Dr. S. Adil HusainDr. S. Adil Husain, a Muslim surgeon based in Gainsville, Florida, will chronicle his journey to Jerusalem and the West Bank for Beliefnet readers. He is on a two-week volunteer program with the Palestinian Children's Relief Fund, a nonprofit American organization dedicated to the medical and humanitarian needs of Palestinian children and others in the Middle East. From January 7 through 19, Dr. Husain will be performing heart surgeries on Palestinian children and trying to get to the heart what makes the holy land so special to the three Abrahamic faiths. He'll be sharing his experiences in this blog.

Saturday, Jan. 20, 2007

Hitting the Ceiling
What I feared most occurred at the hospital as we neared the end of our surgical experience: With the completion of our final few cases, the intensive care units (ICU) at the hospital reached its capacity and we were unfortunately unable to do surgery on the last two children. Medically speaking, this was the hardest thing I had to face in my two weeks here.

Our cases thus far all went well, so we decided to perform surgery on two children with a complicated congenital defect in which there are multiple abnormalities in the heart due to a hole between the two major chambers. This is the most complex operation ever done in Palestine, and more complex cases are sent to better-equipped Israeli hospitals.

I was concerned, but felt confident that we could safely perform this surgery on the two children. The cases went well, but as expected these children could not come out of the ICU setting within a day or so. With the pediatric ICU beds all full, this made it difficult to perform more surgeries. We actually put two patients in the adult ICU so that we could keep operating. This created nursing staff challenges as well.

Overall, we completed 14 cases. This was a bit less than I had hoped for, but considering the challenges at hand, I feel satisfied with what we accomplished. That being said, there were two children left in the hospital we were unable to treat and this weighs heavily on my heart. There was no hiding the families’ disappointment, and their fear of when and how they would return for care. I also feel very uneasy about leaving critical patients who we have operated upon in the hospital as I return to the United States. But Vivian, the wonderful surgical resident, is there to handle everything after I go.

I knew this would be the case prior to starting the mission, yet it doesn't make the prospect and my concerns any less. I will really miss all of the staff, residents and nurses. I made many friends quickly and will think of them often as I return to practice at the University of Florida.

To Bethlehem, Hebron
During my final two days, I visited two additional places that I was interested in seeing. I went to Bethlehem on Thursday and was pleased to get there prior to nightfall, as travel through checkpoints always becomes more difficult after the sun sets. Bethlehem is a very charming city perched on a hill at the edge of the Judaean desert. In biblical tradition, it is the childhood home of David and also the birthplace of Jesus (peace and blessings be upon him).

Thousands of Palestinian refugees occupy Bethlehem as they traveled here after the 1948 Arab-Israeli war. I visited the Church of the Nativity and witnessed the Grotto of the Nativity, which is the church's focal point. The entrance to the church also has historical significance--it is only approximately three feet tall. The door was reduced to present size in the Ottoman period to prevent carts being driven by looters to enter.

Portions of the original floor with its beautiful mosaic design--that survived from the fourth century Basilica--remain in the church. The manger square outside the church was filled with children and people and was surrounded by vendors selling things like corn and nuts.

I also visited Heborn with Vivian. Going to her hometown was important for me as this was a special request from her. Traveling to Hebron was simple, and we cruised through the two checkpoints with minimal difficulty. We visited a few glass blowing factories, which are some of the city's major attractions.

I was most interested to visit the Abraham Mosque, which we were able to do in time to for Asr, the late afternoon prayer. What’s interesting about the building is that it is divided in half for Muslims and those of Jewish faith. So in one building, people of both faiths worship on either side of a wall. The mosque is also referred to as the Tomb of the Patriarchs, or Haram al-Khalil in Arabic.

The Abraham Mosque is still a significant historical dividing issue between faiths, being the site where 29 Muslim worshippers were killed in 1994. This tragedy still creates much emotion when speaking with Palestinian natives of Hebron. Again, it was very odd for me be questioned by governmental security guards as I tried to enter the mosque. Having to go through questioning and metal detectors to visit places of worship has given me a very uncomfortable feeling throughout my trip.

