One rock at a time 6-29-13 #19

I am sitting in Ben Gurion Airport watching all the Christian pilgrims leaving the Holy Land.  We are traveling on the Sabbath so we are avoiding the ultra Orthodox Jews and yes, I am doing my own racial profiling, but they look like goyim, have southern accents, are smiling in that unambivalent kind of way, and this is, after all, Israel.  So forgive me. Last night I shredded all my computer files, hid my camera memory card, placed anything from the West Bank at the bottom of my suit case under the dirty underwear, all in preparation for the are you Jewish enough and politically kosher testing that often occurs in the multiple layers of Israeli airport security. As we approach the airport, we are stopped and the taxi trunk is searched.  Our driver explains this always happens when the driver is Palestinian (which is totally determined by the face, the accent, the look in the eyes, since the car has yellow license plates). In the airport, a sincere young man explains to me that someone may have put a bomb in my suitcase, (how about in my brain?) and wants to know if I know anyone in Jordan, but with my nice Jewish face and nice Jewish name, and a few gray hairs, I have no trouble. I spent the last three days in the West Bank working/observing in three Palestinian Medical Relief women’s clinics in Qalqilya, Kufor Lakef, and Tulkarem, where medicine and occupation and the fragmentation of health care all come together. One doctor is a lovely Romanian woman who met her Palestinian husband when they were studying in Romania, another is a Russian with a similar story and the third is a West Banker who studied in Bulgaria, also with her doctor husband.  They all have children and challenging lives.  Tragically the first doctor’s husband was sitting on a balcony last year when it collapsed, leaving him a paraplegic.  The Russian woman, who is seeing all the men, women, and children who show up because the family doctor did not make it, introduces herself and then states, “I am not happy.”  I cannot tell if that is a comment about her impossible day or her impossible life.  I get the sense that the women who came here for love, all got much more than they bargained for, and their perseverance and dedication is impressive.  Last year, many clinicians were not paid for months when the Palestinians were punished for daring to ask for recognition in the UN.  That can be demoralizing as well as financially catastrophic.   “We cannot plan for our futures.” The clinics are all a strange mix of first and third world medicine and the medical problems are like health care issues anywhere with an overlay of occupation and cultural traditions. The scale is prehistoric, obviously not calibrated, and the women are weighed with all their multiple layers.  How accurate can that be? There are many pregnant women and just about everyone pregnant or not pregnant, gets an ultrasound.  The ultrasound machines are all ancient, some covered with grime and gel, the doctors quite skilled but rushed, (no one has a full bladder which is imperative for a quality exam), the indications seem more social than medical. Women frequently present for vaginal issues, refuse a pelvic exam, then get an ultrasound and a script for yeast medication.  This seems somewhat dependent on how the doctor presents the need for an exam, but, from my first world vantage point, this is practicing gynecology without the data for a correct diagnosis. Mostly it feels to me like a waste of resources and a prescription for incorrect diagnoses and repeat visits. I also notice an overuse of antibiotics, a mix of patient expectation and best guessing. On the other hand, since patients pay for testing and for medications, the doctors are making financial decisions in terms of how to give the most care for the least shekels.  So it is complicated at best and I can see that the essentials are covered: pregnant women are taking folic acid and iron, they have prenatal records they bring to each visit wherever that may happen, IUDs are inserted using sterile technique, etc. There are various protocols (women with IUDs are expected to have an ultrasound every six months), and problems related to the upcoming Ramadan, as women do not want to have their menses during Ramadan because they will not be able to fast while bleeding and then have to fast to make up after the holiday.  Progesterone and birth control pills are dispensed freely to bring on early menses or to delay menses according to where women are in their cycles.  A teenager is seen wearing a tee shirt, “Honolulu Wild Surfing is a Way of Life.”  I am sure he has never seen the sea and I want to cry.  A young boy comes in covered with healing chicken pox pustules and then the next patient is a two week old baby.  I jump up and say that we must put a clean drape on the table.  Chicken pox can kill newborns. The clinic has no scale to weigh the newborn, (critical data in terms of adequate weight gain and breast feeding), but the mother is clutching a scrap of paper with the baby’s weight taken two days ago at a Ministry of Health clinic.  Big sigh.  Another woman was seen at a Ministry of Health hospital, was told she had a urinary tract infection and given Xanax, an antianxiety drug rather than an antibiotic.  Another women made the probably arduous trip to a Ministry of Health clinic for a mammogram and was turned away after being told that mammograms are only done on day five of the menstrual cycle! (Really?) There are certainly big issues here with medical standards, quality of care, and coordination. Most women wear colorful hijabs, some with all sorts of decorative sparkles, matching shoes and coats,(there is actually a lot of fashion going on),  a few are covered with a niqab which they flip back on entering the room, some come with mothers or aunts, or an occasional husband.  I study each face, the young often heavily made up and gorgeous, the prematurely older women mostly look tired and weary. One totally covered woman with a sweet, very pale face asks me, “How is America?  Is it comfortable?”  She wants to go live with relatives in Michigan. Exactly what can I tell her? There are tragic stories of long term infertility (very bad in this culture), labs of dubious quality, medications are costly and sometimes just not available.  In the midst of one visit, a slick male drug representative drops in and dumps a pile of free samples on the desk; these will go to the very poor. At the mobile clinic in Kufor Lakef, one of the community based workers is leading a breast feeding support group.  (Yeah!) There are no prenatal classes (that is what mothers and grandmothers are for), no pain relief in labor, and lots of advice from village women, (like taking birth control pills for polycystic ovarian syndrome will cause infertility rather than treat the underlying disease). PMRS has piles of excellent patient education handouts and the doctors do their best given the time available. There are postpartum home visits if women do not live too far from the city.  