Tuesday, August 25, 2015

Review of Chief Complaint by a Harvard classmate

I am aware of half a dozen reviews of my book, Chief Complaint, having appeared in print or online, all enchantingly positive, I have collected those in a Word file that I treasure and keep expanding. But I haven't posted them on my blog. This is different. It has a certain value added at source; it is from a Harvard Medical School class mate (1968) who is the world expert on the subject of kinship and fertility. He posted his review to the class listserve. I expect some noise to be generated by this review. But noise is always good for sales. I hasten to add that the esoteric few last paragraphs left me less than clear about what my dear classmate exactly means. I visited his website and emerged not much clearer about his aim though, on the whole, it sounds positive. But that is Harvardese for you and I have been weaned from it for near half a century. Still, I am happy to gloat about all the praise and the bright spotlights that my classmate shines on my book in his first few paragraphs. Here it is for your (and my) enjoyment:

Review of Chief Complaint:
I have had the great pleasure of reading Chief Complaint by Hatim Kanaaneh MD (Just World Books, Alexandria, Virginia 2015 and available from Amazon).

It is with some trepidation that I discuss a book that touches on such sacred things. It is a collection of short stories, which is like saying a Mozart sonata is a collection of notes.  The stories are partly fictionalized, as the author points out, with most of the names being changed and some episodes that happened to different people being linked in one person.  The book is disarmingly simple in its organization, being the tales of people who came to Dr. Kanaaneh put together by chief complaint in the routine order of a systems review by a good clinician.

Beneath that inviting cover I found a narrative of different levels, which I shall try to describe. 

The easiest level for me is the political.  Let me quote the first two sentences from “The Gray Champion” by Nathanial Hawthorne.  “There was once a time when New England groaned under the actual pressure of heavier wrongs than those threatened ones that brought on the Revolution.  James II, the bigoted successor of Charles the Voluptuous, had annulled the charters of all of the colonies, and sent a harsh and unprincipled soldier to take away our liberties and endanger our religion.”  Chief Complaint makes clear that British rule was not improved by time, nor was the puppet government they installed.  As with Hawthorne, the doctor’s tale is one of the persecuted as seen by the persecuted – in flagrant defiance of the commonplace that history is written by the victors.  This is Palestine under Israeli rule, British Mandate rule and even Ottoman rule.  The protest is most clear.

The second level is still manageable for me.  That is the narrative style.  I graduated with high honors in English from Wesleyan University, so if this next paragraph is folly, at least it is by a fool with credentials.  There are multiple themes woven into the tale.  It is like spending days on a sailboat accompanied by an enormous pod of many-colored cetaceans.  Sometimes one passes submerged and the is only the hint of color gliding below the surface followed by another and another or more than one.  Then one of them breaches clear of the water and for a time all too brief shines resplendent in the sun.  And there are characters, many characters.  I think I have met more people of the village of Arrabeh than I can recall with such distinctness and understanding from my childhood plus present life.  We see them at their best and at their worst, their injuries and ailments, their deepest woes and their highest dreams, through the attentive eye of the clinician. 

At the third level I panic.  Long years among many different cultures have taught me that some things are fair game for conversation with anyone: family, weather, sports, ghosts, machinery and so forth.  One might not agree, but at least one knows the lie of the land.  But when one ventures into what is precious, sacred memory or dream, table manners and alcohol or tobacco, things immediately in touch with the physical body, one may all unintentionally offend.  The story is set with the constant presence of a wistful, mistful past when the people owned land, the land was bounteous and mouthwatering delicacies were available in their season.  It took hard work to wrest a living from the soil, from the goats and especially from the trappable wild things.  I have no doubt that these sweet memories are valid.  My own experience has been that the past is forgotten or seen through a distorting lens such that friends who seemed to be bounding with joy when they were with me recall later unfairness, squalor and privation I do not recall.  And yet the dream of this lost past summons problems; what would fix things?  Arrabeh is now a city of over twenty thousand.  It could never support itself on the produce of the land.  Nobody could possibly, any longer, be friends with every adult.  Natural increase has dimmed the dream.  Some things could be fixed, obviously, but all? 