Interestingly, all monotheistic faiths believe that Abraham, his wives Sarah and Hagar as well as their sons Ishmael and Isaac, are buried in Hebron.

The return to Jerusalem was quite interesting. Due to the Islamic New Year being the next day, there was much activity around the old city. As our travel back became more challenging, it became impossible to get through the checkpoints. We diverted our path to Bethlehem. Although it was a much longer, tenser route, we were able to return safely without incident.

A Never-Ending Cycle
I am very thankful to have accomplished many of my goals on this trip. I thank the Palestinian Children's Relief Fund to allow me to come and perform surgery in Palestine. My thoughts regarding the political, cultural, and religious issues of this region are evolving now that I am back in the U.S. and am digesting and analyzing my experiences.

This area of the world is truly amazing for an ignorant individual who comes as a tourist. The history, religious structures, heterogeneity of faiths, as well as the overall welcoming nature of the people, make Jerusalem an amazing place. The close proximity of the some of the most important places in the Islam, Judaism, and Christianity cannot be appreciated until you have walked through the Old City.

Although I have tried to be very non-judgmental throughout my time here, I cannot deny that this is a land of occupation for the Palestinian people. They are truly treated as people who have a right to live, eat, and drink--but little else. Traveling, working for a decent salary, access to health care, and other general rights that most take for granted are not offered to the Palestinians.

This is not to say that I understand the historical reasons for the present state of affairs or that I am an expert on these issues. But my eyes witnessed these facts. I think it is safe to say that very few people in the world have any idea of the true nature of life in Jerusalem and the surrounding areas.

The lack of respect for others’ religious beliefs and the inability to live in peace with one another is a very disturbing issue to have witnessed. I struggle with all faiths and people here in regards to the very segregated manner in which they view what is right and wrong. The final product of such unilateral beliefs is an environment that may never foster a respectful coexistence.

Basic principles of good will are lost between the faiths and cultures due to years of historical division. These philosophies are passed on to children at a young age and thus the cycle will be difficult to break. I also witnessed kind hearted as well as inappropriate individuals from all religions during my stay. Although religion is the core and central source of life for so many, it troubles me to see it is also used to create hatred and immoral behavior.

Although these feelings may be naive and the view of an individual who has not lived through the hardships of people here, they are what I have felt. Until people begin to respect life, individual choice, and private manner in which one is religious--and realizes that no religion supports anything but these basic entities--we will continue to see suffering for all. We have seen the outbreak of violence because of this situation in the past, and unfortunately we will likely see it again.

Final Thoughts
As a Muslim, I truly enjoyed my time at the Islamic sites. It brought me much personal satisfaction to be lucky enough to have prayed at these locations and to learn first hand the history behind them. I feel as if my faith was strengthened by these experiences, and I know that in my own private manner, they will assist me in my significant daily struggle to be a better person. My time spent at the major Christian and Jewish sites was also very rewarding and provided me with many of the viewpoints I have highlighted above.

These experiences have educated me and given me more understanding of all faiths and beliefs. I am blessed to have made this trip and hope to return for a similar mission in the future.

Friday, Jan 19

As I Ready to Leave
I am getting ready to leave Jerusalem now and head back home to Florida. I'm flying out today and am filled with mixed emotions--I look forward to getting back to Florida, my work, and my friends and family, but I will miss the new friends I made here. The past few days have been a whirlwind, with the last few surgeries and visits to Hebron and Bethlehem. I have so much to tell about what has happened, and so much to write about my feelings and impressions after being here for two weeks.

If anything, this experience has opened my eyes to a whole other kind of life. I will be posting a longer piece about my last days here and my final thoughts in the next two days. There's just not enough time right now to write down all that I want to say. Please stay tuned ...


Monday, Jan. 15

The Old City: Friday Prayers
Friday was a day off from the hospital, but I began my day by rounding (checking) on the children we had operated on so far. I really enjoy going to the hospital on days when I don't operate because I have more time to interact with families. Although the language barrier makes communicating difficult, the emotions and general enjoyment is not any different.

