Chief Complaint: A Country Doctor's Tales of Life in Galilee

Author

Preface

I come from there…and remember.

—Mahmoud Darwish, I Come from There

One must seize the reality of one’s fate and that’s that, Vincent van Gogh famously wrote, accepting his commitment to an insane asylum. In retirement, and with equal resignation, I have succumbed to my fate as a Palestinian narrator. I attempt to record and leave behind our own truth, in the hope that, in time, it will take care of itself and filter through to the consciousness of the world.

A Palestinian joke speaks of three applicants of different nationalities for a job that demanded ample creativity. Their vetting required each to write an impromptu composition about the randomly selected topic of elephants. The German applicant wrote a piece titled The Origin of the Pachyderm Species; the Frenchman wrote an essay, The Sex Life of the Elephant; and the Palestinian wrote a veritable treatise entitled The Elephant and the Question of Palestine. I am told this is a variant of a European Jewish joke. The irony is bitter: we are the new Jews in Europe’s Zionist colonial project.

We Palestinians are born and nurtured with a sense of injured pride; we have been denied justice by a world community that continues to ignore our claims. We are obsessed with the justice of our cause and the primacy of our case above all the wrongs of the world. There is no topic of conversation that fails to lead us directly to the mother of all world issues, the historical injustice committed against us, and the callousness of Arab and world leaders in abandoning our cause. Mention the weather and the conversation turns to the recent drought that afflicted Palestine and the theft by the Zionists of the aquifer under the hills of the West Bank; speak of the movies, and the only one worth discussing is Mohammad Bakri’s Jenin, Jenin. Listen to a happy melody, and we recall (and begin to hum) Mohammad Assaf’s (2013 Arab Idol winner) latest Palestinian hit; bring up a neutral topic, like sports, and someone is bound to comment that Palestine was the first Arab nation to have an Olympic soccer team, and that Israel has killed and maimed many actual and potential soccer stars, not to mention how it has messed up every aspect of life in Palestine.

I am no exception to this rule. Wherever I go, whomever I meet, and whenever I am given a chance, the subject of Palestine is uppermost in my mind. I am a retired public health physician and a Palestinian citizen of Israel. I spent the 1960s studying in the United States. After obtaining degrees in medicine and public health from Harvard University, I spurned several lucrative offers in the United States and returned in 1970 with my Hawaiian wife to my village in northern Israel, where I have lived and practiced since. Palestinians make up more than 20 percent of the total population of Israel. They are made to live mostly in separate communities from the Jewish majority. They constitute a little-known and often-maligned group that is nonetheless key to understanding the Arab-Israeli conflict, if not the entire Middle East conflict arena. After returning to Galilee, I worked in the Israeli Ministry of Health and became a part of the system. Out of necessity, I doubled as a general practitioner in my home village where conditions of inequality and deprivation were perpetuated by the same system of which I was a part. To deal with this personal dilemma, I took up civil society activism in my community.

Concomitant with Israel’s founding in 1948, its armed forces systematically expelled Palestine’s native population and razed some five hundred of their communities to the ground in the largest and most successfully denied ethnic cleansing campaign in modern times. A mere six and a half decades later, who knows about Damoun, for example? Who remembers it except for its surviving refugee sons and daughters and their descendants? Imprisoned in Gaza’s open-air jail or in Lebanon’s camps, they are terrorized daily by Israel’s sonic booms or real air raids to force on them an alternative narrative of history. Yet Damoun was another Palestinian village, of an equal size to that of Arrabeh, my home village. Like Arrabeh, it was continuously inhabited for some 4,000 years, since the days of the Canaanites who first founded it. And like the rest of Palestine, each had absorbed into itself one conquering invader after another, adapted to a softened version of their dictates, practiced an altered version of their beliefs, and survived on the gifts of its good earth and its hardy crops, its olives, figs, and wheat. Now Damoun is forever gone, replaced by a jealously exclusive Jewish settlement named Yas’ur in an open, premeditated, and so far successful revision of history.

