Doctors without borders

By LARRY DERFNER
May 24, 2007 11:36

Jews and Arabs working in hospitals together say that the life-and-death nature of their work obliterate all on-the-job considerations of race, religion or politics.




derfner jew arab feat 88 298

derfner jew arab feat 88. (photo credit: Ariel Jerozolimski)

Jews and Arabs working in hospitals together say that the life-and-death nature of their work - and the purity of purpose they are trained to bring to it - obliterate all on-the-job considerations of race, religion or politics. Sitting behind his desk peering at his laptop, his two trainees looking over his shoulders, Dr. David Zangen, a pediatric endocrinologist at Jerusalem's Hadassah-University Medical Center, Mount Scopus, is the center of a striking human tableau. Zangen is wearing a knitted kippa and sandals. On his left is Dr. Maha Atwan, a Muslim pediatrician from Bethlehem, her hair and neck covered by a cream-colored shawl. On Zangen's right is Dr. Abdul Salam Abu Libdeh, a Muslim pediatrician from Jerusalem's Beit Hanina neighborhood, wearing no religious markings and looking, in polo shirt and slacks, like the secular cosmopolitan he is. Together we speak Hebrew and English; when Zangen is on the phone, Abu Libdeh and Atwan speak to each other in Arabic. The warmth and admiration among the three is obvious in their easy humor with each other. Until recently, Zangen, 47, was chief medical officer of the IDF's Infantry Command. He led a public campaign in 2002 to refute Palestinian charges of an IDF "massacre" in Jenin during Operation Defensive Shield. Atwan, 30, studied in Jordan and has to pass through IDF checkpoints on his way to and from work. Abu Libdeh, 36, studied medicine in Syria and says he "thinks twice before I'll travel to Ramallah and put up with the checkpoints." Like the 5,000 Jews and Arabs working at Hadassah's Mount Scopus and Ein Kerem hospitals, as well as the many tens of thousands more working at other Israeli hospitals, Zangen, Abu Libdeh and Atwan are able to work together as medical professionals, despite their opposing nationalities, by adhering to two principles. One is that the commitment to healing the sick makes nationality irrelevant. The other, say Zangen, Atwan, Abu Libdeh and every other hospital employee, Jew or Arab, interviewed for this article, is that during work hours, political discussions across ethnic lines are best kept brief and superficial. "I remember during the war in Lebanon," says Abu Libdeh, "when I was on the night shift with a Jewish doctor. It was the middle of the night, we were both tired, and during a lull we each went to our computers. I opened up Al Jazeera to read what was going on with the war, and I saw the other doctor sitting at his computer reading a Hebrew Web site about the same thing. We didn't say anything to each other about the news. For the rest of the shift, we treated a few more patients, and when the shift was over we had breakfast together. Then each of us went home." In a hospital in another country, it might not be noticeable, but in an Israeli hospital, it is: The constant mingling of lots of Jews with lots of Arabs - employees and patients - without there being even a molecule of ethnic tension in the atmosphere, or at least not among the employees. At Hadassah in Jerusalem, Rambam in Haifa, Hillel Yaffe in Hadera, Soroka in Beersheba - at any hospital in a region where there's a large number of Arabs living amid the Jewish majority - the sounds of Hebrew and Arabic mix in the hallways and lobbies, yet no one seems to pay any attention, no one seems threatened by what those "other" people might be saying in their ordinarily dangerous-sounding language. The only place in Israel where one might guess that Arabs make up 20 percent of the national population, and where they coexist with Jews on a purely non-sectarian basis, is a hospital. There are a few other venues, notably universities, where Arabs work alongside Jews at both high and low professional levels, and where one might find an Arab boss giving orders to a Jewish subordinate, but the proportion of Arabs there is going to be small. A hospital, especially one in Galilee, the Negev or Jerusalem, is the only venue in this country where a foreigner who knew nothing about the Israeli-Arab conflict might spend time, then come away thinking that Israel is a country where a Jewish majority lives alongside a sizable Arab minority - and there is no problem between them. INSIDE A HOSPITAL, and only inside a hospital, Israel is a happily integrated society. "An island of equality in a sea of inequality," is how Nidal Haj Yahiya, an MRI technician at Hadassah Ein