After seeing the kids, I went to Masjid Al-Aqsa an hour early to find a spot for Friday prayers. The mosque gets so overloaded with people on Friday that many pray outside in the compound between Al-Aqsa and the Dome of the Rock. The khutba (sermon) was interesting. Although it was in Arabic, I had someone translate for me, and I could understand some of it due to the occasional interjection of an English word.

The sermon’s topic was the internet and how this technology can be abused, especially towards children in the example of pornography and instant messaging. I was surprised by the choice of topic for a mosque sermon, but I guess it should be no different than any other sermon at a mosque, church, or temple. The second part of the khutba was about the conflict between the Hamas and Fatah parties.

Most Palestinians I’ve met say their frustrations of late are not only with the Israeli government but also with their own leadership. Many don't understand why their democratic elections are not being recognized internationally and feel that the internal conflict between the two parties is fueled by outside sources. I think their frustration is no different than that the lack of faith many Americans have in our politicians.

The Old City: Religious Trifecta
Following the Friday prayers, I then went to the Western Wall as well as the Holy Church of the Sepulchre. I was again astonished by how close these religious sites are to each other. I was also struck by many commonalities: The women all had their hair covered at all three locations and prayed separate from men at the Western Wall and mosque. The people who visited the three sites were all very joyous at being able to worship in these sacred spaces, and many worshippers temporarily transcended the political struggles of the outside world.

The Western Wall is an outside structure, and I saw it as the Jewish Sabbath was about to begin. It was crowded by worshipers and many children singing and dancing in unison. There is a great deal of passion and emotion for those up at the wall praying. And there was a great deal of security at this holy site like at Masjid Al Aqsa.

The Church of the Holy Sepulcre is beautiful in terms of its inner architecture. It is built around what is believed to be the site of Jesus’ (peace and blessings be upon him) crucifixion, burial and resurrection. I observed an Armenian Mass filled with candles and singing. I also saw what is thought to be the final resting place of Jesus (pbuh), and the rock that was moved as he left his grave site.

Upon leaving the church, I followed the path of the Via Dolorosa, which was the way walked by Jesus (pbuh) on the way to his crucifixion. The route is marked out by 14 "stations of the cross" linked with events that occurred on his last walk. Though Islam’s belief of the crucifixion story is very different than Christianity, it was very fascinating to follow this route.

Surgery Fatigue and Challenges
As we enter our second week at the hospital, fatigue is setting in and the number of cases still to be done seems daunting. We have completed 10 cases thus far and have nine other children who are in transit or already in the hospital needing operations. I am only scheduled to operate for three more days before heading to Hebron on Thursday and home on Friday. I am not sure how we will complete all of this work, and the emotions of the work are increasingly taxing.

The children we operate on must have financial coverage for the surgery and their families must obtain insurance from the Palestinian Authority for 1,400 shekels (approx. 350 U.S. dollars) to be allowed to travel to our hospital in the West Bank. The transportation issues are difficult, as the hospital is not cleared by the Israeli government to have an ambulance system. So private transportation must be obtained, which is neither cheap, nor in many cases, safe.

So families must work with the Palestinian Authority and the Israeli government to solve financial and transportation issues. As one can imagine, these two entities often do not work well together on such issues. The complexity of getting the children to the operating room is difficult to describe and understand unless you are actually here. I still am not sure I understand it well.

The operating rooms do not have temperature control, which is crucial to pediatric heart surgery. My experience has been to cool the room to around 55 degrees fahrenheit to keep the environment cold, which allows the heart more protection while it is stopped. Here the rooms are unbearably warm and with all of the clothing and equipment we wear for surgery, I find myself drenched with sweat during every operation.

By no means do I mean to slight the people and their dedication. It truly is unmatched in my experiences as a care giver, and I am continually in amazement at their work ethic. I also am really enjoying how the system here is so similar to American teaching hospitals. Although technology, language and cultural norms are different, the interactions between physicians, residents, nurses, and other care givers are all so similar. Fighting for beds, the joking and nicknames for residents, and the general camaraderie between teachers and students is all a lot of fun.

