Teaching Women’s Health in Palestine
It’s a man’s world here. Despite the important roles of women in the home and community, and even though they hold significant jobs like doctors and vice deans, and the minister of health is a woman, men are the preferred gender. So sitting in the women's health course for 4th year medical students for the last two Thursdays has been very interesting. Medical school is six years here, so these students have just started hospital rotations—medicine and surgery—the biomedical courses which are real medicine. The female professor I am working with tells me students consider her course unimportant, but nevertheless, she wanted some help with adult learning techniques rather than the traditional lecture style.
Despite the lecture in Arabic of which I understand little, the discussions about Violence Against Women were lively with the young men arguing with the female professor. She tells me they say that domestic violence is not a problem here and women bring it on themselves. These are not new excuses or thoughts. I’ve heard these in the US as well as in Russia when I trained physicians and nurses about identifying domestic violence in the late 1990s and early 2000s. These students are well-to-do and also think their socio-economic class is spared. Unfortunately violence and abuse occurs with the upper income, it’s just more hidden. As to the retort that women deserve it--victims/survivors often say that about themselves. It’s a complicated topic and even more complicated here.
I encouraged the professor to share facts from a study done in Arab countries which shows that 70% of women experience violence at some point during their lives, including one third of married women. Victims of violence have increased health problems with almost four times more abortions; triple the trouble with sleep, depression, and chronic pain; and more have high blood pressure problems.
I also asked the professor if she should create some context: Violence Against Women is all about power and control. The entire West Bank/Palestinian Territories experiences powerlessness on many levels every day. When you look at the definitions of social, economic, and psychological abuse it is the reality of life here, for both men and women.
She wasn’t so sure about mentioning this fact.
I ask myself daily, how do people cope with the realities of occupation? One morning this week I gained insight. The female professor and I joined another professor called the birdman because his hobby is birds. Before his scheduled lecture he took us to an environmental area in a valley with a stream just a few miles from the university. Despite the dryness of the season and the trash, the ravine was filled with wildlife: Palestine mountain gazelles, rock hyrax (a ground hog size mammal), turtles, fish, and array of birds. The birdman spoke of the peace he felt in nature, how he came here to nourish his spirit. I can relate, nature is also my grounding, where I also meet spirit, god. However, the three of us kept our eyes on the houses high above us on both sides of the cliffs. Settlements I was told, but he clarified: they are really colonists because they grabbed the land like colonizers do. Pipes descended from the houses into cement tanks. Sewage I was told. Thankfully, it's contained now--it was open in the past. And even larger pipes carried water up from the stream bed.
But those ugly realities did not dim our enthusiasm for the lovely birds, mammals, butterflies, dragonflies and amphibians we saw. On the way back to the university, traffic stalled. “We are going to be late,” the birdman said. A fly-by checkpoint--not a permanent one--was suddenly set up on the road. “The new soldiers need to practice,” he told me. These were Israeli soldiers who patrol the roads throughout most of the West Bank.
“That’s what happens with occupation” the female professor said. “It’s not just Arab time,” she added with a chuckle. (Here much like in Latin American, my western punctuality is constantly challenged. Everything starts 10 to 30 minutes after the agreed upon time.)
So back to my question: how do people cope? Locals seem very aware of the occupation, but go on in spite of it with caution and humor. People find reasons to laugh here and do so easily.
But mentioning the powerlessness in the face of occupation in the Violence Against Women lecture? Not a good idea, I guess. But we made good progress with adult learning methods. The female professor agreed to break the students into small groups (4-5 students) and gave them an American Family Physician article to read, making groups responsible for different sections. In the past, she’d divided them into groups of 10-12 and given them a research article which hadn’t worked very well.
The 50 students packed into the non-air-conditioned room, but they counted off and turned their desks around to work together, distributing both male and female students into the groups. They took photos of the section they were responsible for with their smart phones and read the material together. As I circled in between the small groups, I asked students to think about patients they might have seen in the hospital or in their communities with chronic pain or headaches or . . . patients who might be unidentified victims/survivors of intimate partner violence . . . and if they knew of the resources and supports for victims here in Palestine. Some had stronger English skills than others. I explained the difference between homicide and suicide, described the Cochrane data base and US Preventive Services Task Force. The women seemed to temper the argumentative males and some knew of shelters in some of the cities. “Have you seen any doctor ask?” I inquired. Head shakes. “I am not surprised. But you will be doctors who know about the importance of asking about domestic violence.”
I remember saying the same thing to US medical students in the 1990s and 2000s. This is a hard topic and screening for domestic violence happens more frequently in the US now.
The small group spokespersons did a nice job of sharing the facts about their sections. The professor still rushed through her slides. It takes time to learn how to build on and embellish the responses you get during “reverse classroom” activities. But the professor thought the small groups worked well. The students were actively involved in their learning and had a chance to improve their English. English is the universal language of medicine because most journals and online resources are in English.
So as they say in Arabic shway, shway or little by little, change happens. Addressing domestic or intimate partner violence is a tough topic here. Learning new methods of teaching: adult learning vs. spoon-feeding (lecture only) takes time. The Arabic words are hard for me to remember, let along pronounce, so I don’t have much hope for myself there, but I will keep trying. And slowly I am understanding the tough realities here and how locals cope. And maybe with time there will be reasonable and peaceful solutions to the occupation and the incredibly difficult life here.