Blog # 32 June 26, 2014 part two
The darkest aspects of human experience
I have been thinking a lot about torture lately, given the three murdered Israeli settlers and the most likely revenge killing of a Palestinian teen burned to death and then his American cousin beaten to a pulp (check the photos) by Israeli security and if you should come across the website of PCHR (the Palestinian Center for Human Rights), this is merely the tip of an enormous iceberg of human violence and suffering.
As I write this blog entry (belatedly), it is actually fitting that on June 26, a number of us were invited to a conference hosted by the Treatment and Rehabilitation Center for Victims of Torture in Ramallah and we are sitting in a large auditorium at the Red Crescent Society in Al Bireh. A lovely Al Quds medical student is translating quietly as we lean towards her and some of the talks are thankfully in English. I will do the best I can here.
There are many professional looking types, men and women, and two rows of guys in army green and berets, apparently soldiers from the Palestinian Authority also have a lot to learn about torture, prevention, and treatment. On the stage I recognize Dr. Mustafa Barghouti who founded the Palestinian Medical Relief Society and is a political leader (you might hear him on NPR for instance as an articulate voice of reason), Dr. Mahmoud Suheil, the psychiatrist who is the head of the center, and a man from the European Union who spoke at a Birzeit Heritage festival we attended a few days ago. We all stand for a bout of patriotic music, the cameras roll, and the conference officially begins.
Today is the annual international day in support of victims of torture. The EU speaker talks about how torture is abhorrent, against moral and ethical values, “it destroys the victim and dehumanizes the torturer, and undermines the state that tolerates it. Torture is also a crime under international human rights law and unlike many other human rights, there are no exceptions or no justifications to make the unacceptable, acceptable.” He notes that, “these are easy words, the real question is how to combat torture effectively.”
He suggests that torture has to be addressed at different levels that include legal regulations where torture is prohibited by law and mechanisms need to be in place to make sure this is applied. It is also critical to have transparency, bringing to light behaviors at police stations and other places of detention. He asserts that civil society has a role to play here; this work requires public awareness of what torture does to people; this is a constant task, human rights values need to be frequently restated.
In 2013 President Abbas decreed a prohibition on torture and in April 2014 Palestine ratified the UN convention against torture. (The US and Israel signed decades ago for what it is worth.) He notes these are important developments but more needs to happen as Palestinian civil society has regularly reported the use of torture by its own security forces as well as by Israeli forces. He notes that the European Union has regularly criticized Israel regarding the conditions under which Palestinian prisoners are held and the use of administrative detention, he congratulates the treatment center and its partners that “deal on a daily basis with some of the darkest aspects of human experience.” I wonder where is the voice of the US at an important conference like this?
The next series of speakers are talking in Arabic and their main points revolve around the destructive Israeli practices of child arrests, the killing of young children, and the re-arresting of prisoners who were freed in previous deals. There is then a long presentation on Palestinian and international rules, laws, contracts, etc, the bad things that have happened, the need for respect for women’s rights, the illegal torture of Palestinians in Palestinians prisons and appalling Israeli policies and house demolitions.
I am looking through the conference literature and learn that the Treatment and Rehabilitation Center was founded in 1997 to defend human rights, to build a society free from torture through community awareness and education. Their tasks focus on: violence against prisoners, the wounded, families of martyrs, victims of the Apartheid Wall, road blocks, settler attacks, etc. They also offer treatment and support to victims and their families and focus on therapy and rehabilitation, medical and psychological. I am puzzled as someone appears to be setting up an electric piano on the stage.
A woman talks of transitional justice, the need to create official strategies to identify torture, to fix societies that are suffering and to compensate victims. For victims, the torturer needs to be punished and the victim compensated. She notes that with the ongoing history of torture, this will lead to a loss of trust between individuals and society. She acknowledges that the divisions between Fatah and Hamas have created many victims and many people have been hurt.
After apologies to all the people who were unable to get to the conference due to the heightened delays and blocks at checkpoints, it is apparently time for the entertainment. A singing group from an Najah University in Nablus, two women in gorgeous embroidered Palestinian dresses and one man playing the thing that looked like an electric piano but clearly is something else, pour their hearts into the music, giving voice and feeling to a society filled with pain and joy. This is all pretty extraordinary.
The second part of the conference is focused on treatment for prisoners and their families, “who are not sick, but suffering.” They talk about men released from prison after over ten years who have never seen a smart phone, have had years of solitary confinement, physical, and psychological suffering, whose families were not allowed to visit. “But what about the feeling about the father, thinking about his kids, what has happened to them, what kind of treatment they can do to support them. They are suffering from beating, abused, not eating or inedible food. Some have abdominal pains due to bad food and no exercise and that makes it worse. The air is stagnant, six people in a room, health worsens.”
The Center is doing awareness campaigns about the torture prisoners are facing, they have branches in places like Nablus, Jenin, and Ramallah, they offer outreach, go to the homes of the prisoners and families, talk to them, many do not have money to go to the center. The staff also uses psychotherapy, ie. cognitive behavioral therapy, and send staff to Norway to practice and learn to do therapy. Their group includes a psychiatrist, psychologists; they discuss each case and plan treatment, possible medications, psychotherapy, etc. The main goal is to make the victim feel better so he/she can go back to a normal routine and return to society.
The speaker gives a poignant example: one person spent thirteen years in prison, his oldest child was five and now he is 18, “so he will not feel like the father, lost that feeling. The child is used to the absence of the father, he [the father] is not used to being ignored and not asked and is shocked, so he feels like a piece of furniture. He is not asked to participate in family as they are used to being without him.”
When the psychiatrist determines that the released prisoner is ready, he/she is offered professional rehabilitation: the prisoners are paid a monthly income and offered courses to be able to work in their desired field, “so they will be productive in building a future, they want to become productive.” Specialists follow the prisoner and evaluate the results and adjust the treatment program. The
speaker is intelligent and articulate, the audience nods in agreement, and I have a sense that this a group of sincere, decent, professionals honestly working to better the lives of victims and their difficult society.
“The wife of the prisoner, she is the hero, but in the shadow. She is fighting alone to raise the kids, work, so the center is trying to offer the wife work options, ie, sewing in a salon, which is in her home, so her kids are close, she can care for the kids and have an income while the husband is in prison.”
There are more presentations about the legalities and international laws and the groups that monitor conditions. There are human rights committees that write reports in cooperation with organizations like Physicians for Human Rights Israel, “track all the kinds of violations and torture, in order to find the truth, and follow those reports to see more details, in front of government to take action. The torturer should know that he is going to be punished and is not protected.”
Another speaker notes that in the news recently, “there is an increase of family fights that result in killing, so violence has increased in Palestine, girls are being raped. So the laws must be followed, the killer needs to be punished, otherwise the family takes justice in their own hands and this is dangerous.”
There is more discussion about the deaths of Palestinians in Israeli prisons due to inappropriate medical care, the lack of punishment or accountability, the current prisoner hunger strike, the fact that Israeli violations are allowed because they are in power, the possible forced feeding legislation. “It is the worst occupation in history. It is not impossible emotionally to hope for Palestinian society without torture.”
“Even any kind of reporting to Israeli institutions lead to nowhere. So it is time to do it ourselves by legal means.”
Another speaker clearly is more agitated. He talks about the continued cases of torture by Palestinians in Palestinian jails. Of the havoc in Israeli jails and the need to use international committees and the media. “If the torturer is not punished, the Palestinian can track them down using international organizations and other countries and laws. Using the law we can find those murdered in Israeli prisoners who abuse prisoners and try to stop this. During interrogation they torture them until they die.” He describes “Israel [as] a country of killing, torture, destruction, but we are strong and it is our turn to act, to make the laws and the policy.” I can sense his outrage, voice rising in anger and frustration. He ends with the three kidnapped Israeli settlers and the difference in the international response when Palestinians are the victims. “When Israeli kills our children or rearrests prisoners, this is war, it is our right to ask for help through media as well.”
