handshakes

Outside the prison camp
Issa’s name becomes my password
my secret handshake.
I don’t know these men. I reach out
shake hands, my name is Sarah.
Yael adds “she took care of Issa,
the Issa who was shot
crossing the border.”
They shake my hand again, as friends.
(If anyone took care of him
it was Yael.) They all know Issa,
or at least who Issa is
except one man, confused
who knows a few too many men
shot crossing the border,
not that far from here.

Some stories for world refugee day

I worked with Z at the free clinic in Washington D.C. She and her husband were from the Ogoni tribe in the Rivers state of Nigeria, where all the oil is.  She told me how Shell has caused oil spills all over their land and water, with no clean-up efforts, with no resources coming back into the community.  A group of activists were protesting this, including Z’s husband.  One day, Z arrived at the hospital where she worked as a nurse, and was handed a message: grab your baby son, and go into hiding in the bush.  They are coming for you and your son to get to your husband.  They hid in the bush for three days, and were smuggled into Benin.  Ten leaders of the activist group were hanged in a public square by the country’s military Junta.  Z and her family eventually were given asylum in the US.  They could not return home to see family until the junta fell, years later.  She still will never buy Shell gas.

___________

When Issa decided to flee Darfur, he and a friend flew to Cairo, and then hired smugglers to take them to Israel.  At the border fence, Issa was shot by Egyptian soldiers, and impaled on the barbed wire.  He was later found by a joint Israeli-Egyptian patrol, who according to the story I heard, first argued over whose responsibility the body was, before realizing that he was still alive.  He was medevaced to Soroka, and underwent emergency surgery that saved his life, but some things cannot be repaired and he was partially paralyzed below the waist.  Some BGU students found out that he was due to be released, in a wheelchair, with nowhere to go, no access to rehabilitation services.  A Christian missionary hostel for recovering addicts agreed to take him in.  A family doctor from PHR took on his medical needs.  A physical therapy student created a rehabilitation plan for him; my friends and I from the international medical school took shifts helping him with his physical therapy exercises and showering.  A group of Israeli students wrote a letter to the Ministry of Health begging them to give him health care.  When that failed, they wrote to the newspapers.  A social worker from Tel Sheva would come and visit sometimes, just to see how Issa was doing.  Issa would answer his questions with “illhamdul’la, illhamdul’la,” thank God, thank God.

One day, his friend from Darfur, with whom he’d tried to cross the border, came to visit.  His friend was working as a farm laborer, with one day off a month.  The friend took a six-hour bus ride to visit Issa, and a six hour bus ride back. The Sudanese refugee community in Arad heard about him and tried to help him out as they could.  Issa’s roommates in the hostel helped him out too, and also stole his pain medications.  Issa’s request for asylum in Israel was denied.  An anonymous donor read that article and paid for Issa to go to a private rehabilitation hospital.  Eventually, he was given asylum, in Sweden.

__________

I was volunteering at the front desk of the refugee clinic at the Tel Aviv bus station.  A middle-aged woman demands that we help her; there are others ahead of her in line and we insist that she wait, she is not particularly pleasant about that, and keeps pressing us.  We finally get to her, she is here with her mother’s ID and paperwork, her mother lives in Yaffo but has only a Palestinian ID.  Her mother also has suspected cancer in her abdomen. The daughter’s behavior is suddenly more understandable.  I look at the paperwork, the mother’s doctor ordered a CT and she has no insurance.  We can help her set up the CT, we cannot help her pay for it, which seems to be the real problem.  And we cannot help pay for the treatment and drugs that will follow.

A familiar story

The story is a bit too familiar.  Another young man from Sudan or Eritrea was shot by Egyptian soldiers while trying to cross into Israel.  Flipping through his chart, I see he was medevac’d to Soroka University Medical Center and treated there.

He broke into a smile when I said he studied there, so his experience at Soroka couldn’t have been too terrible.  I felt a bit of pride at that, even though I hadn’t been involved in his care.  I feel pride in Israel for saving his life, even if he was later dumped on the street with just a conditional release document rather than having his asylum claim actually considered.  As if people are risking the things that happen in the Sinai for the economic privilege of washing dishes in Tel Aviv.

