The challenges of being a Palestinian doctor in the ‘Jewish state’

Let me start with a reference and ask the reader to check it out before delving into the delicate matter at hand. How did I miss this article till now,….

Let me start with a reference and ask the reader to check it out before delving into the delicate matter at hand.

How did I miss this article till now, I wonder?! Makbula Nassar, our proud journalist, community activist and prime instigator of Arrabeh’s claim to medical leadership, in numbers of doctors if not in institutions, is quoted giving me credit as the first Western trained MD in my village for inspiring its flood of local physicians. Let me acknowledge her praise humbly then try here to give a more realistic explanation for the phenomenal statistics that she provides. Incidentally, my impression is that both she and her fellow Arrabeh Journalist, Mohammad Khateeb, underestimate those numbers.

Perhaps at first I overlooked the patronizing piece because it makes two mistaken assumptions: First it describes my town, Arrabeh, as a “medical mecca.” In reality it is far from that: Both its medical experts and its seriously ill residents have to travel out of their town daily whether to seek employment or for adequate care. Also the article spins the story to credit Israel with the miraculous accomplishment of Arrabeh in the field of medical manpower production. That is what all three readers commenting on the report seem to understand. In fact Arrabeh, and the Palestinian minority in Israeli in general, achieved this distinctive feat in clear violation of the wishes of Israeli planners and despite the country’s standard practices. An example of these policies is the infamous Koenig Report of 1976, the historical document exposing the nature of those policies if not their full details. In the particular field of higher education, Mr. Israel Koenig, then the Commissioner of the Ministry of Interior of the Northern District (Galilee) where the majority of us resided, spelled out the steps needed to discourage, to coopt and to control the numbers of our university graduates. One specific recommendation dealt with ways to discourage our overseas graduates from returning. When his secret memo, submitted to Prime Minister Rabin, was leaked its author was elevated to the post of Director General of the Ministry of the Interior. [In his brilliant foreword to my book of memoirs, A Doctor in Galilee, (Pluto Press, 2008), Jonathan Cook gives an excellent assessment of the background and true impact of the Koenig Report.]

The great majority of our physicians, like other professionals in the Palestinian minority in Israel, with the exception of teachers and nurses, received their higher education abroad. Two factors played a central role in this exceptional achievement: Initially the Communist Party, the majority of whose membership in Israel has always been Palestinian, awarded its diligent youth cadre with full scholarships to universities in the Soviet Union. This was conditional on their return upon completion of their studies to serve their communities and to swell the number of educated party members. The first physician who led this process was my good colleague and cofounder of the Galilee Society for Health Research and Services, Dr. Anwar Awad from the neighboring village of Rama in Galilee.

Simultaneously a parallel spontaneous process started to take root in all Palestinian communities in Israel, including in Arrabeh: Members of farming and working class families would join forces and pool their savings to support a younger son (and more recently a younger daughter as well) to pursue higher education at a local university or, more often, abroad. Considerations of expenses and admission requirements made ambitious students who didn’t qualify for Communist party scholarships opt for Italy, Romania or Germany. In my collection of short stories from my medical practice in Arrabeh, Chief Complaint, (Just World Books, 2015), I alluded to this cooperative family spirit in several of the vignettes. And in the preface I wrote the following:

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.

As is expected, first only few broke through the barrier of unfamiliarity and fear of the unknown. Then their friends or young relatives followed after such pioneers. This trend prevailed more widely with the fall of the Soviet Union and the opening in many of its former member countries of affordable higher education options. Some programs seem to have been specifically designed as commercial enterprises that target our youth as their customers. Fully accredited English-language medical training programs in Hungary, the Ukraine and Moldavia are examples. The student bodies of such programs are almost exclusively Palestinian citizens of Israel. Recently, similar processes also became available in Jordan and in the occupied West Bank, thus opening wider options in the various paramedical professions as well. Some high achievers among our high school graduates get admitted to Israeli medical schools and few of them even qualifying for the occasional scholarship. But this remains the exception. This begs the question of why attempts at establishing a respectable university in Nazareth have met with denial from the Council of Higher Education for the past five decades. The logic of demand and supply should have worked in favor of such a step. But racial and nationalistic considerations in Israel, especially among the higher echelons of the educational hierarchy, mitigate against such a logical step.