The last speaker (before more singing) is a freed prisoner. I brace myself for some horrific litany of pain and suffering, the conference has already felt quite overwhelming and my professional boundaries are fraying. The young man begins by reading from the Quran; he explains, “One can face many difficulties, but if there is a huge trauma those who are patient, Allah promises them with heaven.” He talks about the years when water was his only mirror, his speech is urgent and passionate, and soon I realize that it is all poetry and metaphor, filled with feeling and woundedness, the child inside longing for freedom and land, a symphony of words, all beauty and inspiration. A true survivor.
Sunday, July 13, 2014
Saturday, July 12, 2014
Blog # 31 June 26, 2014 First/third world medicine
Blog # 31 June 26, 2014
First/third world medicine
The newly built Ministry of Health Palestine Medical Complex is filled with all the expected contradictions of building a health care system under occupation in what is ironically a third world kind of setting. We are getting the grand tour from a medical student who did his internship here, “lots of experience, low quality.” The impressively clean, modern, white stone facilities were built in 2010, merging a Ministry of Health hospital and a private hospital (donated by an American) in Ramallah. At the gate there is a sign: "Palestine Medical Complex is Smoking Free Area,” (insha’allah as they say here).
I have a particular interest in quality improvement, (I understand why things are the way they are, but how does health care move forward, even here), and we are soon meeting with Rebhe Bsharat, a PhD in a white coat, short mustache, and warm friendly manner who is in charge of quality and education for nursing. He reviews the different wings of the hospital, including pediatrics, surgery, emergency, general medicine, the ICUs, dialysis units, triage beds, etc, etc. All the trappings of a 21st century medical center. They have 126,000 emergency visits, 200,000 outpatient visits, 27,600 admissions, and 7,000 surgical cases per year.
Quality assurance (which is part of the quality improvement lingo) has been a focus at the hospital for the past three years. Apparently the World Health Organization has a program for “Patient safety friendly hospitals” with lists of standards to be met. In the US over the past few decades, the whole focus on improving the quality of care has been to turn from blaming the “bad doctor who screwed up,” which encourages a culture of secrecy and condemnation, to assuming that most clinicians are doing the best they can under challenging circumstances. Thus the task is to analyze how the system of care makes errors more likely, (different medications with similar names and labeling sitting next to each other on the shelf), and how to make systematic changes to reduce error, (make the labels different colors and put the medications on different shelves.) This obviously has the potential to encourage a culture of joint cooperation and more creative thinking and has the potential to actually make care safer.
Rebhe admits that there a lot of challenges because this approach involves changing the culture and attitudes of the providers. I am so excited to learn that one of their quality improvement programs is focused on hand washing. As a point of explanation, one of my major concerns having worked and observed in clinics and hospitals all over the West Bank, is the fact that almost no one washes their hands before or after seeing patients. As you may imagine, this drives me crazy. This is a preventable risk factor. As a firm believer in the germ theory, it seems to me that even under occupation, clinicians could and should wash their hands and if there is no water, I have been known to leave bottles of Purell on doctors’ desks as a personal contribution to fighting infection.
So you can imagine my delight on seeing a poster in a ward headed with a logo and “Palestine Medical Complex,” with a circle filled with bugs and a slash across it, followed by large letters: no germs allowed, WASH YOUR HANDS and some official signature. It really doesn’t take much to make me happy. As expected, the initial surveys revealed that 20% of doctors and 50% of nurses washed their hands, so now there are weekly lectures, monthly meetings, and patient safety protocols, all good things. Older doctors (like doctors everywhere) pushed back but the trends are good.
Rebhe explores some of the challenges nurses face. He lives in a small village and because it takes between 30 minutes and three hours to get to work, (depending on the checkpoints), the previous shift just has to continue working until the next shift shows up. There are 300 nurses, half have a two year diploma, half have a BA, 55% are women, 20% are over 40. Many work here for ten years or so and then return to their cities or villages. They all need continuing education programs, want better patient education publications and discharge planning and these are in the pipelines. Rebhe was trained in Baghdad and Turkey as high level degrees are not available in the occupied territories and his thesis was on effective planning for cardiac surgery. Meanwhile he is trying to get folks to wash their hands.
We tour the wards and I am impressed with their order and cleanliness, (an incredible contrast to older Ministry of Health hospitals I have seen). The pediatric unit has 40 beds, but only 30 are used due to lack of staff. They receive referrals from all over the West Bank. There is supposed to be one nurse for five patients, but the reality is one nurse for twelve patients, (safe staffing anyone?) Bears, ducks, Disney-like princesses, and Winnie the Pooh (how did he get here?) cheerfully decorate the walls. There are no psychiatrists or social workers and frequent shortages of medications. Today the Ministry of Health doctors are on strike, the outpatient unit is closed and only emergencies are being seen. The month long strike is over salaries and no resolution is in sight. (Jolt of reality.) Politics and medicine, the challenges continue on so many levels, and the patients and staff pay the price. It seems they keep on hoping, keep on praying, keep on showing up for work (sometimes) and for care (always). Alhamdulillah. What else is there to do?
First/third world medicine
The newly built Ministry of Health Palestine Medical Complex is filled with all the expected contradictions of building a health care system under occupation in what is ironically a third world kind of setting. We are getting the grand tour from a medical student who did his internship here, “lots of experience, low quality.” The impressively clean, modern, white stone facilities were built in 2010, merging a Ministry of Health hospital and a private hospital (donated by an American) in Ramallah. At the gate there is a sign: "Palestine Medical Complex is Smoking Free Area,” (insha’allah as they say here).
I have a particular interest in quality improvement, (I understand why things are the way they are, but how does health care move forward, even here), and we are soon meeting with Rebhe Bsharat, a PhD in a white coat, short mustache, and warm friendly manner who is in charge of quality and education for nursing. He reviews the different wings of the hospital, including pediatrics, surgery, emergency, general medicine, the ICUs, dialysis units, triage beds, etc, etc. All the trappings of a 21st century medical center. They have 126,000 emergency visits, 200,000 outpatient visits, 27,600 admissions, and 7,000 surgical cases per year.
Quality assurance (which is part of the quality improvement lingo) has been a focus at the hospital for the past three years. Apparently the World Health Organization has a program for “Patient safety friendly hospitals” with lists of standards to be met. In the US over the past few decades, the whole focus on improving the quality of care has been to turn from blaming the “bad doctor who screwed up,” which encourages a culture of secrecy and condemnation, to assuming that most clinicians are doing the best they can under challenging circumstances. Thus the task is to analyze how the system of care makes errors more likely, (different medications with similar names and labeling sitting next to each other on the shelf), and how to make systematic changes to reduce error, (make the labels different colors and put the medications on different shelves.) This obviously has the potential to encourage a culture of joint cooperation and more creative thinking and has the potential to actually make care safer.
Rebhe admits that there a lot of challenges because this approach involves changing the culture and attitudes of the providers. I am so excited to learn that one of their quality improvement programs is focused on hand washing. As a point of explanation, one of my major concerns having worked and observed in clinics and hospitals all over the West Bank, is the fact that almost no one washes their hands before or after seeing patients. As you may imagine, this drives me crazy. This is a preventable risk factor. As a firm believer in the germ theory, it seems to me that even under occupation, clinicians could and should wash their hands and if there is no water, I have been known to leave bottles of Purell on doctors’ desks as a personal contribution to fighting infection.
So you can imagine my delight on seeing a poster in a ward headed with a logo and “Palestine Medical Complex,” with a circle filled with bugs and a slash across it, followed by large letters: no germs allowed, WASH YOUR HANDS and some official signature. It really doesn’t take much to make me happy. As expected, the initial surveys revealed that 20% of doctors and 50% of nurses washed their hands, so now there are weekly lectures, monthly meetings, and patient safety protocols, all good things. Older doctors (like doctors everywhere) pushed back but the trends are good.
Rebhe explores some of the challenges nurses face. He lives in a small village and because it takes between 30 minutes and three hours to get to work, (depending on the checkpoints), the previous shift just has to continue working until the next shift shows up. There are 300 nurses, half have a two year diploma, half have a BA, 55% are women, 20% are over 40. Many work here for ten years or so and then return to their cities or villages. They all need continuing education programs, want better patient education publications and discharge planning and these are in the pipelines. Rebhe was trained in Baghdad and Turkey as high level degrees are not available in the occupied territories and his thesis was on effective planning for cardiac surgery. Meanwhile he is trying to get folks to wash their hands.
