Tuesday 16 September 2008

PRIDE AND PRIVILIGE - ON BEING A PALESTINIAN MEDICAL PROFESSIONAL

PRIDE AND PRIVILEGE - ON BEING A PALESTINIAN MEDIC

To be a doctor, to be a member of this most humanitarian of professions, is one of greatest privileges that I have been granted. When in any distress or dismay relating to my occupation, I always remember the fact that beneath all the rubble and mess that has affected modern medicine, there lay a great ocean of truth and beauty, an ocean whose sailors made the welfare of human beings, their most important duty. Sailors who do not venture with the deliberate aim of spreading imperialist ambitions in the manner of the Spanish consquistadors, importing slaves in the manner of Sir Francis Drake[1] and Vasco de Gama (and many other explorers of the world), or the indeliberate consequence of spreading tension or disease, like James Cook[2], Frederick Magellan and Christopher Columbus, the man accused of spreading ‘the Neapolitan bone-ache’ (syphilis) throughout the world.

But instead, they are sailors who entered the oceans with three goals in mind, “to prevent disease, to relieve suffering and to heal the sick”, as the great William Osler put it, with their ideal being “to eliminate the need of a physician”, as another great William, William J. Mayo, of Mayo Clinic fame, put it. It is a given fact that some of them have been involved in atrocities (for instance, there is documented evidence of doctors giving slaves “watered down versions of the medicine offered to whites” (Elmer, p.12)), but that is not the fault of medicine, just like it is not the fault of medicine that the two dictators mentioned in my essay on the relationship between politics and medicine were at one time, practising physicians.

The greatest beauty of medicine is that it emphasises the equality of man. While (as I argued in a previous essay) I believe that only as strong faith in God can provide a solid backbone to this belief (all the oaths of the world did not stop Harold Shipman from killing many of his patients, or those doctor-dictators from killing thousands of innocent people) I believe that it is a great thing that medicine upholds this kind of belief. I have not looked into the professional codes of other professions, but I suspect that none of them emphasise the equality of man as much as medicine does.

It is one of the greatest privileges I have to belong to a profession whose heroes include some of the greatest human beings to embrace the planet. I have mentioned many of those heroes in a previous essay too (‘In the Kingdom of Medicine’), and throughout the course of this work, I will mention them time and time again. When distressed or dismayed, I only need to remember that we really do stand on the shoulders of giants, whose traditions we are so privileged to carry, and that automatically brings me back the joy I need, the feeling that what I do is of global importance and significance.

However, no matter how much privileged I feel about being a member of this wonderful profession, it does not compare with the significance it has come to acquire for my own self – something that extends beyond the financial security it has offered me, and the ‘feel-good-factor’ about doing something of service to humanity.

MY OCCUPATION AND THE OCCUPATION

Over the years, I have come to regard the practice of medicine as one of two anchors that have kept me, a self-confessed dreamer and idealist, from floating and flying into self-constructed heavens, whose stars are my literary, philosophical, scientific, medical and mathematical heroes, the likes of Leo Tolstoy, Fyodor Dostoevsky, Anton Chekhov, Naguib Mahfouz, Abbas Mahmood Al-Akkad, Mustafa Mahmood, Bertrand Russell, David Hume, Isaac Newton, James Clerk Maxwell, Paul Dirac, Werner Heisenberg, Ambroise Pare, Theodor Bilroth, Louis Pasteur, William Osler, Leonard Euler, Karl Friedrich Gauss, Henri Poincare, and hundreds of others, and its moons and planets being my musical heroes, Farid El-Atrache, Fairuz, Om Kalthoom (the ‘planet of the East’, ‘Kawkab Al-Sharq’), Mozart, Beethoven, Mendelssohn and the Bachs, all playing and singing, in a grand celestial orchestra, the music of the spheres, with a warm romanticism that stems from the love of all these men and women, a love for Palestine and most importantly, God and His Creation, lying in between.

The intoxication a dreamer can gather out of all this is quite phenomenal. For one to live in a world of dreams as beautiful and majestic as that would be the most magnificent of achievements.

