Getting a little perspective; the cultural divide in medicine

When I write a blog entry, I try hard to capture the essence of the emotion of the experiences of what we’re going through at the time. That isn’t easy, and it’s all the more difficult when writing about events that happened weeks, or even months, earlier. After my last blog entry, several people emailed and called to effectively share their condolences at the difficult time we were going through. Grateful as we are for the concern, perhaps my blog painted a harsher picture than reality. The human psyche is afflicted with what they call ‘loss aversion’, whereby our instinct is to recall the negative aspects of life, and ignore the good stuff. The perfect example is when stuck in traffic on a motorway; you always notice when the lane next to you is advancing while yours is static, but it’s only when you realise the same car has overtaken you three times, that actually your lane is moving just as quickly, just at different moments.

So, I think that the negativity of the blog was for two reasons – one was loss aversion – the sudden awareness of what we are missing. But the second – simply that I didn’t want to ruin the build up to the progress in our lives... In honesty, while I was writing about the difficulty finding work and our financial situation, I had already started work; while talking about the two weeks of cleaning our new home before we left it again, we were already back, settled and living.

Shortly after our return from the UK, Deborah and I both passed the so-called ‘entrance exam’ to medical ulpan – a special course for new immigrants to learn the specific parts of the language required for working in our field. The general rules for attending are:

1. Must have moved to Israel in the last ten years

2. Must be a doctor or similar medical professional

3. Must have a good knowledge of Hebrew prior to starting the course

4. Must commit to 5 hours of lessons every morning, 5 days a week, for 3 months.

One would imagine a group of medics from all over the world, keen to learn the necessary vocab in order to start work here and manage to not kill people due to confusion between anatomical and medical terms. All sounds pretty straightforward, no? No.

In order to run the course, the government require a minimum of ten people. Due to the fabulous organisational skills and publicity of governmental bodies here, no one seemed to know of the course's existence, except those who really shouldn’t have been there.

At the entrance exam, for example, we met a RETIRED pharmacist and his daughter, about to undertake a computer management course at the age of 19, neither of whom could count to ten in Hebrew. Although they were accepted on to the course, they had the good sense to turn it down and await something which might actually benefit them in some way. Knowing the phrases ‘gastric banding surgery’, ‘duodenum’, ‘anal fissure’, ‘Fragile X Syndrome’, ‘Oedipus complex’ and ‘porcupine’ (no idea why that last one features in our vocabulary list. But it does), is generally-speaking less important for the average Israeli immigrant layperson than ‘house’, ‘food’, or ‘Do you speak English?’. I remember being given a book of alternative useful phrases for the world traveller, many years ago, which included in six languages the phrase, ‘Excuse me, I am bleeding profusely. May I please use your belt as a tourniquet?’. Again, not one of the most commonly used phrases, but important in certain circumstances nonetheless.

So, as the lesson stands now, we consist of:

• A general physician (which is the non-demeaning way to say unspecialised good-for-nothing; me)
• An unlicensed pharmacist (Debs)
• An unlicensed gastroenterologist approaching retirement
• An unlicensed cardiologist approaching retirement
• A psychologist
• 2 dentists
• A retired French fireman
• A sports management consultant
• A Maldovan health care assistant, who frankly, produces enough hilarious moments in our lives that she deserves her own blog
• A physiotherapist

Making a total number of 11 – just enough to run a course; which is why they lowered the ability level to... well, nothing. So instead of a dynamic group of medics learning about trauma terms and drug names, we whittle away many an hour with our psychology-obsessed teacher talking about the origins of the Oedipus complex (I know I’ve mentioned it twice – it comes up at least 3 times each week in class and therefore deserves several mentions), why men never ever ever become anorexic (apparently), why gay men look after themselves better (apparently), why fibromyalgia really exists (apparently) and how glucosamine can help, and finally, what the origins of the Oedipus complex are.

The rate of learning is rapid – we cover hundreds of words every week, and the vast majority are very useful, either in medicine or in the general world; if not learning the phrase for ‘central crushing chest pain with radiation to the left arm’, then at least ‘drain blockage’ will come in useful for plumbing calls, if not for angina pectoris. Failing that, did I mention that we learned about the Oedipus complex? We follow a loose agenda, and learn whatever words come up in conversation, and as a result, my vocab list can cover everything from ‘immunosuppression’ to ‘chamelion’, on one page.

Given the informality of the Israeli educational system, we are all free to interject and add in our own experiences and beliefs, for the benefit of the others in the class. It’s just as well, because it means that when our teacher tells us that the urethras connect the kidneys to the bladder, and a single ureter takes the urine out to the fresh air, we can point out that she is in fact spouting crap. On occasion though, our class democracy backfires. We had a heated debate recently (sparked by our Maldovan comrade) over the dangers of various colourful fruit and vegetables, namely pomegranates and carrots. Yes, carrots. Our inferior British medical system neglected to tell us that pomegranates are potentially lethal, as they can ‘thicken the blood’. But that isn’t nearly so scary as carrots, which are notorious for ‘altering the chromosomes in one’s blood’. Appalled at these glaring omissions in the Western medical syllabus, I asked what the mechanism of injury to the DNA was. “I don’t know, but in my opinion, carrots are really bad for the chromosomes.”. End of debate.