We tour the wards and I am impressed with their order and cleanliness, (an incredible contrast to older Ministry of Health hospitals I have seen). The pediatric unit has 40 beds, but only 30 are used due to lack of staff. They receive referrals from all over the West Bank. There is supposed to be one nurse for five patients, but the reality is one nurse for twelve patients, (safe staffing anyone?) Bears, ducks, Disney-like princesses, and Winnie the Pooh (how did he get here?) cheerfully decorate the walls. There are no psychiatrists or social workers and frequent shortages of medications. Today the Ministry of Health doctors are on strike, the outpatient unit is closed and only emergencies are being seen. The month long strike is over salaries and no resolution is in sight. (Jolt of reality.) Politics and medicine, the challenges continue on so many levels, and the patients and staff pay the price. It seems they keep on hoping, keep on praying, keep on showing up for work (sometimes) and for care (always). Alhamdulillah. What else is there to do?
Thursday, July 10, 2014
Blog # 30 June 25, 2014 part two Medicine: If it doesn't kill you, it makes you strong
Blog # 30 June 25, 2014 part two
Medicine: If it doesn’t kill you, it makes you strong
The meeting with the medical students is not that polite. Now I will grant you they had just finished their exams, (because of the Hebron curfew some had six exams in one day), many were about to graduate, and they are living in a variety of ghettos trying to get an education in an impossible place (and FYI, my recollection of medical school is also filled with anger and frustration and I did not cross one checkpoint). They have a lot to say and are obviously happy that there are some curious people interested in listening. One student describes Al Quds as “six years of hell.” The students from East Jerusalem discuss the frustrations of crossing the Kalandia checkpoint twice a day, most everyone has had some frightening experience with a gun toting Israeli who is also their age and sees every Palestinian as a terrorist, everyone complains about the uptight culture of medicine, (sounds a lot like the hierarchical culture of hospitals in the 1970s), physicians who act “like Gods,” and of course, there are longstanding conflicts with the administration.
As we try to tease apart the miseries of medical school in general, from the miseries of this medical school in this place in particular, certain themes emerge. Al Quds (as opposed to an Najar in Nablus) has no teaching hospital so students get dispersed all over. Students with IDs or permits for East Jerusalem get better clinical rotations and there are no standards or clear cut expectations in the clinical curriculum so the teaching is enormously variable and sometimes totally inadequate. (Pediatrics at Al Mokassed hospital is a glowing exception.) The doctors are often brilliant, have trained in high power institutions abroad, they are very busy, have active private clinics, and teaching med students is often low on their list of priorities. In addition, unlike US hospitals, residents (where they exist) are not required to teach the students, so “everything is personal connection.”
The students would love to see the institution improve and are aware that Al Quds has funding issues; that the Israeli authorities are not allowing them to build a teaching hospital in Jerusalem. It sounds, nonetheless, like there is an unacceptable level of chaos: students talk about being “dumped” in hospitals in Bethlehem and Hebron, then having to rent crowded apartments due to the challenges of getting around. They talk about arbitrary grades, lack of mentors and guidance, and lots of small problems. Everyone plans to train “outside” and everyone “plans to come back.” I love their passion, their rage, and their idealism.
We talk about the challenges for patients. Due to lack of funding, patients having surgery sometimes have to buy their anesthetics, IVs, and pain medicine and bring them to the hospital before the procedure. (As a quick orientation here, the world class Hadassah Hospital is a few miles away and you can be sure they have enough fentanyl and saline to do surgery, but I digress.) Some hospitals have no electricity for two hours per day, (this would certainly crimp a specialist’s style, not to mention some poor patient on a respirator). If a Ministry of Health hospital is unable to perform some type of care, they will refer the patient to a private hospital but the government then fails to pay for the care, so private hospitals have growing loans and debt as they struggle to survive.
And beyond the occupation’s political impact on health care, we start talking about the additional social determinants of health: how all the pollution from prolonged bus and taxi routes, endless idling at checkpoints, huge quarries and stone cutting dust, piles of uncollected garbage, the contaminated (radioactive) water dumped by the Dimona reactor south of Hebron (that would be dumped on Bedouins if I recall), how all this makes people sick. And then they face a health care (non)system that is ill prepared to deal with the totality of disease and its profound and complex etiologies.
No wonder these medical students are not only articulate and smart and ready to take on the world; they are also profoundly angry about all the right things. If these are Palestine’s future doctors, I feel very hopeful for the next generation.
Medicine: If it doesn’t kill you, it makes you strong
The meeting with the medical students is not that polite. Now I will grant you they had just finished their exams, (because of the Hebron curfew some had six exams in one day), many were about to graduate, and they are living in a variety of ghettos trying to get an education in an impossible place (and FYI, my recollection of medical school is also filled with anger and frustration and I did not cross one checkpoint). They have a lot to say and are obviously happy that there are some curious people interested in listening. One student describes Al Quds as “six years of hell.” The students from East Jerusalem discuss the frustrations of crossing the Kalandia checkpoint twice a day, most everyone has had some frightening experience with a gun toting Israeli who is also their age and sees every Palestinian as a terrorist, everyone complains about the uptight culture of medicine, (sounds a lot like the hierarchical culture of hospitals in the 1970s), physicians who act “like Gods,” and of course, there are longstanding conflicts with the administration.
As we try to tease apart the miseries of medical school in general, from the miseries of this medical school in this place in particular, certain themes emerge. Al Quds (as opposed to an Najar in Nablus) has no teaching hospital so students get dispersed all over. Students with IDs or permits for East Jerusalem get better clinical rotations and there are no standards or clear cut expectations in the clinical curriculum so the teaching is enormously variable and sometimes totally inadequate. (Pediatrics at Al Mokassed hospital is a glowing exception.) The doctors are often brilliant, have trained in high power institutions abroad, they are very busy, have active private clinics, and teaching med students is often low on their list of priorities. In addition, unlike US hospitals, residents (where they exist) are not required to teach the students, so “everything is personal connection.”
The students would love to see the institution improve and are aware that Al Quds has funding issues; that the Israeli authorities are not allowing them to build a teaching hospital in Jerusalem. It sounds, nonetheless, like there is an unacceptable level of chaos: students talk about being “dumped” in hospitals in Bethlehem and Hebron, then having to rent crowded apartments due to the challenges of getting around. They talk about arbitrary grades, lack of mentors and guidance, and lots of small problems. Everyone plans to train “outside” and everyone “plans to come back.” I love their passion, their rage, and their idealism.
We talk about the challenges for patients. Due to lack of funding, patients having surgery sometimes have to buy their anesthetics, IVs, and pain medicine and bring them to the hospital before the procedure. (As a quick orientation here, the world class Hadassah Hospital is a few miles away and you can be sure they have enough fentanyl and saline to do surgery, but I digress.) Some hospitals have no electricity for two hours per day, (this would certainly crimp a specialist’s style, not to mention some poor patient on a respirator). If a Ministry of Health hospital is unable to perform some type of care, they will refer the patient to a private hospital but the government then fails to pay for the care, so private hospitals have growing loans and debt as they struggle to survive.
And beyond the occupation’s political impact on health care, we start talking about the additional social determinants of health: how all the pollution from prolonged bus and taxi routes, endless idling at checkpoints, huge quarries and stone cutting dust, piles of uncollected garbage, the contaminated (radioactive) water dumped by the Dimona reactor south of Hebron (that would be dumped on Bedouins if I recall), how all this makes people sick. And then they face a health care (non)system that is ill prepared to deal with the totality of disease and its profound and complex etiologies.
No wonder these medical students are not only articulate and smart and ready to take on the world; they are also profoundly angry about all the right things. If these are Palestine’s future doctors, I feel very hopeful for the next generation.
