for the trip from israel to the u.s. this summer, i flew through cairo, egypt. the flight from tel aviv to cairo was on air sinai, an airline which officially does not exist! there is no website, only rumors. it operates one flight a day each direction on the route, using a white, unmarked aircraft. there are no boarding announcements, and the flights do not even appear on the departure and arrival boards in the cairo airport. the reason for all this secrecy is that the egyptians do not want to be known to be operating flights to israel, but thanks to the israeli-egyptian peace treaty, each country is required to operate a certain number of flights to the other. air sinai would appear to be operated by egyptair but officially no one knows. cool right? it is impossible to book the flights directly online – the only options are to go to a nondescript office in tel aviv and pay with cash, or book through a sketchy greek third-party travel website, which is how i did it.
finally in about february i started my first clerkship of the year “at home” in beer sheva! i really loved obstetrics and gynecology. long nights of adrenaline. our soroka hospital in beer sheva has more births than any other hospital in israel, about 13 000 /year. the boss of the clerkship is one of the more iconic physicians in beer sheva and an extremely humorous individual -a type of person i’d like to become more like. except jokes like his would never fly from physician in the u.s. or there would be lots of lawsuits. but in israel the doctors have a lot more latitude for levity. after pediatrics ob-gyn was my favorite specialty.
the next clerkship was psychiatry. this was at a mental health center on the outskirts of the beer sheva. i must say the state of israel does phenomenally well when it comes to taking care of the mentally ill. i was fortunate enough to be placed in the inpatient adolescent ward. one day we watched the film “silver lining playbook” with all the kids; they already knew what bipolar disorder is all about. holocaust memorial day also happened to be while we were there and they had a very touching little ceremony, only with some of the interruptions one would expect in a mental hospital. the clerkship was dominated by a teen who was convinced she was demi lovato and could fly (off furniture and stuff). death threats. ethical discussions on forcible confinement. electroconvulsive therapy supervised by a guy with a big, greasy mustache. good times.
the final required clerkship of my third year of medical school was surgery, at soroka hospital in beer sheva. i am not a huge fan. i was also studying very intensively for the clinical knowledge portion of step 2 of the united states licensing medical licensing exam (usmle), which i took at the end of the clerkship, so admittedly that was more of a focus for me than the stuff going on in the operating room. then, all of a sudden, third year was over, and i headed back to the glorious united states for fourth year electives!
church at mt. tabor, believed to be the site of christ’s transfiguration, galilee
mount tabor is a remarkable place in the galilee, where i went a few times during my family medicine rotation. it is a lone, single standing hill in the middle of the plain, and is believed to be the site from which Christ transfigurated, or ascended to heaven. there is a little monastery, a nice caretaker, and not many tourists. the hill is surrounded by little arab villages. a good place to stop if you find yourself in the gaililee!
church at mt. tabor
the galilee, from mount tabor. the town on the distant hill is nazareth
one weekend last january i decided to take a little vacation down to egypt to get away from it all! (and study for the usmle step 2 on the beach). for $50 i stayed in the five star all-inclusive movenpick resort in taba, just across the border from eilat, israel. unfortunately tourists are staying away from egypt right now due to the political instability. and even more unfortunately just after the time i was there a bus full of korean tourists was blown up right at the border. it was special to be back in “masr” (egypt) after living there for a semester a while ago, although the luxury of the resort life in taba is nothing like real egypt. the buffet food was the best i’ve eaten in years! the movenpick hotel is a five minute walk from the border. and a pleasant surprise was learning that if you stay in taba, foreigners don’t need to pay any visa fees or taxes on either side of the israeli-egyptian border, fees which otherwise are quite prohibitive. wish i would have known about this earlier!
the taba border zone has an interesting history. the sinai peninsula was occupied by israel from 1973 until 1982 when it was returned to egypt following the israeli-egyptian peace treaty. there was a very popular israeli hotel built in the 70s just across the border, now the taba hilton. upon the return of the sinai to egypt both sides wanted the hotel, and the united nations had to arbitrate an agreement. it ended up going to egypt, but it was stipulated that the egyptians may not charge israelis an entry tax to go to the taba hilton. the hotel remained very popular among israelis due to its casino, but in 1994 the hotel was bombed and collapsed in its entirety, killing many, and israelis have generally stayed away since. and it was bombed again in 2004. it has since been rebuilt, but i vote the movenpick as the better place to stay in the border zone.
