I was going to give him the rest of my 1 shekel pieces, but imagining him suffering abuses at the hands of people who hate the other, imagining him afraid and in pain - well, I'm an American, and I do the only thing I seem to know how to do sometimes, I give him a slightly larger tip than I'd planned. "Shukran", I say, thank you in Arabic, one of the few things I've learned to say. "Thank you, sir," he says in that thin, high voice, with a smile, and then turns around and slouches down the hallway. I shut the door. There's a pizza that needs eating.

We are seated upstairs at Rukab so we can avoid tempting the people fasting for Ramadan.

"What flavor did you get?" "Mango. What about you?" "Arabic gum." "What's that taste like?" "I don't know, but it seems kinda chewy - here, I didn't lick this part, try it." "It doesn't really have a strong flavor at all, does it?" "No, it's subtle." We're almost to the cone part.

"I didn't think it'd be so... normal. Did you?" "It's funny, I consider myself fairly well-traveled and informed for an American, abreast of the latest news, but this is still more... normal than I thought it'd be. Less austere." "Yes." We finish our ice cream cones in silence.


Although there are still some things that aren't quite right...

CLEAN BOXERS=PEACE

During the course of my life I've traveled a little; more than some, less than others, and although I still inevitably end up forgetting something (on one memorable field-work trip I forgot to bring a stethoscope - oddly, nobody wanted to be seen by the doctor who'd listen to your chest through a rolled-up magazine), enough to have some experience.

Take, for example, travel gear. A number of my trips have been spent lecturing, which reflects a change in the nature of international medical work. They say that in the past, in order to do medicine abroad, you'd train in a generalist specialty, take an x-ray machine, and disappear into the jungle for a couple of decades, whereas now, what you really need is a laptop and LCD projector so you can teach. So five or six years ago I bought the smallest, teeniest, tiniest laptop money could buy at the time, a Toshiba Libretto, a fully-functioning notebook computer the size of two DVD cases stacked on top of each other, with a keypad so small I could probably blame my arthritis on it, file a class-action lawsuit and live off disability.

I've also learned what not to bring, for example, what's often sold as "travel clothing"; this stuff is usually made out of techy sounding materials and festooned with all manner of zippers, velcroed vents, cords, ties, and snap-buttons. You can usually tell who spent too much time at REI when you arrive in a country and see all the locals dressed in jeans and t-shirts with one guy in their midst sporting an ill-fitting khaki-colored, vented shirt with cargo pants and hiking boots - Dr. Livingstone, I presume?

At the same time, there's stuff you should definitely be taking, no matter what the so-called experts tell you. For example, some people who advocate packing light suggest that you take only two pairs of what are advertised as high-tech quick-drying underwear, one to wear while the other one dries in your hotel room, but it takes only one trip wearing constantly damp drawers while the group edges away into a wider and wider circle around you to learn that it's probably okay to take up a little room in your bag with your preferred cotton boxers.

So I've spent my career in this peripatetic fashion, waiting for my shorts to dry and looking for some place to apply my talents to work that would result in whirled peas, wandering hither, thither and yon looking for a sense of purpose (thought I was going to say porpoise, dintcha? But that wouldn't tie into anything later, you see), but now perhaps I've found it. I'm not reaching any conclusions yet, but: after nodding over a stack of assessments and reports and development plans this morning I decided to take a furtive coffee break in the office kitchen, away from all of the decaffeinated Ramadaners. You can actually look over a broad expanse of Ramallah from the break-room, which was when I realized that I was staring out over Judea and Samaria, and in terms of world peace or the lack thereof this place was ground zero.

In medicine we like to joke that we're saving lives and stamping out disease, and in terms of world peace it's about as likely, I think the closest I'm going to get is blended chick-peas. But to turn down delicious hummus because it isn't the solution to peace in the Middle East doesn't make sense, so even though I'm probably not going to be finding the cure for plantar warts out here doesn't mean that I'm wasting my time. The emergency system here in Palestine - well, okay, there is no system, so there's a start. Emergency medicine is largely unknown here, even though it's a pretty well-established specialty in neighboring Jordan, not to mention Israel, although if there's any place that needs doctors who specialize in dealing with emergencies, it'd probably be this place. So before the coffee took effect, behind my half-closed eyelids I was able to imagine a future for Palestine, a future where health care is maybe even a little better, where the thought of being seen in one its of the emergency departments doesn't scare even the doctors who work and live here; I could imagine a Palestine that was for me a professional homeland of sorts, not because I have the answers but because I love the people. Afghanistan is in many ways my first love, right now it's being the scary girlfriend I just can't quit, but perhaps Palestine is where my mighty hammer has found its nail, and even though that sounds really, really gross and in many ways totally inappropriate, I think you know what I mean.

