No future—the college business graduate who drives a taxi. Brain drain--Medical students who are looking for a way out of Palestine. Further frustration--Administrators who put up road blocks to progress because they can. It all makes me cynical and sad, but you don’t want to read about this. Scrolling through US news doesn’t lighten my heart either. Nor do the weekly reports I receive about the atrocities here. So looking for light . . .

The day I arrived in Jerusalem, I received an email from the medical student research group about doing a workshop on qualitative research for them the following week. Being a can do person, I said, yes or nam, but suggested we have coffee. We met at Kaffeine, a great little coffee café like many independents in the US. I am told students study there before exams. Google got me there because it was not on the main drag, Rafidia. (Please note: every business and person has a facebook page here.) We planned our sessions and 5 days later I began the 3 day workshop.

Electric cut-offs are routine these days (discussed in last weeks blog) and the university gets cut at 1 PM, so I prepared with back up for my session scheduled at 2. Good thing, because when the university’s generators kick in all we have are lights, no internet, no projector, no heat. The room for our first day was in part of the building that didn’t have lights, but it was 2 pm, we had windows. We continued on with white board and marker and lots of group activities. 

Students are used to lecture here, so they are shy at first about participating. Many were reluctant to share an interesting fact about themselves during the introduction. I had sent three articles to the organizer so they would have them on their phones. The phones are not internet dependent. So when we worked in small groups they could each read on there phone which saved paper and made do with no projector.

We learned about the difference between qualitative and quantitative research than began working on a research question. How or What questions are better than Why in qualitative research because why can lead to cause and effect. I posed: how do medical students . . .

And they completed it with: how do medical students manage stress, choose their specialty, find experiences outside Palestine, use music, . . .

They created possible research questions privately, then worked in small groups voting and choosing one question for the entire small group to work on. We refined the questions in class, then they worked on writing interview questions: rapport building for the first, open ended, etc. I won’t give you the blow by blow of my lesson plans, only some of the highlights. And we were in another building so we had lights and a projector on days 2 & 3.

I found a focus group study done in Qatar that examined the American Board of Internal Medicine’s Charter on Professionalism which discussed what worked and didn't work when applying the US charter in the non-Western world. Professionalism is not a foreign concept to the students but needing to re-certify periodically to keep your MD license is. Autonomy was confusing because here the family (usually the head father, husband or oldest son) makes decisions for an individual. And sometimes the family,  does not want to share bad news with the patient, like telling them they have cancer. Women also have less autonomy here, but more than they do in Qatar according to the students. Islam is integrated with daily life and the imam has influence. The religious perspective is not present in the US charter. The student’s understood the social contract—the agreement between the physician and the public that the physician sets her/his interests aside to do the best they can for the patient. In fact, a student showed me the picture he uses for his photo ID in his social media, Jean-Jacques Rousseau and reminded me that this was the philosopher who created the social contract.

One of the Family Medicine faculty copied the charter and the article and planned to use it with the first year family medicine residents. Nice to know I brought something of interest. 

Day 2 was Focus groups. After a little theory the group who had a well refined question on medical students and exercise ran a focus group. The other students (about 10) observed and quickly picked up that the facilitator was not supposed to give his opinions when he asked a question. So we learned by doing and the second round with 2 focus groups went well. Each group had a facilitator and 2 note takers. They talked in Arabic and as an observer I could pick up quite a bit just watching the body language and who was talking.

Day 3 involved coding qualitative transcripts. I used some of my patient transcripts from a recent study and the students enjoyed reading the perspectives of American patients on what is good care and what they like or don’t like about their doctors. Two students told me that the focus groups and coding were their favorite parts of the session.

Of course, we had the Palestinian hospitality with the organizers bring bottles of water and chocolate eggs for all the attendees. Students, used to strict rules, asked permission to take a phone call or use the bathroom. And at the end there were the pictures. A photo of the group taken on several different cell phones, a selfie with the student and me for his mom. Several more student-professor photos, not to mention the periodic videos throughout the 3 days. 

The rewards for this work are abundant. And focusing on what I can do and the little difference I might be making in the careers of these students, keeps me positive during the gray days of the rainy season, these darker moments of our politics in the US and the world. And it is spring here!

I am rereading the Old Testament, something Catholics don’t do very well, and an English version of the Koran or Quran, as well as a book about the early centuries of Christianity. All are filled with struggle and fighting and winners and losers, but trust in some higher power abounds. Perhaps this is the lesson--find the light and do all the good you can do. Find meaning in the day to day. And spring follows winter,