it was great to get a little sunburn and luxury in egypt in the middle of january! anyone at msih reading this – get yoself down to taba next weekend!
one saturday while we were living up in the galilee we decided to make a little trip to the city of jenin in the west bank. jenin is at the northern tip of the west bank just across the border from afula, but the only people who ever visit are israeli arabs from the galilee who go to visit family. jenin was a hotbed during the second intifada; half the suicide bombers during that uprising came from jenin. during that time the city was occupied by israel with heavy tanks and artillery and a lot of people died. we wandered the bustling streets for some time, and had a meal of assorted salads on a rooftop restaurant overlooking the city.
one of the more interesting institutions in jenin is the freedom theater. there, an acting troupe seeks to resist the occupation through art rather than violence, and seek to guide the children of the jenin refugee camp through acting as therapy. its founder juliano mer-khamis, who was both jewish and palestinian, was unfortunately assassinated by a masked gunman on the streets of jenin in 2011. much speculation surrounds the motive for his death. too bad that the good guys usually seem to die too soon in this part of the world.
returning to israel from jenin turned out to be an adventure in itself. we took a taxi to the crossing, but palestinian registered cars cannot cross into israel so we got out to walk across. we discovered however, that though we walked into the west bank earlier that day at the same crossing, it was illegal to cross by foot in the other direction. so we had no choice but to catch a ride with someone in their car. over the next two hours as twilight fell, we begged people in cars to let us cross the border with them, to no avail. one of my classmates eventually became so exasperated that he walked toward the crossing, waiving his hands in the air and protesting in hebrew, despite the disapproving yells of the israeli soldiers who had their automatic weapons trained on him. eventually we convinced him to relent. we finally were able to convince an older arab gentleman to let us into his van for the crossing. while we waited he told us that he had been in palestine to get some dental work done: it is much cheaper in the west bank than in israel. our van was pulled aside for a “secondary inspection” – because we were in it. now we realized why no one wanted to give us a ride. apparently the only foreigners who cross this border are activists. we were all interrogated and patted down, and then directed to a holding area, where we sat for another two hours while they closed all the windows on the van and pumped it full of a gas, the identity of which was unknown to us. strange times at the border. we profusely thanked our driver for taking two hours out of his evening to help our sorry selves. just another day in palestine.
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!
after finishing at the hospital in tel aviv one sunday afternoon i decided to take the bus up to jerusalem to check out the 5pm service at king of kings church in the heart of jerusalem. this church is the largest english speaking american-style evangelical church in israel, and is well known as the standard-bearer of evangelical christian zionism here. every week there are groups of american christian tourists visiting the church, “in the land” to “stand with israel.” a huge, plush auditorium in the basement of a shopping center and great audio-visual set-up. they have the contemporary evangelical consumer worship experience nailed – i quite enjoyed that part of it! great people, and they really do love Jesus which i believe is ultimately what is most important. as soon as the worship time ended however, politics came up and things inevitably started going downhill. the pastor couldn’t seem to help himself from raving about canadian prime minister stephen harper and how he is one of the only remaining world leaders defending israel, and how G-d is going to bless canada for standing for israel. ugh. he also raved about their prayer tower on the 14th floor where one can go and look out over ramallah (in the palestinian west bank) and pray that the “land would not be divided.” this church also regularly hosts conferences where church groups flown in from america listen to wacked-out end-times doomsday fiction authors like joel rosenburg float his weird eschatological fantasies about the impending destruction of the world as obvious “fulfillment of biblical prophecy.” if you can’t tell i’m a little skeptical of the scene.
don’t get me wrong, these are great people and i do believe that the vast majority are truly seeking to follow G-d. for most eschatology isn’t their exclusive spiritual focus. but it breaks my heart when christians in israel and who support israel preoccupy themselves with hypothetical future scenarios, while ignoring – or indeed more commonly extolling – the grave injustices that the government of israel flagrantly promotes – ie. the never-ending occupation of the palestinian territories and the refusal of many of the most basic human rights to the palestinians. i wouldn’t want to assume anything about anyone else’s Jesus, but the Jesus i follow is all about peace and loving our neighbors. He told us to love our enemies, not wall them in. i’ll even go out on a limb and say that the Jesus i follow, if he came to the middle east right now instead of 2000 years ago, might just identify as more palestinian than israeli. not to say that there is no significance in the fact that Jesus was a jew. but i believe that God intentionally made his appearance on earth as an underdog, and as part of a group of people living under occupation. also a fact that over 90% of the local christians here are arab palestinians, so we should really get some solidarity going.