And if you can't imagine whirled peas, look up the story of Jawdat Ibrahim and Abu Ghosh (the good part of the story is in the text box at the bottom of p. 145).

Now that I've wised up about travel clothing I've been having my clothes cleaned by the hotel laundry and it comes up in this packaging - apparently it's done by a doctor who'll give you Asmar with that freaky iron. I see he feels as strongly about a good crease as I do...

So I'm sitting in a rooftop bar/restaurant called Uptown, atop the Ankars Suites in Ramallah; if you try to google it, very little turns up, which is both 1) a pity, since it's lovely up here, and b) odd because it seems like everything is online - shucks, if photos of you drinking too much and mooning the camera can turn up online (that's not me, folks), why can't information and a map about something so nice be there too?

I'm watching the waitstaff put out plates of these gigantic dates on the tables in preparation for breaking the fast at sundown - the first thing you taste for the Iftar meal is something sweet - and I'm stricken by these ideas of piety.

For instance, I was raised in a fairly conservative, American evangelical Christian fashion, and we were told that we weren't to "smoke, drink or chew, or go with those who do," and holiness meant abstemiousness; but here in the Middle East, the Christians are the ones who make the best local beer and can smoke cigarettes during Ramadan (which was perversely liberating - I almost feel like smoking a pack of cigarettes just because I can. Then again, with the number of smokers here I'm going to have to quit second-hand smoking when I get home), eating bacon while the Muslims, who are refraining from eating and drinking, grow fainter and fainter during the day.

What's the point of all of this, besides awesome self-control and being bereft of the wonder that is Spam? I was told a story about a man here, who because it was the holy month went to the friend from whom he had been estranged for the past so many years, took him by hand, and said, friend, let us be reconciled because we should be at peace during Ramadan. Which calls to mind that true religion is to visit orphans and widows in their affliction, and that the peacemakers will be called the sons of God.

Now if only the people behind the bar would stop playing "Unbreak My Heart" over and over again (the rest of the world is where pop music goes to die) - they're sons of something else, dammit.

I AIN'T SAYING HE'S A GRAVEDIGGER (but he does prepare the bodies)

Several people I've spoken with here have expressed what might mildly be called outrage over the conditions at the Ramallah General Hospital's morgue ("Ramallah General Hospital" sounds like a Palestinian soap opera, but it's not - it's the largest public hospital in the area) - "much too small a space, barely the size of a refrigerator, no place to leave the dead". Perhaps it seems a little odd that they would put so much emotional energy in to what happens to those who are already dead, but then the stories...

"During the intifada the dead would be stacked on top of each other...." "The space is so small, the family of Muslims all gather to honor their dead and they couldn't all fit...." "In all the chaos, one man was found alive after having been left there over night with the dead - can you imagine?" "There was no space, and no way we could move them, there are at least twelve people buried on the grounds...." "It's just a small outbuilding - in order to move the body they have to parade the corpse on a trolley in front of everyone watching outside...."

Noor and I visited the hospital again on Friday, which is the Muslim's Sunday, so the place was dead quiet, just a couple of people sitting in the hallways. I wanted to see this part of the hospital to discover for myself what was so wrong. Noor greets a man in the hall; his head, perched atop a slender neck, houses a mouthful of ill-kempt dentures that move whenever he speaks, a head that seems much too small for his immense belly - the proportions are all wrong, he looks like a grinning skull whose body is growing fat by eating death. Or maybe I just think that because this man is the one responsible for the morgue.

He certainly had the easy cheer of one of Hamlet's gravediggers, and when he smiled the eye turned to you seemed to leer out, his gap-toothed grin mocking - I kept checking his other hand to see if he was hiding a skull. We walk up the alley behind the hospital to the morgue, and speaking rapidly in Arabic, he apparently wants me to take a picture of the sign. "You mean the one that says 'morgue'?" No, the sign next to it - the man was incensed by this sign that specified that preparing the body would cost such-and-such an amount, and that clean sheets to wrap the body would cost extra. "It's not proper," he laments.

He unlocks the door and ushers us in - the morgue is, thankfully, empty, but there's that scent that lingers. He opens the walk-in refrigerators and I think faintly, it must be nice to work here during the hot summers. To the right is the slab upon which he prepares the bodies of the dead - "he washes them, stitches up their wounds, even though he hasn't been taught how." "I give them each a kiss," he says, "out of respect. Christians, Muslims, it doesn't matter to me." He opens a refrigerated locker and rolls out the sliding shelf for the bodies - "I don't feel anything anymore." He grins.

