A refugee radiologist: perspective for the apathetic, Part II

...cont.
So, in Syria for a day, and needing to decide whether to leave to Libya by nightfall, Dr. Fajal and his family had a decision to make:  were they to make the relatively simple move to Libya, and start a new life there under another dictator, or were they to stow up in Syria, weigh their options and make the more difficult, costly travel to the United States.  Dr. Fajal's son did not want to leave Saddam's Iraq to be part of Qadaffi's dominion, and pushed the family to make the trip to the States.

Months later, the family was settled in New England, and though Dr. Fajal spoke English and was a practicing physician in Iraq, there are very few reciprocal agreements with respect to medical training and licensing in the United States, and in order to function as a radiologist in the US, he would be required to pass all USMLE tests, and attend another residency in an accredited US radiology residency program.  It is hard for people to conceive the difficulty - hubris aside - of going back and completing a 5 year residency after 20 years in practice.  Even if Dr. Fajal could find quick placement into an American residency, and this is not likely given the competitive nature of the field, and the protracted process for selection of residents, he would have to pay back loans for his travel to the US, and support his wife and children on a resident's salary; all while he was required to work 80 hours per week for 5 years before he could re-establish a practice in the States.  This in mind, he chose the pragmatic approach.  A local community college offered an ultrasonography certification after 6 months, and given his experience with ultrasound over 20 years of practice in Iraq, he pursued this option; the quickest and easiest route to a paycheck; the paycheck which would put food on the table, pay rent, and settle debts for the travel to the US.  Each of his children, at the appropriate age and schooling, worked themselves to support the family. His son worked with the electric company, and each of the daughters worked in retail shops, in addition to their studies.  Each payday, the children brought their checks to their parents to budget and disperse as necessary.  They became citizens in the US.

His son has completed his education, and is a practicing chemical engineer.  His daughters, however, are still in college, and the debt from their cumulative education exceeds what he could afford as an ultrasonographer.  To that end, Dr. Fajal traveled back to Iraq, now as a emissary from the US, to function as a discharge planner, in a contract position.  As I have alluded to earlier in these blogs, these contract positions in Iraq pay exceedingly high salaries, give the danger implicit in being here, so Dr. Fajal, though functioning, again, far below his aptitude and training, can garner the salary necessary to pay his childrens' tuition.  This all comes with a price:  he has been here since 2008, away from his wife, and children.

People like Dr. Fajal inspire us to be better, to try harder.  They conquer obstacles that most of us cannot imagine.  He humbly completes his duties with grace, and is a fantastic "over-asset" to have (imagine having Itzhak Perlman to provide violin lessons to your children) here.  Hearing his story reminds me of the fragility of my material life, and serves as a reminder of the value, and integrity, of work.  My children need to know about his life, and hopefully, they will remember his story. 

Supposedly, necessity is the mother of invention, and suffering the fuel of ambition.  Here's to faith that we can teach the lessons from another's hardship, and avoid the apathetic timbre resonating among so many of our own.

A refugee radiologist: perspective for the apathetic, Part I

As a parent, I want nothing more than the health and happiness of my children.  I do not want them to suffer.  I want to give them more than was given to me, which was more than was given my father, and so forth.  I also want them to understand the value of work, and the virtue of self-preservation.  I want them to be happy, but I do not want them to be apathetic; I want them engaged in their lives.  Nothing engenders responsibility and ambition like suffering and necessity, so how do I teach well-fed children to be hungry, without taking away their bread?  I find this to be the modern American paradox.  How can we develop entrepreneurs and inventors who grow up in the age of Paris Hilton?

It takes discipline, undoubtedly.  I am optimistic I can lead my boys by words and examples, but I stole these lessons; some them from Dr. Fajal.  Yesterday's post tells of this work to place HCN (host country nationals) after their discharge from the hospital.  I did not, however, allude to the path that led him back to Iraq, as an American contract worker.  I decided to provide a drastically truncated narrative of this road over the next 2 blogs... 

In 1998 when the strains of the western embargo on Saddam's Iraq revealed a hopeless future for those wise enough to see it, and brave enough to act on it, Dr. Fajal and his wife made the decision to leave Baghdad.  He could not emigrate, sell his home and more to Jordan or Egypt as any Ba'athist intelligence officials who sensed this plan would seize his assets and confine him, or worse.  He knew his family's departure would have to be surreptitious; that he would leave his life as a prominent physician, all of his extended family and friends, his home and his assets, with the exception of what could be carried on his back.  His children went to school and returned with news from their father that they were leaving within the hour to go on a vacation to Jordan.  They packed accordingly for a week's vacation to Jordan.

