Tuesday, November 30, 2010
Saturday, February 6, 2010
In between editing the 100-plus page of prehospital emergency protocols that were written in, admittedly, impressive, but not close to perfect, English, on the long, long flight from Tel Aviv to
It began even before I got to the airport itself; a soldier, who looked about 17, pulled our vehicle aside for extra screening. Shuffling their feet out in the cold, Ishaq and Abed commented, “it’s because we have East Jerusalem IDs,” wry smiles of apology on their faces. The teenage soldier escorts me to one of those nondescript rooms with x-ray equipment and another bored kid wipes my belongings down with a wand to detect explosives. When the soldier finds out what time my flight is, his eyebrows arch for a second, and then he says, almost, but not quite apologetically, “I will give you a pamphlet that you can show the security inside the airport to help expedite you.” He drops one of the driver’s phones when handing them back, no apology.
Since I am a lone male traveler, in the airport I am labeled the highest security risk, a level 6, and receive what is essentially the most invasive security examination. “Where did you stay while you were in
All of this treatment despite the fact that (or, menacingly, because) I’m a citizen of America,
It’s funny, what the straw for me was: a headphone earpiece. A triviality. Remember: I am a nerd, a compulsive one, and being able to pack all of my electronica with safe efficiency isn’t just something I take pride in, it organizes my psyche. When the security officer escorted me back to the screening area where the clever workers had pulled out every single piece of my gear out on to a table for all to mangle, he said, as though it were a gesture of magnanimity, “see, they have already re-packed your bag.” I began to fume. Quietly seething, I unpacked the uncaringly jumbled mess and began to rewind cords, re-sort compartments, trying to get their psychic urine off my belongings, because that’s what it was, they had pissed all over my stuff. It was then that I discovered that one of the earpieces of my headphones had popped off and was missing. Not the most expensive, but not the cheap ones that come in a plastic baggy with your airplane peanuts, I had traveled hither, thither and yon with these headphones without having lost one of the little earpieces that ensured a proper fit, and some bored teenaged kid had managed to do it while mishandling my gear.
And then imagine, it isn’t a headset, it’s your pregnant wife, your gasping father, your cold, blue child, and you’re forced to sit on the ground and wait at gunpoint because of disagreements that people you don’t know and care nothing of have had. Or if you had watched your sister, mother, aunts, separated from you into another boxcar heading for another place that smoke comes from. Forcing open a clenched fist makes for a pretty crappy handshake, and you wonder to yourself when it’ll get better, and think that it’s going to take a measure of self-dignity that extends far, far beyond the loss of a rubber earpiece.
Maybe I can see if I’m more like Jack Bauer.
Saturday, January 30, 2010
Thursday, January 28, 2010
Sunday, January 24, 2010
I couldn't find my camera in time for this trip, so this photo was taken with the Best Camera (that is, the one that you have with you), my iPhone, with the Jewel filter.
Almost makes up for the stink of poo...
It doesn't let up. Noor starts now. "When is Pak-tahn coming?" For goodness' sake, Noor grew up speaking American English. "It's PAX-ton." "Okay, whatever. Are you ready, Ahrlen?" I can barely keep myself from rolling my eyes and sighing loudly. "Noor, it's Orrine, or-REEN."
For heaven's sake, I'm having to translate English to English for these folks...
Saturday, January 23, 2010
Familiarity has rubbed some of the exoticness off things around here, at least for me. The fact that almost everyone I've met has spoken at least a little English, even if it's an Arabic-English pidgin, has made life here seem much plainer. I, on the other hand, seem to remain bizarre and alien, telling by the frank and slack-jawed stares some people give me, with the occasional "Nihao!" or "Konichiwa!" I wonder if I can have a race-burqa made...
We are in the offices of the Juzoor foundation, a non-profit organization that does a lot of healthcare education. We've contracted them to do life support education for us, and currently we're arguing about whether to order airway positioning first or CPR, seeing as how the new emphasis on chest compressions has confused everyone. Suddenly, all eyes turn on me: "how about you, Tae? As our representative from America, what is your opinion?" Uh oh - playing the foreign consultant card in an attempt to break the deadlock. "Um, gosh, you're both right, but it's a matter of knowing, culturally, what your people would respond to." Wiggled my way out of that one! I wonder if I can have an awkward-political-pawn burqa made...
Thursday, January 21, 2010
We are sitting in his office, tensely negotiating the future of the Emergency Hospital - "who's going to be the medical director?" "I am." "Even though as a member of the board of directors you have a conflict of interest? Who will be the residency director?" "I will." There's a long, awkward pause.