Tuesday, July 8, 2014
Blog # 29 corrected June 25, 2014 Teaching in the ghetto
Corrected..... Blog # 29 June 25, 2014
Teaching in the ghetto
The Jerusalem neighborhood of Abu Dis ended up on the wrong side of the wall; every time bus #36 from East Jerusalem turns this particular corner and there is the monstrous “barrier” (which is quite a euphemism ) up close and personal, all eight meters high of poured concrete stretching along the edge of the road, (or rather defining the edge of the road and in some ways, the edge of existence), I have the distinct impression that military/city planner types are giving us and all the wrong-side-people, a gigantic concrete finger in the eye. Most of Al Quds University is on the wrong side too, (if you live in Jerusalem and of course on the right side if you live in Ramallah or Tulkarem or Jenin or Hebron). For students who are old enough to remember, getting to school from East Jerusalem used to be easy and quick. Now, the journey involves a long tunnel, skirting Ma’ale Adumim, (one of the largest Jewish settlements or shall we just be honest and say colonies on the West Bank), swinging through Bethany, (the biblical one which seems more industrial, auto shops and less Jesus, Lazarus, and lepers) and making a huge snaking swing east and south to get to the bedraggled neighborhood of Abu Dis. Let’s not even mention the increased use of fuel, the challenged shock absorbers that need constant repair, the choking air pollution, the lost time and rising aggravation, and the need to plan life around buses and permits and when is it safe in the first place to try the daring trip to school. What do these people have to complain about anyway????
We meet with Hani Abdeen, the dignified and somewhat burned out dean of the medical school, neat mustache, wire rimmed glasses, striped shirt, very old school, and I feel like this should be called: soldiering on against all odds. Al Quds Medical School was founded in 1994 and graduated its 14th class last week, for a total of 720 graduates to date. Hani is very pleased with his students. He brags that they do very well on qualifying exams for residencies all over the Western world: Canada, US, Europe, “The students are doing a good job, under duress people excel. We do not have a large faculty, all the resources, teaching materials, yet with all these short comings students do well. In the USMLE (US Medical Licensing Exam) Palestinian students are in the top 1% of foreign graduates.” What doesn’t kill you makes you stronger.
This is of particular interest to me as the health and human rights project was involved in starting an exchange program between Harvard and Al Quds Medical School and the students rotate through Harvard hospitals and receive, “glowing reports.” Hani is very worried that while the medical school is doing a good job, they are essentially, “training doctors for America, there is a big brain drain. Once they see how good life is, the standards of medicine, they leave and stay where they train.” He notes this is a problem for all of the third world.
Sadly, “even if they train, but should come back, we are starved of medical personnel.” Hani notes that there is not one well trained hematologist or nephrologist in the occupied territories, and this is true in much of surgery, medicine, and ob-gyn as well. I am surprised to hear him say, “One way to address this: how to change ratio male to female. He notes that now the med school class is 60% female and he wants to increase this to 75% females, “because they stay, they are more loyal to their societies, stay with families and are more of use to the Palestinian population!” His theory is that females, “do much better on post high school exams, have less diversions, are more focused, while males have other goals, politics, etc.” He wonders if women, “may be more intelligent, or more driven to try to prove themselves.” I am not sure how to wrap my brain around this reverse sexism, but I have to agree, this is a creative solution to a vexing problem. I secretly wonder if once again, women hold up (more than) half the sky, put up with the less dynamic careers and keep the family functional.
“We don’t have good residency training, do not have the hospitals, and Israelis do not let us. Everything you build, then there is a fracas and then the whole thing collapses again. This is a big problem. Two days ago, the IDF entered the university at night, wreaked havoc on the infrastructure,” and they did the same at a university in Jenin and in Bethlehem, (remember the policy of collective punishment). There are repeated mass arrests of students and professors, (collective punishment-still illegal). “Obviously what is happening, the Israelis are not interested in Palestinians having their own entity, all they want is ethnic cleansing, get rid of Palestinians and evict them. We are trying to develop, but nipped in the bud…We are fed up with all this talk about human rights. This is how it is on the ground…It makes your blood boil, there is a limit; what are the Israelis trying to do? They have Nobel laureates, etc, in Israel, but don’t they understand what is going on?”
The grinding reality is revealed by the fact that three weeks ago students were about to start two weeks of final exams. But students from Hebron (25 of 80) couldn’t get permits, so the exams were delayed and now as the clampdown continues, (people with IDs from Hebron are unable to travel), students are taking their exams at home from a computer or on pen and paper (you know, that little problem of needing electricity and internet connection while occupied), so the work is multiplied.
“Imagine [a student] prepared for exam, then cannot take it, then bunched together, this creates psychological trauma, [but] we do not have enough psychiatrists. There is not one child psychiatrist in the occupied territories.” Students get supports from tutors, secretaries. “One of our faculty’s house was ransacked in the night, I do not why.” He lived in Hebron, guilty as charged. “This happened to students’ families as well, imagine preparing for exams, the students 17 to 18 years old,” and then the “oasis of democracy in Mideast” enters their bedrooms at night, finger on the trigger. So what does a 17 year old do with all that trauma and rage?
Hani describes what is going on, “It is madness. We need to educate Israeli society, the majority is ignorant of what is happening in the West Bank. The separation wall is a psychological barrier. They have succeeded, everyone behind the wall is a terrorist, and they are not interested in knowing what is happening. What is needed, to educate Israelis, how to get out of their isolation ghetto mentality. We are also in a ghetto, two ghettos, this is more important than educating the Arab world. Human life is sacred, if you want to live with neighbors peacefully, then why are you doing this… Arabs, what have they done to Israelis? How many [Israelis] killed in buses? They [IDF] killed over a 1,000 people in Gaza. This is disproportionate killings; they are all the same, even doctors are participating in force feeding prisoners.”
Hani’s exasperated frustration is palpable. He states he is, “disenchanted with building bridges, when it comes to the crunch, they are professional killers. It is heart breaking as a medical professional, those people who they are detaining have not participated in any crimes.” There is “no court of law.”
We try to focus on the medical school, a six year program that starts after high school. Hani describes a traditional curriculum that is changing to a more integrated organ-based approach next year. The first three years involve basic sciences, the last three years are clinical. They are also planning on a graduate entry program, four years of medical training after college, like most US programs. Students at Al Quds do their clinical rotations at affiliated hospitals like Al Mokassed, Augusta Victoria, St. Johns, and the Red Crescent Hospital in Jerusalem and hospitals in Hebron, Ramallah, and Jericho in the West Bank. He says there is a curriculum for the different clinical settings, but this is in theory only. The hitch is that the first rate hospitals are all in East Jerusalem, so only the students that can get permits to enter Jerusalem can go on these rotations and the rest of the students are forced to train in what are seen as second rate facilities.
But medical care is even more complicated. The Ministry of Health runs community based clinics and the NGO, Palestinian Medical Relief Society, has clinics that are focused on providing health care to poorly served communities. Hani suggests that all of these settings have issues around quality of care and he wants his students to learn medicine “in a proper manner.” The quality issue is a big one. There are “no post graduate courses here,” no continuing medical education courses, (in the US I am required to do 50 hours of CMEs per year and that is part of the task of staying up to date). Additionally, “Everyone doesn’t have a computer, cannot travel, cannot access villages, so logistics are big problem.” The school has no connection with UNRWA, the UN agency that provides health care in the refugee camps, and that care tends to be low quality, overwhelmed and underfunded.
In Gaza, the medical school, Al Azhar, is under the tutelage of Al Quds and the Hamas run Islamic University also has the same curriculum. (Yes there are medical students filled with aspirations and drive in Gaza and they get caught in the incursions along with everyone else.) Hani reports that the graduates do well despite the conditions, (although the last time I checked, the Gaza hospitals were still recovering from being bombed to smithereens and unable to rebuild basic infrastructure like drinkable water and stocked pharmacies so I suspect he is being a bit upbeat here). There is also a medical school in Nablus, called an Najah.
Hani notes that the French government offers scholarships to two to three postgraduate students a year for PhDs in medical science or specialty training, others go to Jordan or the United Kingdom, “but they never come back.” He explains that the students make commitments to return, but then they buy themselves out. They are the top 1% in Palestine, high achievers, they want to be good doctors, but “our hospitals and infrastructure are not conducive to that. Nursing is not that good, physical therapy is not that good. It is not a solid team, so it is much harder to do medicine here. The pay is better, standard of living, career development all better outside.”