Thanks to the Palestinians
I cannot say enough about the hospitality and kindness of the people I have met. These are not bitter and angry people as many would think. People are very generous with their time, and they go out of their way to be generous hosts. I cannot tell you how many times I have had to turn down dinner invitations and offers to tour the city due to a sheer lack of time.

I am impressed at the Palestinians’ ability to discuss their frustrations with government, politics, and occupation, yet do so with a faith that things will get better. There is no doubt that certain topics bring about a heightened level of emotion, and there is also no denying that my short time here by no means can provide a thorough and accurate picture of their personalities.

But these have been my observances. I do wish in some ways that I could also spend some time with supporters of the Israeli government to see their daily life and get their perspective on the history and politics of the region. It would only be fair to hear their opinions to get a better understanding of this complex region.

Thursday, Jan 11

The Domino Effect
I have been trying to go to Masjid Al-Aqsa once a day, and after another busy day yesterday at the hospital, I was able to make it there for the sunset prayer. There were a couple hundred people praying in unison, and I was near the front. After I finished, I sat there for awhile, and then felt a hand on my shoulder. I thought, “Who is that? I don’t know anyone here.” I turned around, and it was the grandfather of the baby on whom I operated on in the morning.

He didn’t speak English, I didn’t speak Arabic. But in that mosque we sort of spoke the same language. He thanked me, but here’s what is interesting. He was thanking me not as his baby’s doctor, but for a different reason: In his family, for whatever reason, he became the designated person to bring the baby in because his travel permits were approved.

The whole journey of getting all the paperwork in order and getting to the hospital with his granddaughter took about 10 days. And after the surgery, he came to Al-Aqsa to do the evening prayer. And he was thanking me for that, for the domino effect that happened from my coming to Jerusalem: I came, his granddaughter got to have surgery, he got to bring her to the hospital, and for the first time in seven years, he got to pray in Al-Aqsa. And he was so happy.

I don’t want to make it sound like all these great things happened because of my coming to Jerusalem. What I want to relate is how special this mosque is to Muslims. And those who live right here--within a visiting distance of the mosque--aren’t able to come to Al-Aqsa because of the travel restrictions. So when they get that chance, it’s very special and very meaningful.

The Domino Effect, Part II
The domino effect isn't only religious in nature. I am working with an amazing young surgical resident named Vivian, who is a Palestinian Muslim. She is originally from Hebron and is in her final year of surgical training. Vivian is planning on pursuing a career in pediatric heart surgery and thus has been my shadow the entire time.

Her skills as a physician and her care for the patients are unmatched in all of the years I have worked with surgical trainees. She reminds me of why I wanted to be in a teaching hospital environment in the U.S. She came up to me yesterday and asked me to keep Thursday of next week free from operations--the day prior to my departure date from Palestine. She said that she wanted to take me to see Hebron, to meet her family, and to visit the Abraham Mosque.

I was surprised by this. There is nothing more she likes to do than spend time in the operating room. In fact, she lives within the hospital compound and takes call on the surgical patients every night. But I quickly realized what was happening: Vivian has not been home in months. The trip will take a mere 30 minutes or so, but due to her not having a "magnetic ID" and only a hospital-issued special permit, her trip home is very challenging.

By taking an American passport holder (me) with her, the trip through the many checkpoints will be much less rigorous. She has warned me that the old part of Hebron is not always safe and to never let on that I am American, but say I am an Indian (I am an Indian-Muslim American). Vivian is an extremely calm and respectful person, but the mere topic of occupation and the geographical make-up of Palestine bring a painful quality to her voice and face. I am excited for her to see her hometown and family after so long and excited for myself. I am sure it will be the culmination to my trip

Old City Religious Experiences
It’s interesting how protective the mosque guards are of Al-Aqsa and the Dome of the Rock. I’ll bet that it’s the same story at the Wailing Wall and other important religious sites in Jerusalem. So many people come here from all over to visit. But the guards are careful who they let inside and are always a bit paranoid that someone may be trying to harm the mosque.

I’m in jeans, and it’s totally obvious that I’m a foreigner. So every time I come to the Dome of the Rock or Al-Aqsa, I get stopped and questioned. They look at my passport and say, “Oh, Syed Adil Husain. You’re Muslim. But are you a practicing Muslim? Can you pray?” And I recited the Aytul Kursi or some other passage from the Qur’an, and they say, “Okay, okay!” and usher me in.

