Lentils or Needles, Your Choice

church
The Church (not abandoned, as I first thought) were our clinic is located.

We saw around 15 patients on our first day. If I this was a video game (maybe all of life is?), by the end of the day my strength bars would have been around 2/5.

Today we have nearly 30 people on the schedule, plus a smattering of missionaries who seem to filter in with loooong lists of medical questions.

The missionaries are amazing. Most consider themselves to be “married” to the mission field, and are here by themselves, living on donations. And not just for a week. For years.

If you’re looking for “underserved” medical communities, no matter your own personal faith persuasion, here’s one. Most Christian missionaries donated their health and bodies to their work long ago. They see a doctor when they can (read: every 5 years on average), but it’s never a regular thing for them.

One question from a missionary yesterday, “We’re so excited. We’ve been given permission to use an old elementary school from the Greek government. People have been defecating and doing drugs in there for the past 5 years. All we have to do is clean it out, and it’s ours! Do I need Hep B vaccination? I think I had one of those shots. What about that HiB thing? Oh, and what about tetanus. Can’t remember when I last did one of those. And should I wear gloves? Maybe a face mask?”

Afghan migrants arrives on the shores of the Greek island of Lesbos after crossing the Aegean sea from Turkey on a inflatable dinghy, Thursday, Sept. 24, 2015. More than 260,000 asylum-seekers have arrived in Greece so far this year, most reaching the country's eastern islands on flimsy rafts or boats from the nearby Turkish coast.(AP Photo/Petros Giannakouris)
Afghan migrants arrives on the shores of the Greek island of Lesbos after crossing the Aegean sea from Turkey on a inflatable dinghy, Thursday, Sept. 24, 2015. More than 260,000 asylum-seekers have arrived in Greece so far this year, most reaching the country’s eastern islands on flimsy rafts or boats from the nearby Turkish coast.(AP Photo/Petros Giannakouris)

Another story: 12 year old girl with dizzyness. She left with her parents from Afghanastan over 6 months ago, running from the Taliban. The family took a number of cars overland from there to Tehran for around 20 hours. They then hiked from Tehran to somewhere in Turkey for days, eventually finding their way to a huge refugee camp there.

Then the family found a smuggler who, for most of their remaining money, agreed to put them in an inflatable raft for a trip to the island of Lesbos, which is officially “Greece,” and would allow them to begin the process of obtaining refugee status.

They were required to get from the refugee camp to the coast on their own. Upon finding the launch site a few days later, according to the mother, they found that the raft was about 8 feet long, and she counted nearly 30 people in it.

They were turned back by the Turkish coast guard 5 times before they succeeded. Each time they were turned away, they were “towed” back to the Turkish coast, which effectively half-sunk their raft because the front end kept getting pulled under the water. Although some had life vests, many did not, and nobody knew how to swim, so the affair was terrifying.

This young patient started her period 8 months ago. She has had to learn how to be hygenic in refugee camp conditions. She can’t understand why she feels so weak and tired all the time. I asked her how and what she eats.

“We got cookies on the road from Tehran to Turkey. They were good.”

“Do you eat the food in the camps.”

“Ew. It’s always bean soup, and they never cook the beans.”

I smile and look at the mother, she is looking at me, rolling her eyes. “Lentils, usually,” She says through my translator Sahar (and Superwoman). “But I can’t get her to eat anything. She’s my pickiest kid.”

Here I am, a billion miles from my homeland, from any Caucasian, from my life, and this mother is dealing with a UNIVERSAL problem of parenthood.

“I have the same problem in my house,” I say smiling. The mom laughs.

I then look at the daughter, “You are probably dizzy because you are losing lots of blood every month. It makes people feel weak, tired, cold and dizzy. The best way to take care of it is to eat. Cookies are not food.”

I look at the mom, smiling again, but shrewdly. “But I don’t know for sure if this is the problem. I need a,” (imagine the audio slowing down here for emphasis), “BLOOOOD TESST.”

The girl’s eyes widen. “Uh huh,” I confirm. “With a NEEEDLE.”

Cute, 12-year old crestfallen face. “So I’ll make you a deal,” I continue. “Lentils or needles, your choice.” Mom laughs again, getting it.

The daughter, I hope, got it too. The mother and I were able to make light of this, but it could get serious. The girl’s arms at the biceps are thinner than my wrists.

