Thursday, 24 June 2021

The Holy Land. Pt2.

 Wanderings in the Negev.

Once on the road again we started heading towards Dimona, a modern Israeli town with a 'secret' nuclear reactor. I say secret in parentheses because absolutely everyone, Arab or Jew knew all about it, I knew all about it too but when I raised the issue they 'shushed' me.
"It's a secret, we don't talk about it!"
Somewhere in this area we pulled off the road again, for one of those pilgrimages to a Bedouin spontaneous settlement that was virtually invisible from the road, and only after a considerable journey over rocky, uneven terrain, they becomes identifiable when you are a few feet away.
Maraud showed us the Nissan hut that had been the medical clinic when he was on his remote rural rotation, which he said he had physically built himself. He described the difficulty in providing appropriate medical care to women, who were only allowed to come to the clinic if accompanied by the husband, who remained present during the history and the physical examination. The clinic had been discontinued when he left, and apparently was to be permanently closed down. The message being that the local people should go to Dimona, which is only a few miles away, where there was a modern well equipped well staffed clinic. My conviction was that after he had left it was impossible to find another physician to practice under those restricted circumstances when there was a modern clinic nearby. He agreed with this theory and he also pointed out that due to the terrain, which was subject to flash flooding, the ambulance would not leave the main road to pick someone up regardless of the severity of their condition.
We ended up at a traditional Bedouin goat skin tent where we were invited in for tea. We were seated around the in-tent fireplace where we were offered something to eat, which we politely declined, and were given the hot sweet tea that the Bedouin sit and talk and sip all evening, sometimes very strong bitter coffee was the alternative.. We sat talking for some time, the Sheik sitting reclining on comfortable woven mats that covered the floor of this communal tent, with their thick embroidered cushions. His traditional keffiyeh framed his dark mustached face, the gray Western style suit he was wearing forming a strange contrast. Shortly thereafter, the Imam or holy man came into the tent to join us, and was greeted with great respect - everyone stood up and shook hands. About eight or nine others sat around the fire, the older ones in traditional dress, the younger ones in jeans, but most wearing the traditional Arab headdress.

An Amusing Exchange.
As we had approached this settlement, I noted that the tents we were approaching were all black. I wondered about this, because, in the desert, where the sun beats down all day, surely the tents should have been white, to reflect the heat and the light of the sun. M. had introduced me as 'Professor Smith from Canada,' and of course all our conversation in both directions went through him.
As our conversations drew to a conclusion the Sheik inquired as to whether there were any other questions I would like to ask.
"Yes," I said, "I want to know why all the tents are black, when it would be much cooler to have white tents?"
All of the occupants of the tent, both old and young, broke out into hilarious laughter. It went on for quite a while.
"What's so funny?", I asked M.
"Well," he said, a smile on his face, " the Sheik said , tell the Professor , that the tents are black because the goats are black!"
After a while we took our leave, and after a long cross-country drive, over moon - like rocky terrain, we passed the Dimona power station and headed back to the road.

Sunday Jan 28th.
Meeting with the Dean scheduled for 11am. First I met witn Pesach, and when I noticed the time was a little past eleven and pointed this out, Pesach said, "oh, he'll wait for us" and carried right on chatting. A few minutes later the Dean's secretary came into his office looking for us. The dean was a very nice fellow, who chatted about the various problems that exist in primary care in Israel, particularly in the area of geriatrics, as this population has a high percentage of elderly people. They are talking about increasing the geriatrics in the program - at te moment there is one month of geriatrics in the FM program, and also of having some sort of a certificate of special competence ingeriatrics.
the dean then said, ( obviously he had read my CV carefully!)
"I hear you have a special interest in stroke prevention."
I agreed.
"I think I see a great need for that in Israel. Perhaps you could put forward some sort of a proposal in that regard while you are here. In fact," he continued casually, "I'd like to see something in place before you go."
"Certainly," I replied confidently. And so I've been commisioned!
After the meeting with the Dean, I came home, picked up Irene and went to Tel Beer Sheva. This is the archeological site of the ancient city of Beer Sheva, and is really very interesting. Particularly fascinating is the well, just outside the town site, which is the well of the biblical stiry of Abraham. The well is excavated to an amazing depth, and with the aid of some recently installed flood-lights one can see right down to the water - a long, long way below. Gives one quite queazy feeling in the stomach to look down there. Even though there is a robust grid over the top of the well to prevent one from falling down. We picked up a pamphlet which incudes a map of the general layout, and which will be a appendix to this journal, so I will not describe what others have done better. I took quite a few photos of the site and of the surrounding hills. The site closes at four , and we were a little late getting down to the exit area. A young bedouoin man told us it was timefor himto have a sleep and so it was time for us to go. (very politely). When we got to the exit the woman on the door said he had wanted to lock up the park, but she had seen our car on the parking lot and told him he was to find us first. Otherwise we would have been spending the night in the biblicalcity of Beeer Sheva. There is a view tower in the centre of the archeological site from which the 360 degree view is impressive.
Afterwards we drove around Beer Sheva a little and ended up in the old parrt of the city. Parked the car and found a seventy shekel parking ticket on it, when we got back. Lots of new Russians around town, and many of the stores had signs in Hebrew and Russian.
Monday 29th Jan.
Met with Dr. Ben-basud, head of the clinical decision making group . A very interesting man who moved here from Jerusalem to head up the decision making group. We talked about changes in medical education, (he is about my age) and the change from histo - pathologic based treament, which despite its rationality often just does't work, to evidence based medicine, which is so much in vogue and spearheaded by MacMaster.
Later I went to oneof the other Family Medicine Clinics in Beer Sheva, and after a drug company sponsored lunch, the topic was vertigo, the drug serc, spent some time talkig to some of the recent Russian emigrants who had been accepted into the FMR program. The Residency here is a four year program, the last of which is, more or less a social service year in which the resident practices independantly for the most part, with some general supervision. This usually occurs in the various outlying clinics in the Negev, as far as I can understand. These imigrant physicians are faced with the task of trying to learn Hebrew and English at the same time- no easy job. Incidentally, they are among the best dressed people I have seen in Israel, where most of the physician are in jeans or cords and shirts. Afterwards I was driven back to the hospital by one of these residents, who was driving one of the nicest cars I've seen in Israel.
Irene has a bad cold so we didn't go out once I came home. I tried plugging in the modem, and though I didn't manage to make the connections I wanted, it didn't fry the modem. So I'l have to experiment a bit. Meanwhile, I will continue to use computers around the hospital.