The director sits back in his chair, and after a moment, leans forward and asks, "have you ever seen the t.v. show, 'E.R.'?" His "R" rrrrrrooooollllllssss off his tongue. Orrine and I look blankly at each other, then turn to face him again - neither of us have watched the show. The grin on his face starts to fade. "How about 'Grey's Anatomy'?" Blank stare. "'Scrubs'?" Nothing. Another long awkward pause.
I didn't realize that there were so many American medical shows broadcast in Palestine. Personally, my favorite medical show was "M*A*S*H".
Wednesday, January 20, 2010
It was still chilly and overcast but the rain had stopped when we'd exited Kabul. The plains were broad and green, punctuated by clusters of walled-off mud buildings while they sloped up to the mountains on our left. We could sometimes see their white peaks through the clouds, rugged and imposing.
Many of the rough mud buildings were in ruins, and there were tank-remains that dotted the fields. Ayoob pointed at different, broad stretches of land and in his careful, deliberate English would tell us, "here, from 1993 to 1996 I cleaned of mines."
Geoff suggested that we stop for tea; Ayoob pulled over in a dusty village where we waited for Geoff to catch up. Their vehicle arrived about a half hour later - it turned out that Borhaan, a pediatrician who was returning to his homeland for the first time in over twenty years, had found some old acquaintances and had stopped to talk. After a brief discussion we decided to try and find a more picturesque village for tea, one with fewer limping dogs and men in dusty single-breasted suits riding bicycles.
The road became tree-lined and shaded, the fields greener and thicker. Geoff's vehicle came to a halt ahead of us, and still irritated by the last half-hour delay I cracked that Borhaan must have found more friends when he stepped out of the truck and embraced the heavily armed man standing at the passenger's side window - looks like he actually had found more old friends. As it happened, while we were driving Borhaan started to recognize the region as the one his uncle's chauffer, whom he'd last seen 25 years ago, was from. The man's son, who immediately recognized Borhaan, was now the regional security chief, and he escorted us to his father's house.
The vehicles were parked by a school and we walked up a broad dirt path, flanked by men with guns. It was, however, still, quiet and peaceful, the men were polite and deferential. You could hear the children playing in the school down the road, carefree.
Borhaan was finally reunited with his family's former chauffer, who had an enormous goiter. No one cried; Borhaan just had this halfway stunned and pleased look in his face the entire time they chatted in Dari, or was it Farsi? We followed Borhaan and his family's former chauffer to the end of the dirt path which opened to a surprise: they had erected a large concrete tea platform and surrounded it with living birch trees that formed an arbor around the retreat. They had fashioned a canopy over the tea platform by laying cross-branches between these trees, and several vines were entangled on the beams overhead, providing a dappled shade. Rosebushes lined the path and stairs to the tea platform, and while we situated ourselves on the carpets and cushions laid out for us, one of the man's heavily armed sons cut a bouquet of the flowers for Tammi.
Borhaan and the old man caught up while his sons served us tea, candied almonds, bread; here, you could breathe, deep, cool breaths, and look at the snow-covered mountains almost hidden by the clouds. Night was falling when we left for Kabul, a dusty, hazy light on the horizon.
Tuesday, January 19, 2010
However, as she often does, my wife got me thinking... food... hmmm... Well, this quarter, I'm taking a distance-learning class, Introduction to Islam, through my grad school, Fuller Theological Seminary. It seemed to be about time; considering the amount of time I've spent traveling through Muslim countries, I still can't tell the difference between my Saalam and my Salman, my Shiite and Shi'a.
I listened to the first lecture last night, and part of the lesson included an explanation about how significant food, and in particular the sharing of food, was in this culture, and how an act as small as sharing tea signifies that you are most welcome, you are accepted, you are one of us. In the West, sharing food and drink is a much more casual event, but in the Middle East this means that you're as good as family. Remembering now all of the times I've been invited to sit down to tea, to hard-boiled eggs, to lavish meals of lamb and rice, by all manner of people in this part of the world, I'm beginning to realize how grateful I really should have been for their hospitality, and how serious my obligations to them are. Even today, sitting in the project's office, plied with coffee, soda, pastries, each offering a message of peace and welcome, symbols of how tied we are to each other.
And yes, I had french fries for dinner again. What - they're good!
Monday, January 18, 2010
In the office, before the morning meeting, Amal greeted me with a smile, calling me her son. Dr. Damianos met me with a hug, "welcome back, welcome home, Dr. Tae!" It's tough to keep things coolly professional when everyone is so warm. Not that every five minutes the office spontaneously stops to hold hands and sing kumbaya, but it's close.
