O' Little Town of Bethlehem

Walking through Bethlehem's Old City (PC: Ethan Craig)

For the past week, we have spent the majority of our time in the biblical town of Bethlehem. We have been toured, worked, and even attended our first medical conference in this historic city. At times, we have been wondering looking for a place to stay, but we have always found comfort in our new home.

Bethlehem is an hour plus drive from Ramallah, despite its close proximity. Each time we which to go, we take a "service," which is a shared shuttle that winds through valleys and hills towards Bethlehem. This service takes the "Palestinian" way, which goes out of its way to avoid Jerusalem and major checkpoints, expanding a quick 21 km (13 mile) trip to over 50 km. The path these drivers take often force you to call on the religious presence found in the shepard hills as you hope to avoid oncoming cars, going off the edge of a hairpin turn, or danger as you ride on the wrong side of the road. Despite the constant nausea, fear, and length, these trips have simply become a way of life.

Bethlehem is a gorgeous city filled with charm and an immense amount of history. We managed to visit the Church of the Nativity twice, Solomon's pools built thousands of years ago, and walk the wandering and bustling streets of the old city. The Church of the Nativity is built over the supposed place of Jesus's birth, as commissioned by Helena (mother of Constantine). Inside, it actually several connected churches, chapels, and cyrpts belonging to different denominations: Greek Orthodox, Roman Catholic, and Armenian Apostolic. All three take care of the cyrpt that holds the sacred spot of the birth. Inside the crypt, you often hear people crying and praying as they touch the dirt that serves as physical presentation of the manger.

Solomon's Pools

This past Sunday, we were able to avoid the "palestinian" way by traveling to Bethlehem with Eloise. She is a photographer/media specialist for PCRF, the organization we are volunteering for this summer. She also happens to live upstairs from Drew and got us our job. She was coming to photograph the summer camp. Driving in a car through checkpoints is no less scary than avoiding them in a service. We spent the entire day playing soccer, painting, and attempting to learn arabic. The kids have taught us to count (up to 10), colors, and common greetings. We only hope that in some small way we have improved their english, but to be frank they are light years ahead of us.

Monday and Tuesday were spent doing rounds with the physicians. During rounds, you discuss the patients of the day, their current ailments, any changes in their health, and their upcoming procedures/medications. These are conducted in arabic, but fortunately the physicians are kind enough to summarize the conversation after for us. We then go and visit each patient where the physicians perform a simple physical exam and check-in with the parents and kiddos. There is however a negative trend associated with these rounds. As physicians walk into younger patient's room, they are met with crying and screams. The white coat, which I assumed was calming to most, is often sign of an upcoming painful procedure, chemotherapy, and painful/discomforting side-effects to these kids. Their eyes often are filled with tears until the physicians leave. We fortunately do not have that same effect on the kids, and they tend to be much warmer towards us.

Because we were staying the whole week in Bethlehem, Ethan and I decided to check out hotels/apartments for the summer. We hoped this would save us time and money in transportation to and from Ramallah every day. We scoured the city using leads from visiting american residents, Drew's friends, and more. We somehow found ourselves test-driving an apartment for several nights. It was a strange experience to be handed keys and told "let me know what you think in a few days."  Ethan and I were reflecting on the bizarre experiences that let us to this empty eerie apartment when "Silent Night" randomly played from Ethan's itunes. It was a perfectly funny moment that put into perspective just how important this town is for so many.

Patients at Summer Camp (PC: Ethan Craig)

Wednesday was the first day that we saw some action in the Pediatric Oncology wing. Our primary attending was away planning a medical conference (that we would attend later), leaving the residents to attend to the patients. There were three intrathecal pumps/spinal taps scheduled for the morning. A spinal tap involves a driving a large needle through the skin, tissue, and into the spinal cord to collect the spinal fluid. The patients must stay extremely still during this incredibly painful procedure, thus the use of an anesthesia for most patients. While you have a needle inserted into the spinal cord space, you can also directly add medicine into the cerebrospinal fluid. This is a typical procedure for some chemotherapy medicines.The first patient, an older (10ish) female, hated the side effects of the sedation so she asked for no anesthesia. You figured without anesthesia, she would have been the most difficult patient, but she was the easiest of the day. The second patient, a young male suffering from Acute Lymphoid Leukemia (ALL), was sedated, prepped, and the procedure was about to begin when the patient had his first focal seizure. His patients are both epileptic, so there was always a chance this could occur. It however makes an extremely bad day to be getting treatment for cancer and diagnosed with epilepsy. The third patient was equally difficult requiring a total of 3 doses of ketamine to be sedated. A typical patient requires just 1. Today just exemplified that no patients are ever the same, and even the easiest procedures can go wrong.

After our busy day on the wards, we moved from our eerie trial apartment into a hotel for a medical conference. The doctor we are shadowing, Dr. Mohammed Najajreh, was the primary organizer for the largest oncology conference in the state of Palestine. Speakers came from all over the world, as well as many local physicians. During the conference, we listened to speakers talk about various aspects of cancer, met palestinian medical students, dined with physicians and hoped to gain something of the mix of arabic and broken english. We were always treated with more hospitality than I have ever witnessed. During our final night, they had a gala at a local restaurant. The gala included a feast, traditional dancing, a fashion show of all the traditional outfits for each major city, henna, and dress up. Ethan and I got to wear the traditional Palestinian clothing and got quite a lot of attention for it.

Traditional Palestinian Clothing

While the conference was tons of fun, it was also a lesson in culture, medicine, and appreciation. My favorite talk was about the Palestinian's first bone marrow transplants. Most patients if they need any advance treatment, including bone marrow transplants, are sent to Israel to receive the procedure. Until recently, a procedure that I take for granted as simple, and standard of care was considered too advanced for the hospitals to handle. The Palestinian hospitals just aren't equipped to handle such situations for various economic and political reasons. Only just recently, have they been able to perform the first set of transplants, over 25 years after the first bone marrow transplant in the United States. Listening to the talk, was a reminder of the struggles that Palestine faces and how these struggles weave their way even into medicine. For example, the hospital received the permits to build the bone marrow transplant center, but didn't receive the permits for sewage so the building remains empty. I tended to believe that medicine was often untouched by politics and conflict; however, I could not have been more far from the truth. While physicians do their best for each patient no matter the circumstances, the establishments from within they work are under the pressures and constraints of the politically and economically driven world in which we live.