i did my six week family medicine clerkship with five good friends in galilee, northern israel. we lived in an apartment on the ha-emek hospital compound in the town of afula in central galilee, and each of us took buses each day to different places to work with different primary care physicians. afula is the largest town in israel’s jezreel valley, and is just down the road from megiddo, posited by some as the place where the world will end. it is also in the shadow of mount tabor, believed to be the site of Christ’s tranfiguration. i got really lucky, as i was placed with a friendly doctor who loved to teach in a very unique town called kfar kama, one of just two circassian towns in israel. the circassians are an ethnicity who originated in the north caucasus — what is now russia around the area of sochi. coincidentally the winter olympics occurred in sochi during the time i was working in kfar kama. these people lost the circassian war to russia in the 1700s, and some small numbers were resettled by the ottoman empire in what is now northern israel. they were warriors back in their homeland, but settled into an agricultural lifestyle in the middle east. they have held on to their religion, sunni islam, and retained their unique culture and language, called adyghe. they also speak hebrew, arabic, and more english than average, which was another reason i was happy to be there. there are only about 4000 circassians in israel, split between two towns. they marry only other circassians. the men serve in the israeli military at the will of their elders; women cover their heads, wear ornate dresses and basically control the place. the women are seriously empowered, and many are highly educated. the teenagers still get acne and the elderly still get hypertension.
circassian society is rather insular, so being in a family medicine clinic provided a remarkable glimpse into their culture which otherwise might never have been possible. there is only one clinic in the town, and just two physicians, each of whom has been working with the community for years and knows everyone in town. on one occasion we learned that an elderly man had unfortunately passed away, so we left the clinic and walked down to his house, which is an unspoken obligation of the clinic staff. half the town was sitting in the home mourning, men in one room and women in another; kids playing outside. the mourning period lasts for three days. they passed around cookies and strong coffee and i was the only one who took any. oops.
my preceptor also staffed another clinic in a small moshav, which is similar to a kibbutz (both are small, communal zionist agricultural communities. kibbutzim are completely communal – i.e. truly communist, while in a moshav each family takes care of their own finances). the moshav was called ha’zorim, and was in a valley just southwest of tiberias. it was started by holocaust survivors, a group which still make up the majority of its population. we would typically go there later in the evening for a couple hours, and a really nice nurse would prepare biscuits and hot tea without fail. i’d do blood draws while the family doc caught up on local gossip in the vernacular.
one evening we rented a car for my friend mayuri’s birthday, and drove up a mount carmel overlooking haifa, where there is a string of druze towns. the druze are an insular pseudo-islamic ethnicity and religion. we got countless plates of salad and wandered the freezing streets. it actually gets quite cold in corners of the middle east during the right time of year. another evening we took the bus up another big hill in the other direction to the arab city of nazareth, where we ate at the oldest and most expensive restaurant in town, and sampled some coffee which has been constantly brewing for the last 70 years! we then realized that we’d missed the last bus back, so spent half the night in the only establishment that was open – a dry shisha-sports-bar, trying to figure out how to get home on our budget. family medicine – fewer dull moments than you’d expect!