Walking away, I realize that I never shook his hand, but he didn't seem to mind.




Dyin' ain't much of a livin'. Unless you're this guy...

RAMALLADALLAPALOOZA

Today's the first day of Ramadan!

Okay, perhaps the title of this post is a bit irreverent for Islam's holy month, but I try to take as good as I give, and after all, I kid because I love (I also apparently love cultural references dated by half a decade).

Since Ramallah is a religiously mixed city (not meaning that it is compulsively churned, but rather that many faiths peacefully coexist here) many of the shops and restaurants are still open, although out of deference to the Muslim faithful they close their patio seating areas. During the month Muslims fast from sunrise to sunset in order to practice restraint and to purify themselves, refraining from, amongst other things, food, smoking, even drinking water during the day. At least I've got the smoking one down pat...

Not being Muslim, of course, I was eating breakfast (and still not smoking) in the hotel restaurant this morning. It was still early (the only time I have a regular sleep-wake schedule is when I'm abroad; having normal human hours is actually kind of nice) so I was seated by myself , when the restaurant's only other patron walked over and introduced himself. At first I couldn't discern his accent, but when he said his name, "John McDonald," it all clicked and I recognized his Scottish burrrrr.

That's one of the beauty things about travel. The hotel we're staying in is a bit shabby (if one were to be kind one might call it "comfortable") - for example, the other morning I was using a washcloth which tore to shreds in my hands, and I have very soft skin so I don't think it's my fault - but it's occupied by all sorts of honest, hard-working NGO-types who are the kind of lovely people who don't give a second thought to coming over, shaking your hand and asking where you're from.

It turns out that John is actually "Professor McDonald", in public health, and he was in town on one of his biannual, ten-day long visiting professorships teaching at Birzeit University, which he's been doing for the past 14 years or so. I forgot to ask what Birzeit's mascot was. I gave him one of my business cards (handing out cards is kind of a novel thing in emergency medicine. We typically hope our patients don't need to come back, but over the past couple of years we've discovered that giving cards to our patients makes us look more professional and gives them a name to the face, a much more humanizing experience. I've recently taken to instinctually flipping out cards when meeting new people, almost reflexively, like a ninja throwing knives at a surprise assailant). But we sat and chatted for five minutes or so about our respective countries (he actually lives in Australia), about Palestine, about the people.

As I'd mentioned in a previous post, I've never worked in an office before, but I am familiar with little bits of corporate-speak, one of which is that any organization is only as good as its individuals. So even if you have an excellent corporate structure established, its full potential depends on the quality of the actual individuals working in it; in that respect, Palestine's got it made.

The people are pretty terrific. I know I've already said that, but it bears saying again: the people are the best resource here. In Qalqilya we met a general surgeon who'd trained in Jordan, and was the only general surgeon who covered the entire hospital. In addition to performing general abdominal surgeries, he also does all of the thyroid surgeries, the pediatric surgeries, the breast surgeries, the trauma surgeries. Taking time out from his day, he walked around the hospital with us, "do you see this picture? This young man was in a car accident, and the next day he developed a fever, and had pain in his abdomen, I did a laparotomy, this was his pancreas, he had lacerated his pancreas, and I did a distal pancreatectomy. He now has diabetes," he says, to which I reply, "yes, but he's alive!" and to which he responds, "yes, this is the point, he is alive!" We both smile and keep walking, "there was a child, he had been in a very bad accident, he had infarcted much of his small bowel, I resected three meters of his bowel and then a jejuno-colonic anastamosis, he is now on TPN because of short bowel syndrome," and grinning at each other, we finish, "yes, but he is alive!" He rarely has a day off. I give him a business card.

Growing up pale and chubby the way I did gives me a particular heart for the weak, for the underdog. These people are certainly the underdogs, but they are by no means weak. I am grateful to know them.



Refraining from bringing guns in to the emergency department isn't just for Ramadan - it's kind of a year round thing.

"That's my house," says the UN hospital administrator in Qalqilya, pointing at a squat concrete building that's abutting the compound. Qalqilya has the dubious distinction of being the Palestinian town that's entirely surrounded - and therefore potentially cut off from the outside world, like Gaza - by the Israeli security wall.

"Do you see that blue door?" she asks, pointing at a little metal door, perhaps about three feet tall, that's built into the hospital's wall. "I used to take that to get to work every day during the Israeli incursions at the time of the second intifada." "That must make it hard to get any rest." "Oh, yes, people would constantly knock on the door, even if I didn't answer my mobile phone, always needing things. I used to have to take the oxygen cylinders to Jerusalem to have them filled. Each trip would take three days!"


My commute doesn't seem so bad anymore...