But at the same time, it is quite dangerous, for two reasons. Firstly, it risks the dreamer losing sight of his or her end goal, which would be to attain paradise in the hereafter. He or she runs the risk of announcing with that great Persian master of verse, Omar Khayyam:

“Here with a Loaf of Bread beneath the Bough,
A Flask of Wine, a Book of Verse, and Thou
Beside me singing in the Wilderness,
And Wilderness is Paradise enow”

Secondly, and more immediately, the dreamer runs the risk of losing sight of his or her humanity.

To counter this risk, God has blessed me by being a Palestinian first, and a medical professional second. And for this I am ever thankful. The main people I am thankful for, for both qualities, are my parents – my father, a businessman from Gaza, and my mother, a former teacher from Jaffa.

By being born to Palestinian parents, I have acquired a sense of duty to my stolen homeland and its people. Palestine and its suffering people have always remained at the forefront of my mind since a very early age, and will remain so, so long as my mind remains intact. The situation is so tragic, that anyone looking at it from the heavens is bound to shed a tear or two, and wish to return to the Earth to sort out its many injustices. My Palestinianism has served to anchor me firmly in the earth, and the pains and worries of Palestine and its people.

It is those same parents, who, I must confess, kind of forced me to enter medical school, diverting me from pursuing my great teenage dream of studying philosophy and physics in Bristol (the original home of Paul Dirac, my favourite quantum physicist), Oxford University or King’s College in London, or mathematical physics in Imperial College in London. Their persuasion was based mainly on a greater understanding of the financial implications of a career in those specialties; they simply do not have the financial security of a medical professional.

In any case, regardless of the financial issue, I think if I had become a physicist, I would have been trapped in those heavens, with cyclotrons and telescopes, and lost sight of my humanity. Studying medicine has served to ground me firmly in the world, lest I fly, and kept me in touch with fellow human beings, rather than positrons and electrons, black holes and supernovas.

Either being a Palestinian, or medical professional, can only bring pity to one’s soul, for both involve the witnessing of a seemingly endless barrage of suffering and pain. By being both, the Palestinian medical professional is the first witness to the quite pathetic health care systems we have, which were recently described by ‘Palestine Children’s Relief Fund’ (PCRF) founder and president Stephen Sosebee as “near breaking point”, the ‘medical oppression’ that occurs on a day to day basis by the Israeli army – the prevention of sick children, men and women from passing across checkpoints, because they are Palestinians, and therefore either terrorists or subhuman; women delivering at those checkpoints and many dying, to many other practices that I described elsewhere. He or she is witness to a disastrous state of mental and physical health. WHO described the former as follows:

“Epidemiological data on mental illness among the UNRWA population is not available. However, reports by psychiatrists working in some of the field areas, reports of brief visits by child mental health consultants and results of an exploratory study confirm that there is a high frequency of mental health problems in the refugee population. The Director of Mental Health Services, Gaza, reported in 1989 that there was a high incidence of hysteria, anxiety, depression and psychosocial problems presenting with somatic complaints. Discussing the increasing incidence of mental health problems, the report says that, “… scattered throughout the world, the Palestinians do not feel at home anywhere. They are unwanted everywhere and are regarded as a source of potential trouble. Their anger and fear are turned into aggression. Daily life is a continuous story of fighting. Violent demonstrations are common occurrences in the life of Gaza and the West Bank. Cases of anxiety, depression and psychotic reactions are frequently seen following confrontations. Children’s problems like outbursts of temper and aggressive behaviour, sleep disturbances and anxiety are also on the increase.””
As for the latter, a few quotes suffice. The first regarding child mortality, also from the WHO website, “As a result of the deplorable sanitary conditions in many camps, 12% of infant deaths and 20% of child mortality are due to acute diarrhea”.