But in the same time period, much more has been happening than just ulpan. At the end of July, I finally started work, just 2 weeks after getting my license.

I’m working for a chain of private clinics that do something really unique in Israel, but which has revolutionised the health care system here. Filling a gap between primary care and emergency medicine, we are a walk-in centre, but with our own instant laboratory, radiology department, orthopaedics, gynae, and minor procedures. Patients don’t need to wait eternity in an emergency department, and the health insurance companies don’t need to pay a fortune for an unnecessary hospital attendance. Seeing up to 500 patients a day at a high turnover, and with the option to refer the few really ill ones directly to hospital, we have become an intrinsic part of the medical system. So much so, that we keep having NHS managers popping in to pry and work out how they can set something similar up in London.

Starting work in Israel was never going to be straightforward, but moving from the freedom and incredible support of the NHS to a private clinic with such a massive turnover was in itself a massive challenge. For the first time, I wasn’t at the bottom of a ladder of people, working in a team who could always advise me on what to do next; instead, each patient was my own, I can order whatever tests I want when I want, and from start to finish, no one else will interfere... unless I get really stuck and call the boss at home. In fairness, there’s always support when it’s needed, but at the same time, in a private clinic, time is money, and so finding a balance where you stay in control and don’t ever put anyone at risk, while still meeting your quota of patients per hour, is not easy when you need to pop out and call someone for advice. Now, try getting used to that system, while working entirely in a foreign language. Finally, and most importantly, don’t forget that you’re dealing with the largest Jewish population in the world.

Chest pain: A case study

A UK patient

Doc: How are you?

Patient: My chest hurts.

Doc: Where?

Patient: In my right armpit

Doc: When did it start?

Patient: Yesterday, when I was drunk and fell onto a railing outside the pub

Doc: Any shortness of breath?

Patient: No, just pain where this big bruise is.

An Israel patient

Doc: How are you?

Patient: Doctor, I’m in the worst pain of my life. I have this central crushing chest pain in my right armpit, which came on during exertion, shortly after I fell from a height onto a sharp metal railing. Please could you do an ECG, Troponin, and a full blood count? Also, I’d like a chest X ray, because I had a cold last week and want to make sure it hasn’t gone to my chest. Oh, and while I’m here, please could you check my thyroid function? I put on 6 ounces last month. Do you think I need to go to hospital for a CT scan? Or can you do that here?

The sad thing is, in private medicine, where patients can be stubborn, often the patient will get what they want, within reason, even if it isn’t medically justified, or in their best interest. Why? Because, as I learned the hard way, trying to reason with them just wastes valuable time while more patients build up. And the more a patient waits in line, the more they feel they’ve ‘earned’ a longer consultation, and the more justified they feel in asking for even more obscure, pointless, and dangerous investigation. All of a sudden, the whole modus operandi of a doctor has been turned on its head. No longer do we ‘treat the patient, not the illness’ – that is what family medicine is for. In an urgent care clinic, we very much focus our efforts on the matter in hand. ‘If it’ll kill her tonight, treat it, if she’ll still be alive next month, send her to her GP’.

At the end of the day, it makes perfect sense. Allowing ourselves to be slowed down by timewasters not only puts other patients at risk, but also effects business. But it’s hard to get used to saying ‘What’s brought you here today’ instead of ‘How are you?’, which invites the patient to list non-urgent problems too. It’s even harder to refrain from saying at the end ‘Is there anything else I can help you with?’.

So while I’ve been having fun in my clinic, Deborah has also been sent to the grindstone, after finding work in a local pharmacy as an assistant, while awaiting her impending licensing exams. On paper, the job is perfect. Five minutes walk from home, dispensing meds, learning the system, the practicalities of pharmacy here, and the necessary lingo. So what’s the problem? In reality, she has become a shopkeeper’s slave, organising handbag displays, aligning bottles of shampoo, unpacking deliveries. Like me, she gets to enjoy the front line of patient exposure here; for example, the woman who arrived after closing, covered in hair-dye with a towel round her shoulders, begging to be let in for an emergency; upon entering, she handed three pages of repeat prescriptions, all due to run out that evening. And all for 30p over minimum wage... which means that she can afford to buy a cup of coffee each half hour. But, it’s work, and the money adds up (extra large double latte with cream and chocolate sprinkles please!), and in reality, until she gets her license, it won’t be easy to find anything that pays better with any relevance to her training. Almost all of our friends from the first six months have landed comparable jobs, or jobs that pay equally appallingly but with greater risk, like building work, cleaning, or telesales. Many remain unemployed, and make do on the £200 monthly unemployment benefit, with top-ups from mummy and daddy. Some have gone off to the army, where they will not need to spend a penny for the next however-many-months, while earning... well, pennies. And one or two have already packed up and moved back to wherever they came from.