IT'S ALL ABOUT THE LOVE, BABY. AND ACTUAL BABIES, COME TO THINK OF IT.

We've just completed the morning briefing and are leaving the glass-enclosed conference room when someone comes rushing over: "Dr. Tae, Dina has been in a car accident and is being taken to Sheik Zayed! Can you go there with Dr. Taroub?" (Be sure to roll the R's a bit more when you read it to yourself.) Dina is - wait, I'm not really sure what she does in the office; hang on a sec while I check the staff list - Dina is the HR administrative assistant.

Rats - when I travel to particularly austere places I usually take a medical kit with me. It's got a couple of useful things, like finger splints, Zofran, a reflective blanket, an epi-pen, but I figured, hey, I'm going to a city where there are hospitals, why would I need any of this stuff?

Actually, Dina's being taken to not just any hospital, but to the Flagship Project's emergency hospital (the "Flagship Project" involves making a complex of hospitals in to a "center of excellence" for Palestine, and includes a pediatric hospital, a surgical hospital, both of which are undergoing completion, the renovation of the Ramallah General hospital, and the aforementioned emergency hospital, which is currently up and running). What do they need me for?

Dr. Taroub is looking for someone to drive us there, not quite frantic, but by no means nonchalant, either. Dr. Taroub is the local chief-of-party for the Project; she's in her mid-fifties or so, practiced family medicine, but has been working in development for the past 27 years. Her family is from Ramallah, in fact, an uncle founded the city in 1556, and there are very few places in town where you would find someone not related to her. Palestine is who she is.

We arrive at Sheik Zayed, but no Dina - Noor has gone to pick her up from the site of the accident, but there is confusion as to whether she's taken the ambulance or her own private vehicle. Dr. Taroub paces, and free-associates with me. "My brother is a cardiologist in Iowa. He started this hospital. I just want you to see Dina and make sure she's okay." She explains that she has little confidence in the local hospitals, having opted to take members of her own family to other medical centers in Jerusalem for treatment in the past. To put it mildly, how unfortunate; the checkpoints can delay care for precious hours, and the people here need healthcare they can have confidence in.

Dina arrives by Noor's car. She and her sister, both young women - girls, really (I think her sister is actually in high school) - were in the accident, and as they walk up Taroub envelopes them in an embrace, a concern that can be described in no other way but maternal on her face. I give them a quick once-over - they're fine. It is awkward for me to look the doctor on duty in the eye. Dr. Taroub, however, is reassured.

Now, given her long-standing and well-established history in Ramallah, Dr. Taroub and Dina certainly may have been related, but Taroub's reaction to the news of Dina's accident is emblematic of the attitude of the people involved in this project: it's all about the love. In the morning Wafa rings a bell and everyone staggers in to the conference room, little cups of strongly cardamom-scented Arabic (or Turkish, depending on whom you ask) coffee in hand and begin good-naturedly joking with each other, put-downs and praise mingling with the ease of people comfortable with one another, without fear. There are, of course, many Muslims, but there is also a surprising number of Arab Christians in this office as well, and perhaps a few Jews, although I haven't confirmed it, all of these people gathered together, peacefully trying to build something out of dust and USAID.

Dr. Damianos is a small, white-haired, bearded man who's the deputy chief-of-party, and several times a day he stops by my desk, shakes my hand warmly, and says, "thank you for coming, thank you for working with Noor, we love her, we love both of them!" gently patting Noor's pregnant tummy. Noor is actually a Palestinian American, speaks English with an American accent, trained as a paramedic in Florida. She's pregnant with her second child, and she'd rather give birth here while trying to make the emergency health care system work - another part of Ramallah becomes a family thing. Everyone butts in and good-naturedly gives her advice on how she's managing her pregnancy, an extended work-family, aunts and uncles of different religions and ethnicities to her unborn baby.

This kind of love is infectious. Tomorrow may be the start of Ramadan, and I think most of the Christians in the office will fast during the day as well so as not to stumble or harm their Muslim friends on this project. At times during the day, I find myself thinking, I could stay here with these people who have such big hopes for this place. It's all about the love.


Maybe it's all about the tiny cups of really excellent coffee.

WHERE THERE'S HARASSMENT, THERE'S VETTING. AND M.O. 21.

Before I arrived in country USAID required that I read two documents.

The first related to sexual harassment in the workplace. Now, this is a topic with which I am well familiar. Not because I've needed to remediate it, ha ha, but rather because my workplace has interpreted the law to mean that anyone in any supervisory role, including attending physicians, be required to take this sort of training (although, with regard to "supervisory", you and I know that people barely listen to what I have to say to them, if at all, even though I'm almost always not wrong).