The second from a more detailed report from WHO:

“Border closures, strikes and deteriorating economic conditions are impeding the Ministry of Health’s effectiveness to respond to pressing health needs. All hospitals have reduced services, most frequently due to a lack of medical supplies, spare parts and adequate maintenance of medical equipment because of the Palestinian Authority’s fi nancial crisis. With healthcare quality deteriorating and mental health symptoms on the rise, the main issues identified are:

1. Access to medical care, in particular pre-natal medical care, is compromised.
2. The reduction of services affects diagnostic services and vital specialized treatment, such as kidney dialysis.
3. Shortages of essential drugs and other medical supplies are recurrent, mainly in Gaza.
4. Border closures and restrictions impede the referral of patients in need of secondary and tertiary health services unavailable in the Gaza Strip – close to 6000 people were referred for treatment in Egypt and Jordan as well as in the West Bank, East Jerusalem and Israel between January and September 2007.
5. According to surveys, 86% of the population report sleeping problems, 77% deteriorating family relations, 72% increased tension among children, and 55% feel insecure. Almost half seriously fear losing their home, losing their land (46.1%) and being displaced or uprooted (44.5%).
6. Micronutrient deficiencies are the main nutritional problems: according to UNRWA, iron deficiency anaemia affects 57.5% of children under three in the Gaza Strip and 37.1% in the West Bank, and 44.9% of pregnant women in the Gaza Strip and 31.1% in the West Bank.
7. The procurement and funding of drugs for 2008 are not secured.”

The third from an article, by Sonia Nettnin, ‘Palestinian Health Care’ published online on the 10th of October 2005:

“When a person has a heart attack and calls for an ambulance, he may have to meet the ambulance at a checkpoint; or if the ambulance travels to retrieve him, Israeli soldiers decide whether they will allow the ambulance to pass through the checkpoints. In the area around Qalqiliya, the wall stands 25 meters high and cuts into the West Bank. The snake like structure weaves between Palestinian communities thereby forcing people to travel the winding pattern of the wall to reach Qalqiliya's main hospital. For people who live just south of the city, they travel 90 km around the wall. For a person in distress, the stress of the travel may cause further health complications.”

Finally, an excellent summary of events from the ‘Ibdaa Health Committee’. Its revelations are shocking:

“Health conditions in the occupied Palestinian continue to deteriorate at an unprecedented rate and alarming level, warning of a dangerous humanitarian catastrophe in the making, 70% of all children throughout Palestine now suffer from anaemia. Malnutrition, cancer, and diabetes are on the rise.

The PA employs 57% of all health care workers and provides nearly 65% of the general health care to the Palestinian population. Its inability to maintain service provision, which includes the dispensing of medicines, is having a devastating impact on the people's access to healthcare and shifting the unsustainable burden of filling the gap in services onto non-governmental healthcare organizations.

Additionally, the number of people who can no longer afford needed medical attention, due to lack of employment and/or loss of income, is alarmingly high. More than two-thirds of the population now lives under the international poverty level—less than $2 per day. The economic sanctions and trade embargo are no doubt leading to the collapse of the healthcare system; and thousands of patients, some of whose lives are in danger, are not receiving treatment.

Mental health disorders constitute one of the largest and least acknowledged health problems in the OPTs. Approximately one-third of all Palestinians are in need of mental health interventions, yet mental health services are among the most under-resourced areas of healthcare provision.”

All these things should bear a great significance to the Palestinian medical professional everywhere. For me, all those problems multiply the pity I feel at the suffering of man manifold. This is humanity at its worst. For a Palestinian who aspires to be in the heavens, such pity can only bring one back down to earth. Bertrand Russell, a man who devoted his last piece to the defence of the Palestinian people and the critique of Israel, expressed a similar feeling so beautifully in the prologue to his autobiography:

“Love and knowledge, so far as they were possible, led upward toward the heavens. But always pity brought me back to earth. Echoes of cries of pain reverberate in my heart. Children in famine, victims tortured by oppressors, helpless old people a burden to their sons, and the whole world of loneliness, poverty, and pain make a mockery of what human life should be. I long to alleviate this evil, but I cannot, and I too suffer.”

It is a very sad situation the Palestinian medical professional lives in, but to me, it is a blessing that I find myself belong to those two things. I remember coming across a section entitled, "When two anchors are better than one” in ‘The Complete Idiot's Guide to Boating and Sailing’ by Frank Sargeant:

"When anchoring larger boats overnight, particularly in a crowded harbor, you may want to use two anchors at a 45 degree angle from the bow. The extra anchor keeps your boat from swinging widely and banging into other boats, and also gives you added security in a storm."

