CRITICS, PROGRESS, AND THE DANGER OF FRIES

It's raining in Ramallah, seriously pouring, the big kind of drops that seem to fly whip in sideways under umbrellas leaving big splotches on your clothes that wrinkle your supposedly wrinkle-free duds. The critic John Ruskin described what he called the "pathetic fallacy", the human tendency to interpret the condition of the natural world in anthropomorphic terms, so one might say that today's weather was angry or downcast, when in fact the weather doesn't really care one way or another, and I agree - rather than seeming unwelcoming, this weather makes me supremely cheerful, I love this stuff!

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...