The first sessions began, oh, maybe six years ago? And at the time the powers that be at work (TPTBAW) decided to call it "Sexual Harassment Training", quickly realizing that the last thing they wanted to do was to train people to sexually harass. That the videos they used in the training sessions featured the same circa-80s actors with porn-staches who probably starred in porn didn't help. The following round of courses (they're required every couple of years) they caught on and decided to call it "Sexual Harassment Awareness Training", quickly realizing that, well, simple awareness that harassment was ongoing did nothing to help the situation, and that the course was now unfortunately abbreviated "S.H.A.T.", which, for obvious reasons, made a lot of people (okay, me) giggle. Subsequent to that round, TPTBAW finally decided upon "Sexual Harassment Awarness and Prevention Training" (italics mine), a title that finally conveyed more or less what they intended from the course and had the unwieldy but non-giggle provoking acronym of "S.H.A.P.T."

And here we are. So now, having been trained in S.H.A.P. previously, I felt quite comfortable with concepts, or rather the idea of the concepts, or that in concept that these things are wrong - oh, you know what I mean. I guess it speaks well of me (or at least to my extreme naivete) that my first reaction to the news that I'd have to read this material before leaving for Palestine was, ewwww, who in the world would want to harass someone else, but especially in the field! A thought which was quickly followed by a second one, oh my, they must have mandated the training based on prior unfortunate experiences.

Last night, however, I realized how much this idea made sense. Not because I harassed anyone (nor was I harassed). Rather, last evening there was an informal after-work reception for all of the FNGs in the office, including yours truly (for all of you unfamiliar with this acronym, the "NG" stands for "New Guy", and if I tell you that it's a military acronym, y'all can pretty much guess what the "F" stands for). In attendance were a number of the local USAID contract workers, and these people were really cool, very nice, and this was when I had my epiphany. Aid workers tend to be Young, Fabulous and Bulletproof - they're often in their mid-to-late twenties, well-educated, urbane, attractive, the cream of the crop, cosmopolitan people who are also wildly romantic because, of course, they're all out to save the world, right? If it tells you anything, they were starting to make me feel old, and given that I'm sort of Dorian Gray, that's hard to do. But all of a sudden the need for S.H.A.P.T. for all of those out in the field started making a lot of sense.

This evening reception dovetails nicely on the second document I was required to read, Mission Order 21 (M.O. 21), which was the topic of some heated discussion during the party. To wit, M.O. 21 requires that all parties to whom USAID offers assistance undergo a process of vetting in order to ensure that they do not "inadvertently provide support to entities or individuals associated with terrorism."

Now, at first blush, that makes a lot of sense - why should my hard-paid tax dollars go to a terrorist when they could be bailing out Goldman Sachs? I'd prefer that we vet the heck out of these people! So here's the response: imagine that you approach a local agency, say, a Palestinian NGO, one that's got a terrific reputation for doing really excellent development work here, and you tell them, hey, you've got a great thing going on, and we'd really love to partner with you. Oh, one thing: we're just going to put you through a vetting process to make sure you don't support terrorists.

Has it sunk in yet? It took me a couple of tries too. But think about it - what if you were on the receiving end of that little speech? It presumes that you're guilty until you can prove your innocence. We won't work with you until you can prove to us that you're not guilty of terrorism. And if you're just a guy trying to make his homeland better and happen to speak arabic, perhaps this approach seems, say, a little judgmental. Plus, it's deeply unAmerican.

Your response may be, hey, we've got every right to make sure that the terrorists don't win! And you've got half a point. Because to assume that people are guilty until they can prove themselves innocent flies in the face of our modern American system of justice. Fear made us willing to compromise on some of our values, it's not very smart, and you can see how it'd be difficult to "capture hearts and minds" when we treat our local partners with suspicion.

What would have been really smart, at least I think, is to presume that these agencies or people who work with USAID are innocent. This presumption, however, doesn't mean, by any means, that we have to fold and perhaps accidentally give terrorists money - NO WAY, especially because I'm a total cheap-skate and I don't want a penny going to Osama, by accident or not. No, first you partner with an agency, because that gives you access to their world, and you can then begin to actually document what occurs, and if you discover that they really are in the wrong, then pow! you freeze their assets, make a legal case based on the evidence you now have (which you never could have collected by refusing to deal with people until they submit to vetting), and then you have a legitimate conviction of actual guilt, one which can send them to prison for a long, long time, during which they can contemplate the error of their ways and undergo a righteous punishment.

I'd begin by making them undergo S.H.A.P.T. sessions.

THE OFFICE

I have never actually worked in an office before. Until now.