to round out my quintessential middle-american-in-israel day, i cracked open a budweiser on the bus home and listened to some lady antebellum. one day was enough for me of this sub-culture; too bad it is not going away anytime soon.
thanks to much prodding from the class above us, we got christmas day 2013 off! christmas eve was spent at our hospital in bnei brak/tel aviv working – just another regular day in israel. as evening wore on we dropped the hint to our tutor that it was christmas eve – and she was all like “omg i totally didn’t even realize that – go!!” so we did, hopping on a bus to jerusalem and then another to bethlehem, the birthplace of Christ! the main border crossing into the west bank was closed due to “security concerns”, so we had to take the long way around, making what should have been a 20 minute drive into a 3 hour one. by the time we finally arrived at about 9 pm the party was in full swing! bethlehem is obviously a huge destination for christians from palestine and around the world this time of year, and there was a while lineup of ethnically varied choirs singing familiar carols in manger square, including my favorite, a composition of cute toddlers from south korea. we met up with about 20 of my classmates and had a nice feast of chicken burgers and beer in the restaurant on manger square. the funding for bethlehem’s holiday festivities comes mostly compliments of the us agency for international development. this year palestinian activists constructed a poignant christmas tree from spent tear gas grenades and barbed wire – it is truly sad that the birthplace of Christ remains under military occupation 2000-some years later, an sadder still that this occupation is endorsed and indeed propagated by so many christians in america. midnight mass occurred in the church of the nativity – prominent guests included the president of the palestinian authority mahmoud abbas and the european union’s foreign minister, whose motorcades of black swerving suvs almost ran us over as they arrived. some of us got tickets to go in but the rest of us watched on a big screen from outside. a group of us stayed in the home of a local who we had never met – lined up through some guy my friend andrew spent the whole day traipsing around the west bank trying to track down. turned out pretty well! christmas morning we grabbed some falafel for breakfast and payed a visit to bethlehem’s infamous “stars and bucks coffee”. we then went for a long walk through the aida refugee camp, which is circumscribed by the separation barrier, upon which is a plethora of fascinating art, including a selection of works by banksy. my favorite art on the wall is a large all-caps “love wins”, which is apt for christmas and any time of the year. thank you Jesus for freedom in all its forms, and viva palestine!
my neurology clerkship was at assaf harofe hospital, in the south tel aviv suburb of zeriffin. five of us got to commute every day from beer sheva, and it was a long one. one hour on a train each way, along with a 30 minute taxi ride with an angry chain smoker that usually had to be waited for. oh well, it was just two weeks, and it was the only clerkship of the year that didn’t involve an exam at the end, so it was a nice change. there were israeli students from tel aviv university who were there with us as well so that was fun. the hospital compound was a former british military base. it is a huge campus of a hospital. and the cafeteria food was unparalleled!
a few days i made a detour through jerusalem part of my commute. even ran into some old friends there which was great!
one day as we were leaving the hospital someone yelled out that they had found an abandoned box at the bus stop, which everyone immediately suspected might be a bomb. very quickly the highway was shut down and a robot was called in, as is standard in israel. everyone stood back a couple hundred meters. a non-descriptly dressed guy drove up in an unmarked car and casually loaded the machine gun on top of the robot with ammunition. the robot then made its way over to the item of interest – probably just a package someone had forgotten at the bus stop. a protective cover unfolded over the suspicious item, and the robot shot it to hell. everyone cheered. nothing exploded. we then went on with our commute.
my pediatrics clerkship was amazing! four of us spent six weeks at mayenai hayeshua hospital in bnei brak, a suburb east of tel aviv that is populated completely by haredi jews, or the “ultra-orthodox.” bnei brak is one of the poorest and most densely populated cities in israel.