Once you’re in, everyone is so friendly. There’s always someone to explain the landmarks to you, to show you around. There’s just an immense feeling of friendliness and history when you’re inside this huge compound. There are kids playing soccer, people walking around, others are worshipping in some private manner. It’s like a big sanctuary. There’s no protocol to follow, like when you’re on the Hajj. You do what you want, and it’s just so nice.

Friday is a holiday at the hospital, and the Palestinian equivalent of a weekend only lasts for that one day. I have planned a day of Juma (Friday) prayers at the mosque but will also go to the Holy Church of Sepulchre where Christians believe Jesus Christ (peace and blessings be upon him) is buried. I also plan on visiting the Western Wall, the last remnant of the second temple, a retaining wall thought to be the holiest place in the Jewish faith.

Visiting these two places are high priorities to my experience here, and I look forward to seeing what I get out of them in terms of emotion and history. I continue to find it amazing that these three religious structures are literally steps from one another, yet the land and the people struggle so much to live in respectful unison. Having been here only one week, I have no right to make such a statement in a judging manner, yet I cannot hide my amazement about this conflicting fact.

Surgery in a Strange Land
My daily surgeries are going well, but I’m filled with anxiety at every turn. It’s so hard--when you’re used working with certain instruments--to perform surgery in a totally unfamiliar setting without all the necessary equipment.

These are very sick children, and each surgery is a very nerve-wracking procedure. The doctors, nurses, and other support staff are terrific. I’m the one who is so anxious. Of course I don’t want there to be any complications. And more so, I don’t want there to be any problems that come up after I’m gone.

We have now performed five open heart operations in three days, and I am so relieved that they have all gone well and the little patients are off the ventilator. We must move them through the Intensive Care Unit (ICU) setting to the pediatric ward quickly, as there are only three beds in the ICU and we have to continue to do cases daily.

Although the equipment, ordering of tests and other "routine" care protocols that I am used to following are lacking here, the care and devotion of the nurses and other care givers gives me such comfort that the children are receiving the best post-operative care possible. I have been here only a short time but already know that I have made life-long friends. I will miss so many people in this hospital when it is time to leave.

Tuesday, Jan 9

The Work Begins--My Anxiety Mounts
Having been in Jerusalem now for 48 hours, I cannot imagine a more productive yet emotionally draining two days. We saw a few children in a clinic my first evening here and then scheduled operations for three children for the next two days. There are two more children set to arrive from Gaza today who need surgical care and inshallah (God willing) we will be able to do their operations before Friday.

The difficulties for Palestinians--in regards to travel permits and identification card requirements--are overwhelming. Children arrive for their operations without their parents, but rather with friends of the family or grandparents. They come with anyone who has a permit to travel--the important thing is just to get to us. Some families took nearly seven hours to travel a mere 100 km yesterday to see us. The time delays are not due to road conditions, but all the checkpoints. We decided to admit these children to the hospital in fear of their inability to travel on their designated operative day.

We completed our first operation this morning, and I was perhaps the most frightened I have ever been in all my years of training and practice. To perform delicate procedures on these helpless children in a land where I don't speak the language, am not used to the equipment, and must work with people whom I have never met before is a daunting task. The welcoming nature of the local caregivers is so very kind that I feel embarrassed at times in the manner in which they treat us "foreigners."

Alhumdulillah (thank God) the case went well. But I am all the more anxious in anticipation of several cases that have yet to come. The differences in medical technology and standards of care are challenging me to find new ways of making sure that we provide the safest and most complete surgical care possible.

My First Prayers at Masjid Al-Aqsa
I have been blessed to visit and pray at Masjid Al-Aqsa as well as within the Dome of the Rock. The area of "Old Jerusalem" is indeed an amazing place, as the four quarters are all confined within an approximate 10-15 square kilometer area. The holiest of places for all three monotheistic religions are in this tiny area, and there is no denying the amazing variety of people, cultures, customs, and religious principles that can be found here.