In college I was employed as a tutor for the university, so my workplace consisted of a classroom and a dry erase board. I worked briefly for Kaplan MCAT prep during med school. Subsequent to that, I've been employed as a physician, and there's not much office in an emergency department. As a matter of fact, I don't even have an office now! (Shhh... don't tell anyone... 'cause if I did I'd be expected to spend even more time at the hospital...) (Oh yes - I also briefly worked at an auto garage in high school until I started getting nosebleeds from the fumes.) (Not huffing.)

But now, for the first time in my life, I'm working in an actual office, in Palestine! USAID leased out two floors of a building for the project to work out of here in Ramallah. It's actually... really quite nice. It's a new building that's enviromentally friendly - for example, the heating and cooling works on a geothermal pump system (living in austere conditions, such as having limited access to electricity, forces you to make green choices), and it's big and clean. For the first time in my life, I've got a desk, there's a receptionist, a conference room, a break room with coffee pots and even a water cooler! I realize that I may sound as though I'm being sarcastic (or totally insane), but it's really a novel experience, and granted, it's only my first real day there so tomorrow I may start hanging Dilbert cartoons on the walls of my cubicle and hiding in the basement so I don't get fired. But it's different, and different, right now, is kind of nice.

Here's a view of the office - I'm in one of the cubes on the right.


That's the receptionist, and the conference room in the back.




That's the view from the men's room's window. See? Told you it was nice.

I PLAY A DOCTOR ONLINE

One of the odd things is that the people here keep addressing me as "Dr. Tae". I wasn't sure if they were trying to be cute (many of the young people at the church I used to attend called me Dr. Tae), or if it was because they had confused my surname with my given name: since Kim is often a Western first name, I thought that they might not be sure which name was which. I'd contemplated clarifying the matter, but I've discovered that it seems that everyone is addressed as such - people with titles are always called by their title, if they are comfortable around you they use your given name, and surnames are reserved for formal settings - that explains it!

Today seems more promising in terms of doing actual development rather than doing the stop-gap measure of local continuing education lectures. Okay, so it's only really my second full day here, but still, my heart really sank when the doc yesterday said that I could help by giving lectures. Which I'd happily do if that's what they needed and wanted, of course. But I think I was asking the wrong question: rather than asking what I could do for them, I think I should be asking what it is that they think they need, what they think their system needs, and trying to figure out how I might address that need. Of course, assessing their needs as an outsider is also important, but asking them the right questions might go a long way.

It's funny; I was just chatting with a primary care doctor, and he started listing a number of complaints (or needs): people don't have access to their primary care doctor, who often doesn't want (or can't, by law!) deal with emergencies, so the patients begin to self-refer to emergency departments which are then inundated with primary care patients; EMS often is unable or has difficulty contacting hospitals they're going to, so patients often arrive to the surprise of the emergency staff; there's a disconnectedness between secondary/hospital care and primary care, so often a patient is discharged with no communication between the hospitalist and the primary care provider resulting in loss to follow-up. Listening to this litany of problems began to feel awful familiar, and I didn't have the heart to tell him, buddy, you and I are in the same boat, and that all of the resources of the world's premiere superpower wouldn't necessarily ameliorate all of these problems! I guess I'll let him discover the awful truth for himself... later... and then we can have group therapy...

I may appear youthful (and handsome), but in fact I was raised in a very conservative fashion. I was brought up to understand that religion and politics weren't topics of polite conversation.

So I work at a Christian institution which sent me to a predominantly Muslim area that's at odds with the Jews in order to work with a US federal agency that's partnering with a politically appointed Ministry of Health while health care reform is being considered in our own country.

I'm not sure how I'm going to get out of this one... maybe I can pretend I'm Canadian... or learn how to talk about the weather in Arabic...

At the hotel's breakfast buffet this morning they were playing Bob Marley. I love reggae, I love Marley, and his message of peace, love and understanding, but does that mean that the Palestinians embrace Zionism as so long it's practiced by nice Carribean guys with dreds and urine drug screen positive for cannabinoids?

I've been surprised to discover that Palestine is the first developing country I've visited where almost universally the people in cars wear their seatbelts, even the drivers.

I visited the Sheik Zayed Emergency Hospital in the Palestinian Medical Complex today. It was actually very well run and organized, and the doc on site was happy to show us around. There's no specialty of emergency medicine here, so what the docs do is go to 6 years of medical school which gets them an MBBS, then a year of internship, then licensure. When I asked what they thought I could do for them, the response back was "continuing education lectures".