I wonder why Hani is still here. He trained in the United Kingdom, but “my mother was ill and alone so I came back [thinking] I will stay for a year and then I got myself sucked up.” The immense need, the possibility to build something better, the inertia and grinding difficulty of getting through each day let alone planning a career or an escape, the small victories and sense of place, and then family and commitment and decades later…. He finds himself still here, talking politics and medicine with some curious folks from the US who are trying to understand.
Teaching in the ghetto
The Jerusalem neighborhood of Abu Dis ended up on the wrong side of the wall; every time bus #36 from East Jerusalem turns this particular corner and there is the monstrous “barrier” (which is quite a euphemism ) up close and personal, all eight meters high of poured concrete stretching along the edge of the road, (or rather defining the edge of the road and in some ways, the edge of existence), I have the distinct impression that military/city planner types are giving us and all the wrong-side-people, a gigantic concrete finger in the eye. Most of Al Quds University is on the wrong side too, (if you live in Jerusalem and of course on the right side if you live in Ramallah or Tulkarem or Jenin or Hebron). For students who are old enough to remember, getting to school from East Jerusalem used to be easy and quick. Now, the journey involves a long tunnel, skirting Ma’ale Adumim, (one of the largest Jewish settlements or shall we just be honest and say colonies on the West Bank), swinging through Bethany, (the biblical one which seems more industrial, auto shops and less Jesus, Lazarus, and lepers) and making a huge snaking swing east and south to get to the bedraggled neighborhood of Abu Dis. Let’s not even mention the increased use of fuel, the challenged shock absorbers that need constant repair, the choking air pollution, the lost time and rising aggravation, and the need to plan life around buses and permits and when is it safe in the first place to try the daring trip to school. What do these people have to complain about anyway????
We meet with Hani Abdeen, the dignified and somewhat burned out dean of the medical school, neat mustache, wire rimmed glasses, striped shirt, very old school, and I feel like this should be called: soldiering on against all odds. Al Quds Medical School was founded in 1994 and graduated its 14th class last week, for a total of 720 graduates to date. Hani is very pleased with his students. He brags that they do very well on qualifying exams for residencies all over the Western world: Canada, US, Europe, “The students are doing a good job, under duress people excel. We do not have a large faculty, all the resources, teaching materials, yet with all these short comings students do well. In the USMLE (US Medical Licensing Exam) Palestinian students are in the top 1% of foreign graduates.” What doesn’t kill you makes you stronger.
This is of particular interest to me as the health and human rights project was involved in starting an exchange program between Harvard and Al Quds Medical School and the students rotate through Harvard hospitals and receive, “glowing reports.” Hani is very worried that while the medical school is doing a good job, they are essentially, “training doctors for America, there is a big brain drain. Once they see how good life is, the standards of medicine, they leave and stay where they train.” He notes this is a problem for all of the third world.
Sadly, “even if they train, but should come back, we are starved of medical personnel.” Hani notes that there is not one well trained hematologist or nephrologist in the occupied territories, and this is true in much of surgery, medicine, and ob-gyn as well. I am surprised to hear him say, “One way to address this: how to change ratio male to female. He notes that now the med school class is 60% female and he wants to increase this to 75% females, “because they stay, they are more loyal to their societies, stay with families and are more of use to the Palestinian population!” His theory is that females, “do much better on post high school exams, have less diversions, are more focused, while males have other goals, politics, etc.” He wonders if women, “may be more intelligent, or more driven to try to prove themselves.” I am not sure how to wrap my brain around this reverse sexism, but I have to agree, this is a creative solution to a vexing problem. I secretly wonder if once again, women hold up (more than) half the sky, put up with the less dynamic careers and keep the family functional.
“We don’t have good residency training, do not have the hospitals, and Israelis do not let us. Everything you build, then there is a fracas and then the whole thing collapses again. This is a big problem. Two days ago, the IDF entered the university at night, wreaked havoc on the infrastructure,” and they did the same at a university in Jenin and in Bethlehem, (remember the policy of collective punishment). There are repeated mass arrests of students and professors, (collective punishment-still illegal). “Obviously what is happening, the Israelis are not interested in Palestinians having their own entity, all they want is ethnic cleansing, get rid of Palestinians and evict them. We are trying to develop, but nipped in the bud…We are fed up with all this talk about human rights. This is how it is on the ground…It makes your blood boil, there is a limit; what are the Israelis trying to do? They have Nobel laureates, etc, in Israel, but don’t they understand what is going on?”
The grinding reality is revealed by the fact that three weeks ago students were about to start two weeks of final exams. But students from Hebron (25 of 80) couldn’t get permits, so the exams were delayed and now as the clampdown continues, (people with IDs from Hebron are unable to travel), students are taking their exams at home from a computer or on pen and paper (you know, that little problem of needing electricity and internet connection while occupied), so the work is multiplied.
“Imagine [a student] prepared for exam, then cannot take it, then bunched together, this creates psychological trauma, [but] we do not have enough psychiatrists. There is not one child psychiatrist in the occupied territories.” Students get supports from tutors, secretaries. “One of our faculty’s house was ransacked in the night, I do not why.” He lived in Hebron, guilty as charged. “This happened to students’ families as well, imagine preparing for exams, the students 17 to 18 years old,” and then the “oasis of democracy in Mideast” enters their bedrooms at night, finger on the trigger. So what does a 17 year old do with all that trauma and rage?
Hani describes what is going on, “It is madness. We need to educate Israeli society, the majority is ignorant of what is happening in the West Bank. The separation wall is a psychological barrier. They have succeeded, everyone behind the wall is a terrorist, and they are not interested in knowing what is happening. What is needed, to educate Israelis, how to get out of their isolation ghetto mentality. We are also in a ghetto, two ghettos, this is more important than educating the Arab world. Human life is sacred, if you want to live with neighbors peacefully, then why are you doing this… Arabs, what have they done to Israelis? How many [Israelis] killed in buses? They [IDF] killed over a 1,000 people in Gaza. This is disproportionate killings; they are all the same, even doctors are participating in force feeding prisoners.”
Hani’s exasperated frustration is palpable. He states he is, “disenchanted with building bridges, when it comes to the crunch, they are professional killers. It is heart breaking as a medical professional, those people who they are detaining have not participated in any crimes.” There is “no court of law.”
We try to focus on the medical school, a six year program that starts after high school. Hani describes a traditional curriculum that is changing to a more integrated organ-based approach next year. The first three years involve basic sciences, the last three years are clinical. They are also planning on a graduate entry program, four years of medical training after college, like most US programs. Students at Al Quds do their clinical rotations at affiliated hospitals like Al Mokassed, Augusta Victoria, St. Johns, and the Red Crescent Hospital in Jerusalem and hospitals in Hebron, Ramallah, and Jericho in the West Bank. He says there is a curriculum for the different clinical settings, but this is in theory only. The hitch is that the first rate hospitals are all in East Jerusalem, so only the students that can get permits to enter Jerusalem can go on these rotations and the rest of the students are forced to train in what are seen as second rate facilities.
But medical care is even more complicated. The Ministry of Health runs community based clinics and the NGO, Palestinian Medical Relief Society, has clinics that are focused on providing health care to poorly served communities. Hani suggests that all of these settings have issues around quality of care and he wants his students to learn medicine “in a proper manner.” The quality issue is a big one. There are “no post graduate courses here,” no continuing medical education courses, (in the US I am required to do 50 hours of CMEs per year and that is part of the task of staying up to date). Additionally, “Everyone doesn’t have a computer, cannot travel, cannot access villages, so logistics are big problem.” The school has no connection with UNRWA, the UN agency that provides health care in the refugee camps, and that care tends to be low quality, overwhelmed and underfunded.
In Gaza, the medical school, Al Azhar, is under the tutelage of Al Quds and the Hamas run Islamic University also has the same curriculum. (Yes there are medical students filled with aspirations and drive in Gaza and they get caught in the incursions along with everyone else.) Hani reports that the graduates do well despite the conditions, (although the last time I checked, the Gaza hospitals were still recovering from being bombed to smithereens and unable to rebuild basic infrastructure like drinkable water and stocked pharmacies so I suspect he is being a bit upbeat here). There is also a medical school in Nablus, called an Najah.