Kerem for the last 15 years, describes the hospital. As the technician on duty at the time, Haj Yahiya ran the MRI exam on Ariel Sharon when he was taken to Hadassah after his first, relatively mild stroke last year. "It's an honor to the country that an Arab performed such a sensitive test on the prime minister," says Haj Yahiya, 39, from the Galilee town of Taiba. I ask if he had to go through any security checks before administering the test. With a little laugh, he says no. Only in the environment of a hospital does this seem a silly question with an obvious answer. "Israeli Arabs have proven their loyalty in the hospitals. This shows that Arabs can work in all sorts of positions and we don't have to be discriminated against on the basis of so-called security," says Haj Yahiya. "In other places you're categorized as an Arab as soon as they hear your name. Here you don't feel any difference between Arab and Jew. Nothing." With one exception, all the medical professionals interviewed for this story work at Hadassah. Unlike hospitals outside Jerusalem, Hadassah employs not only a lot of Israeli Arabs but also a lot of east Jerusalem Palestinians. In addition, it has a couple of dozen or so Palestinian doctors from the West Bank, such as Maha Atwan, who train in specialties before going back to work in the West Bank or elsewhere. Like other hospitals, Hadassah doesn't keep statistics on the ethnic makeup of its staff, but Dr. Yair Birnbaum, director at Ein Kerem, guesses that Arabs account for 10%-15% of the 5,000 employees at Ein Kerem and Mount Scopus, including about 10% of the doctors. None of the 11 medical professionals interviewed - six Arabs and five Jews - say they have ever come across ethnic discrimination or racism from their colleagues or superiors at Hadassah. Some of the interviewees have also worked at other hospitals - Shaare Zedek in Jerusalem, Ziv in Safed, Kaplan in Rehovot, Meir in Kfar Saba, and Nahariya - and say they found no on-the-job discrimination or prejudice in any of those places either. Some describe the hospitals as a "bubble" which the harsh political realities of the Middle East can't penetrate. And the bubble never pops, not even during the wars, not even when Jewish victims of Palestinian terrorists or Palestinian victims of Israeli soldiers are being wheeled into the emergency room. "The important thing is that the people on the surgery team always put their feelings and political views aside and focus on the patient," says Dr. Mahmoud Badriya, a surgeon from Jerusalem's Wadi Joz neighborhood who operated on several Jews and Palestinians, including children, during the intifada. He worked in teams including "every possible combination of Jewish and Arab surgeons and nurses," he notes. Adds nurse Etti Ben-Ya'acov: "I've never seen any racism here, and so long as I'm in charge, at least, there won't be any." A 40-year Hadassah veteran, now head nurse at Ein Kerem's Trauma Unit - a vortex of unimaginable calamity during the intifada - Ben-Ya'acov has seen pretty much everything at the hospital that there is to see. Nurit Wagner, a former Hadassah chief nurse who now heads the Ethics Bureau of the Nurses Union, recalls incidents from the 1991 Gulf War that run directly counter to the legends of Arabs "dancing on their rooftops" as the Scuds fell. "I was head of the nursing school at Kaplan at the time," says Wagner, "and it was davka the Arab nursing students who didn't go home, who stayed to calm the patients and help them put on their gas masks." THE REASON why Jews and Arabs can work in a hospital as if they were in Finland, the interviewees say, is that the life-and-death nature of their work, and the purity of purpose they are trained to bring to it, obliterate all on-the-job considerations of race, religion or politics. But again, this depends on Jews and Arabs keeping their political discussions to a minimum - or, if they have extreme political views, keeping them strictly to themselves. Zangen says he often discusses politics with Arabs at the hospital, adding that some argued with him while he was speaking out against Palestinian claims of IDF atrocities in Jenin. However, the only time these arguments went beyond reasonable bounds, he says, was when an Arab medical student in his office harangued him with wild tales of Sharon having personally shot Palestinian refugees from a balcony in Sabra and Shatilla during the first Lebanon war. I ask Zangen if he could work with a Hamas supporter. He replies: "I imagine that some people here voted for Hamas in the last election, although this might have been over social issues. But if I knew that one of the doctors or nurses here supported