To supplement the hours, she’s also started some online work ‘categorising clinical trials of oncology drugs for their unlicensed uses’. ROCK AND ROLLLLL!

In terms of daily routine, things have really settled down for us now. Were it not for the fact that we are juggling three jobs between us, mine being based on a 4pm to midnight shift most weekdays, and are both spending 25 hours a week in education, with 3 hours of commuting each day, life would feel quite normal. But as things are right now, I get home for 5 hours a day, of which I try to spend every moment sleeping. When I see my wife, we’re either in class, or she’s fast asleep. Until ulpan finishes in 2 weeks, we won’t be exactly living a normal married life. But on the plus side, it’s very difficult to argue with each other, when the only conversations we can have are about carrot-induced chromosomal defects, and we both share exactly the same views on that.

The first trip back to Exile

We were forewarned before aliyah, and several times afterwards, that one of the most difficult times for an oleh is that first visit back 'home' to the UK, or wherever (s)he came from.

A few days after finishing our language course, and after what was ultimately two weeks of cleaning and tidying, we said goodbye to our first EVER real marital home, leaving it in the hands of a friend/lodger, and headed back to the UK. The intentions: 1. See new babies (Debs’ first nephew and my 2,416^th niece). 2. See rest of family. 3. See friends and go to a friend’s wedding. 4. Make some money by working a bit!

For months before we left, Deborah was so excited to see the new Baby Joshua, yet I was hardly brimming with the excitement of going back – primarily because I was scared that we would realise what we were missing.

As our Jet2 budget plane with its plastic seats and amputee-only legroom came in to land in Manchester, we looked out of the window to see our old haunts – my student days in Fallowfield, the Hilton Hotel from our earlier dates, country walks in the Peak District and Winter Hill. And we landed to be met by eerily pleasant weather. The sun was setting, people were out in T-shirts, and the ground was dry! Someone had stolen Manchester. Probably a Scouser.

As we moved around the country, from Manchester to Liverpool to Chester to London to Manchester to Liverpool to Lake District to Liverpool to Manchester, we both suffered somewhat from the grass-is-always-greener syndrome; although of course, it literally is when you come to the UK from the Middle East.

The first shock was when I went into a bakery in Manchester. I queued up in a line (queue and line are two words that don’t feature prominently in Israeli culture), and when I got to the front, the smiling woman said, ‘Hi, what can I get you?’ So shocked was I not to have been greeted with ‘What?’ that I commented to her how nice her manners were. And these little miracles continued for the duration of our stay; cars that indicate before they turn, drivers who give way at give way junctions and people who say ‘thank you’ when you hold a door for them. Using bins is the norm, not the extraordinary, and most smokers are considerate enough to obey the law and go outside while they kill themselves.

Of course, despite our rapidly improving Hebrew, street signs, newspapers and adverts in English are so much easier to understand, and the cars were on the correct side of the road!

As we saw more people and places, it really struck home what we were missing. My nieces and nephews had all grown, although thankfully did seem to remember who we were. Our old homes were as inviting as ever, and Deborah’s cat Rupert still moped about on the grass (he’s famous by the way – you can see him on Google Maps Street View. Moping about on the grass.). The countryside from the luxurious high speed train seemed greener than ever, and the food in the supermarket was cheap! On top of all this, it hardly rained the whole time we were there.

After a week of seeing friends and having fun, it was time to earn our keep, and so we each went off to the temporary jobs we have taken for a four day stint of ‘damage limitation’, that is, to try and balance the books in some small way after half a year of unemployment, and to make a meagre attempt at retaining some small element of medical/pharmaceutical training (respectively) before it all seeps away through lack of use. So, having only been back in the UK for a week, we each commenced a week of real life – commuting, working and earning. One would think that long days of high pressure work, with little time to ourselves, rushing to get there in time, stressing over sick patients in unstable conditions, eating out of a plastic pot in a hot staffroom while Wimbledon / World Cup / other mind-numbing activity plays on the TV, would not be considered a good life. But bizarrely, after a long period of feeling useless and at a loose end, this was exactly what we both needed; I never really realised how important it is to have a purpose, albeit temporary, and coming back from the end of a long day, feeling that you had worked hard and earned the money that will feed and house you, is something we take for granted.

After three weeks in the UK, it was time to head back to Israel, but no more information about our long or short-term future than when we left – still waiting for licenses to start work, still with no idea of when the army will call me, not knowing whether we were going to start our medical ulpan or not, not even completely sure if our apartment would still be in the same position we left it in, we headed back into the unknown.

