Friday, July 31, 2015

Plastering Over Some Striking Figures

Arrabeh, better known by attribution to its fertile valley as Arrabet-el-Battouf to distinguish it from Arrabet-Jenin or Arrabet-Jabal Nablus, excels in a wide range of things. Among those for example is the high number of professional plasterers. Our subcontractors and their professional teams of plasterers leave their mark on homes and offices across the country. In the old days before the Nakbah Arrabeh exported its hardworking young men, its wheat reapers or hassadin, to all the neighboring and better-landed villages such as Lubya and Saffourya. Another distinctive product of Arrabeh is its watermelons. The product is in such great demand that over ten fold of its Battouf Valley’s productive capacity is sold annually under the label of “Battouf watermelons.” Also, we in Arrabeh are famous for our high consumption of the seasonal gourmet dish of Akkoub, a wild thistle especially plentiful in the Golan Heights. Sadly, a few members of our community have been killed or maimed by landmines in the area. But we still have the decency to make light of this culinary addiction, some even reported to vocally oppose the return of the area to Syria without guaranteeing our free access to its Akkoub in any peace treaty.

And we have a striking number of university graduates in our village. Some fifteen years ago when Dr. Ali Badarni and I did a rough survey of manpower supply in preparation for the establishment of Elrazi – The Center for Child Rehabilitation, we discovered that over two thirds of the licensed Arab psychologists in Israel at the time were from Arrabeh. Ali knew the field well of course because he was a founder and the first head of the Association of Arab Psychologists. Our neighbors in Sakhnin thought that obviously we needed all of those psychologists. We in Arrabeh agreed with the explanation except that we blamed it all on the fact that the breeze we breathed daily blew from the west right over Sakhnin, which was enough to drive us mad.

More seriously, in the last couple of days a mini-tempest has been brewing on Facebook around an article that Ms. Makbula Nassar, a fellow Arrabeh villager and a respected media personality, wrote in Hebrew about the high number of physicians from our village. Later she went on to raise the same issue on a popular evening TV show in Hebrew as well. Responses have varied from gloating about the achievement to contesting the accuracy of the figures or belittling their significance given the unimpressive civic status of our village. Another prominent friend of mine, Adv. Jamil Dakwar, challenged me to respond to the debate. My own feeling is mixed: I feel proud, especially since Makbula credits me personally, as Arrabeh’s first native physician, with having something to do with the striking figures.

She credits several factors with bringing about the astronomical increase in the numbers of physicians among the Palestinian minority at large and in Arrabeh specifically. Pride and survival strategy are at the base of this development, she thinks. Then, in an open parody of the traditional Jewish mother, she credits the “Arab mother” with the burning wish, backed by struggle and sacrifice, to have a physician son or a physician groom for her daughter. Then she veers off from the general to the specific: Most of our medical students who study abroad return home, she explains and I proudly translate here from her Hebrew article: “Exactly like our mythological village doctor, Dr. Hatim Kanaaneh is his name, one of the first physicians in Galilee. His choice in the late 1960s [actually in 1970], after ten years of study and specialization at Harvard in the USA,  to return to a village with no electricity was a heroic act. [In him] we gained an exemplary figure and an impressive physician who served the entire Galilee. He didn’t only deliver medical care but also tended to knowledge and changed wrong traditional health beliefs. In my childhood I used to hear mothers in our neighborhood declaiming his advice and directions.

“In [1981] he already established the Galilee Society with the intention of providing accessible health [services] for residents of [Arabic] unrecognized villages in the Negev and the Galilee. For years the [nongovernmental] organization operated tens of mobile clinics and provided immunizations to children in those villages. There was no mother that didn’t wish for a son like ‘The’ doctor Hatim. Dr. Hatim, may God grant him long life, has already summarized his experience as a physician in Galilee in a book that he published in English. Currently he enjoys every minute of retirement by writing and resting. He has already contributed his share.”

To be honest, even now in retirement, I do feel a heavy sense of responsibility to act in a way to harness the positive promise of such a rich human resource. Makbula did allude to the need for and appropriateness of establishing a regional hospital. (Of course, concerned government officials would want such a facility to be established in Karmiel, if only those intransigent terrorist Bedouin squatters in Ramyeh would get off of their patch of land and let the state of the Jews develop the Galilee the right way for its rightful Jewish residents! But that is another and thornier issue.) Some 30 years ago, as the director of the Galilee Society for Health Research and Services, I proposed such a scheme to the three local authorities (Sakhnin, Arrabeh and Dier Hanna, then still fresh in people’s memory as the Land Day Triangle) and located potential funding resources in Europe. Faced with the inability to take the first step of securing the appropriate plot of land for the project, the plan was shelved. I agree that it is time to address this ambitious dream again. I know that the potential to lead such a project exists among the younger generation of physicians. That is the main source of my optimism on the matter.