All in all, these alternative pathways to professional training in the medical field and the various health allied professions made it possible for our youth to bypass the two major hindrances that Israeli universities mount in their way other than the excessive financial expenses and the limited scholarships for non-Jews: First there is the minimum age requirement intended to delay our youth for the specific period that their Jewish age mates spend in the compulsory military service. This service gives the Jewish applicants upon discharge automatic priority whether in admission or in financial aid. And there is the culturally biased entrance exams weighted to disadvantage the non-Jewish applicant. This, of course, is no easy matter given the entrenched disadvantage of our separate and unequal elementary and high school educational system. It is thoroughly infiltrated by the Shin Bet, the Israeli secret police, and operates with government budgetary support at one-half to one-sixth of what Jewish schools receive per student. Add to that the disadvantage of our students having done all their studies in Arabic and then needing to compete in exams administered in Hebrew. And they need to switch to the Hebrew as the teaching language in all Israeli universities. But they do it successfully. Or they strike out abroad to fulfill the Palestinian version of the Jewish mother’s ambition for her son ‘The Doctor.’ Makbula Nassar sums it up well in two words: “pride and survival.” You could also call it resilience, often verging on plasticity. And we have the directive of our prophet Mohammad, God’s blessings be upon him, prodding us to “seek knowledge even if in China,” China being the far end of the known world at the time and the paragon of its wisdom.

Here is the place to point out the two exceptions mentioned earlier: Nursing and teacher training. Our teacher-training tract has always been fraught with the heavy-handed interference of the Shin Bet. Such programs are essentially self-contained system-designed and sponsored processes under the auspices of the Ministry of Education. Despite the many bad apples, it is actually amazing how many decent teachers manage to keep a low enough profile to sneak under the system’s radar and to do an excellent job of teaching their young charges. As to the nursing schools, a combination of severe shortage and the relative validity of the profession’s claim to humanitarianism above all other considerations seem to have opened the door to our youth. A major factor as well is that the nursing school training process permits the students to work part time and earn enough income to cover most of their university expenses. They serve as nursing aids or as scribes for observant Jewish doctors on Saturdays.

These points apply to the Palestinian minority as a whole. The oddity of Arrabeh’s high number of physicians is only that, a peculiarity that proves the general rule. Perhaps we in Arrabeh have a special knack, a little more than other Palestinian villagers, for following the example of pioneers and lead elders of the profession who might have impressed us. And medicine is not the only field. A standard joke claims that in Israel if you get sick on a Saturday you better speak Arabic. Otherwise an Arab physician will make the wrong diagnosis and an Arab pharmacist will dispense the wrong medication.

Two decades ago I joined Dr. Ali Badarni, a senior psychologist, in establishing a rural child rehabilitation center. In preparation we surveyed the health manpower supply in our villages. Lo and behold, Arrabeh had over half of all the licensed Palestinian psychologists in Israel. All in all, not only Arrabeh but the Palestinian minority in Israel as a whole is on its way to becoming a major health manpower base for the entire country. Similar to the particular cases of medicine, nursing and pharmacy, all the health-allied professions are rapidly increasing in their numbers in our towns and villages. The Jewish sector is focusing more and more on high tech, on the military and security industry and on finance. Many of its university graduates qualifying in such fields as well as in medicine, find employment in the wider and better paying world market. A less stressful and more secure life experience abroad, whether in Berlin or New York, seems to attract many young Jewish professionals, including medical experts, and to hold them for the long haul.

This brain drain is hardly noticeable among our own Palestinian professionals in Israel. Even those who make it to Western countries for post-doctorate research or for super-specialty training seem to return home regularly. The brain drain carries them no further than Haifa, Tel Aviv or Jerusalem where more and more impressive positions in the institutional hierarchies are opening to them. They stay a reasonable traveling distance from their village whether commuting daily to work or home to the village for the weekend. Something in their subsistence farming village tradition holds them on a short leash even when that farm no longer sustains the expanded and more modern family. Filial piety and the hold of the extended family, if not tribalism, seem still to play a role. Or perhaps it is the virgin olive oil from the family trees or our world-renowned poet, Mahmoud Darwish’s deep down sentiments of “I long for my mother’s bread.”

In sharp contrast, there is also the ‘push’ of the undercurrent of mutual distrust given full expression in state sponsored residential segregation between Arabs and Jews, jealously maintained by municipalities and given the stamp of approval by the Supreme Court. It keeps our top professionals from melting away into the zones of their Jewish work places.

Overall, the domestic field in the less racially contentious area of health has gotten more and more accepting of us as employees. Our oversupply of health professionals is absorbed in medical institutions across Israel. Yet even here discrimination does show its ugly head, even if indirectly: In Israel’s near seven decades history not a single hospital has been opened in an Arab community. With Arrabeh’s central location in Galilee, a district with half of its population Arab, and with our oversupply of young health professionals, the long ambulance ride to a hospital is becoming more and more unacceptable. Rumblings of discontent are often heard, as is obvious in Makbula Nassar’s statement in the article that is at the heart of this diatribe. But mark my word, when the Ministry of Health grants the required license, it will find ample justification to place the needed hospital in a Jewish locality next door to Arrabeh. It is the ‘Jewish State’ reality. After all, not only the janitors and parking-lot attendants but also our doctors, pharmacists and nurses working in ‘Jewish’ hospitals reflect an iteration, albeit a refined one, of the biblical enslavement designs on us to serve as “hewers of wood and drawers of water” for the Jewish masters.