The Next Prescription: More Reflections of a Country Doctor

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Alas, the olive harvest has started, and families are hard at work in their groves. One of the ways people appear to manage is celebrating time with family and these age old rituals. One of the Family Medicine resident doctors promised me a bottle of fresh-pressed olive oil. Where is Qalqilya you ask? Since the early s, there is only one road which is managed by a checkpoint. The heart of the city is cut off from its surrounding communities and farms, creating much distress for the farmers and residents who work outside the city.

Our hosts, who are college students in Nablus, talked about the long waits at times to get to and from the University due to checkpoint closures which occur out of the blue. Four years ago the city launched the Guava festival on the Zoo grounds to support their farmers and create fun for families. Guava is the Arabic word for quince. Booths sold boxes and boxes of quince along with other vegies including avocados and tomatoes. We were given free coffee at the local coffee roaster— Al Rasheed Coffee.

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Espresso lovers, it is rich as tasty. Our host was the student of another Fulbright scholar who teaches English to engineering and nursing students. Our gracious host, much to my chagrin, would not let us pay for anything. The festival committee had arranged our transport, about an hour between Nablus and Qalqilya; paid for our dinners; a kilo of quince for each of us; and all the coffee we wanted to drink. We arrived mid-afternoon, and it was easy to wander around the uncongested festival grounds.

We shopped, sampled honey and sweet treats, and visited the animals who were sleeping in the shade on this warm, sunny day. By dusk one moved very slowly among the packed streets and the area in front of the stage where families waited for the start of a traditional dance troop. We dined on barbecued chicken and lamb with sides of humus and pita bread as well as a pickled cabbage and beets.

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My companions than headed upstairs to the open-aired smoking area to smoke fruit-flavored tobacco in the shisha, hookah, also known as the nargila. But I had an interesting conversation one of our college student hosts who was studying French.

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She educated me about smoking in Palestine. Men routinely smoke in public. Coffee houses are filled with men playing cards, backgammon or just chatting as they sip coffee and smoke cigarettes or shisha. Most of our male Family Medicine physicians smoke cigarettes as do the taxi drivers and both have offered me cigarettes or asked me if I mind them smoking.

Women do smoke, but in private. The student told me she smoked cigarettes and shisha and her mother introduced her to both at age It is clearly a social activity, inhaling from the water pipe and chatting with your companions as you chat. The scents are really quite lovely. A few days later I was part of an interesting discussion about smoking between the 6th year medical students on their community health course and the Family Medicine faculty. One student posed: How do you respond when your patient asks you if you smoke. The faculty member who does smoke, suggested deflecting the question.

Another said it was an ethical issue, could you lie? They asked my opinion. So life here in the West Bank continues to fill my heart with the goodness of people trying to make the best of a difficult situation, wrestling with familiar challenges—healthy life style decisions and ethical questions—in a very difficult and challenging environment. My family is dealing with my elderly mother who has slipped into a dramatic decline—frequent falls and intermittent confusion—her body and her mind have betrayed her.

Much to her dismay, she can not live alone. These days, months, and this entire year is not what she hoped for—definitely not the golden years society promises. It is hard for her and hard for my sisters and I to watch.

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There are feelings of helplessness and hopelessness as she struggles bitter and resentful about her current state. This week I am preparing a session on dementia for the 4th year Family Medicine residents here in Nablus. They have had lectures on this topic in the past, so my goal is to be interactive, give them tools and skills to use and to better understand how they address issues such as poly-pharmacy, competence assessment, and elder abuse.

If these resources are not available, what are their responsibilities as community leaders to grapple with the needs of an aging population in the 21st century. When I observe them in their training clinics, seniors are often accompanied by an adult child who is caring for them. I am told families help each other with child care, and senior care much more here than in the US. More than half of the young family medicine doctors are women with children. Would they give up their careers to care for a parent as well as their children? Could they afford to financially?

On Thursday, I had a chance to see how Nablus is responding to their elderly residents.

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I watched six 6th-year medical students on their community health rotation talk about dementia at a local charitable organization for seniors. Nearly seniors gathered in the center which was located in an older part of Nablus. The younger seniors did just that—sunglasses perched on top of the hijab like a crown. Judging from clothing choices, a range of socio-economic groups were present and a few spoke a little English. Based on the number of wrinkles, many were born before the war, known as the War of Independence for Israel and the Nakba , translated as the catastrophe, for Palestinians.