The fourth level takes me where others might not choose to venture.  So if you have problems, let me say, “READ THIS BOOK.”  Now you can bolt any time you like.  The thing is that I see in this book not only the past but the future.  The rich countries of the world have an unsustainably low birth rate.  That is common coin.  My own work suggests that the middle class the world over will have a birth rate fall that will be extremely abrupt and profound.  But I do not see that in Arrabeh.  A large proportion of the Palestinians are highly educated and highly skilled.  They make money.  And they make babies.  Nobody else seems to be able to do both.  I imagine the reason is that there is such a close emotional attachment to the land, to the place, to the community, that they marry cousins frequently enough to keep the babies coming.  So the rest of us (I can’t even get a date, and that is really no new thing.) will not leave the world to the places that still have substantial growth: Yemen and Afghanistan I’m thinking, and sub-Saharan Africa.  Nice folk.  Love ‘em all.  Not so keen on the education thing.  But the Palestinians will endure.

And the fifth and final level is a voice that says, “Why wait?” Marrying cousins, specifically third and fourth cousins, maximizes your birth rate.  Tell them.  Ah, but high birth rate is already a problem; don’t blame global warming on the Palestinians, but just maintaining their society is difficult.  And I, after years of study, can’t tell you just what to do.  Go to my last summary of January 1, 2015 on nobabies.net and you can verify in the Iceland study that those third and fourth couple pairings are the most fertile, first cousins less so in the second generation and that distant ones, say ninth cousin or greater, even less so still.  Incidentally there is no difference between ninth cousin and somebody from the far side of the world.  Nature doesn’t care how distant your distant kinship is; what matters is how many generations it goes on.  (It doesn’t matter how far from the building you jump, it’s how long you fall.)  The Icelanders have looked at children and grandchildren, and it is the same story.  They have not seen fit to extend, as it seems they could, their study to great grandchildren.  I’ve written to encourage that.

Again on the web site I mentioned there is a Swedish study showing that rich people (who presumably leave forever their ancestral villages) have the same decrease in children and grand children and the decrease in great grandchildren is greater than the first two generations of outbreeding combined.

Ah but people keep track of such things in Arrabeh.  Do memories go back that far into the Ottoman regime?  Do the elders still chat?  Could they put together their own genealogies and see whether the rule holds, “Each generation of mating outside ninth cousin cuts fertility in half?”  That does not seem to be exactly the case, but something close to it.  Even so, it’s tricky.  The family trees will not be symmetrical at any level.  But we are talking about people intelligent and well educated who like to use their minds.  Maybe they can work it out.

But this summons another demon.  Now you know.  What do you do about it?

In the end, thank you, Dr. Kanaaneh, for this warm hearted, gripping and well woven book. 


Friday, August 21, 2015

A Tribute To Mohammed Allaan

At the risk of offending some of my fellow countrymen, I will express my disagreement with what is happening in the Palestinian Occupied Territories. (and I use the term Palestinian Occupation advisedly for it is the accursed Palestinian miscreants who have occupied the sacred land on which our forefathers trod millennia of years ago.) In fact my opinion about those running the Palestinian Occupation for us is rather negative. To be quite frank, they are the stupidest officials on the face of the planet. And believe you me there are stupid officials whichever way you look; need I mention the USA occupation of Iraq or of Saudi Arabia? Ours though take the grand prize for stupidity; they cannot put two and two together. We on this side of the Green Line do all we can to simplify things for them by passing all the necessary and expedient laws for them and they still mishandle everything. Take this Mohammed Allaan for example, the hunger striking Palestinian who is making so much noise we have to deploy the iron dome in the south of the country in another preemptive step for him. And what is his objection to being held in Jail? It is the fact that he is a lawyer and we treat him like other Palestinians which is to say we hold him in administrative detention without trial and extend the period by another six months every time the magic period expires. The first stupidity is why the number six? You are putting so many of them in administrative detention that the six month limit keeps so many court clerks, lawyers and military judges busy with paper work that it is self defeating. What about them, you say? Well, the Palestinians are mostly unemployed anyway. So why not choose a nice round figure like ten or a hundred from the start? Did someone think it was easier to count to six since it was the number of the fingers on one’s hand?