Now, I enjoy lecturing, and my major (likely only) contribution to global healthcare has been the introduction and dissemination of "medical jeopardy' to the third world. But I didn't want to stop there - lectures benefit the individual docs with a certificate of training or whatever, and they help the public with the skills they learn in class, but these lecture do nothing for the system of healthcare as a whole, there isn't a systems-wide improvement or change, nothing brave or innovative about it, nothing that would affect the system as a whole, like coordinating EMS care between three different cities that are separated by checkpoints and the security wall.

Which reminds me: speaking of brave, one of the things the medical director brought us was a photo album, but rather than having pictures of his smiling children or of the interns under his tutelage, page after page held photographs of injuries sustained during the intifada; each page of the album documented the horrific injury patterns that the "non-lethal" weapons that had been used against the Palestinians had inflicted on these people. The rubber bullets penetrated and broke bones and caused hemo-pneumothoraces, the "super sock" shot gun rounds made awful limb hematomas that caused necrosis - the doctor was assembling a record evidencing the abuses the Palestinians had suffered.

Perhaps what they really need is a continuing education lecture in medical forensics...

SHOWERS AS A POLITICAL ACT

Before you start calling me compulsive, a) I already know, and b) don't judge me. But I prefer to take showers two, sometimes three, and rarely but on some occasions four times a day. Having short hair definitely helps, and I don't mind cold water, so each individual shower takes only 3 minutes or so.

I've discovered that the Israelis have cut off the Palestinians' water supplies (they control all of it in this desert), so the roofs of Palestinian homes and buildings are studded with water towers, a bunch of them, squat, black, plastic structures littering the roofs the way satellite t.v. dishes do homes in the States.

That means that every shower I take eats in to the Palestinians' water supplies - but I can't just stop bathing! So, following the example of Rick Steves' book, Travel as a Political Act, I've decided now to shower as a political act - I've made my already brief showers even shorter, going full Navy style, turning off the water any time I'm not rinsing.

Every little bit, right? By bathing I can stick it to the man!

That sounds gross....

UNCORRELATED AGGREGATED OBSERVATIONS OF GLOBAL TRAVEL THAT HAVE NOTHING TO DO WITH MEDICINE BECAUSE I JUST GOT HERE

There was a young woman at LAX balancing a cup of bright, pink-purple Starbucks beverage on top of a flat box, and naturally it fell off and splatted on the ground while she was in line for boarding - SPLAT. I felt a little sorry for her, but also sensed that to think, yup, saw that one coming, would be needlessly snooty and schadenfreude-ly. Turned out I sat between her and another novice traveler for the LAX to Philadelphia leg of the flight. Took care with the beverage service.

Maybe I'm just imagining things, but there seemed to be tons of children on this flight, more than I've ever seen in international travel. All manner of children, of all ages, googly infants, toddlers running head first, tweens all knees and elbows, disaffected teens too worldly-wise for this trip with mom and dad. The ultra-orthodox Jews encourage large families, but these folks just seemed like generic, secular Jews. With tons o' kids.

Being somewhere this consciously religious makes me again wish that I belonged to a religion with a cool uniform. There are a lot of imposing looking people in dark suits, in black robes, cassocks. The closest I've come to a religious uniform was a church camp t-shirt. Lime green is not an imposing color.

I've always loved the occasions of spontaneous applause that sometimes break out when a plane lands. This outburst of gratitude and appreciation for landing, for the flight crew, makes me feel like a part of a community, a community that has traveled together, a community that spills ill-placed beverages, and that's okay.

GETTING THERE IS LESS THAN HALF THE FUN

I hate to travel.

Okay, that may sound a bit odd to those of you who have an idea of how much traveling I've been doing over the past so many years, but I hate to travel. Now, the automatic response that many of you are probably making is that, no, wait, you hate to travel, meaning the sitting-in-airports part, but surely you love the destination! And while it's true that I find my life richer for having been to some of these places, and I am exceedingly grateful for this opportunity to work while I visit some of these places, I ultimately would rather spend a week puttering around my home than zipping around the globe.

Okay, now having said that, I can say that I'm still grateful for the fact that I have been able to be in all manner of interesting and odd places, the stories you have at the end are great, I wonder if traveling with my wife will make it a lot more fun, forcing myself to get out in the big world has really affected the way I view the world, and the getting-there part of international travel is really in fact the downer.

The getting-there bits of travel aren't always all bad: I've been on, say, long road trips, or train rides, or bike paths, or hikes, where the journey is the journey, but often, well, getting there is much less than half the fun, it's no fun at all.