At this time many Palestinians were forced from their homes and the UN eventually responded by creating refugee camps, initially tents, which are small cities in themselves some sixty years later.

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I am guessing some of the attendees were from there, generally a poor population. Before the session started, we stood and sang an upbeat and rousing song which a kind senior translated as: I love my country. I reflected on the many changes this group had lived through. As youth they knew a much less restricted Palestine. With the building of the wall, which began in life became more complicated with trips between cities six miles apart as the crow flies becoming journeys well over an hour Bethlehem and Jerusalem. During the Intifadas in and , Nablus was a hot spot with tanks rolling through, citizens jailed or killed for unclear reasons, and curfews lasted for days at a time.

But none of those traumas or losses were evident on Thursday. They listened to the students, took notes, accepted plastic cups of water, then tiny paper cups of strong coffee, followed by candy—berry flavors in plastic wrappers. The hosts were gracious and the audience was engaged. When time came for questions many started talking, only a few raised their hands.

The questions continued for twenty minutes and the host had to tell the audience the event was over. Several came up to ask the students more questions. Here, everyone talks with their hands. At home, there is often silence when it is time for questions and I usually plant a question or two to prime the pump.

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The Family physician faculty who invited me was proud of his students. He told them that the pace of life was changing. Many families could not afford to have the wife stay home and take care of aging parents. The charitable organization also ran a 25 bed facility for elderly women. These young physicians would be addressing these changing needs. They were vital and engaged, seeking knowledge and fellowship.

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As I watched and listened, I thought of our own struggle with my mother. Despite all the resources we have in the US, the process of aging and all the challenges it brings are still difficult.

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Needs are not fully addressed and emotions are raw. Perhaps it is the loss of control that is the most difficult. Or perhaps the poet Dylan Thomas is right: Do not go gentle into that good night , Old age should burn and rave at close of day; Rage, rage against the dying of the light. Despite the important roles of women in the home and community, and even though they hold significant jobs like doctors and vice deans, and the minister of health is a woman, men are the preferred gender.

Medical school is six years here, so these students have just started hospital rotations—medicine and surgery—the biomedical courses which are real medicine. The female professor I am working with tells me students consider her course unimportant, but nevertheless, she wanted some help with adult learning techniques rather than the traditional lecture style. Despite the lecture in Arabic of which I understand little, the discussions about Violence Against Women were lively with the young men arguing with the female professor.

She tells me they say that domestic violence is not a problem here and women bring it on themselves. These are not new excuses or thoughts. These students are well-to-do and also think their socio-economic class is spared. Victims of violence have increased health problems with almost four times more abortions; triple the trouble with sleep, depression, and chronic pain; and more have high blood pressure problems.

I also asked the professor if she should create some context: Violence Against Women is all about power and control. When you look at the definitions of social, economic, and psychological abuse it is the reality of life here, for both men and women. I ask myself daily, how do people cope with the realities of occupation? One morning this week I gained insight. The female professor and I joined another professor called the birdman because his hobby is birds. Before his scheduled lecture he took us to an environmental area in a valley with a stream just a few miles from the university.

Despite the dryness of the season and the trash, the ravine was filled with wildlife: Palestine mountain gazelles, rock hyrax a ground hog size mammal , turtles, fish, and array of birds. The birdman spoke of the peace he felt in nature, how he came here to nourish his spirit. I can relate, nature is also my grounding, where I also meet spirit, god.

However, the three of us kept our eyes on the houses high above us on both sides of the cliffs. Settlements I was told, but he clarified: they are really colonists because they grabbed the land like colonizers do.

The Next Prescription: More Reflections of a Country Doctor The Next Prescription: More Reflections of a Country Doctor
The Next Prescription: More Reflections of a Country Doctor The Next Prescription: More Reflections of a Country Doctor
The Next Prescription: More Reflections of a Country Doctor The Next Prescription: More Reflections of a Country Doctor
The Next Prescription: More Reflections of a Country Doctor The Next Prescription: More Reflections of a Country Doctor
The Next Prescription: More Reflections of a Country Doctor The Next Prescription: More Reflections of a Country Doctor
The Next Prescription: More Reflections of a Country Doctor The Next Prescription: More Reflections of a Country Doctor
The Next Prescription: More Reflections of a Country Doctor The Next Prescription: More Reflections of a Country Doctor
The Next Prescription: More Reflections of a Country Doctor The Next Prescription: More Reflections of a Country Doctor

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