There are more stories from only this first day. To depict them is like trying to pour the entire Mediterranean Sea into a rain drop. It just can’t be done.

This world, these sorrows, these tragedies…they can only be know by walking, even for a moment, with those that are living them.

Reader Q: My Med School

bgucloseI get lots of questions about my med school.  For those few not in The Know, I attended the Medical School for International Health.  The school is located in Israel, in the ancient town of Beer Sheva (you can find it in the Bible, dude…can you say something like THAT about Maple Acres, Kansas?).  The institution is Ben Gurion University.

The program focuses on providing medicine in an international context; particularly to the 3rd world.  The school is a collaboration project between BGU and Columbia University, so blokes like me have a reasonable shot of doing residencies in the U.S. after graduation (got my 1st choice in residency program).  

Anyway, emails come in from all over the world asking me about my experience there and soliciting my advice about going.  This latest query was so expansive and had such good questions, I figured that if I was going to go to the trouble of replying to it, I might as well post it as a blog so everyone could check it out:

My name is Bryan and I am an accepted MSIH student from Provo, UT headed to Israel in July.  Here are a few questions for you:  

What did your spouse and kids do while in Israel for the 3 years?  

They found all kinds of things to do.  Getting settled in Israel is quite a job compared to the U.S.  Everything is slower to accomplish, from records to mail to shopping, things just take lots of time.

That said, my wife and I had 2 children while in Israel, so that kept her busy in ways that older kids wouldn’t.  She also took a Hebrew class that provided lots of social interaction, friends and experiences in the culture.

Additionally, you will have WAAAY more time that you might expect.  The first year, you don’t even take an exam of any kind for 5 months.  Not one.  You just go to class.  Or don’t.  Depends on your learning style.  Then, when exam time does roll around, you are home studying most of the day.  I don’t know if that’s how it is at other med schools, but that’s the way we roll in the IS.

So, you won’t be gone as much as you probably envision.  And, the family will have more to do that you might think.

BGU from a distance:  Lots of dirt and dust...then, suddenly, CITY
BGU from a distance: Lots of dirt and dust...then, suddenly, CITY

Did your kids attend school at all?

Mine didn’t, but they easily could have.  I started the program with just one 2 year old girl, but we had 2 more by the time we left (like I said…you do have, *ahem* free time).  The oldest would have done fine in their preschools, called Gan (pronounced GONE, means garden).  

I would recommend it, especially if your kids want to learn Hebrew.  Like most European countries, education is a huge emphasis, so they’ll want your kid there EVERY day, all day.  Even preschool.  This was the hang-up for us.  Something M/W/F might have worked, but my wife wasn’t ready to ship our 3 year old off for full-time school, so we skipped it.

Did your kids and your spouse learn the language?

 

See comments above about wife.  Kids didn’t learn it (although for some reason, we ALL still regularly say ‘agvanot’, which means tomatoes).  I wish they had been a bit older, becuase then I would have insisted on school for them.

Did you have any Hebrew before MSIH, or did you buy a program like Rosetta Stone to get you started?

I had none, and sucked at it all the way through.  Figured out how to buy food pretty quick, though.  I bought a tape-series that supposedly was used by State Department people, but never even opened the box.  

The school provided a pretty good immersion class, but really you need to take the same Hebrew class that my wife took at night to actually learn the language.  The Israeli people (unlike many lame ethnocentric Americans like me) know English almost universally in addition to their native Hebrew.  So, they would rather work on their English with you than let you work on your Hebrew with them.  All of your classes are in English.  You actually don’t get as much exposure to the language as you might think.

Furthermore, on the wards, I’d say Hebrew is only spoken by about 60% of the patients.  Beer Sheva has to be one of the most nationally-diverse cities on the planet.  Walk down a typical medical ward, and you may hear anything from the Big Three:  Hebrew, Arabic and Russian, to many “lesser” languages of the area like English, Spanish, Bulgarian, Yiddish, Romanian, French and others.  Although Jewish in heritage, the people who immigrate to Israel come from nearly every country in the world.  Their primary language usually isn’t Hebrew.

If you truly want to learn the language – and the best reason to is so that you understand the ward doctors during your 3rd year – my recommendation is to go to Israel 2 months early and take a true immersion course.  This is how they do it for the new immigrants.  You live in a house with other immigrants and they DRILL the language into you.  You’ll have it forever after that.

