Life’s Ebbs and Flows
The violence in Nablus and Palestine has decreased with the conclusion of the Israeli election and the olive harvest. Borrowing from Reed: “it has been a cauldron of simmering conflict, oppression, resistance, protests and sporadic violence whose origins go back a millennia or more, but whose wounds are as fresh as yesterday.” The sitting prime minister of Israel no longer needs to show his aggression to gain the support of the far-right orthodox voters, he lost to someone even farther to the right. The future doesn’t bode well. And the next generation of resistance leaders is organized.
The olive harvest is over and the settler attacks on Palestinian groves have lessened. Olive trees symbolize Palestinian steadfastness and are deeply valued for their ability to thrive and send down deep roots in land where water is hard to come by. Many olive trees are thousands of years old and yet continue to produce olives. Harvesting is a family activity. Attacking pickers, uprooting trees, rolling burning tires into groves has become an annual activity and denies Palestinians safe access to their lands and deprives them of a key source of annual income.
The rains have begun. Dramatic thunder and lightning storms that feel Biblical. Lightening cracks across the sky, the thunder rolls—only thunder not gunfire—and the rains scour the dust from the trees and air. Finally the dry Wadis (valleys) fill with precious water.
Two weeks ago, the US State Department told us to leave Nablus halfway through what turned out to be a 3-week lockdown of the city. All roads to were Nablus closed. So, I worked remotely from Ramallah, the capital city of the West Bank and then from Bethlehem.
Wall-size carved relief—thanks for COVID-19 assistance
In Bethlehem, I took the posted photo of the wall-size relief on the road into the city. It commemorates the efforts of the people who stepped up to help with the COVID-19 pandemic. The first cases occurred in Bethlehem brought by holy land visitors from Asia. Now cases still occur, but nothing like before. Physicians no longer wear masks. The ebb and flow of it all.
From Bethlehem I taxied the 1-hour trip to Hebron, an ancient city and the burial site of Biblical Matriarchs and Patriarchs (Abraham, Isaac, Jacob, Sarah, Rebecca, and Leah.) I taught two 6-hour workshops to classes of fifty 4th year medical students, the equivalent to 3rd years in the US, just starting their clinical rotations (the first 3 years are our college). Students in the qualitative research workshop session worked in groups to think about their research questions: depression in medical students, managing stress among students, and improving safety for factory workers. They worked hard to consider their biases related to these topics and how and where to recruit participants.
The second workshop focused on communication, reflection and feedback. This has been a doctor-centered medical culture and reflection is not encouraged. It is hard to reflect too deeply with all the crises around you. And any criticism is perceived as derogatory. Students warmed to reflecting on the negative feedback they had received in their brief careers and role-playing different approaches using the “sandwich technique” which includes honesty, specifics, timeliness, and a nonjudgmental manner. The students gave me the ultimate compliments: selfies with me and wanting to friend me on Facebook.
There will not be enough jobs for all the medical students that Palestine will graduate. The dean, a surgeon, told them that if they want to stand above their peers, they must do research. He also spoke eloquently about how he learned about communication and patient safety from a British pilot and the value of the checklist. It was refreshing to hear a surgeon talk about the importance of communication with staff, thorough patient education, and taking the time to collect a good social and family history.
This has been the most difficult of my Fulbright award segments. Faculty have a hard time planning ahead. I have come to understand it is for good reasons. One day they can drive the 20 minutes to the university, the next day they cannot because the road is closed, but they can spend 2 hours on back roads to get there. Why bother? Many students commute to Nablus from villages, so the classes switch to Zoom.
Another day, a national strike is called to protest the killing of a Palestinian and the country shuts down. No stores or schools are allowed to open. We’ve had 3 of these in my 2 months here. Exams are delayed because of the Zoom classes and shutdowns, and all must be made up when the university opens again. One professor planned to attend to make a presentation at the regional conference WONCA in Oman. Her visa finally came through a week before the event which gave her little time to purchase her airplane ticket, plan the care of her 3 young children, arrange coverage for her lectures and clinic patients, and travel across the bridge into Jordan so she can fly out of Amman. Palestinians have not been allowed to use Tel Aviv for at least 30 years. The trip across the bridge into Jordan can take a full day.
Is it no wonder the faculty is hard to engage in plans a week or 2 in advance?
I learned about témoignage when volunteering with Doctors Without Borders some 20 years ago. It means standing with, witnessing the atrocities and injustices. While personally experiencing the realities of life in an occupied land is enlightening—a chance to walk in the shoes of the other, I must admit these 2 months have been exhausting and frustrating, the challenge of living with such uncertainty. I have called it a privilege to be here, although difficult. And such experiences give me perspective me and remind me to count my own blessings, but for the grace of God…