Maybe it's because I'm a man. Whenever one travels, you see this particular tribe of traveler, the solitary male. Middle-aged, maybe a bit of a paunch; maybe a ring, maybe none; some light hand-carried luggage; business-casual, polo shirts, jeans, khakis; always talking on a cell phone, and I wonder, to whom, to a wife, a mistress, a child, a business partner; and I always wonder about this man's business here, trade, industry, consulting, sex tourist. Whatever it is, these men represent the antithesis of home, and I find it depressing to be among them.

Then there's the interminable amounts of sitting: sitting at the terminal, sitting on the plane, sitting at the lay-over, sitting on a plane. I heard on NPR recently that sitting is a fairly recent human development, that standing and reclining make much more sense in terms of our physiques, and if you ask me, it feels better for our souls. If I were to run Guantanamo, I would have made the inmates sit in modestly padded seats with 30 inches of pitch for days on end, days without night, while the airplane chases the sun around the rotating earth...

And then there's the food. Airports have gotten fascinatingly non-local, all struggling to achieve the same, indistinct, transnational and globalized ideas of what constitutes passably good; the same McDonald's Happy Meal available everywhere in one sense, but in my mind a better illustration is the Irish pub that's in the departure terminal in Dubai's airport, a promise of down-home anywhere but.

I wonder how the hummus will be in Ramallah....

I'm going Web 2.0 crazy!

I am no technophobe, by no means, but I am totally capricious in what sorts of tech I'll dive in to and what I won't. In terms of communications technology, my family has been the motive force behind my forays into it: my brother had a beeper in high school (that was during my Luddite phase) and then worked at a cell phone store before they really started taking off in 2000, and my sister persuaded me to use e-mail in college (back when they still had Unix terminals on campus), and then got me on my old blog when she started posting photos of her newborn baby girl in 2003.

But since then, I've been a rather reluctant, foot-dragging convert to all of the social networking craziness that's followed. A friend convinced me to use Friendster so she could embiggen her circle of... friendsters? I signed up for Myspace when its music applications really took off, but haven't been on it much at all. I had resisted Facebook until my wife forced me to join earlier this year in order to see pictures of her niece and nephew, and even then logged on infrequently, and rarely posted any comments (I'm still puzzled by the entire "poking" thing that happened - what exactly does that mean?). And even though I'd read stories about kidnapping victims who've twittered their locations to rescue, I didn't think anyone would want to know, in excruciating, minute by minute detail what I'm doing during the day - I wanted my posts to mean something, and the short form wouldn't allow for any depth of thought. So far, I've been happy expressing myself through maximally verbose posts on my old backwater blog, contented to have it read by the few people who still use the site.

Until now.

Getting ready for this trip to Palestine, I decided that I'd make it a public, political sort of an act, to keep my family, friends and coworkers updated on what I'm seeing, hearing, thinking, feeling, so parts of the world becomes humanized and neighborly. So I started posting my own frequent status updates of Facebook, opened a Twitter account and started twatting. The faculty in our department at work started a social network ring today on something called Wiggio, so I joined that and started posting there, too. Following a friend's example I decided to start this blogspot site so I could post in longer form in a way that I'd feel comfortable having my coworkers read (fewer f-bombs). I've even activated the mobile update options on any of the accounts that had them so I could text message updates from my cell phone (if, say, I've been kidnapped and the kidnappers are too dumb to take my cell away from me). In internet exposure terms, I've gone from zero to Perez Hilton in the space of a week!

Perez Hilton... well, I guess at least the pressure of having to say something profound is off now.

INTERNATIONAL, MAN - IT'S A MYSTERY

I'm getting ready to leave for Palestine on Saturday! I'm going to be working as a consultant on a USAID development project in Ramallah. There's a medical complex of five hospitals, and I'll be working with the EMS and emergency medicine services, which is hugely exciting.

Like most of us Americans, I don't know enough about the enormously complex and confusing history and political environment of the region, but here are a couple of thoughts: while the Israelis have a fantastic, well-developed Western-style EMS and healthcare system, the Palestinians do not. Even though Ramallah is just a few kilometers away from Jerusalem, a car accident or heart attack victim has no access to the Israeli hospitals because of the security wall and border checkpoints. You can imagine a rough parallel by thinking about what it would take somebody with an emergency in Tijuana trying to get through the border crossing to get in to a San Diego hospital. The Palestinians are at an enormous economic disadvantage, and improvements in their healthcare system would do a lot to improve the quality of their lives.

To say that navigating the region's political and ethnic conflicts is difficult would be to put it mildly. There are issues of religion (Jews, Muslims, and Christians), race (Arabs, European and African Jews), and class (Israel enjoys a robust economy, while the Palestinians have a number of barriers, political and physical, to development).

This trip will be the first medical development travel I'll have done in a while, and I'm a little rusty. I know I'm forgetting to pack something....