Despite the loveliness of seeing our family and friends, our trip back still felt a little bit like a kick in the teeth. A reminder of what we had given up. While we try to avoid getting into debt by buying cheaper vegetables, our friends are buying houses and nice cars. While we concentrate to get the gist of the news, to find out when we can collect our gas masks in case Ahmadinejad decides to try and destroy the world, our friends stress about whether to buy the iPhone 3G or wait for the newer model. Only yesterday, a couple of our close friends announced that they had decided to move to the US; and although we hate to hear it, and hate to see them give up on Israel, we understand why. Life here is more difficult than other places. It takes a lot of effort and a lot of courage.

But, despite all this, we don’t have a regret in the world. It’s tough, and it’s sometimes daunting being here. We are living a dream that, even if it doesn’t work out and we decide to leave, would have haunted us both for the rest of our lives if we didn’t give it a go. And we both know that until we give ourselves a real chance here, feel what it’s like to live here as a true Israeli, to work, pay taxes, vote, serve in the army, own a home, and even bring up a child, we’ll never really be in a position to judge and decide to live anywhere else. Like it or not, this is home. Sooner or later, for the Albert family to grow up in their homeland, where they descended from, where their forefathers lived and thrived, someone will have to make these sacrifices. We recently met for the first time some elderly relatives here who knew my great grandfather; they told me that he always dreamed of coming to live in Israel, but it never happened for one reason or another; it’s an honour to be the ones to attempt to make the dream come true.

All change!

---I wrote this entry almost two months ago, but never got round to uploading it! So apologies for the details which are now obsolete.....---

Five and a half months into aliyah, things are falling into place. During the course of our ulpan, which finished today, we have achieved a lot; not just in terms of our ability to talk the language (we’re proud to say that we managed to complete our entire apartment-hunting process in Hebrew, from shopping around, to viewing, to negotiating... although we still got an Israeli lawyer to check over a few bits of the contact we were unsure about), but also in terms of direction. The applications for both of our professional licenses are complete – I’m just waiting to receive the damn thing, and Deborah is waiting for the next licence exams. We both have potential jobs, pending the licences, I’ve finally had word from the army and can expect some information on my call up dates soon, and next week, we will finally be able to live in our new – and first – real home since we married 9 months ago!

So, on the one hand, it feels like we’ve made progress. On the other hand, we have absolutely nothing to show for it – we are still waiting to work, still in the absorption centre, still living on savings and benefits, and still have no idea whether I’ll be commuting to a clinic from home in 2 months time, studying in a medical ulpan, or living in a bunker on the Syrian border. Long-term planning is simply not the vogue in Israel, no matter how hard immigrants try.

It has to be said though, we have been suspiciously lucky/blessed with our home hunting. Courtesy of some good friends who are estate agents here, we were able to get a list of properties available in the neighbourhood we wanted, and could then shop around, without having to pay the agents fees. We saw some tiny places, and some beautiful but overpriced places, through a different estate agent – another friend, but a very pushy one who was looking for a sale. Having politely dumped him, we came across what was to become our home. We viewed it while it was still occupied by three Russian immigrants, happily smoking away inside it, but friendly enough. It’s top-floor location means that Deborah and I are happy – we get to avoid noisy upstairs neighbours, get more light, a fabulous view from our shoe-box size balcony, and a cheaper price – since it’s considered desirable here to be on the ground or first floor. As a result, we are now the proud renters of a three-bedroom place, that is one of the best value places we’ve seen or heard of in Jerusalem. The catch? Only when the Russians moved out did we realised how much filth they had left the place in, and how much repair work was needed. Supposedly wooden kitchen window frames were in fact granite, covered in such a thick layer of grime that they had both the appearance and sound of wood. The kitchen sink drain was not connected, resulting in a nice pool in the cupboard below on the rare occasions that the sink was used. The subsequent rot and ants’ nest were hidden by the Russian grimy pots until we moved in. The window shutters were nearly all seized up – I’ve fixed all but one, which is home to a nest of starlings – I’ll wait a few months before they get their eviction notice. The electrics vary between the unusable and the downright dangerous in parts, and we even had a tomato plant ‘weed’ – complete with fruit – growing out of the drain on the balcony. The stove was not only covered in grime, but our soviet comrades did not feel the need to even remove dead flies from it, before they moved out. Finally, they didn't get round to moving out on time, and we found our living room full of their bags and furniture as we opened the door of our new home.

Add to all this the state of the second hand furniture we bought, and you’ll understand why Deborah and I have spent an entire week cleaning.

We decided to work out how much it would cost us to furnish a place from scratch, using only new stuff. For a first home, with no family hand-me-downs or wedding gift furniture to use, our most realistic option was to buy all the cheapest versions of the essentials from Ikea (yes, it’s here too). Suddenly, another option appeared, and one that appears to happen quite often here for those of you planning to follow us – a religious couple who had been studying in Jerusalem for a couple of years had left to go back to the USA, and were trying to make a quick sale of literally their entire lives, all in one go. The inventory they sent us was impressive – 4 beds, new fridge, oven, leather sofas, bookcases, washing machine, dryer, microwave, and so on. The price was reasonable, in fact not a great deal more than the new stuff would cost, but of course, much of this was much better quality than the Ikea stuff we would have ended up with. We travelled across the city to view it, and were happy, if not a little overwhelmed, by the quantity of items.