I am a big ship (being 6 foot 3 tall), and one anchor (being Palestinian or being a doctor) would not be enough to keep me stable. I need the two anchors, Palestine and medicine, to stop me from being swept away, or escalating into the heavens. And what is more, is that, I believe that the anchors are mutually reinforcing; being a medical professional can help the Palestinian in so many ways, and being a Palestinian can also help the medical professional in certain ways.

Can a Palestinian benefit from being a health professional. And indeed, can a health professional benefit from being Palestinian. The answer, to me, can only be in the affirmative.

I think the most important thing that medicine teaches is what I have mentioned before, the emphasis in medicine upon the oneness of humanity. As a Palestinian, it is easy to fall into a paranoid suspicion that the rest of the world hates us, that the other Arabs, the Americans, and the Zionists (and all their followers around the globe) do not care about us. This may reflect in our attitudes towards these people. The Palestinians may then develop no concern for any ‘other’, since ‘the other is against us’, and isolate themselves from humanity, with ill consequences.

What medicine can do is cause a new understanding of humanity, “the conception is that of the human race as a whole, fighting against chaos without and darkness within, the little tiny lamp of reason growing gradually into a great light by which the night is dispelled. The divisions between races, nations, and creeds should be treated as follies distracting us in the battle between Chaos and Old Night, which is our one truly human activity" as Russell suggests in his forgotten book, ‘On Education’ (p.144). Palestinians would then view their interest in the Palestinian problem to be part of an interest in all of humanity, and it is only by virtue of them being born to Palestinian parents that fate has obliged them to pay a bit more attention, though by no means exclusive, to the Palestinian problem. They need to say with H G Wells, "Our true God now is the God of all men. Nationalism as a God must follow the tribal gods to limbo”. They will need to understand that all borders are artificial, and that indeed, “our true nationality is mankind" (ibid). They will need to set forth an example to the rest of humanity. Medicine will serve this purpose brilliantly.

And this is not difficult for a Palestinian, and this is a perfect example of where being a medical professional and Palestinian are mutually reinforcing concepts. Palestine was a holy land for the Jews (many of whom currently reside in it), Jesus Christ was born in it and lived there, and the great prophet Muhammad (PBUH) prayed there in his famous ‘Isra Wal Miraj’. And all, until the Zionist invasion, lived in harmony and bliss. Palestine’s history reminds us of the unity of the Abrahamic faiths, medicine emphasizes this humanity even further.

By being a health professional, the Palestinian has a great opportunity to help his fellow man. This is one of my dreams, to be able to actually utilize my energy and understanding to benefit our long suffering people.

And by being Palestinian, one’s medical practice is affected in at least two ways. One is the need for having razor sharp clinical acumen; for the Palestinian working in his homeland, resources and investigations we take for granted here in the UK are almost certainly rare or impossible to attain in the occupied territories. Hence the need to excel in basic clinical skills, and in this, they are being truer to the tradition of historical medicine, which emphasizes their paramount importance. The Palestinian medical professional is almost forced to excel clinically, because, if he or she is actually living in their homeland, or expecting, at some point, a visit or even return to their homeland, they do not expect the availability, or indeed the functionality of investigative tools available to them. He or she is confronted with a situation not unlike (if not worse than) that described by Michael Brook, a contemporary British physician in the chapter on ‘Symptoms and Signs in Tropical Medicine’ in the textbook, ‘Manson’s Tropical Diseases’, published in 1996, “When medicine is practised in the tropics, with little or no aid from laboratory tests, clinical acumen is the most important tool used in arriving at the correct diagnosis.”