terror, then no, I couldn't work with him." From the viewpoint of a Jerusalem Palestinian, Badriya says that while he has no problem working alongside Jewish right-wingers and settlers, he has his limits, too. "I would not work for someone who supports transfer, who says I have no right to live here," he maintains. He assumes there are Jews at Hadassah who think that way, but has never heard such opinions spoken aloud. Compared to Jews and Palestinians from east Jerusalem and the West Bank, Israeli Arab employees seem to have a harder time separating politics from work. Because they are connected to Israel and the Palestinians at the same time, without being totally connected to one or the other, many are not sure which side they identify with. And this is a problem when you deal with colleagues and victims from both sides every day. Lamese Shibli, 29, is a Beduin from Galilee and a social worker in Hadassah Ein Kerem's Pediatric Intensive Care Unit; she deals with child patients and their families. A petite, sensitive woman who says she "doesn't look for fights," Shibli lives in a neighborhood on the Jewish side of Jerusalem. "Most of my friends at Hadassah are Jews," she says. But when it comes to the politics of the Israeli-Arab conflict, Shibli naturally identifies with the Arab side. Sometimes the dissonance isn't such a problem. While all or virtually all Arab hospital employees oppose the West Bank settlements, there are those who will travel to the settlements to attend a family function of a close colleague, and there are those who won't; Shibli, who has worked at Hadassah for seven years, is one of those who will. She recalls a close relationship with a settler who worked at Hadassah: "My best friend at the hospital, before she left, was a Jewish social worker. She was religious. We did everything together; we never discussed the 'situation,' it didn't matter. When she decided to move to a Gush Etzion settlement, she made a point of telling me personally. I told her, 'Look, I'm completely against the settlements, of course, but to me you're still Shira, and I love you.'" But sometimes her conflicted identity as an Israeli Arab, one who has many Jewish friends and whose political sympathies lie with Palestinians, is a heavy load. "Right before the bombing of the Moment cafe [in Jerusalem in March 2002], about 40 Palestinians were killed by Israeli soldiers in the space of two or three days," she recalls. "One of the Arab nurses at Hadassah called me and said the Arab employees were going to wear black to work. I prepared some black clothing to wear, and on the day I was going to wear it, there was the bombing at Moment." Shibli says she used to eat there with friends. "Everybody you see there is young, happy. They didn't deserve to die," she says, then adds, "The Palestinians didn't deserve to die, either." She went ahead and wore black as planned - "for all the victims." She doesn't like being in the hospital on the day after a terror attack. "I get really sad; I cry over it and the Jewish social workers in the unit know I do. But I feel like I can't grieve with them, I can't be part of this sadness. It's not legitimate, it's not permitted to me." She says that no Jewish social worker ever told her this, or ever would, but she feels it anyway. As an Arab, she would feel implicated in the attack. "During the intifada, my biggest dread, something I carried around all the time, was that one of the Jewish social workers I'm close to would lose an immediate family member in a terror attack. What would I say to her at the funeral? How could I go to the funeral?" Then, when a Palestinian family would come in with a child who was shot and maybe killed by Israeli soldiers, Shibli would feel implicated in that killing, as an Israeli. "The families blame it on Israel, on the Jews, and to them I represent Hadassah, I represent a Jewish hospital, a Zionist institution. I want to identify with them, but there again, I feel I can't. THIS UNDERSTANDING, this ability to cast aside blame, to empathize, to feel remorse, is something that characterizes the behavior of Arab and Jewish hospital employees in the face of war and terror. It does not, however, always characterize the behavior of the families of the victims the employees treat. The reactions of some of these families - mainly Jewish families - are the one way in which the divide between Arabs and Jews affects the work routine at Hadassah and other hospitals. Ordinarily, patients are assigned to rooms without regard to whether they are Jewish or Arab. But in the case of a terror attack in which there are both Jewish and Arab victims, Hadassah separates them, to the