Adonis Diaries

Archive for May 22nd, 2011

Feinberg PPH: Commencement Address given by Bechara Choucair, May 4, 2011

Dr. Bechara Choucair is Commissioner of public health of the city of Chicago.  I liked his Commencement Address at Feinberg School of Medicine at Northwestern University and decided to publish it on wordpress.com.  This speech covered all the grounds and it is impressive.  I found it acceptable to edit out sentences that are not closely related to the subject matter in order to shorten the message.

“Today is about you. You decided to invest in your education. You decided to focus on public health. You worked hard. You read many articles. I am sure you wrote many papers. You participated in many work-groups. You sat for many exams. You gave many presentations. It is all paying off today. Congratulations.

My mom, dad, my sisters and my grandfather came along to my college graduation. I was so excited to have made it through College. At that time, I was accepted into Medical School at the American University of Beirut. I was really happy with the progress I made. My grandfather, who graduated from the same school 60 years earlier, gave me a big hug and said: “I could not be any more proud!” To this day, these are the words that come to mind anytime I think of him. He passed away a few years later. I am so glad I made him proud.

I have no doubt that many of your loved ones could not be any more proud today. To your loved ones: Thank You. Thank you for your support. Thank you for your love. And most importantly, thank you for being there.

As I reflect back on how my career has evolved, I can’t help but wonder if I would be here today if I did not work with Dr Hamadeh as my community medicine project mentor in my second year of medical school. Dr Hamadeh is a Family Physician with a Masters in Public Health. I worked closely with him and I realized that there is a lot more to Medicine than seeing patients. I saw the potential power that public health has, to truly make our population healthy. Every time I go back to Lebanon to visit with family, I make sure to stop by his office. I hope he knows how critical his role was, in shaping my career.

Today, I wanted to do 3 things:

  1. I will briefly describe the history of public health in Chicago
  2. I will talk about the intersection between public health and medicine
  3. I will tell you about the future of public health in Chicago

The population-based approach of public health has had a tremendous impact on the health of our communities for almost two hundred years.  In Chicago, the formal establishment of public health took place in 1834, when the Board of Health was established to fight the threat of cholera.

During this Early Sanitation era, sanitation and quarantine were our best tools for fighting disease. The first sanitation regulations were passed and required all men over 21 years old to help clean the city’s streets and alleys. We conducted home visits to persons with infectious diseases and boarded ships in Chicago’s harbor to check on the health of crewmen.   Our deepest public health roots can be traced to disease control.

[Slide 1]   Earliest public information efforts.

Starting in the 1850’s,efforts in the era of sanitary reform, focused heavily on sewers, water and food and dairy. During this period, the Health Department issued regulations governing the drainage and plumbing of new buildings (1889); we initiated meat inspections at Chicago’s Union Stock Yards (1869), and; full milk inspection activities began (1892).

We saw some of our highest death rates during this era due to diphtheria, typhoid and scarlet fevers, measles and whooping-cough. Using his regulatory authority, the health commissioner at the time, Dr Oscar Coleman De Wolf required the reporting of contagious diseases by physicians in 1877.

[Slide 2]   By 1887, our advancements in medical understanding helped us see that typhoid would continue to kill unless we stopped the flow of contaminated water into Lake Michigan–the source of the water we drank, the water we cooked with, and the water in which we bathed.  Building the 28-mile Sanitary and Ship Canal, which reversed the flow of the Chicago River by 1900, was a major medical/public health intervention.

With the advent of the Hygiene Movement (1880’s-1950’s), and continued advances in understanding disease and medical practice, the focus of public health shifted to individual hygiene and medical care, particularly children’s health.

In 1890, a Chicago child had only a 50% chance of reaching 5 years of age. By 1900, the odds of surviving to age 5 had increased to 75%.   In 1899, with the support of 73 physician volunteers, the City initiated its first campaign against infant mortality.

Service delivery focused on the provision of dental services in schools in 1915, public health nurse home visits to infants in 1925 and educational campaigns against venereal disease in 1922.   These remain among our priorities today.

[Slide 3]  Early public health nurses at work.

On the bottom is one of a group of nurses known as “finders of sick infants.” These nurses would seek out sick babies and refer them and their mothers to Tent Camps where they would receive medical treatment and hygiene education.

[Slide 4]These pictures are from 1956 when 516 persons were stricken with polio. Public health authorities assigned 90% of the city’s health workers to reach a goal of one million inoculations in 2 weeks. One year later, Chicago had only 28 cases, and in 1959 when the U.S. went through a record breaking year for polio, Chicago had only one case.