They ultimately arrived in Turkey, north of Kurdistan, knowing no Turks or Turkish, without work or a place to stay.  Dr. Fajal and his family lived on savings as he took menial jobs to help supplement expenses during the next several months for their asylum application to be processed.  At the end of 8 months an order for deportation arrived, and the family had six days to determine where they would pick up and settle.  They applied for asylum in Syria, but as the border was closed, they had to await for approval from the Syrian embassy in Ankara.  On the last day prior to their ominous deportation back to Iraq, they received permission from the Syrians, and made their way toward Damascus.  

They arrived in the Syrian coastal city of Banayas on the day of the monthly ship to Libya.  His family had to make a decision just then: were they to emigrate to Libya, or make attempts to reach America... (to be continued tomorrow)

Disposition

Providing a disposition for American patients going home with an injury is pretty simple.  We communicate with the flight surgeon, they arrange for a plane, and off he (or she) goes.  Discharging third country national (TCN) contractors is a little more challenging, but there is a discharge team here to help communicate with the contracting company to arrange for the patient's transport to where ever they may be going.  These patients then go on to heal in the country where they have their further therapy, or back in their home country.

The quandry comes with host nationals (HNs) - Iraqis.  Most of the Iraqi patients we see here are victims of IED blasts or local children suffering severe burns.  They often stay in the hospital for months - we may delay this to provide the best salvage possibility - but eventually, they have to leave the hospital, and they will need to be cared for by someone.  Another person will need to help them change dressings, dress and wash themselves, and often help them toilet or change their ostomy bags.  This in a country that doesn't stock ostomy bags at the local bazaar.  In this wasteland deplete of long term rehabilitation facilities, and families without the knack or funds to care for these people, we have lost more than one patient to dehydration, starvation, infection, or depression after discharging them from here.  But you cannot keep them here forever; they need to re-enter their lives.  Dr. Fajal (not his real name) is the person who shows them how to live on their own after their accidents.  Within the HN cultural context, he explains to families how to provide this care, he arranges communication between the patient with his or her family (not as routine as you may think as HNs are not let onto this base very easily), and ultimately arranges for transportation of the patient back to their home - or, if necessary, a local hospital for further staged care. 

Dr. Fajal works in this role as contract discharge planner for an American company, as a fluent Arabic, English, Turkish, Farsi-speaking specialist who gave up his career in medicine in his escape from a bankrupt Iraq under Saddam.  In his escape, he spent years as a refugee, before settling in the United States, where he acquired an ultrasonographer license after taking some basic courses, to provide for his teenage children.  The United States which did not allow his medical degree or post graduate training; the United States which decimated the remaining infrastructure of Saddam's Iraq; and, ironically, given the hazard of the job, the United States which now provides him a professional man's salary for assisting in providing a disposition to these HNs.  This is an amazing individual.

More on him later.

Smile for the Cameras

Volcanogate ended, and the cumulative Iraq-Afghanistan trauma melange ceased to exist in my ICU.  After the subsequent VBIED from the Iranian border, we still had the less common Iraq traumas come through several times a week, and an assortment of contractors and active duty patients with new heart attacks and strokes.  The unit had been more sparse, though, and this had afforded me a chance to take a deep breath and relax a little. 

Then we had a high level Iraqi minister coming for a visit, so there the brass wanted to fill up the hospital with Iraqis.  Thus, the policies which have taken been molded over the past several years on which host country nationals we see - and which we don't - were put to the screws.  Somehow, the reins loosened, and we had a ward full of host country nationals, just so the Iraqi minister could see a ward full of Iraqis.  There are still 8 HCNs (host country nationals) here.

We recently had the surgeon general, and then the chief of the air force stopping by as well.  There were several announcements about the incoming visits, biographies circulated, and then the requisite instruction to "clean up your area" followed by a command inspection. 

With a culture so well suited and steeped in the punative, I don't suppose I can blame commanders for wanting to avoid hearing about unsatisfactory behavior or demeanor of those under their command, by those higher up the food chain than themselves.  By the same token, however, it seems antithetical that the highest leaders of any organization the size of the military would have any concern or time with pedantry, but, rather, instead hope to discover a sense of the true uncensored sentiment of those in their charge.

