Sunday, September 6, 2009


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...

Saturday, September 5, 2009


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!

Friday, September 4, 2009


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?

Thursday, September 3, 2009


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.

Wednesday, September 2, 2009

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"...

Tuesday, September 1, 2009

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.