He or she knows that there is no readily available echocardiogram to give them the diagnosis of cardiac failure, so they would ardently listen to the S3 and gallop rhythms we learnt in our textbooks here that, after graduation, become buried as distant memories. They would spend time in palpating and percussing their jaundiced patient’s abdomen, lest he or she have any hepatomegaly that characterizes chronic liver disease, because they know it is likely to be impossible that an abdominal ultrasound, or gold standard in the wealthy West, would take place any time soon[3]. He or she takes time in looking at, palpating, percussing, and listening to the patient coming in with fever and chest symptoms, to detect the clinical signs of pneumonia, a condition that here in the West has somehow become transformed into a synonym for ‘consolidation on a chest X-ray’, and may well find Rene Laennec’s ‘A Treatise on Diseases of the Chest’, published in 1819 (nearly 100 years before the first medical use of X-rays was established) and stating that “lung auscultation could detect every possible case of pneumonia” (McGee, p.xiv), a much more valuable guide than all the current textbooks of chest radiology. The complete, arduous neurological examination becomes a necessity in any patient presenting with neurological symptoms, since he or she knows that the shadows of neurology that Professor McDonald Critchley infamously stated would be removed by the CT-scanner, will forever remain, together with its music[4]. Neurology, as I tried to show in a previous essay, is arguably the most clinical of specialties (see my essay, ‘Truth or Envy: Do neurologists ‘know everything and do nothing’), and in being almost entirely dependent on clinical acumen in the diagnosis of neurological conditions, I may be right in saying that Palestinian neurologists may be among the finest around. I do not know of any personally myself, so I cannot answer that question based on experience.

But if Palestinian neurologists are anything like the many Palestinian general practitioners, physicians, surgeons, paedatricians and gynaecologists who I have encountered, then the future looks bright for those Palestinian medical students and junior doctors who Lina Nashef, a Palestinian consultant neurologist based in the prestigious King’s College Hospital in London, and her colleague, Martin Prevett of the Wessex Neurological Centre in Southampton met and wrote about in a report published in the BMJ journal, ‘Practical Neurology’ a few years ago (2004;4:62-63), in an article entitled, ‘Neurological Letter From Palestine’:

“On our last day, the students generously made a presentation to us. Afterwards they surrounded us, the women and men naturally forming two separate groups, showering us with questions mixed with warmth and appreciation. A few were already contemplating a career in neurology”.

And this brings me nicely to the other impact of being Palestinian on one’s medical practice; that of aspiring to professional excellence. Now I do not claim that being a Palestinian, or born to Palestinian parents endows one with special genetic characteristics, as some other people have claimed about their own people. But what I am trying to say is that by knowing that one is Palestinian, one knows that he or she belongs to a long tradition of great men and women, people who I think were motivated to excellence by virtue of struggle and appreciation of life. Palestinians live, or ought to live, in a continuous appreciation of life, for they know that, at every moment, they face the threat of extermination[5]. They built this tradition of excellence because its impact would remain as a historical fossil pointing to their existence as a people one day. The possibility of extermination brings out all that is best out of the potentially creative minds that contemplate it - for it drives them to accomplish tasks that outlast their lives, in an attempt to defy mortality. Herein I think lay one of the secrets to the many accomplishments of many Jews throughout history, something that the brilliant Albert Einstein described so well under the heading ‘Where Oppression is a Stimulus’ in the essay, ‘Why do they hate the Jews’:

“In the foregoing I have conceived of Judaism as a community of tradition…perhaps even more than on its own tradition, the Jewish group has thrived on oppression and on the antagonism it has forever met in the world. Here undoubtedly lies one of the main reasons for its continued existence through so many thousands of years.”

And indeed, this oppression could well be the explanation for the brilliance of many Palestinians throughout the world, in all field of human endeavour. The words of Albert Einstein in another essay, ‘The World as I see it’, ring true, that, “Everything that the human race has done and thought is concerned with the deeply felt needs and the assuagement of pain”. The late Elisabeth Kubler-Ross, famed for her work on the stages of death, once stated that, “For those who seek to understand it, death is a highly creative force. The highest spiritual values of life can originate from the thought and study of death”. It certainly has been to those great men and women, consciously or subconsciously. Whether they know it or not, they are listening to and following God’s most beautiful words:

“Wealth and children are an ornament of the life of the world. But the good deeds which endure are better in thy Lord's sight for reward, and better in respect of hope” (18:46).

