The challenges of our times are hard to escape. Here in the US: collapsing buildings likely related to climate change with encroaching oceans and poorly maintained infrastructure, sweltering temperatures in the Northwest, and reportedly appalling conditions in the detention centers where asylum seekers are housed on our southern border. Elsewhere the horrors of COVID and the delta variant continue as wealthy nations' slowly respond to COVAX. This week one of my Palestinian colleagues who trained in the UK sent me this: Palestine returns expiring vaccines sent by Israel. How do I maintain hope, find the light?

My work with Palestinian Family Medicine colleagues have been lessons in resilience. This week I helped with the second continuing education effort sponsored by the Palestinian Family Medicine Association for family physicians in the West Bank and Gaza. The 90 minute session focused on how to provide psychologically informed care in the primary care setting.

You may read this and think--this is good medicine, normal practice in the US. But this is a BIG deal in Palestine. My 20 to 25 patients a day or a patient every 15-20 minutes seems like cake with frosting compared to the 130 to 150 patients to be seen between 8 AM and 2 pm in government primary care clinics in Palestine. While some of those visits are med refills, it seems unfathomable to do much more than ask a few questions and write a script or make a referral. But that's not Family Medicine and it's not good care.

The session organizers flipped sessions, so this topic would come earlier because their colleagues in Gaza are struggling since the recent 11-day war. Allow me to underline the importance of this: On a political level, the leaders of the West Bank and Gaza don’t talk, their Ministries of Health have nothing to do with each other. So it was seen as progress as well as a political move when Gaza’s leadership, Hamas (considered terrorists by the US), responded to Israeli police blocking the Damascus Gate in Jerusalem on one of the holiest days for Muslims. This is the Palestinian route into the old city to reach the Temple Mount and the Al-Aqsa Mosque, where Muslims pray. West Bank government (Fatah) did nothing, but Hamas responded. While it was a political calculation, it also demonstrated solidarity.

In reality not much has changed. Life continues to be difficult in Gaza and the West Bank, and most of my colleagues don't pay much attention to what their governments do. Gaza deals with the destruction of hospitals and clinics and the injuries and deaths of citizens and colleagues. WB colleagues can return to work.

But I witnessed, on a human level, the bridges being built through the PAFM (Palestine Association of Family Medicine). West Bank Family physicians invited Gaza Family physicians to share in these joint learning opportunities, a rare collaboration, and efforts to help each other be better doctors for their patients.The sessions were in English and Arabic – the nuances of metal health issues presenting as physical problems like headache and fatigue are difficult to grasp when English is your second language. Gaza physicians were dealing with post traumatic stress. As I listened, then helped to facilitate a small group, I could not helping reflecting on what these physicians had been through: Gaza 11 days of being under fire with overwhelming casualties and deaths. The West Band facing strife in their own communities near the Israeli settlements which have turned the WB into Swiss cheese with settlers blocking roads to Palestinian village and other acts of violence, along with increased military presence at checkpoints making it nearly impossible to shop or go about work and daily life.

But here they were, Gaza and WB family physicians, on a weekday evening actively participating and learning together. Amazement and gratitude filled my heart and one of the UK organizers privately messaged me: "Isn't this fantastic." My heart was bursting with gratitude (to be part of this effort) and humility--the courage and resiliency of these Palestinian colleagues. The old adage, but for the grace of God go I, or for the Arabs their expression when they talk about anything in the future -- In Shallah --god willing.

So in spite of your weariness, find a way to let in the light.