Saturday, August 29, 2009

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.

Friday, August 28, 2009

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?

Thursday, August 27, 2009

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.

Wednesday, August 26, 2009

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...

Tuesday, August 25, 2009

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...

Monday, August 24, 2009

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.

Sunday, August 23, 2009

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...