I found an elderly person at Al-Aqsa who was so very helpful in describing to me the details of the mosque. The symbolism in the Dome of the Rock was very interesting in terms of the number of arches and pillars throughout the structure. To see the Ayatul Kursi (a passage from the Qur’an) carved into the dome itself was breathtaking.

I was able to do my midday prayer in Al-Aqsa, and this will surely be a highlight of the trip. I am sure that doing Salat-ul-Juma (Friday prayers) in this mosque will be quite overwhelming.

Sunday, Jan. 7

I have arrived safely in Jerusalem. I was detained for five hours at the airport in Tel Aviv and was asked every question you can imagine. I guess one should expect this for a Muslim with Indian heritage who is a born American and is flying through Israel to work in Palestine for two weeks while carrying medical equipment and toys.

I am sure they had a hard time processing all of those variables. I was prepared in my mind for this and although it was very tiring I wasn't too bothered. I saw the Dome of the Rock on my drive into Jerusalem. More soon.

Friday, Jan. 5

Why Volunteer?
For a lot of personal reasons, I felt that this was a good time for me to do volunteer work. I figure that if I want to make this an ongoing part of my life, then now is the time to establish set of volunteer experiences that I can then carry out for the rest of my professional career.

I found the Palestinian Children’s Relief Fund on the American College of Surgeons website, which has a link for global volunteerism. Though I looked online at many other volunteer opportunities, that specific link led me to PCRF.

This group is dedicated to providing treatment and training to specialists that isn’t readily available in the Middle East. Their mission is to provide free care to sick or injured youth who can’t be treated locally or can’t travel to other hospitals. What was great for me was that they were very flexible in terms of timing, and they had a need for someone with my particular skills.

Why Jerusalem?
I have a few objectives in going to Jerusalem: First I really wanted to do volunteer work--to give back, and to learn and gain personally from the experience. Anytime you remove yourself from your normal environment, you gain perspective. You see how others live; you see the challenges that others face; you see the hardships that others have to deal with it. It makes you take things less for granted. It changes what frustrates you and what excites you in life.

Jerusalem is in a region of the world that I’m very interested in. Religiously speaking, it’s a chance for me to visit Masjid Al-Aqsa, which is the third most important mosque to Muslims. Most Muslims aren’t able to fulfill the desire to see this mosque because it takes so much effort to get to the Haram Sharif (Grand Mosque) in Mecca and Masjid Al-Nabuwi (The Prophet’s Mosque) in Medina for Hajj. There’s often no time or money left to visit Al-Aqsa.

So this volunteer experience will help me achieve this personal goal of visiting Al-Aqsa, as well as seeing the other holy sites in Jerusalem. I really want to get a feel of this holy land that is so important to Muslims, Jews, and Christians. It’s amazing to think that within walking distance, there is Al-Aqsa, the Wailing Wall, and what many people believe is the final resting place of Jesus.

There’s no doubt that we’re reaching a climax of religious uncertainty and conflict in this world. And this location is perhaps the focal point of much of the unrest that is occurring. So it may be a bit altruistic, but I think it’s going to be very interesting to visit this very small area of the world to just gain some personal viewpoints as to how the people live there.

To be able to actually say “I’ve been there, I’ve seen some things. This is my perspective.”--that is what I personally hope to gain.

My Fears and Expectations
I don’t expect to have a spiritual epiphany. I don’t think two weeks in Jerusalem will sway me from where my spirituality is right now. I think it will allow me to be able to speak in a more educated fashion about the politics and beliefs of the region. I don’t think this trip will redefine what kind of a Muslim I am, but we’ll see.

A lot of the abilities that we have as physicians in this country are not just based on inherent knowledge and skills, but it also is based on the climate and the technology and the environment that we work in. So it’ll be a very good challenge for me to have to rely on my core skill set to work in a region where some of the things I take for granted on an every-day basis aren’t available to me.

And let’s be honest. I am afraid a bit as well. This is a volatile region and things happen there all the time. I worry that something will happen when I’m out doing some sightseeing or conducting clinics in other parts of the region. But I’m not letting fear stop me from trying to help a group of people who have a real need.

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