After a briefing we short term technical advisors make a site visit to the Palestinian Medical Complex where I am pleasantly surprised. Okay, that's to put it mildly, I'm actually cheerily gobsmacked to discover that many of the changes we'd suggested in our technical reports from my last visit were put in place, or at least initiated. One entrance was converted to "ambulance only", the other to ambulatory patients, with registration and triage areas. They'd instituted a fast track, a tiny one, but a fast track for nonurgent patients. They'd took patient rooms that had been turned in to administrative offices back in to patient rooms, and the administrator who lost his space met me with a cheerful handshake rather than the fury of the evicted. Most stunning, we learned that three weeks ago the PMC had decided to recognize emergency medicine as a specialty. (For a brief history of emergency medicine residency training in the States, click here.)
I had put in hours of desk time writing those reports which felt like so much busy work that I imagined the bureaucrats of the Palestinian Authority would politely ignore, and my advisory documents would be filed away to slowly decompose. One reason I was so surprised was because everything I'd heard about the progress at the PMC when I'd returned to the States made it seem that things were actually going backward - the nurses had gone on strike twice, the housekeeping contract had been lost and replaced with a decidedly inferior one, etc. Of course, the truth of the matter isn't that my technical reports had been so lyrical, so moving that the readers had been compelled to obey them, like international development scriptures, but rather that the local people who worked on the project had been diligently chipping away and making real progress. (Although, to confess, I was surprised at how many people casually mentioned that they had read the reports.)
While at the site visit, however, we learned something rather distressing: at the morning meeting we were told that the cousin of one of the project's employee's had died recently, and then subsequently discovered during our tour that he had died because of something that had happened at the PMC, at the very emergency department we've been trying so hard to improve. It's getting personal now...
Tonight's the second consecutive night here in the Holy Land that I'm having dinner with french fries. The food critic Jonathan Gold writes that to him, fried potatoes are proof of the continued existence of a loving god. I notice that the menu makes no mention that these fries are free of trans-fats or other dietary malices. It seems that in the Middle East the people are unfraid of death, at least by coronary...
Sunday, January 17, 2010
Just to refresh your memory, your faithful correspondent is in the Holy Land as a US Agency for International Development technical consultant in emergency medicine, and not just for the fantastic kebab, shawerma, shish tawouk, falafel, hummus, shashlik, clay pot dish... but of course, for dinner tonight instead of those delicious local dishes I somehow managed to order myself a chicken sandwich. With french fries. And extra ketchup.
As mentioned, the flight was super-long and painful, but I think I might be getting used to sitting in the plane for those long stretches - perhaps I'm developing butt calluses...
Traveling alone unfortunately gives you the temptation to do all sorts of awful, tawdry, shameful things, things you wouldn't normally do in the presence of your peers... on that long flight over I cheapened myself by watching "City of Ember", "Max Payne", and "Love Happens". Okay, I didn't watch "Love Happens", but I'm still having trouble looking at myself in the mirror...
Well, actually, I didn't travel alone (but the joke was so much more effective that way), but rather with a really terrific human being, Orrine, who's a nurse. We've known each other for a while now but recently I realized that the first formed memory I have of her speaks volumes about her nature. Now, if you're squeamish you may want to skip this story - working in health care, particularly emergency care, means that all sense of propriety has left your soul and you no longer intuit what's appropriate to share with a mixed audience - but if you're like the 99.9% of the world that relishes a gruesome story: a nurse rushes up to the doc's desk and asks, a bit flustered, "hey, are you all busy? Can somebody come and see this guy?" As the new kid trying to ingratiate myself, sure, I volunteer myself and walk over. So, the background story is something you have to know: the patient, a man, said that he had tried to vault a barbed wire fence a week ago but had somehow gotten his (you can cringeingly see where this is going) "delicate bits" caught on the pointy barbs, and had let the wound(s) fester for a week before finally deciding that, hey, an abscessed, bleeding penis is probably a health problem.
Now, having had some of the new rubbed off me since then I now realize that what I had naively assumed was the truth was probably, well, let's say part of a broader narrative that I may not have entirely uncovered, but the points to remember are 1)blood, 2)pus, and 3) this man's "junks". I walked in to the room to see Orrine, who was the triage nurse that day, finally figure in to my meandering retelling, because she had done exactly what you do with uncontrolled bleeding, applying direct pressure to the area, and in this case, the area was one typically covered by one's bathing suit, and there she was, death grip on this gentleman's exsanguinating willy, but doing so with total composure, calm, even aplomb, and still somehow also compassionate, all while trying to prevent death, or at least loss of gender identity, and I thought to myself, wow, what a cool customer, this Orrine, someone who epitomizes what ER nurses do every single day. I mean the calm, compassionate, critical care stuff, and not the handling-of-a-guy's-you-know-what-that'd-been-injured-while-leaping-over-barbed-wire part. Anyway, she's well-equipped for this USAID project.
We were met at the airport in Tel Aviv by Waleed, one of the project's drivers. We shake hands warmly and I ask, "what's new?" and he says with half a grin, "nothing, nothing's new!"
Which, I suppose around here, is actually sometimes a pretty good thing...