Tue 30th January.
This morning I went up the the shopping centre to have a haircut, while waiting for Irene to wake and see how the cold is and whether we would be able to make the trip to Jerusalem or not. Went into an Israeli salon where they didn't speak much
english and I said I wanted it short. And boy, did I get it short, in a very military sort of style! At least I won't need another haircut for a long time! I still haven't become used to the manner in which Israelis invade your space, quite unlike Canada and the US. As I sat in the chair, one of the female stylists came over to talk o the young man who was cutting my hair. She leans over to talk to him, her bare midriff right in my face, totally oblivious to my presence.
We left for Jerusalem at about two p.m. and made our way across the countryside enjoying the rolling hills, the very green fields, this must be the greenist time of the year, the trees and the sights. Just coming out of Beer sheva, the Bedouin Shanty towns, followed by nice new permanent Bedouin housing developments. Took some photos of both of these to illustrate the contrasts. Once onto the main Tel Aviv Jerusalem stretch, the traffic was horrendous, and the Israeli phenomenon of turning a normal human into a lethal driving machine. As we get into Jerusalem and the traffic slows down before the ultimate gridlock, the other Israeli compulsion of honking the horn incessently becomes evident. Israelis sound their horns insistantly and incessently, for reasons that are often not clear. Sometimes I think its just to let yo know that they are there. They also pass on single lane highways in situations that most sane N.Americans wouldn't think of.
Jerusalem was far busier than when we were last here in 1989. As we were driving in we recognized the area where we were
living then, and drove and walked around a little 'til we found 18 Mitudela where we had stayed in then. We then drove downtown and after much hunting around managed to find a parking place. Ambled around King George street and Ben Yehuda St. and finally found a nice outside restaurant and had fish and chips. Thought it time to start heading back to Beer Sheva as I had no idea how to start back. Stopped at a gas station for some directions and they advised me to head the most direct way which was through Jericho. Now even we are not so poorly informed that we don't know that this is a dangerous place, and since the attendents at the gas station seemed to me to be Arab, perhaps they were underestimating the dangers. Since we remembered that we came in on the Tel Aviv road we headed back out that way to look for the turn off to Beer Sheva, which we somehow seemed to miss. We soon found ourselves almost at Ben Gurion Airport, and I decided to turn into the airport for further direction. As we turned into the airport there ws a sort of obstacle course, which quite obviously, in retrospect, is to stop any would- be car bomber from geting in to the airport. As I came through the path, three heavily armed soldiers, came out and waved me down. I stopped the car immediately and jumped out. They had me pull the car out of the traffic lane, but quickly seemed to rule me out as a serious terrorist threat, despite my military haircut. They could speak hardly any English, and I just kept saying in my very few words of Hebrew "Where is Beer Sheva?" They told me in very simple Hebrew how to get back on the road, and sent us on our way. Later discussed our avoidance of the Jericho route with some of our local acquaintances. They assured me it was the right decision.

Wed 31 Jan 1996.
Went to Research meeting on Bedouin Health and their perceptions of their health care. Main coordinator of the research program is Maroud, a Bedouin resident, who speaks Hebrew, Arabic, Czech, English and Russian. A tall, handsome, dark-skinned man in his early thirties, he is carrying this project almost single-handedly, because acceptance of researchers of other ethnic origins would not be acceptable to the Bedouins. The research project calls for many meetings involving all the different communities and requires separate meetings for men and women, and Maroud attends almost all of the meetings. In addition he attends to his duties as a family medicine resident on his one year rotation of Internal Medicine. Many of the issues are identical to those of our Canadian Indians, and to providing continuity and comprehensiveness of care in the rural areas. One of the differences is that the distances are so small in Israel, that even from the most remote areas its at the most a couple of hours drive to a major centre. Anyway, after the meeting I had an interesting chat with Maroud, and he suggested I might like to go and visit some Bedouins and drink some coffee in the tent. I said I'd love to and he is going to give me a call sometime.
Later I went to a meeting of the Family Medicine Dept, during which time all the peripheral teachers come in to have a dept. meeting and a cme presentation.
When I, the great Canadian Professor, came into the meeting the Chair asked me if I could follow the meeting in Hebrew.  When I answered in the negative he said, "Professor Smith cannot follow the meeting in Hebrew, is there anyone who would object if we change the language to English?"  Not a person objected!

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