extent possible, in different rooms to avoid tension between the families and friends coming to visit. "It's common sense. The families' emotions are very raw after a terror attack," explains Birnbaum. Interviewees say it is Jewish families of victims, not Arab families, who are more likely to take out their anger in outbursts against the entire "enemy" nationality. "I've seen it several times from Jews, but never from Arabs," says Ben-Ya'acov. "I think the Arabs are afraid. They think that if they say boo, they'll be in trouble." In private, closed-door sessions where they can speak Arabic, though, many Palestinian families of patients shot by Israeli soldiers vent their hatred of "the Jews," says Shibli. She doesn't show up on the ward after a terror attack - as a matter of department policy, one that frustrates her, but which she understands and, finally, has to agree with. "Around the start of the intifada, a Jewish family from Hebron came in with their injured child, and the mother attacked an Arab doctor here. Since then, the policy in the department is that I don't come onto the ward after a terror attack. I answer the phones. On the phone, families calling in can't tell if I'm Arab or Jewish," she says. "I wish the reality of the situation was different, but given the reality of the situation, I have to say that the policy is right. If I were a hospital administrator trying to protect my Arab workers, I would do the same thing." There have been times when Jewish families of patients who were in the hospital for illnesses having nothing to do with terror or war have evinced anti-Arab prejudice, she continues. "Once a haredi man came up to me and complained that his family was in a room with the family of an Arab patient, and here he had paid money to have the operation done privately," Shibli recalls. "I told him that I was the last person he should make that complaint to because I was an Arab. After that he shut up and went to sit in the room next to the Arab family." Ethnically based complaints from Arabs tend to be that they are not getting the treatment they're entitled to simply because they're Arab, says Birnbaum, adding that he knows of no such complaint that turned out to be justified. THERE IS one other complaint about discrimination at hospitals that is voiced by some Arabs - not by patients, but by Arab medical professionals themselves. The complaint is that they are passed over for promotion in favor of Jewish colleagues purely on the basis of ethnicity. Yet while several interviewees for this article had heard such complaints, and in some cases were prepared to believe there was something to them, not one, Arab or Jew, knew of a specific case in which a promotion was given to a Jew over an Arab even though the Arab was more qualified. Shibli, in fact, says being an Arab has worked in her favor in her career at Hadassah - because, being bilingual, she can treat both Arab and Jewish patients. "I'm in such demand - too much demand," she says jokingly. Some of her Arab colleagues confide in her that they were passed over for promotion because of their nationality, she says, noting that such suspicions are voiced more often by West Bank Palestinians than by Israeli Arabs, and more often by lower-level professionals. "In some of these cases, I know that the real reason they were passed over was because of their performance," says Shibli. She knows of no case in which the reason was discrimination. But prejudice in job promotions is suspected by many Arab medical professionals. "It's something I've heard complained about often. I haven't checked it out scientifically, but I imagine that even if all the complaints aren't justified, at least some of them probably are. I'm sure that if an Arab candidate for promotion has greater qualifications than a Jewish candidate, the Arab will get the job. But if they're both equal, I suspect that there are cases where the Arab doctor, or the non-Jewish doctor, will not get the promotion," says Dr. Radi Shahien, a Druse who heads the Neurological Unit and chairs the doctors committee at Ziv Medical Center in Safed. When asked, though, if he had personally experienced any discrimination in career advancement, Shahien, 53, who has been at Ziv for 12 years, and at Nahariya and Hadassah Ein Kerem for many years before that, said that he had not. "None whatsoever." I ask him if being a Druse who had served as an IDF physician had shielded him from any anti-Arab discrimination. "No," Shahien replies, "if I were an Arab Muslim or Christian, I'm sure it wouldn't have made any difference." Ali Haider, co-director of Sikkuy, an NGO that monitors discrimination against Arab