Hani notes that the French government offers scholarships to two to three postgraduate students a year for PhDs in medical science or specialty training, others go to Jordan or the United Kingdom, “but they never come back.” He explains that the students make commitments to return, but then they buy themselves out. They are the top 1% in Palestine, high achievers, they want to be good doctors, but “our hospitals and infrastructure are not conducive to that. Nursing is not that good, physical therapy is not that good. It is not a solid team, so it is much harder to do medicine here. The pay is better, standard of living, career development all better outside.”
I wonder why Hani is still here. He trained in the United Kingdom, but “my mother was ill and alone so I came back [thinking] I will stay for a year and then I got myself sucked up.” The immense need, the possibility to build something better, the inertia and grinding difficulty of getting through each day let alone planning a career or an escape, the small victories and sense of place, and then family and commitment and decades later…. He finds himself still here, talking politics and medicine with some curious folks from the US who are trying to understand.
Blog # 29 June 25, 2014 Teaching in the ghetto
Blog # 29 June 25, 2014
Teaching in the ghetto
The Jerusalem neighborhood of Abu Dis ended up on the wrong side of the wall; every time bus #36 from East Jerusalem turns this particular corner and there is the monstrous “barrier” (which is quite a euphemism ) up close and personal, all eight meters high of poured concrete stretching along the edge of the road, (or rather defining the edge of the road and in some ways, the edge of existence), I have the distinct impression that military/city planner types are giving us and all the wrong-side-people, a gigantic concrete finger in the eye. Most of Al Quds University is on the wrong side too, (if you live in Jerusalem and of course on the right side if you live in Ramallah or Tulkarem or Jenin or Hebron). For students who are old enough to remember, getting to school from East Jerusalem used to be easy and quick. Now, the journey involves a long tunnel, skirting Ma’ale Adumim, (one of the largest Jewish settlements or shall we just be honest and say colonies on the West Bank), swinging through Bethany, (the biblical one which seems more industrial, auto shops and less Jesus, Lazarus, and lepers) and making a huge snaking swing east and south to get to the bedraggled neighborhood of Abu Dis. Let’s not even mention the increased use of fuel, the challenged shock absorbers that need constant repair, the choking air pollution, the lost time and rising aggravation, and the need to plan life around buses and permits and when is it safe in the first place to try the daring trip to school. What do these people have to complain about anyway????
We meet with Hani Abdeen, the dignified and somewhat burned out dean of the medical school, neat mustache, wire rimmed glasses, striped shirt, very old school, and I feel like this should be called: soldiering on against all odds. Al Quds Medical School was founded in 1994 and graduated its 14th class last week, for a total of 720 graduates to date. Hani is very pleased with his students. He brags that they do very well on qualifying exams for residencies all over the Western world: Canada, US, Europe, “The students are doing a good job, under duress people excel. We do not have a large faculty, all the resources, teaching materials, yet with all these short comings students do well. In the USMLE (US Medical Licensing Exam) Palestinian students are in the top 1% of foreign graduates.” What doesn’t kill you makes you stronger.
This is of particular interest to me as the health and human rights project was involved in starting an exchange program between Harvard and Al Quds Medical School and the students rotate through Harvard hospitals and receive, “glowing reports.” Hani is very worried that while the medical school is doing a good job, they are essentially, “training doctors for America, there is a big brain drain. Once they see how good life is, the standards of medicine, they leave and stay where they train.” He notes this is a problem for all of the third world.
Sadly, “even if they train, but should come back, we are starved of medical personnel.” Hani notes that there is not one well trained hematologist or nephrologist in the occupied territories, and this is true in much of surgery, medicine, and ob-gyn as well. I am surprised to hear him say, “One way to address this: how to change ratio male to female. He notes that now the med school class is 60% female and he wants to increase this to 75% females, “because they stay, they are more loyal to their societies, stay with families and are more of use to the Palestinian population!” His theory is that females, “do much better on post high school exams, have less diversions, are more focused, while males have other goals, politics, etc.” He wonders if women, “may be more intelligent, or more driven to try to prove themselves.” I am not sure how to wrap my brain around this reverse sexism, but I have to agree, this is a creative solution to a vexing problem. I secretly wonder if once again, women hold up (more than) half the sky, put up with the less dynamic careers and keep the family functional.
“We don’t have good residency training, do not have the hospitals, and Israelis do not let us. Everything you build, then there is a fracas and then the whole thing collapses again. This is a big problem. Two days ago, the IDF entered the university at night, wreaked havoc on the infrastructure,” and they did the same at a university in Jenin and in Bethlehem, (remember the policy of collective punishment). There are repeated mass arrests of students and professors, (collective punishment-still illegal). “Obviously what is happening, the Israelis are not interested in Palestinians having their own entity, all they want is ethnic cleansing, get rid of Palestinians and evict them. We are trying to develop, but nipped in the bud…We are fed up with all this talk about human rights. This is how it is on the ground…It makes your blood boil, there is a limit; what are the Israelis trying to do? They have Nobel laureates, etc, in Israel, but don’t they understand what is going on?”
The grinding reality is revealed by the fact that three weeks ago students were about to start two weeks of final exams. But students from Hebron (25 of 80) couldn’t get permits, so the exams were delayed and now as the clampdown continues, (people with IDs from Hebron are unable to travel), students are taking their exams at home from a computer or on pen and paper (you know, that little problem of needing electricity and internet connection while occupied), so the work is multiplied.
“Imagine [a student] prepared for exam, then cannot take it, then bunched together, this creates psychological trauma, [but] we do not have enough psychiatrists. There is not one child psychiatrist in the occupied territories.” Students get supports from tutors, secretaries. “One of our faculty’s house was ransacked in the night, I do not why.” He lived in Hebron, guilty as charged. “This happened to students’ families as well, imagine preparing for exams, the students 17 to 18 years old,” and then the “oasis of democracy in Mideast” enters their bedrooms at night, finger on the trigger. So what does a 17 year old do with all that trauma and rage?
Hani describes what is going on, “It is madness. We need to educate Israeli society, the majority is ignorant of what is happening in the West Bank. The separation wall is a psychological barrier. They have succeeded, everyone behind the wall is a terrorist, and they are not interested in knowing what is happening. What is needed, to educate Israelis, how to get out of their isolation ghetto mentality. We are also in a ghetto, two ghettos, this is more important than educating the Arab world. Human life is sacred, if you want to live with neighbors peacefully, then why are you doing this… Arabs, what have they done to Israelis? How many [Israelis] killed in buses? They [IDF] killed over a 1,000 people in Gaza. This is disproportionate killings; they are all the same, even doctors are participating in force feeding prisoners.”
Hani’s exasperated frustration is palpable. He states he is, “disenchanted with building bridges, when it comes to the crunch, they are professional killers. It is heart breaking as a medical professional, those people who they are detaining have not participated in any crimes.” There is “no court of law.”
We try to focus on the medical school, a six year program that starts after high school. Hani describes a traditional curriculum that is changing to a more integrated organ-based approach next year. The first three years involve basic sciences, the last three years are clinical. They are also planning on a graduate entry program, four years of medical training after college, like most US programs. Students at Al Quds do their clinical rotations at affiliated hospitals like Al Mokassed, Augusta Victoria, St. Johns, and the Red Crescent Hospital in Jerusalem and hospitals in Hebron, Ramallah, and Jericho in the West Bank. He says there is a curriculum for the different clinical settings, but this is in theory only. The hitch is that the first rate hospitals are all in East Jerusalem, so only the students that can get permits to enter Jerusalem can go on these rotations and the rest of the students are forced to train in what are seen as second rate facilities.
But medical care is even more complicated. The Ministry of Health runs community based clinics and the NGO, Palestinian Medical Relief Society, has clinics that are focused on providing health care to poorly served communities. Hani suggests that all of these settings have issues around quality of care and he wants his students to learn medicine “in a proper manner.” The quality issue is a big one. There are “no post graduate courses here,” no continuing medical education courses, (in the US I am required to do 50 hours of CMEs per year and that is part of the task of staying up to date). Additionally, “Everyone doesn’t have a computer, cannot travel, cannot access villages, so logistics are big problem.” The school has no connection with UNRWA, the UN agency that provides health care in the refugee camps, and that care tends to be low quality, overwhelmed and underfunded.