And why the administrative detention in the first place? We just passed a law to put anyone who throws a stone in jail for ten years with no need to prove an intention to harm. And our military courts are quite efficient on this one: 98% of youth who are accused of throwing stones are indicted provided they are proven to be Palestinian. And this Allaan guy is unconscious. So why not put a stone in his hand and have him take a selfie that you find accidentally when you bring him his lunch?

Oh, the hell with it! I forgot that he is on hunger strike in the first place. But we gave you the legal right to force-feed him anyway. You say that is torture and the doctors will not do it? Tell me again! Haven’t you read Eva Illouz’s discourse about the loss of humanity in our hospitals? I am a doctor and I was part of the system; After two decades of trying in vain, I gave up and left defeated. I know the system from the inside! ‘We buried him together,’ as the saying goes. Besides we are talking about Palestinians here! So what is all the talk about ‘human’ rights?

At the risk of boring you, I will tell you the story behind the village saying: It speaks of two merchants who owned a donkey in partnership that they called Sabir – tolerant --, a proper Arabic first name for a man as well as for a young donkey since Arabs classically nickname a donkey Abu-Sabir for putting up with so much abuse. On one of their joint trips their donkey tripped, fell and broke its neck. The two merchants were devastated by the loss. They buried their beloved donkey in a proper grave by the roadside, placed a huge pile of stones over it, and planted a shade tree in the style of the graves of holy men.  Passers by started to show their respect by making presents of lit candles and green satin cloth that they hung on the boughs of the tree or over the stone pile. The two merchants liked what they saw and kept their secret to themselves. Years later, on one of their trips, an argument concerning the division of their profits broke out between the two as they sat to rest in the shade of the tree by the holy shrine known far and wide as the “shrine of Sheikh Sabir.” One of the two raised his right hand in the air and swore “by the grave of Sheikh Sabir” that he was telling the truth. The other reached up and pulled his partner’s hand down saying: “We buried him together, remember?”

Let me go back to the stone throwing stupidity: It turns out that we plan to spend millions of Shekels on keeping East Jerusalem teenage boys a little longer at school each day, so that they will have less time to throw stones. Conveniently, most high schools in East Jerusalem are segregated by sex. So they decide that there will be no long school days for girl schools. I call that stupid for a couple of reasons. First girls are the ones behind stone throwing in East Jerusalem. It is the girls raucous applaud of stone sharpshooters that keeps those young men at it all their free time. And contrary to your plans of keeping stone throwing boys longer at school, our sources tell us that most stone throwers are dropouts on the first place. So there!!

More seriously though, the whole mess of occupation and the Israel-Palestine conflict could have been avoided all together from the very start. Had it not been for the exclusivist mindset of the Zionist founders of Israel things could have looked different. Here is an illustration of what I mean: A friend of mine was reminiscing earlier today about the first celebration of Israel’s independence day that he attended. A group of young men and of fully grown ones from our village got in the back of two trucks and drove to Tel-Aviv the night before independence Day. They even took Uncle Hassan, the village’s blind reed pipe player, with them as well as an agile leader of the classic Palestinian group dance, the Dabkah. It so happened that the young man was a refugee from Mi’ar, the 1948 destroyed village that a couple of decades later would became the site of the Jewish settlement of Ya’ad. The municipality of Tel-Aviv had closed one of its widest avenues, Zionism Avenue, to traffic. The group joined the other celebrants from all over the country and started its own spontaneous show forming a circle and proceeding to do their dance with full enthusiasm. Curious onlookers gathered around them, clapping and singing along. Suddenly a strapping young man of huge proportions and a thick beard stepped to the center of the circle, grabbed the reed pipe from Uncle Hassan and wanted to know in Arabic where was the group of dancers from. They told him and he cursed loudly, spat in their direction and threatened violence against them. The circle broke up and they headed to the nearby historic Hassan-Bik Mosque to sleep the night off. The weird sheikh of the mosque let them in on the condition that they had to do the dawn prayer there. My friend doesn’t remember how the rest of the night went or how early they left Tel-Aviv, they all were so ashamed. In response to my disdain and disbelief he explained that that was the first time anyone could leave the village and go to the big city without a special permit. The Military governor had let it be known that no written permits were required and no traffic violations would be issued regardless of how many passengers the two village drivers loaded in their trucks. I remember myself going down to Haifa that night with three high school friends. But we had a vey clear justification: We wanted to see all the Kibbutz girls dancing in their short shorts. What excuse did my friend’s circle of village men, especially the grown-up ones, had, I wondered?
“Remember, we were used to following orders. The police would come and heavily fine any shop in the village that was open on the Holocaust Remembrance Day or closed on Israel’s Independence Day. You had to be open and sell candy, colored balloons and noisemakers. They had us well trained. Someone in our group must have been ordered to go down and celebrate and the rest of us followed. We were like caged birds let loose. You didn’t consider who saw you taking flight or which direction you flew,” my friend explained. “Besides, at the time we all knew that the refugees would return and that Israel would join the Soviet Block and peace and equality between Arabs and Jews would reign.”
Mind you, my friend was and still is a communist. He sees all positive things colored red. But he has a point: The Palestinian community in Israel was as leaderless, unsophisticated and frightened as a group of nursery children abandoned by their attendants. Had someone bothered to give us a warm hug and a bottle we would have settled down and gone to sleep. It took us nearly three decades before we gathered enough courage and trust in each other to stand up together on Land Day and say “NO!” to the government’s continued designs on our land.
“We had a chance to be together for one night with no one to tell us what to do,” my friend added in conclusion. “What was more natural than to join hands and dance the Dabkah? But, at a deeper level, we must have felt guilty. Otherwise how did it happen that we all cowered in front of that bearded Palestinian young man? We all simply folded our tails between our legs and withdrew whimpering. He was strong because he was right.”