So, we made a deal to buy EVERYTHING, thinking that we would sell the excess stuff that we didn’t need. We booked a removal company, and I set about disassembling everything to make the move quicker.

Only at this point did we realise the two problems with the stuff – nothing major, but hugely annoying nonetheless.

The first was that Americans apparently don’t know how to assemble furniture. If it wobbles, for example, don’t tighten the screws – simply whack in a few extra nails in random places and ruin the veneer of the furniture! If you spill something in the oven, just pretend it isn’t there and let someone else deal with it when you sell the oven. And most importantly, if you move out of your apartment, make sure you leave the window open so that the pigeons can easily enter and crap on the top of every high place.

After much cleaning, and repairing, we have a beautiful set of furniture which we’re excited to use, with just a few scars of the battle of being carried down 4 storeys, and then up 4 storeys in a different neighbourhood.

The removal company is a story in itself. Three guys – two Jewish Israelis, one Arab from Hebron in the West Bank. I’m sure you don’t need to read a blog to know that intolerance and tension are somewhat prominent between these two groups – Hebron is the second holiest Jewish city in the world (Jerusalem being the first, of course), but is also a point of huge dispute – during the Jordanian rule of the West Bank from 1948 – 1967, all Jews there were massacred, and only after Israel gained control of the territory in 1967, were they allowed back there to live and pray. It is 40 min from Jerusalem, and the bullet-proof armoured buses leave every hour or so, winding their way past resentful eyes and concrete walls. When the intifada began in 2000, thousands of workers came each day to Jerusalem, along with dozens of terrorists, but since then, checkpoints and security allow only those people with a work permit to enter. His special skill? Weight lifting. At 51 years old, but with that wizened, cracked, and emaciated look of a 90-year-old who has smoked most of his life (be warned), he worked harder and faster than the other two men put together. While the other men smoked and looked at the mountain of furniture in the van, he carried up washing machines on his back or entire cabinets in one go. It was so frustrating to watch this man do so much work while his counterparts took their time, and all the more so in the knowledge that he would likely be receiving a lower split of the fee. The years of Jewish labour and independence, the same energy and ideology that built the state, have given way to a population dynamic the same as the UK and every other developed country – the jobs that no one wants to do are the ones that the outsiders do – the street cleaners, bin men, field workers, even the carers, are either Arab or East Asian. The Jewish people, who transformed the sterile wilderness of the land of Israel to a fertile country filled with potential, have been superseded by capitalist entrepreneurs and skilled professionals. I’ve no idea whether that makes me happy or sad.

Anyway, as Deborah and I prepare to move the last of our belongings to our new home, right on the edge of Jerusalem, looking over to Jordan and the Dead Sea, we look forward to accommodating those of you who want to visit.

The little book of short stories...

Often the things that make life memorable and special are the things that are easily forgotten. I started to make a note of some of the really special moments in Israel so that I could add them to the blog, but none of the stories have felt significant enough to create a blog entry out of. I suppose that’s paradoxical since the whole point of a blog is to allow short little bits and bobs.

So, here are five short stories of our first 5 months.

The International Atomic Energy Agency.

I think everyone would agree that sometimes the brain hears what it thinks it ought to hear, and not what has actually been said. The perfect example of this is when learning a new language, and when new words are said. Wernicke’s area of the brain (the language centre – or least thought to be until recently) will try and identify a sound in its archive, and may conclude that a similar sounding word is actually the same word. So, for example, a young child may hear the word ‘baffle’, and think that the person is talking about an ‘apple’, or a ‘duffle’ coat. The same also applies to people with too much wax in their ears.

I’m not sure therefore, what my excuse is for mishearing ‘הסוכנות הבינלאומית לאנרגיה האטומית’ (The International Atomic Energy Agency – HaSochnut HaBinleumit L’energia haAtomit) incorrectly. The first word sounded familiar, but I could quite place it. When I announced to the class the phrase ‘הזונות הבינלאומית לאנרגיה האטומית’, or ‘The International Atomic Energy Whores’, both our teacher and the class seemed a little confused...

Dancing on the ruins

It doesn’t take a genius to know that Jerusalem is a site of unrivalled historic and archeological wonders. The problem is, in a capital city, and one where the population grows quickly, it’s virtually impossible to build without coming across something special. The perfect example of this came at a fabulous wedding we went to recently at the National Convention Centre. This big shiny new building, for governmental conventions, major concerts, and the occasional broadcasting of the Eurovision Song Contest, lies on such a site. A State so proud of its roots, whose very existence is largely justified by the undeniable evidence linking its people to the land for thousands of years, could never permit ancient sites to be destroyed, but similarly, cannot live in the past.