Purple hearts

The division commander, Major General C, came to present our young injured troops with purple hearts in the hospital last week.  These were the boys injured in the VBIED whom I previous wrote about previously (see "Weeping heart").  None of the physical injuries sustained in the attack will leave these soldiers permanently disabled, though they lost 2 close friends, and the screening from the trauma incidentally found 2 advanced tumors in 2 separate soldiers.  For this they have the psychological burden of thte attack, and foul luck.

In the tiny hospital ward, a dozen or so Army Rangers packed in between we medical personnel to take part in a ceremony to award the purple hearts.  Purple hearts are for soldiers injured in the field of battle and represent one of the oldest awards given by the military - dating back to the American Revolution.  It was somber, and a sobering 5 minutes for each of the injured.  These were granted by the general along with meritious service medals, so the whole thing took close to 45 minutes.  As I stood among the Rangers and the other physicians and nurses listening to the citations being read, my spine stiffened with a sense of the honor shared among these men, and the privilege of their witness. 

I can also attest that I am pleased to know that these are the special operations guys - the guys who go deep into enemy lines.  I am not a small man, but each one of these hulking masses stood 2-4 inches higher than me, with the breadth of their shoulders equal to mine plus me sideways, while maintaining a similar waistline.  It was as though I was wandering amidst a crowd on a planet with a different species of humanoids.  Each one of them appeared to be capable and proficient with snapping men's necks between their thumbs and forefingers.  They are well disciplined and professional, but their anger after this cowardly attack has tightened their resolve, and focused them in their pursuit.  I am glad that they are on my side, and I fear for our enemies.

My day

16.43	Weeks
115	Days
2,755.23	Hours
165,314.00	Minutes
9,918,840	Seconds

I have been here for a while.  Not that I am counting, but it appears to be approximately 9.9 million seconds...  ...or so.  I have talked before about the folks who have been out hre multiple times for 12-15 months at time, and put this, and my paltry 6 month deployment, in perspective with the boys from both World War I and II who slept in foxholes for 3 years with no word from home.  That doesn't mean that I cannot look forward to going home, and it won't stop me from counting down days remaining - now that I am well past the 1/2 way point.

I am careful not to wish my life away, however, and continue to soak every bit of goodness from being here.  Ironically, this is probably the best Father's Day I have had.  Near midnight, I received and opened a wonderful package from my sons.  It was filled with snacks, and pictures with them clad in homemade t-shirts that read: "My Dad Rocks."  They sent to me life-size silhouettes of themselves - each of them inches taller, with bigger feet than when I departed.  There were handwritten notes.  One in cursive from the eldest, the first multiple sentence letter ever from the 5 year old.  They aren't so good on the telephone, but it nice to see they remember me, and sort-of appreciate me. 

When you are away from what you love most, you can appreciate the magnitude of your affections.  Absence may or may not make the heart grow fonder, but it clearly provides a higher altitude view.

Saint-sational entertainment, for who?

This picture is a little larger than usual for obvious reasons.  In the middle my friend Brett, a nurse anesthestist friend who comes from the Bayou.  This is not a headliner, as far as the USO is concerned, but I think Brett was quite pleased to have his team represented here.  [If you haven't met a "Who dat?" t-shirt-clad cajun, you have yet to meet a rabid football fan].  So all right!  Glad that the Saintsations made it by!  (I hope that they were wearing sunscreen).

The attempts by the USO to keep the deployed entertained and happy, and the generosity of different entertainers is laudible.  I missed the cast from the Sons of Anarchy, with great dismay, as I would have like to share a near beer with them - one guy who came, Kim Coats, plays a complete psychopath, so I was interested in what he was like in real life.  Zac Brown Band came also, and they recently released a video filmed here in Iraq.  Most of the footage is from here at my hospital and base (http://www.cmt.com/videos/zac-brown-band/522070/free.jhtml). 

You might think that visiting dignitaries would spend time with the brass, but the cheerleaders and actors would be led to the young enlisted to meet and enjoy.  You would be thinking wrong.  In fact, for reasons not clear, the people in charge - the commanders and senior NCOs - are the ones giving the cheerleaders the tours of the hospital.  In all actuality, it is a little embarassing that the guy in charge is spending his time showing the cheerleaders what an ER looks like, when that task would be the envy of any 25 year-old sergeant.  You will have to trust me on this (I do not have bandwith available to prove it), but there are pictures, on the hospital servers of the Command or 40-something superintendents getting chummy with every actor, singer or Hooters girl who has passed through this place.  The worker bees are in the hive collecting honey.

I am just glad the Captain Brett got to meet his Saintsations.  But I wouldn't expect a cajun to tolerate otherwise.