Suddenly my friend’s face glowed with an inspired flash of genius:

“I think his name was Mohammed Allaan!”

Saturday, August 1, 2015

Giving Thanks Where It Is Due:

It is not everyday that one wakes up to his name being strung along with a veritable rosary of literary luminaries that starts with Kafka, Balzac and Chekov. That was my good fortune this week when I was advised by a mutual friend, Dr. Rita Giacaman, of Professor Graham Watt’s academic review of my collection of short stories, (‘vignettes’ is a more accurate descriptive,) Chief Complaint: A Country Doctor’s Tales of Life in Galilee (Just World Books, 2015.) The review appears in the August 2015 issue of the British Journal of General Practice. And indeed it is a worthy read for it gives a panoramic view of published works by and about country doctors.

My pleasant surprise was redoubled when I discovered that my reviewer and I share another mutual friend, Dr. Runa Mackay, who was forced by circumstances to become the grand old dame of gynecology and obstetrics in Nazareth’s environs throughout most of the second half of the twentieth century, though at heart she remained always a dedicated pediatrician. Runa also was a staunch convert to public health and a cofounder of the Galilee Society for Health Research and Services, my single most significant professional contribution to my official field of specialization. With the dearth of recognition in Israel of all things Palestinian it is no small compliment to have my book favorably reviewed by a friend of such a local pillar of our profession in Galilee as Dr. Mackay. And the review is made doubly credible by avoiding the morass of the interminable Israel-Palestine conflict. It lays the bare facts relevant to my discourse leaving it up to the reader to reach his/her conclusion.
Thank you Prof. Graham Watt for your unbiased academic insight and analysis and for involving Kafka, Balzac, Chekov, James Harriet and all the others.
Here it is:
Chief Complaint
A Country Doctor’s Tales of Life in Galilee Hatim Kanaaneh