citizens, says that while he has no concrete evidence to prove prejudice in the hospitals, there is a great deal of circumstantial evidence. "Certainly it exists," says Haider. "Except for a couple of [European church-sponsored] hospitals in Nazareth, there is no Arab director of an Israeli hospital. There are very few Arab department heads. I'm sure all the doctors give equal treatment to Arab and Jewish patients, but there is a glass ceiling of some sort for Arab medical professionals, and it has to be broken." AS A WHOLE, Jews certainly hold higher positions in hospitals than Arabs do. As Haider notes, there are no Arab hospital directors. And, at the other end of the professional scale, virtually all the janitors at Hadassah, for instance, are Arabs, notes Ben-Ya'acov. "Jews won't do that sort of job," she adds sarcastically. Birnbaum, 54, who has been at Hadassah Ein Kerem for the last six years, says there are no Arab department heads at Hadassah, although Dr. Ahmed Eid, an Israeli Arab now living in east Jerusalem, heads the hospital's Transplant Unit. However, Birnbaum also points out that during his tenure, about 50 to 60 doctors have submitted their candidacies for job openings as department heads - and not a single one has been Arab. Asked to explain this, Birnbaum says he can't blame it on anti-Arab prejudice because he's seen none, and he can't blame it on some general professional handicap among Arab doctors, because he hasn't seen that, either. The one "objective" reason he can point to is that "interns who studied medicine in Arab countries tend to enter the hospital less well-prepared than interns who study at Israeli or Western medical schools." But even in this instance, he says, interns who studied in Arab countries "catch up very fast after they come here." Yet while Arabs hold a disproportionately small number of the higher positions at Hadassah, their presence is growing, says Birnbaum. Nationwide, there are now several Arab department heads and senior physicians, says Shahien, adding that this wasn't the case a generation ago. For all the discrimination that still exists in general against Arab citizens, there is less and less of it at the academic and professional levels of society. The Arab professional class is steadily growing, and the profession in this country that has always been most open to Arabs - with its strict, universal, non-discriminatory code, its uniquely integrated clientele and its few "security-related" considerations - is medicine. Noting that there are Arab resident physicians in every Hadassah department he can think of, Birnbaum says, "They're climbing the ladder, and this is the result." An obvious question arises here: Can the Jewish-Arab relations inside a hospital serve as a model for the rest of society? Can they be duplicated elsewhere? Most of the interviewees think not. "Equal treatment is a defined goal in the field of health, but not necessarily in other fields," says Birnbaum. "We're not the police, we're not the army, we don't deal with political problems. We're a bubble. Outside the bubble it's different. In the [nearby] Malha shopping mall, you see Arabs and Jews and they won't even touch each other." Says Badriya, the surgeon from Wadi Joz: "If you can't treat Arab and Jewish patients and colleagues equally, you wouldn't choose to be a doctor in the first place. But I don't think people in 'regular' professions can necessarily make that separation between their political opinions and their professional duties." Wagner, the former chief nurse at Hadassah, now volunteers with Machsom Watch, which monitors soldiers' treatment of Palestinians at West Bank checkpoints, and where she sees Jewish-Arab relations of a starkly different quality than she found in hospitals. She, too, thinks they have a unique nature that can't be copied elsewhere. "Equality is inherent in our training from day one, it's inherent in the whole purpose of a hospital," she says. "You can't just artificially duplicate it in a factory or someplace else." But at least there is one Camelot in this antagonistic land. "During Ramadan, when the Muslims I work with are fasting, I don't eat in front of them. Just like on Pessah, they don't eat bread in front of me," says Alexander Benstein, 49, a CT technician at Ein Kerem. A one-time cardiologist in Moscow, he is now a settler in Tekoa with a long, gray beard, which he says is a completely irrelevant set of details for him and everybody else at work. "Kashe [critical], beinoni [moderate] or kal [mild] - that's how you differentiate among patients," says Benstein. "Not Muslim, Christian or Jew." n


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