There is surely something to be said for the Palestinians having some of the highest literacy rates in the world – it is testimony to the belief of most Palestinians in the importance of knowledge and learning and to their resilience in the presence of an oppressive occupation and a quisling government. Even before that, the Palestinians have always shone in the world of academia and practical conduct. The ‘Wikipedia’ encyclopedia article on Palestinians point to this fact as follows:

“In the late 19th century and early 20th century, Palestinian intellectuals were integral parts of wider Arab intellectual circles, as represented by individuals such as May Ziade and Khalil Beidas. Educational levels among Palestinians have traditionally been high. In the 1960s the West Bank had a higher percentage of its adolescent population enrolled in high school education than did Israel. Claude Cheysson, France’s Minister for Foreign Affairs under the first Mitterand Presidency, held in the mid eighties that, “even thirty years ago, (Palestinians) probably already had the largest educated elite of all the Arab peoples.””

I actually remember reading many years ago in a source I cannot trace at present that the Palestinians actually had the highest literacy rate in the world. But right now, they are second in the Arab world, which is not an insignificant achievement. The Occupied territories (Gaza and the West Bank) and Jordan (which of course is the nation with the largest percentage of Palestinians in the world – over 40%) have the second and third highest literacy rates in the Arab World, at 92.4% and 91.1% respectively, after Kuwait (93.3%).[6]

It is this emphasis on education and learning, and in a word, survival, that has led to the eminence of people like Abdel Bari Atwan, one of the finest journalists and political analysts of our time, a man on a parr with the likes of John Pilger and Tariq Ali. Like Hanan Ashrawi, Ghada Karmi, Said Aburish and Azmi Bishara, four of the most honest political analysts of our time (not to mention the jailed Marwan Al-Barghoothi). Khalil Al-Sakakini, May Ziade, Ghassan Kanafani, and Mahmoud Darwish – poets of the highest caliber. Muhammad Izzat Darwaza and Ismail Raji Al-Faruqi, two of the most rational and appealing Islamic thinkers of 20th century. Simon Shaheen, Naji Al-Ali, and many other great artists working today are of Palestinian origin and I think there is great hope in the actress Saba Mubarak, who radiates intelligence, humanity and motherliness, in all her interviews, declaring an air of what can only be described as a form of mysticism, and not to speak of her obvious beauty that was described by one journalist in the following terms, “There are some people, who after seeing them only once you could never forget their face and that is the case with Saba Mubarak.” I have seen very little of her actual work, but the little that I have seen makes it very easy for me to see why she is regarded as the best Jordan-based actress, and one of the best and most popular actresses in the Arab world.[7]

I have mentioned nothing of the humanitarian endeavors of the Palestinian-born Queen Rania of Jordan, or the intellectual brilliance of the incomparable Edward Said, the only man who can compete with Noam Chomsky over title of polymath of the last third of the 20th century, and other intellectuals like the unrelated Walid and Rashid Khalidi. And I dared not venture into their achievements in the medical world, lest I am accused of professional bias, but the names of two men should be household to all Palestinian medical professionals. Firstly, Professor Mansour Armaly, the great ophthalmologist, who was arguably before his death in 2005, the foremost world expert on glaucoma, and was president of ‘the Pan-American Glaucoma Society’. Second, Professor Ahmad Teebi, a paediatrician and medical geneticist whose work, including founding, in 1985 of the first Arab neonatal screening program in Kuwait, followed by establishing hundred of genetic services in several Middle Eastern countries, including the Persian Gulf countries, the Palestinian territories, Jordan, Tunisia, Egypt, and Saudi Arabia, is of the first class.


It is in the remembrance of all those figures that the Palestinian medical professional strives for excellence. He or she would then wish to follow this magnificent tradition. This also has the very important consequence of giving away a message to all those who misunderstand us as ‘terrorists’. Once the Palestinian doctor (or any other profession) speaks, his or her accent is noted, and the immediate next question from the patient is “where are you from”. The response Palestinian, I believe, is a provocative one, and registers a much more indelible imprint in people’s minds than other responses (though I could be mistaken), simply because it has many political connotations. The actions of the Palestinian are noted, and if he or she is noted to be caring and striving for excellence, then the patient is bound to be influenced, and alter his or her false opinion, caused by the majority of British right-wing journalists, that all Palestinians are terrorists (but some are more terrorist than others). He or she may even start sympathizing with our cause, and listen to it. Is that not something that Palestine, our ‘mother’ who was robbed and abused for the past 60 years, deserves?