The fate of Damoun, and of the other hundreds of erased and largely forgotten Palestinian villages, serves as a lesson to us, members of the Palestinian minority in Israel. Ethnic cleansing still looms large on the horizon. Every time we hear the saber rattling of an impending war with Syria, Lebanon, or Iran, the threat of being driven across an altered border comes alive. Whom can we trust to stop that from happening? Not the international community— not after its media correspondents stood on that emblematic Hill of Shame north of Gaza and watched the white phosphorus light show in 2008–9, reporting to their evening news viewers at home what the Israeli army fed them, not to mention its continued inaction in the face of the bloodier carnage of the summer of 2014. Why should the international community be moved to action by our slaughter when it comes? And yet, here I am writing in English, addressing myself to the very same international audience in the hope of calling its attention to my pain. I eschew Arabic, my mother tongue and an official language in Israel, and my fluent Hebrew, in an attempt for wider and less contested reach to all, including my Jewish co-citizens. But will it really help?

The Palestinian citizens of Israel stand at the crossroads of hope for peace in the Middle East, their achievements uncelebrated and their promise untested. As a member of this indigenous group, I try in this collection of vignettes to bring our existence to light, to sing out our pleasure and pain, to echo our sense of alienation and dispossession, to face up to the dilemma of our schizophrenic identity, and to hail our occasional successes and our trust in the future.

In 1948, on the morrow of the Nakba, the group destined to become the Palestinian citizens of Israel woke up to a new and disturbing reality. Some 85 percent of the Palestinian residents of what was to become Israel had been forced to cross the borders and become refugees in neighboring countries. The remaining 15 percent found that a brutal border crossed them, as Dr. Hunaida Ghanim, one of their descendants, puts it. They became Israeli citizens through no choice of their own. Those Palestinians, together with residents of East Jerusalem and the Golan Heights, now make up more than one-fifth of the total population of Israel.

In 1948, between one-fourth and one-third of us were internally displaced to become what is officially known in Israel as present absentees. Laws were promulgated to deprive members of this subgroup of their homes and private property, including their land and bank accounts. The rest of us gradually lost most of our land to confiscation by the state through dozens of specifically designed and finely tuned laws and ordinances that claimed to serve the public good or the security needs of the state. The tacticians of the new state were inventive in applying all types of control and dispossession tactics to the group of defeated, thinly dispersed, and leaderless peasantry. They adapted the British Mandate emergency regulations, originally promulgated to deal with Jewish underground movements, including a draconian military rule that denied Israel’s Arabs—as the state liked to call us—freedom of movement and occupation for two full decades. In 1967, the entire system was moved lock, stock, and barrel to the occupied territories of the West Bank, Gaza, and East Jerusalem.

Simultaneously, the Jewish majority population proceeded to define the state it dominated as coterminous with itself, thus defining us, the Palestinian minority, for all practical purposes, out of the emerging public good and the state’s security concerns. We now own less than three percent of Israel’s land and are essentially exempted from utilizing any of the remainder because it is owned by the Jewish National Fund or defined as state lands, the very essence of the Zionist enterprise. In contrast, about half of the constituent Jewish population of Israel arrived from the countries of the Middle East and North Africa with socioeconomic attributes not unlike those of the Palestinians. The main difference was that the state, backed by the world Jewish community, invested massive funds and efforts in well-coordinated programs for the socioeconomic betterment of one group. Not only did no parallel programs exist for us, the Palestinians, but also our agrarian communal underpinnings were undercut with massive land confiscations and limitations on crop selection and marketing, and on irrigation schemes for the benefit of Jewish cooperative farms. As the oriental Jews (Sephardim) in Israel were corralled into Ashkenazi cultural hegemony, members of our community were further marginalized to become day laborers in construction and agriculture in Jewish cities and new settlements. We lost our agricultural self-sufficiency while lacking an alternative base for development such as industry or commerce. The image of our villages as peripheral enemy locales added to our isolation. Our towns and villages became bedroom communities to which men returned nights and weekends. This was the actualization of Zionist biblical dreams of using us, the Palestinians, as hewers of wood and carriers of water.