The “conditional release” does not forbid this young man from working, but it also doesn’t give him permission to work, which limits his access to the legitimate job market, where his employer would be required to provide him with foreign worker health insurance, which would be not unlike the insurance I have as a foreign student.

It’s two years later, and he continues to have pain and disability from the wound, which is why he is here at the free clinic. Unless a lot changes, or rather, unless one simple policy changes, any further medical care he gets, future surgeries, rehabilitation, pain management, will depend on charity.

I think medical privacy prevents me from telling you his age, but he is far too young for this burden.

Staples and Stoicism

I was on the train back to Beer Sheva, answering practice test questions on my laptop, when I remembered the look on David’s* face and my stomach lurched. I was on my way back from volunteering at a free clinic, where I’d been helping one of the nurses. David was the first patient to come in, and the crown of his head was wrapped with bandages.
The nurse read over his letter from the hospital, which said that he needed his stitches removed today. So this, she told me, is something that the nurses do, and it is a quiet day here, so we’ll just do it here in the triage room. She asked me if I’d ever removed stitches and staples, and when I said that I hadn’t she suggested I come and learn. We went with David and his friend into the adjacent nursing station, and the nurse gathered her tools: bandages, chlorhexidine, and a gadget for removing medical staples that was not unlike the one used in offices to remove regular staples.
She removed the bandages from his head. Underneath, his close-cropped hair was matted with scabs, dried blood, and crusts. Stitches and staples snaked around the top and right side of his head, still abraded and swollen with bruises. She showed me how to remove a staple, and then handed me the tool.
“Try it,” she suggested.
I put on gloves; they were too big and flopped over the ends of my fingers. I placed one hand lightly on the unscathed side of his head, to tilt it to the right angle but also hoping to be reassuring, before getting to work.
It wasn’t hard: slide the bottom teeth under the staple, squeeze it, and out comes the staple, bent into an “M” shape. I started with the staples in areas that had healed cleanly and these first dozen or so came out easily; then I turned to the ones in the abraded and scabbed areas. It was often hard to get the tool under the staple because of scabs adhering to the staples. I tried wetting the scabs with more chlorhexidine to soften them. And then there was inserting the tool against tender areas. David sat there stoic, but when I struggled to insert the gadget in the messier areas I heard his sharp intakes of breath and I could feel his body tense. A few of the staples seemed to have rotated and I had to work them around to be right-side up before I could pull them out. Blood started to trickle down his temple and I patted at it with more gauze and chlorhexidine. It occurred that the worst thing I could do was hesitate once I had both of the teeth under the staple; the kindest thing was to work fast and smooth and get it right on the first try.
When I was done with the staples, and they were piled neatly on the counter, I double-checked that there were none left in his head, and then shook his hand. “Kol hakavod,” I told him. “You have a lot of strength.” He laughed, and motioned that he wanted the staples. His friend found a bag, I scooped up the staples, and he smiled and tucked it away in his pocket. I went to find the nurse to learn what to do about the stitches.
The nurse showed me how to take the pinchers, grab the end of the suture, pull it taut and cut it with a scalpel blade right below the knot, and then pull the suture through and out. I took the tools, and started with the next suture, but I struggled to find the knot beneath the scabs. I moved to another set of stitches with less scabs, and the first few came out more easily, and then it was on to the harder ones. The sutures I was pulling out were often covered in scabs and ooze, and occasionally, fresh blood.
Finally David stopped me, and motioned to me to wash the wounds again with chlorhexidine before continuing. As I started to do so, his friend explained that he was never going to say that he couldn’t take the pain, but that he needed a break. I washed the wounds twice over, taking my time, trying to moisten and soften the scabs while giving him as much time as I could. Then I picked up my tools again.
At one point I realized that left hand was trembling as I worked, and that I had been at all of this for almost an hour. I switched the scalpel to my steadier right hand, and worked at grasping the blue plastic sutures with the pincher in my left hand. The last ones that I did were so encrusted in scabs that finding the ends meant digging through the scabs and reopening them. Every move led to a sharp intake of breath from David.
When I finished removing the sutures and they were piled up spider-like, dabbed with scabs and pus, I offered David my hand again and told him he had a lot of strength. We agreed to throw out the sutures, since they were disgusting, leaving just the staples as a souvenir. The nurse instructed me to bath his head in polidine, and taking more gauze, I slowly traced over and over the maze of torn and healing skin on his scalp, hoping that it would be enough to prevent infection from setting in.
Later, on the train, after helping out in the pharmacy with other students, finding medicines for patients, after listening to the stories from another pretty amazing nurse and catholic nun, after learning from her how to draw pus out of a wound with hydrogen peroxide, after walking back to the bus with a patient and a volunteer translator heading for the same way, and practicing my Arabic with the translator, an Eritrean man a year or two younger than me who was practicing his English, finally I was on the train, and trying to get a bit of actual schoolwork done, when I remembered David and his stoicism and his pain.
How I had had to pull the sutures against injured skin, and hold it taut while trying to find the place to cut. How painful this had been, repeated again and again, twenty times, thirty times. How a patient shouldn’t have to suffer through that. There must be a better way that this is done, maybe lidocaine spray or something. I hadn’t tried to look for it, maybe there had been something like that in the poorly organized pharmacy, that could have eased the pain, if I’d thought of looking.
I had never removed sutures and staples before, and it is a hard thing for a patient to be student’s “first”. It is a hard thing to depend on free rather than professional/institutional health care.
I felt sick about his pain, and sick that I hadn’t tried to do more.