At the clinic in Tulkarem, we are offered a steady stream of juice, water, tea, coffee, and finally a huge plate of hot manakish, delicious dough that is baked with zetar and cheese, piled in the midst of the charts and medical paraphernalia. In our journeys to these three clinics, most of the checkpoints have hot, bored looking soldiers but we are not stopped.  At Anabta checkpoint at 9 am we see the traffic slowing as we approach the guard tower. The soldiers are setting up “slow down” signs, they are loaded down with all sorts of guns and gear ready for mortal combat amongst all these civilians trying to live their ordinary lives, and mostly we sit and wait for no particular reason.  Maybe because this is a good way to disrupt people trying to get to work?  After 12 minutes, we are waved through without even checking our passports.  I count 52 cars and trucks waiting in the opposite direction.  This is how the IDF maintains total control; because you never know when you will be stopped, turned back, for how long, etc, etc; planning anything is basically a crap shoot.  Our last day with PMRS ends with a discussion and reflection on how to support the Farrah Rehabilitation  Center where my other colleagues have been working for three days with an amazing dedicated staff and devoted parents, and then we go to a “barbeque.”  This involves a bouncing ride to Beit Furiq, a rural village maybe 30 minutes outside of Nablus where the brother of one of the PMRS staff is building a magnificent stone house, all hand carved.  We wander around the unfinished three floors, gasp at the stunning views in all directions, and marvel at the love, skill, and craftsmanship that he is pouring into his future home.  He is an incredibly skilled stone mason. The house has already been spray painted by nearby settlers as part of their “price tag” policy.  They want him to know they are watching; they are offended that he is building on his family property, they may come back, burn his car, trash his house, who knows?  The family remains, undaunted by this threatening behavior. The brother has a zareb, an oven that is a deep pit in the ground where he has created a bed of coals and then lowered down a many layered basket holder, each filled with aromatically flavored chicken, potatoes, carrots, and onions.  They cover this with a concrete top and seal it with dough along the edges.  After 2 ½ hours of baking, this is all opened up and we watch and taste and smell the magnificent meal as it emerges. Then we pile into the cars, shock absorbers challenged, gears grinding, and arrive at another family home where tables are pushed together and the barbequed food is added to an extraordinary array of bread, pickles, and salad and a most amazing Basmati  rice/almond/carrot/corn/onion thing all steamed in chicken broth dish.  (Big wow) The mood is generous and happy, we are repeatedly welcomed and fed and fed some more.  We soon discover there are no plate boundaries and more food than the crowd of guests and family can possibly consume.  Three sisters live here with 18 children and two husbands.  The third husband left for another wife who could provide him with sons.  (Traditional society still hasn’t figured out that the sperm carry the “x” and “y” genes, but I digress.) His first wife is clearly a survivor; she opened a minimart, anchored herself in the bosom of her extended family, and raised her daughters.  Her face is both warm and proud and she looks much older than her 50 years. The men retire to the living room to smoke argila, talk men talk, and the women rearrange the tables and chairs for our coffee klatch and kanafe, a famous Nablus concoction. Children of all ages are constantly in and out, sitting in laps, taking care of each other, sharing candy, crying, laughing, playing.  There is lots of love and physical contact with the little ones.     Back at the airport, there is always a fascinating exhibit of large photos after customs and security, as travelers walk towards the food court.  This year, the exhibit highlights Israeli sports, “A story in pictures.”  There is the tribute to the eleven slain athletes in the Munich Olympics and lofty text about how sports are part of the “national ethos,” part of the Israeli culture of struggle and winning. The images are inspirational and multicultural: women swimmers and weight lifters, girls in hijabs playing football, various wheelchair athletes, coed rowing, but mostly strong, handsome, powerful men doing great athletic feats. This is the message the Israeli tourist authorities want us to leave with: a vibrant, struggling, modern, democratic country that knows how to win and win big. On the other hand, I am thinking about the meaning of resistance: the kind that involves getting up every morning, taking care of your children, picking your olive trees, celebrating every wedding, waiting at checkpoints without losing your mind, refusing to bend.  I think about the Palestinians and Israeli supporters who are stubbornly working on the boycott, divestment, sanction movement, (McDonalds just announced that they will not open shops in the settlements); the students I met in buses and guest houses, studying English literature or communication at Birzeit University, getting their masters degrees, plotting PhDs in London, refusing to be hopeless; the film makers telling the stories over and over again. I think about the women coming for prenatal care, IUDs in, out, creating the next generation that will live on this land, deeply connected to place and history.  This is a powerful stubbornness. I fully understand that the political and societal issues for Palestinians are vexing and complicated. Everyone I talk with speaks of the current political leadership with a mixture of disgust and cynicism and there is definitely a weariness and hopelessness present much of the time, but there is also joy and creativity and determination.   For me, being on the ground, bearing witness, and joining in solidarity work, this refusal to bend is really inspirational.  Today, I notice that I do not have my usual gut gripping airport anxiety, maybe because I have chronicled this struggle each day, hit the cathartic “send” button, using my voice as the most powerful weapon I have.  My traveling partner is wearing a tee shirt she bought that is emblazed with “Free Palestine” and a big graphic of Handala, the symbol of resistance.  She has it on inside out so security will not find it in her suitcase, but she is standing proudly in line and I know it is there.  Another piece of resistance.  I deeply believe that every bit counts; this is about moving mountains one rock at a time; about using these rocks to build bridges rather than walls, about using our American privilege to support the people that are engaged in a struggle that is far more critical to the survival of everyone in this region than the sky diving, archery, and acrobatics highlighted in the image making that bids us goodbye.