Adding insult to injury, fellow Arabs across the malicious border portrayed us as a collection of lackeys of the Zionist state who chose to stay and hobnob with the enemy. This malformed image only started to fade with Israel’s 1967 occupation of the West Bank, Gaza, and East Jerusalem, a process that put us in touch again with fellow defeated Palestinians. Our politicians stepped in to offer what little favors they had within their means, our entrepreneurs assumed the ranks of subcontractors and middlemen between occupier and occupied, and our literary figures glowed in the new limelight of the national and literary fidelity they had never abandoned—witness the likes of Mahmoud Darwish, Samih Al-Qasim, Taha Mohammad Ali, Toufiq Zayyad, and Emile Habibi.

Since the establishment of the state, we have endured systematic dispossession and ghettoization. Of late, the process has turned vicious: fundamentalist messianic Zionists and settler leaders, the abrasive curse of occupation, have assumed advanced positions in Israel’s political and military leadership. With this, the process of our exclusion has gathered greater speed and legitimacy, buttressed by racist legislative steps and a vindictive public mood verging on consensus. 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 United States. 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 bodily 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, steadfastness. A half dozen young doctors and nurses, all grandnephews and nieces, surround me for a photo at a relative’s 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.

In Galilee, villagers tell of two children bragging about their wise fathers. The first says, My father is so smart, he knows how to fix a broken arm. The second trumps him: My father is smarter. He fixes an arm before it is broken. Prevention is an integral part of my public health training and practice. Why then not attempt to paint for generations to come a portrait of the Arrabeh I have known, a realistic picture with all the human beauty and joy, and all the pain and suffering of its Palestinian people that I witnessed throughout the years of my practice as their first Western-trained physician? Should our worst fears materialize, our children will have something to remember, something beyond the frayed memories of old men and women—a written record, black on white, with which to knock on the walled conscience of the world and demand attention from it.

Throughout my career, I have used writing and audiotaping as a form of psychotherapy to help me deal with my schizophrenic existence as a Palestinian and a citizen of Israel. It certainly is not conducive of a balanced psyche to be a member of a minority whose mere presence is officially decried as a cancer and existential threat to the state, and the source of regret for not having been ethnically cleansed by the state’s establishment. Imagine how much worse it was functioning as a cog in the wheel of that state. Now in retirement and drawing on a half century of recorded memoirs, I have set myself the task of telling the story of my village to the world, in the hope of breaking the imposed silence and isolation of the Palestinian community in Israel. My first book, A Doctor in Galilee: The Life and Struggle of a Palestinian in Israel (Pluto Press, 2008), focused on my public health and civil society efforts. It has received acclaim not only as an informative resource document, but also as a literary contribution. My second book, Chief Complaint: A Country Doctor’s Tales of Life in Galilee, whose pages you now read, is a more inventive literary attempt that draws on my clinical work as the first indigenous physician in my village. It consists of a series of sketches rendered as short stories that weave a rich portrait of life, in disease and health, in a typical Palestinian rural community in Israel. It is narrated in a more personal style than my first book. Out of this collection of half-invented protagonists, I hope that a panoramic picture emerges depicting my community as I saw it in the years I lived and practiced in it. It focuses on my home village and, in ever-widening but softer eddies of memory, spreads to reach the surrounding locales of Galilee. The recollections and flashbacks of my composite characters cover roughly the last two-thirds of the twentieth century, essentially my own lifespan.

My characters, with the few exceptions of members of my extended family, are fictional. With those exceptions, all the men, women, and children the reader will meet in this collection of vignettes are invented characters, composite personalities concocted out of multiple individual patients of mine. All incidents and discourses are real and I, directly or indirectly, witnessed them happen to people in my village and in neighboring villages in the Galilee. As expected in an account of a lifetime of fond memories, nostalgia abounds and impressive types, some endearing and others outlandish and orientalist in their hue, parade across my stage. Through fiction, I hope, their collective existence in my imagination gains reality, universality, and immortality.