Did you buy a car?

 

We did.  It was very expensive and a bad idea.  Getting all the paperwork for it took 3 solid days of sitting in offices all over the town of Beer Sheva.  Gas is spendy.  Insurance and licensing is more than in the states.  

We should have just used cabs instead.  They crawl all over the city all the time.  You never wait for them, and a trip anywhere in town is only 15 shekels, which is about 3 dollars. We calculated that we could take 60 one-way cab rides a month for the monthly cost of the car.  

Years out, I still talk to the guy on the left a few times a month.  He's starting a fellowship in pulmonary/critical care next month at Henry Ford in Detroit.
Years out, I still talk to the guy on the left a few times a month. He's starting a fellowship in pulmonary/critical care next month at Henry Ford in Detroit.

Right about that time, I got into a minor wreck;  we parked the car after that because we didn’t want to spend the money to fix it.  I watched with interest as teenagers slowly dismantled the thing on a semi-nightly basis over the ensuing months.  I ended up with a twisted metal creature that can only loosely be described as a “machine”.  They took everything.

“Oh well,”  my friend Brian consoled me one day.  “Just be happy that you probably made some high school kid’s senior year 10 times funnier as they systematically ripped your car apart every night.”

Do many students buy cars while there?

Nope.  Just the dumber ones.

How else can you get to the more remote sites like Masada, Dead Sea, Elat and the like? 

Rent cars.  Fairly easy.  Fairly cheap.  Pool with friends if you aren’t going with the fam.  We saw EVERYTHING in Israel in nice Skodas or Seats (see-aht) with power windows and A/C and no worries about breaking down.

You can also take the train, which is efficient and fun…except when its crowded and you’re crammed between 6 sweaty IDF soldiers with automatic rifles, some of which are pointed at you and your kids. 

Where did you do your residency and what specialty did you choose?

Olympia, WA.  Family medicine.  I felt then, and still feel, that my specialty is absolutely the best preparation for medical mission work.  

I have not once regretted my specialty choice or the residency program I chose.

Did you know of any MSIH grads applying to the handful of International Health Residency Programs?

None of my class applied, but this largely had to do with location, not competitiveness.  We wouldn’t have had a problem getting into those programs, in general.  U of Rochester had a good connection with our school and a few of our grads went there.  Their Intl Health cirriculum is fantastic (or was a few years ago when I was looking at them).

Is there any personal advice you think would be beneficial to me; advice that might not be included in the admissions packet?

Be flexible, don’t whine like an American.  Don’t expect anyone to care about you or your little worries.  Be a traveler.  Be observant and end your sentences with question marks rather that declarative periods at a ratio of at least 2:1.  

ipconflictRecognize that there is no answer to the Israel-Palestinian conflict.  Accept that you have no right to have any opinion on the issue until you can say honestly that you have deep friendships with BOTH an Israeli and a Palestinian.  Until then, try as hard as you can to shut up learn.

Travel, travel, travel as much as you possibly can.  Drive the country from end-to-end at least twice.  Stay at a Kibbutz or Moshav.  Swim in the waters of Gan Hashlosha and the Med.  Absolutely see the Golan Heights in the spring when curtains of flowing green grass are punctured by brilliant red Israeli poppies.  Try as many foods as you can and never turn down invitations to Shabbat, Passover, Rosh Hashanna or Succoth. 

Spend lots of time in Jerusalem – especially the Arab Quarter of the Old City – and try to hang out in the Armenian Tavern for dinner at least once.  See the Wall and the Dome on the same day.

The Golan
The Golan

Jump on chances to go to Europe, especially the eastern countries.  See Turkey, Jordan and at least the Sinai of Egypt.  Get certified in SCUBA in 3 days on the Gulf of Aquaba (look up a guy named Hamdi in Dahab if you are interested).  Consider your experience there a colossal failure if you miss out on many of these opportunities.

Pick up a cause that will build the school.  I started the literature and medicine class.  I think it’s a required class now, so if you hate it, you can thank me.  Pour part of your life into the school.  Put MSIH on the map in your own small (or big) way. 

Will every moment of your experience into the marrow of your soul; drink its precious nectar as if you never will again.  Because you won’t.

And pass your damn tests.