In Gaza, the medical school, Al Azhar, is under the tutelage of Al Quds and the Hamas run Islamic University also has the same curriculum. (Yes there are medical students filled with aspirations and drive in Gaza and they get caught in the incursions along with everyone else.) Hani reports that the graduates do well despite the conditions, (although the last time I checked, the Gaza hospitals were still recovering from being bombed to smithereens and unable to rebuild basic infrastructure like drinkable water and stocked pharmacies so I suspect he is being a bit upbeat here). There is also a medical school in Nablus, called an Najah.
Hani notes that the French government offers scholarships to two to three postgraduate students a year for PhDs in medical science or specialty training, others go to Jordan or the United Kingdom, “but they never come back.” He explains that the students make commitments to return, but then they buy themselves out. They are the top 1% in Palestine, high achievers, they want to be good doctors, but “our hospitals and infrastructure are not conducive to that. Nursing is not that good, physical therapy is not that good. It is not a solid team, so it is much harder to do medicine here. The pay is better, standard of living, care
Monday, July 7, 2014
Blog # 28 June 24, 2014 Traveling while occupied
Blog # 28 June 24, 2014
Traveling while occupied
Blogging retrospectively is a challenge, I am reporting from the ground and the ground is in constant seismic shift mode.
Let me acknowledge that the deaths of the three kidnapped Israeli youths Gil-Ad Shaer, Naftali Fraenkel, and Eyal Yifrah provided the Israeli leadership with the opportunity to unleash a horrific barrage of military might, home incursions, arrests, and killings that had little to do with a careful investigation of the crime and the capture of the perpetrators. Collective punishment is still all the rage and at this point I would just call it official policy. Even the Israeli generals are trying to tone down the let’s destroy Hamas rhetoric coming out of our dear Prime Minister’s mouth. The abduction, killing and burning of Mohammed Abu Khdeir, on the other hand, is being approached in a totally different manner; there is the police statement that they are not sure if the murder was “nationalistic” ie done by an Israeli, or “criminal” ie done by a Palestinian. Then there was the false rumor put out by the police that Mohammed was gay and that this was some kind of revenge killing by the homophobic family. (not) To the Palestinians in Shuafat, a neighborhood of East Jerusalem, this is clearly a revenge killing and to my eye, given the explosion of Arab hatred, the attempt two days earlier to kidnap a ten year old called Mousa Zalum, (his parents called the police, no one responded), and the gangs of right wing Jewish teenagers roaming the streets of Jerusalem chanting “Death to the Arabs!” I vote with the Palestinians. Maybe we should just go demolish a few Israeli homes and arrest a bunch of teenagers, probably start with the lovelies in Hebron and Kiryat Arba, oh, but we don’t do that to Jews. As East Jerusalem explodes, the police use live fire on the inhabitants in the neighborhood, (ID carriers and Israeli citizens), (also read: not Jews).
To give this a little context, according to official statistics, since September 2000, more than 1,400 Palestinian children have been killed by the Israeli military, which is equivalent to one child killed every three days, and some 6,000 injured in the past 13 or so years. I think a year of national mourning is in order but this is a military occupation and well, what can I say about who counts and who doesn’t. Which brings us to some other realities of daily life.
I was hoping to tell you more about the realities of occupation, in particular, traveling while occupied. I (and every Palestinian I know) always dreads Kalandia checkpoint, the major checkpoint between Jerusalem and Ramallah. It is a chaotic, traffic plagued, military terminal with guard towers and concrete walls and grimy garbage and narrow turnstiles, and people waiting, waiting, waiting. Faces range from utter resignation and defeat to outright indignation and rage. I vary.
There is a sign on entry that says in English and Arabic: “Please keep terminal clean,” but the Hebrew reads: “Please keep order and cleanliness.” Can’t trust those frisky Arabs to stay in line. People queue in narrow chutes, two to three feet wide, with vertical floor to ceiling bars, and an excruciatingly narrow turnstile that makes passage with luggage, shopping bags, or small children a humiliating joke. The turnstile is controlled by the Israeli security and I note that even the green light does not necessarily mean the bars will turn. Once in the maize, bags are x-rayed and I walk through the metal detector. Sometimes in protest I do not take off my watch and the metal detector buzzes and no one cares, sometimes they do. I then approach a bullet proof window where I press my passport up against the glass and sometimes get the attention of a 20 something in uniform on the other side. Sometimes not, there is always a cup of coffee, or phone call, or….Communication is challenging. Two members of our delegation were pulled aside for extra security investigation and were asked questions like: “Do you love Israel?” “Are you afraid of us?” “Are you sure you are not an Israeli citizen?” “Do you love Palestinians?” (Really). Then there are more turnstiles of the humiliation you-are-a-rat-in-a-cage and-we-really-control-you-in-case-you-did-not-already-get-the-message variety and then you are free (to fight for a taxi or a bus or a service with the license plate appropriate for whichever side you are on now. On the “other side” I note a sign in Arabic that says: “Judea and Samaria,” in case you are not clear on the concept. My recollection is that there is a sign in English that says, “Have a good day!” or some such thing.
So I was thinking, if I were bent on revenge, or strapped in a suicide vest (this is about security right) would I really hazard a visit through Kalandia? I think not. So what is this massive, time consuming demoralizing daily exercise about? Control and humiliation comes to mind. Also, it might just be easier to stay home and skip the visit to Al Aqsa this year, if one were lucky enough to get a permit in the first place.
Attachments area
Traveling while occupied
Blogging retrospectively is a challenge, I am reporting from the ground and the ground is in constant seismic shift mode.
Let me acknowledge that the deaths of the three kidnapped Israeli youths Gil-Ad Shaer, Naftali Fraenkel, and Eyal Yifrah provided the Israeli leadership with the opportunity to unleash a horrific barrage of military might, home incursions, arrests, and killings that had little to do with a careful investigation of the crime and the capture of the perpetrators. Collective punishment is still all the rage and at this point I would just call it official policy. Even the Israeli generals are trying to tone down the let’s destroy Hamas rhetoric coming out of our dear Prime Minister’s mouth. The abduction, killing and burning of Mohammed Abu Khdeir, on the other hand, is being approached in a totally different manner; there is the police statement that they are not sure if the murder was “nationalistic” ie done by an Israeli, or “criminal” ie done by a Palestinian. Then there was the false rumor put out by the police that Mohammed was gay and that this was some kind of revenge killing by the homophobic family. (not) To the Palestinians in Shuafat, a neighborhood of East Jerusalem, this is clearly a revenge killing and to my eye, given the explosion of Arab hatred, the attempt two days earlier to kidnap a ten year old called Mousa Zalum, (his parents called the police, no one responded), and the gangs of right wing Jewish teenagers roaming the streets of Jerusalem chanting “Death to the Arabs!” I vote with the Palestinians. Maybe we should just go demolish a few Israeli homes and arrest a bunch of teenagers, probably start with the lovelies in Hebron and Kiryat Arba, oh, but we don’t do that to Jews. As East Jerusalem explodes, the police use live fire on the inhabitants in the neighborhood, (ID carriers and Israeli citizens), (also read: not Jews).
To give this a little context, according to official statistics, since September 2000, more than 1,400 Palestinian children have been killed by the Israeli military, which is equivalent to one child killed every three days, and some 6,000 injured in the past 13 or so years. I think a year of national mourning is in order but this is a military occupation and well, what can I say about who counts and who doesn’t. Which brings us to some other realities of daily life.
I was hoping to tell you more about the realities of occupation, in particular, traveling while occupied. I (and every Palestinian I know) always dreads Kalandia checkpoint, the major checkpoint between Jerusalem and Ramallah. It is a chaotic, traffic plagued, military terminal with guard towers and concrete walls and grimy garbage and narrow turnstiles, and people waiting, waiting, waiting. Faces range from utter resignation and defeat to outright indignation and rage. I vary.