Each story carries a heading that was the chief complaint of its protagonist, the principal reason for him or her to seek medical attention at my clinic, the primary connecting thread between my patient and me as a healer. These then follow the simple ordering of the body’s working systems and their functional roles starting with the head and ending with the feet, with general complaints falling at the start or at the end of the list. This is the classic tool of the medical profession known as review of systems. If Primo Levi, a chemist, can utilize the periodic table to relate the memories of his personal suffering and that of his people, why can’t I, a physician, employ the system central to medical practice to narrate to the world some of my people’s struggle, pain, and joy?

In its totality, this collection of fictional short stories conveys my community’s foundational chief complaint: its conflicted relationship with the state of Israel. Through it, I strive to inform readers about my community as an integral constituent of the Palestinian people. With the increasing worldwide recognition of the Boycott, Divestment, and Sanctions movement called for by Palestinian civil society, it is my hope that this contribution to Palestinian lore will help shine a tender light on my long-misunderstood people.

Arrabeh, Galilee

October 20, 2014

Cartography by Diana Ghazzawi and © 2015 Just World Publishing, LLC.

Cartography by Diana Ghazzawi and © 2015 Just World Publishing, LLC.

High Fever

On their faces are their marks,

(being) the traces of their prostration.

—Qur’an 48:29

In the middle of a rainy night, there was a loud knock at our door. Didi went to try and deflect another disturbance to my fitful sleep. In those days, in the early 1970s, I received all emergencies in town, regardless of how many there were in one night, because there were no other doctors. She came back and shook me out of sleep and into a physician’s nightmare.

It sounds serious enough. And it is another house call. You think you could drive or should I drive you?

I stumbled to the door and had to rub my eyes twice before I recognized a classmate I hadn’t seen since my high school days. Even under the exceptional circumstances, I had the presence of mind to make the socially required gesture of asking him into our home.

"Tfaddal! Come in!" I blurted after a vigorous hug.

"Not at this hour, thank you. You have to come see my father at home right away. You remember my father, old man ‘Abd al-‘Adheem, don’t you? He is boiling with fever and has started to speak shatt wamaghyabani."

I got my bag, and we were on our way on foot. The house was not far.

We found ‘Abd al-‘Adheem at the door of his single-room home with his wife and daughter hanging on his arms as he attempted to escape. And indeed he was speaking arrant nonsense, wanting to be released from their clutches so that he could fetch something black that he needed. None of us understood exactly what that was or where he wanted to go. He was dressed in his standard three-piece outfit: a blotchy and tired, white, baggy shirwal, a gray woolen shirt thoroughly drenched with sweat, and a long lambskin coat, its bedraggled locks heavy with years of accumulated grime. And he looked exactly like I remembered him more than a decade earlier when he came to see me off as I readied for my fateful departure to America to study medicine. Nearly every grown man in the village attended that occasion, of course. He was a giant of a man, cause enough for villagers to contract his name simply to ‘Adheem (Almighty).

I contemplated his rough-hewn, rock-like head firmly balanced over a short neck and broad, sloping, bearlike shoulders. His red eyes peered in amazement from behind his lashless lids. A week’s worth of white stubble covered his face to merge imperceptibly into his thick chest hair and around his ears, and a tuft of thick, matted, curly, graying red hair sprouted from under an old, hand-sewn skullcap. He immediately recognized me and treated me as his guest, extending his huge hand in greeting. Despite its bulbous joints and firm, locking grip, his rough hand felt feverish. He welcomed me again as best as he could, explaining that he was actually preparing to come to my parents’ home next to the diwan, the receiving room, of my uncle Salih, his former boss; he needed that black ointment from his friend, my father, he explained. I tried to explain that I no longer lived at that address and that my parents were both long dead and gone, as was my uncle. But he didn’t seem to comprehend. He insisted that as soon as his wife finished making tea for my due welcome (lawajbak), and he did his two morning compulsory prostrations to God, we would go together to my father’s place.