So, if ever you find yourself at a concert, function or conference at the National Convention Centre, go to the toilet. Seriously. To your left, you will find an entire brick factory, complete with the coins and machinery of the 17^th Roman Legion, who were busily working to manufacture sufficient weapons to invade Jerusalem (which was then small enough to be just over the next hill) approximately 2000 years ago.

Ship shape?

We made a painful decision when we got married. We decided that we would not open a single gift from our giftlist until we got to Israel. Partly for the excitement and suspense, and partly for the VAT relief on exporting new goods J. So, we arranged for all our belongings and all the gifts, to be combined and sent in one bumper shipment, all to arrive in Israel 4 weeks after we landed.

However, the best laid schemes of mice and men... as we eagerly opened our boxes, we found that the entirety of our gift list had disappeared; from plates, to towels, to kitchenware. We had the good fortune of receiving crucial things (like Deborah’s tool-box full of beads, and my emergency sock drawer), but nothing we could actually put any value on, or in fact be happy to see again (a large part of me was hoping for an iceberg in the Mediterranean to allow us to get rid of all Deborah’s... I mean OUR clutter, and start fresh).

Our shipping company were in no rush to help. The Israeli company called us up 24 hours after the arrival of the old stuff that we had shipped to see if we were happy with the service. We said ‘no, we’re still waiting for most of the stuff’ and so we didn’t hear from them again. In the UK, they didn’t bother to return my calls or emails until I sent them a rather direct threat pointing out that if they didn’t sort things out they would possibly never see another aliyah customer again. Suddenly, things sprang to life, and the entire shipment was found safe and sound on land in the UK, where the shippers had ‘forgotten to send it’.

All’s well that ends well though, and four months after our wedding, we finally got to see the lovely gifts, which had all arrived safely, despite the fact that the boxes themselves had literally been ripped apart and were held together with sellotape. We haven’t used many of them yet – that honour is being reserved for June 1^st, when we hope to move out of the immigrant centre, into a place of our own, and for the first time, begin to live like a normal married couple – with cutlery that isn’t plastic!

Biking in Jerusalem

It’s not quite the same lush green colour as Scotland and Wales, but come visit with a bike, and you’ll find some fantastic off-road fun here. A brand new bike resort has just opened on the slopes of Mount Hermon, and even just 45 min cycle from the centre of Jerusalem, there are rides past natural springs, where you can stop to have a swim to cool down. So, excuse the pun – on your bike!

The Hurva – the synagogue of the ruins

One of the most distinctive landmarks in Jerusalem for the past 33 years has been the arch, in the middle of the Jewish quarter of the old city. Known as the Hurva (Ruins) Synagogue, the arch stood on the site of what was once the main site of prayer in the old city (second, of course, to the Kotel, or the Western Wall of the Holy Temple, destroyed by the Romans and now the foundations of the Muslim Dome of the Rock.) The synagogue was first build 800 years ago, destroyed in wars and riots, rebuilt, and most recently destroyed by the Jordanian forces in 1948, when they invaded the Jewish quarter, massacred the people living there, and then built a mosque adjacent to the re-ruined Synagogue. In 1967, when the Old City was recaptured by Israel, finally the Western Wall, the site of the Temple, and the whole Jewish quarter were finally accessible to Jews again. As they entered the Old City, the soldiers of the Israeli army discovered that the Western Wall had been converted into a public toilet by the Arabs.

Within a decade, the arch of the magnificent Hurva synagogue was re-erected, to give a hint of the enormity and splendour of the building. In-keeping with the Israeli declaration of independence, granting rights to all religions, beliefs, genders and ethnicities, the mosque build in the Jewish quarter was left untouched and undamaged.

In 2010, we were proudly Jerusalem residents when finally the Hurva synagogue was rebuilt, standing as an exact replica of its original form, in the centre of the Jewish quarter, where it had stood for centuries before.

But nothing is simple. This building, although only 5 or so storeys high, lies on higher ground than the Temple Mount, and therefore, is taller than the Dome of the Rock. According to the Grand Mufti of Jerusalem (the Muslim Leader, whose equivalent in 1940 sat with Hitler to discuss the most appropriate ways to destroy the Jews), it is forbidden to allow any other faith to have a building taller than a Minaret. Hence began another stage of riots, lock downs, and massive police presence in the Holy City, until eventually the trouble makers got bored.

Today is the 43^rd anniversary of the reunification of Jerusalem, where just 48 hours after the start of the war, Jerusalem was unified, with all its citizens allowed to move freely, to practice their faiths, and to live in safety, without the racism of Jordanian rule. 43 years since the Jews’ capital was restored, 2000 years after it was destroyed.

Friends - the one where the couple gets sidelined.