*Names and identifying details are made up to protect privacy, the rest is as true as true can be.

A Family Story

My father’s family came to America, specifically to the Lower East Side of Manhattan, around 1896, from Novogrudok, Belarus. It’s a common story, I learned earlier this week that a classmate’s family came to the US from Minsk, Belarus, at almost the same time. My brother is our family historian, so he might correct me, but my understanding is that where they lived was part of Russia at the time, and Czar Nicholas had levied a draft on the Jewish community where the boys who were drafted were forced into twenty or so years in the army.
So one of my great-grandmother’s brothers was drafted, and the family dropped everything and fled to America. They were tavern-keepers in Novogrudok, and I’m not sure how the first generation supported themselves in New York, except that it involved teenage daughters working in garment factories (that would be sweatshops).
It worked out for the best in many ways, of the grown children and other relatives that stayed behind, one branch eventually made it to Palestine; the rest, in my grandmother’s words, were “butchered, all of them” in the holocaust.
I don’t know why it took me so long, but it hit me yesterday while sitting on a bus in Tel Aviv, the similarities between my family fleeing to America, and many of the Eritreans who flee to Israel, who are fleeing a repressive government and unlimited terms of conscription into the Eritrean army.
Except my family could flee to a place that would take them in.

Being Chicken, and Refugees

Chicken (and Refugees)
I am a big chicken. My friend reminded me recently that during the “hostilities” last November, after the first night of rockets, I gchatted her that “the last rocket sounded really close” and convinced her (and myself, I suppose) to head for Tel Aviv. No one seems to know what to call what happened last November, hostilities doesn’t convey much, but it wasn’t quite a war. Let’s settle for “the lobbing of explosives towards places filled with fragile and unique human bodies, too successfully by the Israelis in that 158 people were killed, which is 158 too many, and less successfully, but still too successfully by Gaza, because six people dead is six too many.”
But I want to talk about leaving Beer Sheva. As I said before, I am a big chicken. One night of sirens, and running for the corner of the house away from windows, and I packed a small bag and headed for the train. It was actually a good time to leave, my friends who left later than me had to duck for cover multiple times while trying to get to the train station.
From Tel Aviv, I went to Nazereth for a weekend, and from Nazereth I went to Afula, where my school had already assigned me for Family medicine. When patients heard where I was from, they would say “You ran away from the rockets,” but with a smile, because they had relatives sleeping on their couches, and I would insist that I was just in the north for school, but they were more or less right.
There is something very primal, very human, about the urge to run away from violence. It’s an instinct in all of us, and generally a good one.
My journey out of Beer Sheva made me think about journeys others had made. I went to Tel Aviv because I had friends there and because it is where most of the buses and trains go to from Beer Sheva. I had read once that before Israel’s independence, Gaza City was the transportation hub for the south. When a lot of people fled the violence around Beer Sheva in 1948, they ended up in Gaza.
But unlike them, I was able to go back.