There is a sign on entry that says in English and Arabic: “Please keep terminal clean,” but the Hebrew reads: “Please keep order and cleanliness.” Can’t trust those frisky Arabs to stay in line. People queue in narrow chutes, two to three feet wide, with vertical floor to ceiling bars, and an excruciatingly narrow turnstile that makes passage with luggage, shopping bags, or small children a humiliating joke. The turnstile is controlled by the Israeli security and I note that even the green light does not necessarily mean the bars will turn. Once in the maize, bags are x-rayed and I walk through the metal detector. Sometimes in protest I do not take off my watch and the metal detector buzzes and no one cares, sometimes they do. I then approach a bullet proof window where I press my passport up against the glass and sometimes get the attention of a 20 something in uniform on the other side. Sometimes not, there is always a cup of coffee, or phone call, or….Communication is challenging. Two members of our delegation were pulled aside for extra security investigation and were asked questions like: “Do you love Israel?” “Are you afraid of us?” “Are you sure you are not an Israeli citizen?” “Do you love Palestinians?” (Really). Then there are more turnstiles of the humiliation you-are-a-rat-in-a-cage and-we-really-control-you-in-case-you-did-not-already-get-the-message variety and then you are free (to fight for a taxi or a bus or a service with the license plate appropriate for whichever side you are on now. On the “other side” I note a sign in Arabic that says: “Judea and Samaria,” in case you are not clear on the concept. My recollection is that there is a sign in English that says, “Have a good day!” or some such thing.
So I was thinking, if I were bent on revenge, or strapped in a suicide vest (this is about security right) would I really hazard a visit through Kalandia? I think not. So what is this massive, time consuming demoralizing daily exercise about? Control and humiliation comes to mind. Also, it might just be easier to stay home and skip the visit to Al Aqsa this year, if one were lucky enough to get a permit in the first place.
Attachments area
Blog # 27 June 23, 2014 part three Building dreamers in a nightmare
Blog # 27 June 23, 2014 part three
Building dreamers in a nightmare
I write this blog belatedly about a visit to the Old City of Jerusalem and Yasser Qous, an Afro-Palestinian who runs a youth center in a cavernous stone structure dating back to the twelfth century. And because this is about two visits in June that now feel like a decade ago, I need to acknowledge the murder of the three Hebron settler youth and the frightening revenge/pogrom- like behavior that now characterizes the Israeli military and some of its citizens. Perhaps if you get to know some of the folks who are now at risk, (ie any Palestinian), although they were at risk before, it was just more invisible, you too will be filled with dread and worry and horror.
Yasser Qous is wearing a dashiki and has a warm open face, a shaved head, and a rolled cigarette in his mouth. He is dark, has very expressive hands, and an intelligent, laid back manner. He says, “The Old City is like our house,” and welcomes us as if we are his personal guests. He grew up here, became active as a student at Bethlehem University, his father came from Chad in 1952. He works with city youth doing photography, alternative media, and is involved in psychosocial interventions around issues like drugs and sexual abuse. He comments that there are no addiction treatment centers, that drug use is a symptom of hopelessness and lack of opportunity and thus is a political problem. His program is preventive rather than treatment oriented. He finds that the Israeli government is only concerned with drug use when it starts affecting Jewish youth. There are the usual stories of house demolitions and a new policy of house arrest for teens.
We see a drop-in café with sprawling couches, drinks and ice cream, and a TV that is nonstop World Cup. He is very excited about the upcoming Ramadan events, there is a competition between neighborhoods for the best light decorations. (This is starting to look a bit like Christmas in Queens). He explains that the rituals of Ramadan include all night celebrations with Sufi dancing and music, followed by quiet, (thirsty) days. I am told that hunger is less of an issue around day three of the fast which starts with the morning prayer (3-4ish am) to sunset.
Since unemployment is such a huge problem in East Jerusalem, (60% poverty rate for Palestinians in East Jerusalem), the center is involved in training and supporting small business. They are part of a tourism coalition that sells handicrafts, but the crafts are all from Nablus and Hebron. “What is the East Jerusalem identity?” he asks. The center is involved in reviving East Jerusalem handicrafts based on research and training. They have a good relationship with a French development agency and an upcoming project involves supporting ten street sellers, (they all need permission from Israel). Twenty youth will be trained to create a photo studio on Al-Wad Street (the main street); they will take photos of the Old City and sell them, create and sell handmade accessories, and do alternative socially oriented tours from 4 pm to midnight. They also do art and music, have a band, dance dabke (traditional Palestinian dance), hip hop, and capoeira. They have made good relationships with African-American students from the US and did an event for a South African representative.
Yasser explains that most Africans came in the fifteenth century to Jerusalem as Moslem pilgrims on the Hage (to pray at Mecca and Al Aqsa), but many settled here, particularly towards the end of the Ottoman Empire and during the British Mandate when it became more difficult to go home. This youth center was previously a prison after the Arab revolt, before that a compound/hospice called a Ribat, [see Wikipedia: A ribat (Arabic: رباط; ribāṭ, hospice, hostel, base or retreat) is an Arabic term for a small fortification as built along a frontier during the first years of the Muslim conquest of North Africa to house military volunteers, called the murabitun. These fortifications later served to protect commercial routes, and as centers for isolated Muslim communities. Ribats were first seen in the 8th century.” This compound is the oldest Ribat in Jerusalem, founded by a Mamluk Sultan who brought slaves from Egypt.
With the British Mandate, the property went to the Mufte and the African community settled here. After 1948, half left to Jordan, some to Lebanon, and others to Jericho, Tulkarem, Khan Younis in Gaza, and the Negev. There are now 350 mostly Afro-Palestinians in Jerusalem out of a total 183,000 Palestinians in the East Jerusalem municipality; they call themselves “coconuts,” Black outside, Palestinian inside. Their main connection with each other lies with the Hage. They have been part of Palestinian resistance, martyrs in all the wars, and many have been imprisoned. The first female political prisoner was Afro-Palestinian and she spent 13 years incarcerated. The neighborhood is subjected to frequent collective punishment at the hands of Israeli security. Many have intermarried with Palestinians, “marriage is between families, not individuals, we want someone from the same class.” They are proud of their roots but not well connected to Africa, are Muslims and Christians, and face discrimination, (Black, Palestinian, lower class), and high employment in Jerusalem. Most are from Nigeria, Senegal, Sudan, and Chad.
A week later he takes the delegation on a tour of East Jerusalem, through the many Christian and Muslim sites (Fourteen stations of the cross, Church of the Holy Sepulcher where Christ was crucified). Interesting tidbit, by legal tradition, a Muslim family opens and closes the church each day because there was too much fighting for the honor between the many Christian sects. He keeps advising us to “stay in the shadow” so we won’t get roasted by the sun. A right wing Jewish group, Ateret Cohanim, which conveniently has established a yeshiva in the Muslim Quarter, using Palestinian collaborators, rents and sells houses to Jews and displaces Palestinians. (That’s the goal). We see four Jewish families in their gated and guarded home, guards walk the Jews out of the Muslim Quarter to the Jewish Quarter, (which was depopulated of Jews in 1948 when it was taken by the Jordanians). Yasser explains that not only are these folks expanding into Muslim and Christian sectors (no one else can get permits FYI) but they are creating a Jewish ghetto for themselves. In the Jewish sector, which is obviously well funded and pristine from an archeological and tourist point of view, there is evidence of all the different conquerors who built on top of the preexisting civilizations. We wander down the Cardo, the ancient Roman market with a multistory excavation. Armed security guards escort herds of young children to their destinations, and I can only think, they look like tough teen boy babysitters with guns and walky talkies, and what are the children learning from this daily experience? Life is dangerous and “they” all want to kill us?
The center created the Longest Chain of Readers at Damascus Gate, 6,000 kids reading books and then donating them to libraries. They were celebrating a kite festival with 300 children, but the IDF attacked the event and destroyed the kites. (Do they really have to be this way?)
When Yasser was ten years old he was given a book, “Children of Palestine,” and the introduction explained that life is like theater, there is the audience and there are the players. It was at that point he decided that he wanted to be a player. Just imagine the dreams that were crushed in those flying kites. So why are kids throwing stones? Wouldn’t you?
Subscribe to:
Posts (Atom)