The numbers that Makbula quotes are guarded. This summer our mayor participated in the graduation ceremonies of thirty Arrabeh physicians from medical schools in Romania and the Ukraine alone. There has to be more graduates from medical schools of other countries. And, of course, there are graduates in other fields as well. The accumulated number of university graduates from Arrabeh in all fields is very impressive indeed. You can now have your new home plastered by a team of university graduates from Arrabeh. And, even if it were to leak or flake off, you can be sure that you will feel better about it because some of the plasterers will be psychologists, medical doctors and pharmacists.

But quite seriously, and speaking not of Arrabeh alone but of the Palestinian community in Israel at large, the numbers of new graduates in the health field in recent years is strikingly high: There are programs in some East European universities and in Jordan that are tailor made specifically for our high school graduates. To understand the background to such developments let us go back in time to the mid 1980s: Dr. Anwar Awad (the first Arab medical graduate in Israel to have studied on a Communist Party scholarship) and I conducted a survey about the supply of Health manpower in our villages. The findings were presented at the First Health Conference in the Arab Community in Israel, held in Nazareth on April 12, 1986. Five years later in the Second Health Conference in 1991 I revisited the same subject of health manpower supply in our community. Here are some of the relevant observations on the subject based on the two papers:

1)   The number of physicians in our villages has increased at an exponential rate with the great majority of them graduating abroad. Two major hurdles facing our medical graduates were:
[i] The government exam that has been used as a valve to control the number of new graduates entering the medical care system and
[ii] Admission to specialty training in the various hospital departments in Israel.
Currently, my impression is that both of these roadblocks have been overcome to a large degree because of the system’s need for our foreign graduates to meet the growing demand for physicians in Israel at large. The competition from the Jewish majority seems to have diminished and hence the ease with which our medical graduates, mainly from overseas, can overcome the two mentioned hurdles. What lies behind this trend is not entirely clear to me. I suspect that many of the Jewish students in higher education opt for the more lucrative and relatively faster track of high tech thus decreasing the competition for entry to medical schools, to internships and to specialty training. Also many of the new Israeli Jewish medical specialists find their way to better paying positions in Western Europe, Canada and the USA.

2)   Our medical graduates’ tendency not to emigrate to first world countries, America being the prime destination of such brain drain, is an exception to the rule of the behavior of the educated class in third world communities as well as in Israel. It is a fact that very little brain drain has occurred among our physicians. I hesitate to offer an explanation of this phenomenon but if I have to then my guess would be that our level of material comfort as medical practitioners in Israel is reasonable. After all, Israeli officials always point to medicine as a field that has the lowest level of racial discrimination. At the same time there is a high sense of belonging in our villages that borders on clannish attachment. Perhaps this combined with the acute awareness of the threat of ethnic cleansing from the creeping fascism of the settler colonialist political majority in Israel makes a decision to emigrate seem less attractive. And even treasonous. Many seem to opt for sticking around and ‘plastering over’ all the rough spots.

To sum up I will draw on another ready source in responding to Ms. Nassar’s and Adv. Dakwar’s challenge: In the preface to my recently published collection of short stories from my medical practice in Arrabeh, Chief Complaint: A Country Doctor’s Tales of Life in Galilee (Just World Books, 2015,) I wrote:

“In the face of the current wave of distrust and enmity culminating in lynch mobs, I struggle to draw courage from my social surroundings: I ask a village neighbor about his family and he proudly announces that his firstborn is studying biochemical engineering in the USA. I wonder about the high expenses and he raises the electric saw high in his right arm and gives a proud buzz in response, his sweaty brow glistening in the light of the setting sun. I pay a visit to a younger colleague seeking his reassurance in the face of some compromised body functions of mine. He reminisces about his own father, a refugee who put his three boys, now a doctor, an architect and a physiotherapist, through university relying solely on the power of his biceps as a plasterer. My colleague flexes his arm in a proud show of sumud. A half dozen young doctors and nurses, all grand nephews and nieces, surround me for a photo at a relatives wedding and I feel proud beyond the fidelity and solidarity this implies: Yes, in the ‘state of the Jews’ education is the Palestinians’ strong card: We are proud sumud and education freaks. Entire families pool their combined labor wages to support a student through college. Young professionals are hard at work to guarantee their community a future and measure up to the high expectations of their hard slugging artisan fathers and mothers, descendants of land-stripped subsistence farmers. The practice and the tradition should be enough to sustain us in the face of the gathering storm.”

It is to Makbula’s credit to have raised this subject and especially to have rekindled interest in the dream scheme of a regional hospital, a dream that in a normal country should have already been a reality. Still, for the sake of accuracy I should point out before closing that to those among us who are familiar with the scientific use of statistics there is an obvious fallacy in taking our local numbers and comparing them to those from published international data. Our numbers relate to small data sets and comparisons to large data sets such as those for entire countries are misleading. Imagine me for example making a statement about my household where out of the two residents one is a physician. It is misleading, though factually accurate, to state that 50% of my reference population are physicians. The larger the numbers the more significant the conclusions one can draw.

Still, believe me, Arrabeh is the one and only.