After recovering a bit from jet lag, I had my first assignment and a full day of work Tuesday January 10. I had arrived at Ben Gurion Airport in Tel Aviv, Israel at 2 am and with the drive to Ramallah, West Bank of Palestine arriving at my hotel in Ramallah at 4:30 am.. My first thoughts were whose appendix needs coming out and second thought, I am too old for this. Israel and Palestine are two countries with a unique arrangement. The West Bank is part of Palestine and is considered part of the Occupied Territories by Israel since the 1967 war. This is when the 7 days war enabled Israel to gain control all of the West Bank of the Jordon River and the Dead Sea. This was part of Transjordan and Hashemite Kingdom. Now as Jewish Settlements pop up in these disputed areas conflicts arise, who’s land is it. Ramallah is its biggest city and to my eye very peaceful, quite cosmopolitan, with friendly people, (mostly Muslims and Christian Arabs). It is in Area A, run autonomously by the PA, Palestinian Authority My charge was not to settle these conflicts but assess the quality of vascular care and needs of the various hospitals and providers and support staff to achieve improvement. I would say look at a detailed map to get an idea what I am saying.
My first stop was with the surgeons at the Palestinian Medical /complex (PMC). This is really several hospitals combined into one, including Ramallah Public Hospital, Al-Sheik Zaed Hospital, and the National Center for Blood Diseases to be built with Kuwaiti Funds, Funds from Bahrain possibly will be built Bahrain Pediatric Hospital.
I did not meet the administrator but the vascular surgeon grabbed me and I scrubbed in with several of the practicing vascular surgeons who are skilled and interested in growing a program
1.Dr, Adali Idress. He is well trained already in open and endo skills having done two years fellowship training in Germany and then UK, He can perform all the types of endovascular surgery needed. He did not see problems with conflicts with interventional radiology nor cardiology. He showed me the brand-new hybrid room, or as we called it combination room for doing both open and catheter based procedures. The hybrid room appeared state of the art with a Siemens digital I/I on a fixed system. Really perfect to get started doing complicated endovascular work. The problem seems no one seems to knows how to turn it on. To be fair getting the right voltage and current compatable. This seems like an easy fix. Perhaps PCRF can help.
Dr Igress has a laundry list of supplies needed to supplement his practice which I will forward, and also a fair amount of investment will be required to obtain a baseline supply of wires, balloon, stents both self and balloon expandable and covered stent-grafts. Of the groups I saw this group has the most potential to become the center of excellence for vascular. They are far ahead on the curve as they have qualified surgeons already, and have back up with a total of 4 surgeons. Also Dr Igrees does the only kidney transplants in country. Other needs is training of support staff. (applies to below with Dr Marridi Abdelrahman the hand surgeon)
I also talked extensively with Dr /Abdelrahman. He is an orthopedic surgeon with hand fellowship training, Most of his hand work is now tendon and nerve repairs however he is interested in full reimplantations as he has seen and increase His asks are to trained whole team in assessments, tools, set up etc. and he suggests with scholarships from PCRF he could get a team trained This would allow him to ultimately do reimplantations and free flaps. Cool eh.
I am now back in Ramallah and leave here again at 2:30 am. These time zone changes are difficult. I had the day here so went for a walk throughout the city. There is no such thing as a city block as the streets wind around and cross the hilly terrain sometimes it seems randomly. I visited the old city, the downtown, Yasser Arafat square, an ancient mosque, and ancient Eastern Orthodox church. The sites and sounds of the open market were the most interesting with all sorts of home grown fruits, vegetables, and then clothes, and souvenirs. I will add some pictures. I still cannot get used to the call to worship over the loud speakers, and the noise of the horns which are used instead of turn signals. There is nary a stop sign in all of Palestine. Most traffic circles that are more free for all than organized with a few traffic lights. I will be glad to be home despite the snowstorm I hear awaits me.
This is a cemetery in Gaza from WWI where the British forces composed of Muslims, Jews, and Christians from the middle east all fought and died. There are also citizens from throughout the British Empire at that time including Canadian, New Zealand, India, Australia. It is still maintained by the British government
Good bye Gaza
Hello Ramallah
markandmartysurgeryinpalestine 