It's surprising how difficult it is living as a couple in the absorption centre. We're in a weird limbo, living with singles in ulpan, who view us as the mature wise old farts. They come to us with their problems; they trust us and like us. But when it comes to a night out, or even a movie night in, they won't think to invite us because clearly a married couple wouldn't want to go to a bar, or squash onto a bed with 6 horny guys and girls who are getting turned on because they all fancy each other. It's a little hurtful when we pop over to a friends’ room and find that a group of people are chilling and no one has thought to knock on our door; but it is certainly not personal (we assume); just the way they perceive marriage.

Marriage also makes going away really difficult – gone are the days of crashing on someone's floor or on a sofa – we have standards! So escaping the pressure of living in the world’s holiest city is not straightforward. Plans are hatching for buying a tent and going on wild camping expeditions, bike rides and other wholesome Enid Blyton entertainment.

The combination of the perception of our single friends, and the difficulties of socialising with people who after all do have a different perspective on life, means that it’s impossible to avoid the inevitable fact that couples clique just like singles do. The inevitable gravitation towards other couples is almost amusing, as we find ourselves arranging ‘dinner dates’, ‘movie nights’ and shabbatot with those other young couples also lost in the deep blue sea of the Jerusalem social scene. While other people are heading off to the city that never sleeps (Tel Aviv) Deborah and I continue our mission to find somewhere affordable in a nice quiet neighbourhood of Jerusalem, out of the centre but not too far from work.

The housing system here works very differently to the UK. Tenants seem to lose out at every step. For example, let through an agent, and you will find that your one month’s commission charge may not just apply when you move in, but every 12 months thereon in, and is paid for by the tenant. The tenant must provide guarantors, and it is the tenant’s responsibility to paint the apartment upon leaving. An unfurnished property can be completely devoid of any ‘unnecessary’ items – so you may move in to find that not only has the toilet seat gone, but also the light fittings. And despite this, the cost of rental in Jerusalem, where poverty is high and the average wage is about £3.50 (the same as a box of cereal!), is not far off that of London.

One golden rule for those of you who follow in our steps – before you take a property, speak Hebrew! The English-speaking property sites are invariably more expensive, and letting from an independent Israeli landlord in Hebrew, rather than an American agent living in a luxury area, will save you a substantial amount of money.

It’s just as well then, that it looks like finding work should be easy for both of us – it seems that jobs are plentiful for pretty much any healthcare professional. And as we speak, legislation is being proposed in the Knesset to increase Doctors’ wages in Israel. That means that Doctors will be better off by the year 2476.

Until then, let's just hope we can find a cheap place to rent!

Remembering the present

Yom Hazikaron leshoah ulegvurah (Remembrance day for the holocaust and its heroes) is commemorated on a different day in Israel to the rest of the world. While the rest of the world commemorates the Allies’ arrival in Auschwitz for its liberation, Israel remembers the day that the Warsaw Ghetto uprising began (which began the night before Passover... and so is commemorated a couple of weeks later).

Over the years I’ve read books, seen films, been to the world’s best museums in Jerusalem and Washington, where I’ve seen the mountains of clothes, shoes, glasses, even false teeth, extracted by the Nazis from their victims to maximise the profit and efficiency of the extermination camps. And yet, in honesty, I’ve always felt totally detached from the Shoah. Perhaps that is a coping mechanism, but more likely because I’m unable to grasp the utter horror of reality, the fact that we as a people, and me as a person, were so close to the edge. It helps that I don’t know of any immediate relatives who were still in Europe when Hitler and Eichmann started their final solution. Truthfully, I’d rarely notice Holocaust Memorial Day in the UK.

Two days ago, I experienced my second memorial day here in Israel. People are more subdued, the buses quieter, the radio plays solemn music. At 10am, a siren blares across the entire nation for two minutes, while people stop their cars in the middle of the motorway to get out and stand in respect. I remember my minute of silence each year in the UK for those fallen in the two world wars; stopping in a corridor in a hospital while people walk past eating, talking, looking at the odd doctor who is just standing there.

Thank G-d I’ve never been in the wrong part of Israel at the wrong time, and so have never heard an air raid siren (although they still happen every day in the Southern cities near Gaza), and I never heard the siren warning of an incoming scud missile during the Gulf War. As long as the world wakes up from its slumber, perhaps I’ll never hear the siren of a missile coming from Iran, either. So, I don’t know whether the siren they sounded two days ago sounds like the one I never want to hear. But either way, there’s an incredible link between the two. As 6 million Jews in Israel stop to remember the 6 million who were slaughtered, suddenly the reality of the world’s hatred becomes real. The noble attempts of Jewish organisations to make the Shoah tangible – by giving each university student the name of a real person who lived sixty years ago, for example – becomes so irrelevant when you watch your teachers, the people who came here or were born here 50 years ago and now teach the next generation to talk in our ancient tongue, light a candle, and weep as they proclaim, “I am lighting this candle in honour of my mother, my father, my uncle, my auntie, my grandfathers and grandmothers, and their sisters and brothers, who died at the hands of the Nazis”. Our teachers, full of zeal and enthusiasm, so proud of our little country, so bright about the future, all of a sudden reduced to those infants who were taken from the camps by soldiers, or who escaped Europe on the kindertransport. Suddenly Israel’s mistrust of the outside world is legitimate, because it really wasn’t long ago that even the most friendly of countries left the Jews for dead because it wasn’t a priority during their war plans. The US and UK both made the decision that they couldn’t afford one single raid (one single bomb) to destroy the gas chambers at Auschwitz and save quite literally millions of lives. It’s significantly less time since the UN obeyed Egypt when she told them to leave the border with Israel, so Egyptian forces could invade. So when the rest of world points at Israel, working hard to fortify herself to the hilt with fences, radars, patrols, check points and soldiers, and asks for a proportionate response, suddenly the cynicism of Israel’s senior population makes sense. Why should they trust anyone?