these are the old-school jews of your imagination, who wear black suits and hats and side curls and follow their rabbi’s suggestions to the letter. the haredi population is growing exponentially in israel, and it is a society that in many ways is at odds with the more secular jewish majority. for example, the vast majority of haredi men do not work, rather spending their days studying the torah (old testament) and praying in yeshivas (roughly the jewish equivalent of a seminary). the government subsidizes this life-long education, a significant drain on the national economy which is despised by many secular israelis. the government also financially subsidizes having children in israel, with each family receiving a monthly check for each child. thus, 10 – 15 or more children per family is the norm in bnei brak, in large part because having a large quantity of children is the only way most families can afford to subsist. many israelis are also frustrated that the haredi are not required to serve in the military as other israeli jews are – an issue so charged that it was essentially the storyline of the last israeli national election. many secular israelis stereotype the haredi as being stuck in the past, exemplified by recent high profile altercations such as a haredi man spitting on a teenage girl because he thought her skirt was too short and haredi bus lines that make women sit in the back of the bus. because the haredi population has become so large and is constantly increasing, their political parties have firmly entrenched themselves as kingmakers who “punch above their weight” in israel’s political system of proportional representation. that is why the subsidies continue, allowing for the continued expansion of a population whose lifestyle would not be viable without the financial support of the government.
anyway, for the most part these big societal issues weren’t relevant when we were taking care of the children. i love children so much! one day each week we were in the neonatal department. the hospital has 1200 births per month, the second busiest in israel after soroka hospital in beer sheva. in the cribs of the haredi babies, instead of cartoon animals or colorful shapes, there are pictures of frowning elderly rabbis. what a world to be born into! and what fun to do newborn baby checks! palpate, palpate… is that a testicle?… urine fountain! fun time! snuggle time when its over!
mayenai hayeshua is the only hospital in israel built specifically to serve the haredi population. there is a hospital rabbi who calls most of the shots. it is a kosher zone, no outside food may be brought unto the premises. this was especially fun during the first week of the clerkship when we were living in the hospital as they hadn’t found us an apartment yet. the hospital cafeteria is of course kosher, as is every hospital cafeteria in israel. this one though is also gender segregated – i wasn’t allowed to sit with my female classmates at lunch. we got to chat with the hospital rabbi and he was a really interesting guy. he is a lot more liberal than many other rabbis in the community on a lot of issues. i would have loved to discuss ethics with him for hours, at least before he started talking about jewish-arab relations. he spends a lot of his time convincing people to have procedures done that they are waiting for a rabbi’s permission for. a simple thing like draining an abscess is an ethical question that must be deferred to a rabbi for some people. some rabbis are wackjobs, recommending against lifesaving treatment. there is one rabbi that many consider the authority when it comes to medical issues. he promises to have a response to your question for free within 15 minutes, and is always available. he has considerable financial resources at his disposal, and has been known to fly people halfway around the world for organ transplants at his expense on the spur of the moment, which only adds to his mythical miracle-worker reputation.
if there is a man in the elevator when a women gets on, he often will turn and stand with his face in the corner. all of the women wear head coverings – wigs count. there are as many wig stores as there are bakeries. some sects in bnei brak speak yiddish. some of the children are so sheltered that they only speak yiddish – not even hebrew. that’s like growing up speaking exclusively latin in inner city america – a) how does that happen? and b) how is the child going to survive? no family has any chronic diseases – when you ask them that is. they actually have quite a few. but because marriages are arranged, no one wants to ever admit to any diseases in the family, as that may harm their children’s potential to get the best marriage match. nowadays genetic testing is done before marriage matches are made to minimize the prevalence of certain genetic diseases that had unfortunately become increasing common in certain jewish populations. this approach has worked quite well in decreasing the prevalence of these diseases!
our attending physician was excellent. she was from california and had a bit of a hippie vibe going on. we got to go to clinics out in the community a few days. we lived about a 45 minute bus ride away in the secular city of petach tikva, a world away from bnei brak. petach tikva is often considered israel’s most boring city. but i thought it was great – there was an epic shopping mall and an ethiopian disco-bar/restaurant that we visited on a regular basis. it was great being in the suburbs of a big city like tel aviv where it is possible to get around on shabbat (saturday). this isn’t possible in beer sheva. a few of us visited the tel aviv art museum one day – it was really impressive actually with some excellent photography exhibits and warhol, van gogh, picasso, etc. we patronized the local microbrewery, jems. it was freezing for a lot of the time. i mean it was literally below freezing, which never happens in tel aviv where heaters are unknown. most of the levant got snow – it even snowed in cairo for the first time in 100 something years!
my favorite were nights in the pediatric emergency department. after countless attempts, my first successful intravenous line insertion on a baby was a happy time! best clerkship ever!!
