Thursday, March 29, 2012

Visiting Surgeon in the Middle East: Part 14

We settled into a small conference room, and I tried to get my Mac to work. For those who routinely talk in front of audiences, I don’t need to tell you that the scariest part of any lecture is the minute before you start while you are waiting for the computer to sync with the projector. Needless to say, it didn’t. Despite my technical difficulties, we managed to get the talk projected and had a very lively discussion. The group was small, so we all crowded around my 15-inch monitor and talked as colleagues about how to do various operations. Though I didn’t have the opportunity to operate with them (the case had been cancelled), I was thoroughly impressed by their obvious expertise (and ability to describe technical facets of surgery in English). These folks, obviously, were very well educated and qualified.

I learned a lot about health care delivery in Lebanon. or example, a night in the local hospital costs about $100 compared to over $1000 in the US. For that reason, length of stay as it relates to cost is not a very big determinant in Lebanon for making health care decisions. Trying to advocate for more technically difficult operations based on a lower length of stay was not impressive to Lebanese doctors. They were most interested in whatever made an operation faster, safer, and more efficient. No matter where you are, surgeons will always put the patient’s safety first.

Thursday, March 22, 2012

Visiting Surgeon in the Middle East: Part 13

We picked up the area manager and the local sales rep and drove to Byblos. We headed north on what seemed to me to be their version of Pacific Coast Highway. The road hugged the rugged coast and overlooked beaches and resort areas. The sun was out and the water was sparkling. It felt a lot like California, especially the traffic. The 40 miles took about 2 hours. We arrived in Byblos a little early, and I was offered a tour.

Byblos is a 3000-year-old Phoenician city that, according to my tour guides, was the place of the first alphabet. There were ruins from that era, Roman, and Byzantine. We walked around the cobblestone streets lined with fossil and religious icon sellers. We settled in to a restaurant on the ancient harbor and ate a meal of fresh fish, hummus, and a variety of other incredibly delicious treats. I could really get used to this.

After a 2-hour lunch, we arrived at the private hospital in Byblos. It was small with a dirt parking lot that the local kids used as a soccer field and had a beautiful view of the sea. Unlike the other private hospitals I saw on this trip, there was neither marble on the walls or a foreign staff. Few women wore headscarves, and the men were dressed casually. As with everywhere I visited, everyone was entirely warm and gracious. The staff had even prepared a back table with local sweets made of nuts and honey.

Thursday, March 15, 2012

Visiting Surgeon in the Middle East: Part 12

Wissam’s brother picked us up at the airport and they quickly dropped me off at my hotel as I think Wissam was anxious to see his mother. The hotel was a trendy American chain that was in a bustling downtown area. The first thing that struck me after my time in Saudi Arabia and Kuwait was the bar. I checked in, dropped my things in my room, and decided to have a nightcap to celebrate my safe exit from the Arabian Peninsula at this precarious time. I sampled a local Northern Lebanese white table wine. Despite my low expectations (and, perhaps, Californian affectations) I was blown away by the complex flavors. This was not a response to being in wine-free countries as this experience was replicated over the next few days. The Lebanese can make wine!

The next morning Wissam picked me up, and we stopped by their corporate office in Beirut to get the rest of his team. From my hotel in downtown near the Mediterranean, we headed east past the infamous Green Line, a flashpoint and heavily contested area dividing the Muslim and Christian sections of Beirut. Though life on the street seemed to be going on just like in any other big city, I could not help but notice the occasional pockmarked building and soldiers around armored personnel carriers on every corner. Interestingly, however, the soldiers were always outside of their vehicles chatting with folks on the street. If they were not worried, I wouldn’t be either.

Thursday, March 8, 2012

Visiting Surgeon in the Middle East: Part 11

I had the afternoon to myself. Rather than sleeping, I decided to wander around Kuwait City and check it out. The beachfront along the Persian Gulf was gorgeous. I had expected it to be full of freighters and tankers, but none were in sight. Rather, there were mostly jet skis catching air and doing tricks over their wakes in the Gulf. Am I really right next to Iran? The city is bustling, with any empty space the host of a large, multimillion-dollar construction project. I explored the area and found a lovely park along the water. I followed it and was accompanied by every facet of Kuwaiti society, rich and poor, native and immigrant. No matter where people come from, a beautiful coast will always serve as enticement to get people outside.

We then went to the airport en route to Beirut. Our flight was uneventful, except the time the pilot asked the passengers to put on their seatbelts as we were going over “unstable air.” I looked at the GPS and saw we just entered Iraqi airspace. I am still not sure if the pilot meant that as a matter of fact or a political joke.

We landed at Rafiq Hariri International airport. I was first struck by the beauty of it being right on the Mediterranean, but was later entranced at the incredible efficiency of that airport. At Raleigh-Durham, I expect to wait at least 20 minutes for my bag. In Beirut, Lebanon my bag beat me to the luggage carousel. My only quick stop was at customs, where a young woman in a Lebanese military uniform spent a long, uneasy 5 minutes (felt a lot longer) pouring over every page of my passport. No one else on my flight from Kuwait City got that treatment and, frankly, I was feeling a little discriminated against. Is this because Lebanese people have such a hard time getting visas to the US? I asked Wissam, a Lebanese citizen, and was told she was making sure I did not have an Israeli stamp in my passport. If one was found, he told me, I would be refused access into Lebanon. Though this same restriction is on the books in most Arab countries, it is most strictly enforced in Lebanon I was told. An American with an Israeli stamp landing in Riyadh or Kuwait would likely be harassed and “interrogated,” but it is only in Lebanon that one would be unequivocally denied access.

Thursday, March 1, 2012

Visiting Surgeon in the Middle East: Part 10

We took a cab and went through new high-rise after high-rise to our hotel. Hungry, we stopped by the Lebanese restaurant at the hotel where they were showing a Madrid vs. Barcelona soccer match projected onto the side of the building. We ate delicious Lebanese cuisine that Wissam said rivaled his mother’s and watched the match. We smoke shisha (tobacco in a water pipe) and enjoyed the evening. A good match, and, oh, what great food. The hummus was crisp and lemony. The meats were lean. Oh, so good.

The next morning we woke early and went to the outskirts of Kuwait City to operate with some Kuwaiti surgeons. Surgery is such a small world that the Kuwaiti surgeons and I immediately bonded over a mutual friend who, though Kuwaiti, trained in California and Texas and now practices in Minnesota. Our world is a small one. We, together, completed a fairly complicated case with little drama. The OR’s were clean, large and filled will folks who were obviously very well trained. They challenged me on why I did certain things and how I could do it better. I liked this dialogue. I liked the fact that they did not just accept what I was doing but wanted to know why. These guys, I told myself, were going to be great surgeons.

We finished our case early and decided to go to lunch. I was taken to a restaurant on the Persian Gulf known for their fish. The local reps, all Egyptian pharmacists, joined us. This was the only conversation I had on this trip that was political and, wow, was it informative. As an American, I think we tend to get a perspective that may not be representative of Arabs. We had a long, frank discussion over phenomenal seafood, fragrant shisha, and a desire to understand one another. It was quite an education…. And meal. The Persian Gulf glistened, and I reveled in the luxury of having frank discussions with people of different perspective who could teach me their perspectives.