His wife didn’t make tea; she went out the back door to the adjoining shed. I could hear their cow mooing and kicking in objection to being disturbed at that hour of night. Their donkey responded with sharp braying. She came back with some milk and made us fresh café au lait on the rekindled embers in the earthen fireplace next to the couple’s floor sleeping space.

With the help of his son, my classmate, we managed to get ‘Adheem to lie still in a supine position on his wool-stuffed mattress. In the faint light of the kerosene lamp, augmented intermittently by the flickering of the revived fire in the hearth, the moss-like, white fuzz on his ears and the permanent, bemused smile of acceptance with undetermined reservations on his wrinkled face created the eerie impression of being in the presence of a sacrificial lamb—or, rather, a sacrificial ram. And his face spoke medical history to me: the moonscape of his face, lit up only on one side, betrayed deep creases spreading out from the depth of his eye socket down to his ear, intercepted at right angles by deeper furrows around his toothless mouth, with the entire terrain interspaced with many dark, craterlike depressions, the pockmarks of childhood smallpox. Two brothers had died and one sister went blind, I knew, but ‘Adheem had escaped with only permanent, deep scarring.

And there was that darkened, fig-sized protuberance in the middle of his forehead declaring to the world that he was a good, practicing Muslim who prostrated himself in private communion with God five times a day. The repeated touching of the forehead to the ground, when done with enough vigor to emphasize devoutness and seriousness of intent, especially when the supplicant’s head is particularly heavy or dropped with abandon, confirms the prescription in the holy Qur’an of simahum fi wujuhihim—on their faces are their marks. And ‘Adheem had all it took to cultivate a large and angry identifying sign. A certain neighbor was known to avoid standing next to him at the Friday noon prayer, because the sudden collapsing style in which he prostrated himself and the forceful pounding of his forehead on the mosque’s floor would distract this neighbor from his own focused attention on God in heaven. (But then, this neighbor had a questionable commitment to the faith; his own family reported that he repeatedly expressed doubts concerning the validity of the promised rewards in the afterlife for keeping on the straight and narrow path in this one. Especially on cold winter mornings when he did his ablutions with cold water in the open yard and after he finished washing his genitalia, he would be heard talking to himself: And what if there is no afterlife? When tilling one of his fields in the Battouf Valley, he always chose to pray at the southeast corner of the field, leading people to speculate that as he prostrated himself on the ground, he would nudge the border demarcation stone a few millimeters into the neighbor’s field.)

For a moment, I felt powerless in dealing with this confused giant of a man. Then I gathered courage and did a cursory medical examination in search of the source of his 41-degree Centigrade fever. It wasn’t hard to find: his leg was red, swollen, and tender, and his wife confirmed that the chronic pus flow from the open wound in it had lessened during the previous week. I touched his leg. He jerked it away and started hallucinating about needing to visit my father to bring that black ointment for his wound. It now dawned on me what residual memories must be swirling in his head. He must have heard his family discussing the need to call me over and remembered an incident from our shared past.

I explained, more to his wife and two children than to him, that in my professional opinion he needed to be in a hospital. I knew what a harsh judgment that was, considering that, like other villagers, he had no medical insurance. I knew that it would likely mean selling a piece of land to cover the expenses. I promised to visit him in a day or two and to intervene with social services on his behalf to lighten the financial burden. They must have already thought about hospitalization; they wouldn’t hear of it. Is he that bad off? they wanted to know. If he was, they preferred that he die at home. Much as I tried to persuade them, they stood their ground and enlisted the man of the house, in his incoherent way, to reject the suggestion.

Some of the best tricks of the medical trade that I had learned at Harvard came from its School of Public Health, not medical school. In the face of the family’s intransigence, I recalled the words of a guest lecturer and world-renowned expert on international health and the practice of medicine in developing countries who once spoke to my class. His experience in Africa taught him that "If you were to go out in the wild and were given the choice