I do not mean to say here that Palestinians need to be perfect in order to justify their cause or support for it; far from it – even if the Palestinians were the most corrupt people on earth, the Palestinian cause would remain fair and just, and the Zionist one inhumane and deceitful. But surely striving for excellence (in medicine and other specialties) would spread a great message across, and indeed help us eventually construct a nation full of excellence when we retrieve it one day.

It is in the remembrance of the suffering of the Palestinian people, of their lack of resources that one would wish to strive for clinical brilliance and resourcefulness. By his or her being a Palestinian, he or she knows that they belong to a long tradition of pluralism, that believes in the unity of all human beings, be they Muslims, Christians, Jews or other (even Bahaism has strong roots in Palestine, and its founder is buried there). This is a notion luckily reinforced by being a medical professional, who, by oaths and codes of professional conduct (such as the GMC’s), is expected to treat all human beings equally and justly.

The Palestinian medical professional ought to be full of pride and privilege in belonging to those two magnificent traditions, medicine and being Palestinian, both of which can fill one with the greatest ecstasy, hope and joy, yet can serve to bring the hearts of those who reflect on them, the greatest pity and despair.

For my part, a person who would like to describe himself as a minor, simple sailor in the ocean of truth, they serve a mutual purpose. They are my two anchors, without which I would find it very difficult to survive in our atrocious world, from which an escape into the heavens could sometimes be the easiest option.
[1] One encyclopedia article on the man put it thus, “Drake accompanied his second cousin Sir John Hawkins in making the third English slave-trading expeditions, making fortunes through the abduction and transportation of West African people, and then exchanging them for high-value goods.”

[2] As put by an encyclopedia article on the man, “Cook's return to Hawaii outside the season of worship for Lono, which was synonymous with 'peace', and thus in the season of 'war' (being dedicated to Kū, god of war) may have upset the equilibrium and fostered an atmosphere of resentment and aggression from the local population. Coupled with a jaded grasp of native diplomacy and a burgeoning but limited understanding of local politics, Cook may have inadvertently contributed to the tensions that ultimately brought about his demise.”
[3] I sometimes feel a great sense of dismay at those patients who complain, here in England, that their “scan was delayed by a few days” or even a few hours! I have seen this before my very eyes many times in my relatively short career, and it is appalling, further reinforcing the notion that we are living in the land of the whinging pom and ungratefulness.
[4] Dr McDonald Critchley, the prominent neurologist was once asked while on a tour of the United States what impact CT scans will have on clinical neurology; will history and physical examination be thrown out of the window? His response was both poetic and prophetic: "CT scanning will take away the shadows of neurology, but the music will still remain.".
[5] Indeed, some like former Israeli Prime Minister, Golda Mair believe that Palestinians have vanished, making the infamous remarks, “How can we return the occupied territories…there is nobody to return them to…there is no such thing as Palestinians”.
[6] And considering the wealth of the latter, it is no surprise that the Palestinians have been overtaken; indeed, what is surprising is why the country with “the world's fifth largest proven oil reserves and is the fourth richest country in the world per capita” (according to the ‘CIA Handbook’ (2007))” does not approach the Western average of 99% literacy rates, and why nation whose GDP is $55,300 has only a 0.9% greater literacy rate than the Gaza Strip, with a GDP of $1,100. It is all testimony to the brilliance of the Palestinians and their emphasis on education.

[7] As she put it in a recent interview, “أمضي نحو الفن الحقيقي والصرف أينما قادني..إلى مسرحٍ معتمٍ بزاوية مدينةٍ نائية، أم قادني إلى فيلمٍ عالمي، أريد أن أحافظ على نشوة الفن الصوفية حينما أعرف أنني لمست أحداً ما في مكانٍ ما بأدائي”.

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