Just World Books, 2015, PB, 256pp, $21.00, 978-1935982340

The ‘Country Doctor’ is one of the most iconic figures in medicine. Kafka and Balzac wrote novels about him (most examples are male), and Chekov based many of his short stories on his experiences and insights as a country doctor.1 John Berger wrote The Fortunate Man, with photographs by Jean Mohr, based on John Sassal, a GP in remote and rural Gloucestershire.2 W Eugene Smith produced a famous photographic and text essay on a country doctor in Kremmling, Colorado, for Life magazine.3 John Bain and Rosie Donovan in Scotland,4 and Tom O’Dowd and Fionn McCann in Ireland,5 recorded many country doctors in photographs. There is a substantial literature of potboilers, doing for country doctors what James Herriot did for country vets in All Creatures Great & Small.
More than any other figure in medicine, country doctors exemplify what Trish Greenhalgh described as:
‘... the internalised, embodied knowledge that comes from years of listening to stories, building relationships, touching the flesh, responding to real or perceived crises, and witnessing the suffering, healing, coping and dying of ordinary folk’.6
Or as Julian Tudor Hart wrote of his patients:
From many direct and indirect contacts, many non-medical through shared activities, schools, shops and gossip, I have come to understand how ignorant I would be if I only knew them as a doctor seeing them when they were ill. It is a compact world, in which integrity and a sense of proportion are more easily retained than in cities, provided that one accepts the multiple faces one must wear in an intimate communal life. There is immense friendliness, much bravery and generosity, a good deal of petty meanness, treachery and servile cowardice — but never indifference.’ 7
The latest addition to this rich strand of medical literature comes from an unexpected source, Dr Hatim Kanaaneh, a Harvard-trained physician who returned to his home village of Arrabah in Galilee. Although over 500 Palestinian villages have been demolished, built on, or covered with pine forest since the creation of the State of Israel in 1948, Arrabah has survived, in the heart of northern Israel, situated west of Galilee, east of Haifa, north of Nazareth, and south of Lebanon.
About 20% of the population of Israel comprises ‘Israeli Arabs’ as they are officially called, but in the north of the country the figure is near to 50%. In the same way that Raja Shehadeh used a series of Palestinian Walks,8 to describe aspects of living under military occupation in the West Bank, Kanaaneh uses a series of presenting, or chief medical complaints in general practice to tell tales of Palestinian lives inside the State of Israel.
Drawing on stories of family, friends, neighbours, and patients, Kanaaneh describes Palestinian society, based largely on family, religion, and working the land. A major recurring theme is how people have adapted to the loss of land and people in 1948 and to the gradual but systematic loss of land since then. Although Kanaaneh returned to Arrabah in 1970, his stories and memories span a longer period, covering Ottoman, British, and now Israeli, rule. Much of the culture will be unfamiliar to western readers but Kanaaneh is a helpful guide, sprinkling the text with definitions and explanations of Arabic words, phrases, sayings and customs.
Kanaaneh’s previous book A Doctor in Galilee: The Life and Struggle of a Palestinian in Israel, recounted his frustrating experiences as the only Arab doctor working in Israel’s Ministry of Health.9 His new book is less angry and more pastoral, letting stories speak for themselves. All human life is here: pregnancies, weddings, and funerals; involving husbands and wives, daughters and sons, relatives and neighbours, at home, or in exile abroad. Conversation, coffee, and cuisine are the staple fare of ordinary life, with music and dance for special events. Many of the themes are familiar, involving the loss of the old ways, the scattering of families, improved health care, new ways of making a living, and so on, but the circumstances are extraordinary, having citizenship but not nationality, in a place where they have always lived. One of the subjects of the stories reflects:
Every Palestinian has a story worth telling. You scratch the surface and there is a treasure trove in every life.
By drawing on a lifetime’s practice as a country doctor, Kanaaneh brings the story of his people to our attention.
1. Coope J. Dr Chekhov. A study in literature and medicine. Isle of Wight: Cross Publishing, 1997.
2. Berger J. A fortunate man. London: Penguin, 1969.
3. Smith WE. Country doctor. New York, NY: Life Magazine, 1948.
4. Donovan R, Bain J. Single-handed: general practitioners in remote and rural areas. Caithness: Whittles Publishing, 2011.
5. Trinity College Dublin. Gallery. General Practice Exhibition May 2012. http://www.medicine. tcd.ie/tercentenary/gallery/general-practice- exhibition2012.php (accessed 4 Jul 2015).
6. Greenhalgh, T. Thirty years on from Alma-Ata: Where have we come from? Where are we going?BrJGenPract 2008;58(556):798–804.
7. Hart JT. The Lancet career guide for medical students. London: Lancet Publications, 1973.
8. Shehadeh R. Palestinian walks: notes on a vanishing landscape. London: Profile Books, 2008.
9. Kanaaneh H. A doctor in Galilee: the life and struggle of a Palestinian in Israel. London: Pluto Press, 2008.
Graham Watt,
Norie Miller Professor of General Practice, University of Glasgow, Glasgow.
Graham Watt
General Practice & Primary Care,
1 Horselethill Road, Glasgow G12 9LX, UK.