I heard a very interesting observation today, from the Israeli author David Grossman. “The rest of the world refers to the Shoah as what happened ‘back then’. Jews refer to what happened ‘over there’. To us, it’s living memory. To many, it’s first hand living memory. And it’s not over”.

First steps to a job...

Last time I wrote, I talked about the Storming Norman theory of group dynamics. Four weeks have flown by since then, and suddenly I’ve realised I have a lot to write about.

Aliyah remains fabulous but odd; as I fully expected, it doesn't have the magic of Israel tour or a gap year, but in a way, that IS the magic - that this is normal life. Things tick along, you meet people, you study (and hopefully soon work), all in Israel. It's Israel! Home!

Having read through the old entries, I can’t believe that I forgot to mention the job offer! Right at the end of the first entry I mentioned how I’d emailed a Professor to enquire about jobs, and barraging him with dozens of questions about the training process, salaries, hours, responsibilities and so on, of working in Israel. I got a rather short reply back, telling me that it was easier to meet in person, and ask face to face. So, one afternoon in our first few weeks, Deborah and I hopped on a bus to Givat Shmuel, a very religious town just outside Tel Aviv, with a copy of a CV quickly flung together and updated to express a life-long yearning to be a GP. Having dumped Deborah at a coffee and crepe shop (no complaints there), I walked over to the Professor’s clinic. ‘The Prof’ as he will be called hereonin, is the Head of the Family Medicine training programme for one of the four health funds in Israel. So, meeting him was a little scary.

We sat down as soon as he got back from afternoon prayers; he knew I’d be early because ‘Englishmen always are’, but nonetheless still didn’t make it back in time for the meeting. We waited for a colleague of his who has served in the army and might be able to answer some questions about my service, and then we chatted for over an hour and half, about life, medicine, aliyah, the UK, families, ambitions, and everything in between. It was all very informal, with jokes, complaints, light-hearted banter etc. So, at the end of the meeting, when I asked how I should go about applying for a job, I was somewhat taken aback to see him laugh, look at his colleague briefly, and answer ‘you just did. And you’ve got one.’

So, that’s that. I haven’t accepted the job offer, because I’m not ready until after ulpan, another special medical ulpan, and then the army, which takes me up to 2012. The job is only guaranteed until the end of this year, so it’s not the most useful job offer... but it’s fantastic to know that there’s hope!

On the subject of medicine, the break from work was great until last week, when I saw a bloke on the bus trying to examine his own X ray film. Given the relaxed confidentiality rules here, it’s quite usual for patients to transport their own results, and even blood samples, between clinics, labs and hospitals. Watching this elderly gentleman hold his own lung fields upside down and back to front, clearly having no clue what the significance of the left middle lobe consolidation and right lower atelectasis could be, I got a pang of sadness at what I'm missing; which was really bizarre. I get consulted on a daily basis in the absorption centre, usually by Russians with colds, occasionally with a suspected appendicitis, cellulitis, or alcohol related injury. I get no satisfaction from that and usually tell them to piss off and stop wasting my time... and tell them to pay 7 sheks to see their own Doc if they really think it’s necessary. But seeing the X ray made me think of the hospital, real medicine, a challenge, and a chance to make a difference. All in good time, I suppose.

It’s a little ironic then, that I've applied for a training post in 'Family medicine'. Although not as exciting as the hospital life, I really enjoyed my GP placements, and frankly, my priorities in life are changing. I love hospital work now, but down the line, I want the freedom to spend time with my (bli neder) family, to be my own boss, and to feel a connection to my patients; I want to be in a place where my patients bring their kids to see me, and maybe in another generation, the kids bring their kids. If our dream to live in a small place in the North comes to fruition, then I can see that happening. In the meantime, I have 2 years of hospital medicine to do (at least), during training, plus 18 months of army, plus my annual reserve duty. So the pressure medicine isn't over just yet.

The application forms, as of two days ago, are officially in the hands of משרד הבריאות (the ministry of health), along with my destiny in Israel. It is up to them – assuming they don’t lose the forms meanwhile – to give me my license and open the gates of Israeli medicine. All in good time!