The 1950’s saw the beginning of dramatic growth in medical interventions which prompted the era of health care services. During this time, the delivery of personal health care services, primarily to low-income populations, was becoming the primary public identity of public health in Chicago.

In 1959, the Health Department opened the Mid-South Mental Health Center, the first of what would become a network of community mental health centers by the early 1970’s.

[Slide 5]The first half of the 1970’s also saw the development of several Department neighborhood health centers under the federal Model Cities Program. The first of our centers, in the Uptown community, was established in 1970. Here you can see our clinics in Lakeview and the 1987 groundbreaking for the expansion of our West Town clinic.

The 1960’s and 1970’s brought significant changes at the federal level as well. The passage of Medicare and Medicaid in 1965 greatly expanded access to care for some of our most vulnerable populations.

Since that time, CDPH has greatly expanded its capacity in Epidemiology, Policy, Planning, Resource Development, and more recently, Information Technology, while maintaining its efforts in critical public health functions such as disease prevention and control, and in the last decade, emergency preparedness.

We have a public health history to be proud of. From the early days of the sanitary reform era to running medical care facilities, I can’t be any prouder of our history as a City. We always invested in building a healthier and a safer Chicago.

The intersection between clinical medicine and public health. These two worlds are often seen separate. We often see them as different disciplinary silos in which many of us spend entire careers. Ted Schettler, the Science Director of the Science and Environmental Health Network, frames both disciplines with respect to focus, scale, ethics, education and the nature of the science.

Clinical medicine focuses primarily on the individual while public health focuses on the community. Relevant time frames in Clinical Medicine are usually single lifetimes, while public health thinks in terms of generations.

From an ethics perspective, clinicians advocate for individual people. Public health practitioners advocate for the community, for a group of people. In clinical medicine we focus on individual patient rights. In public health, we think about human rights, social justice, and environmental justice.

From an education perspective, in clinical medicine we focus on the biomedical model with more emphasis on cure than prevention (although this is shifting now). In public health, we learn more about sociology, epidemiology, cultural anthropology, economics and more.

Think for a moment about the evidence of the science. In clinical medicine we love to talk about controlled, double-blind clinical trials. We don’t find that type of approach often in public health.

Have you ever asked yourself where do you fit better? Have you ever seen yourself in one of the two worlds?

Clearly, there are differences: differences in focus, differences in scale, differences in ethics, differences in education and differences in the nature of science.

But the reality is that the health of the individual and the health of the community are inter-related and inter-dependent. Maintaining two disciplinary silos is NOT the answer. Bridging the gap is critical if we are serious about improving the quality of life of our residents.

Bridging the gap starts right here. It starts with education. We have to enhance the understanding of public health principles among our students in the clinical field and we have to enhance the understanding of clinical medicine principles among our public health students.

Bridging the gap happens in research. We have to expand our research portfolio to focus on health disparities and other population level research.

Bridging the gap will not be successful unless we translate what we learn in research all the way into public policy.

And finally, it is people like you, like the faculty here and like me, who will take the lead in bridging this gap. The good news is that here in Chicago, there are great people who have done great work in bridging this gap. I am forever grateful for their contributions.

At the Chicago Department of Public Health, we are exploring how to fully exploit the intersection of public health and medicine. We are excited about having the opportunity to use, as the foundation of such efforts, the proliferation of HIT initiatives, particularly in under served communities. A major federally-funded initiative to help us achieve this goal is CHITREC, housed here at Feinberg and funded through stimulus funds (American Recovery & Reinvestment Act).

CHITREC (Chicago Health Information Technology Regional Extension Center) provides technical assistance to primary care providers serving predominantly uninsured, under insured, and medically under served populations in developing an Electronic Health Records system that will improve health outcomes. CHITREC is collaboration between Northwestern University and the Alliance of Chicago Health Center Services, a health center-controlled network. It builds upon extensive collective Electronic Health Records implementation and clinical informatics experience.

We anticipate that as the participating providers come on-line, there will be wonderful opportunities to use the wealth of data available through an Electronic Health Record to measure population health and be able to pinpoint where particular interventions are needed to improve outcomes.

Other federal funding, including the 2010 Patient Protection and Affordable Care Act, has provided additional opportunities for investments in the electronic data infrastructure supporting population health. Your Chicago Department of Public Health (CDPH) is positioned to become a leader in the public health applications of Health Information Technology. Current CDPH activities include:

  •  Funding of 26 acute care hospitals in Chicago to assist in their efforts toward establishing capacity to transmit data of public health significance to CDPH;
  • Partnering with the Centers for Disease Control and Prevention (CDC), GE Healthcare and the Alliance of Chicago in a pilot evaluation the feasibility of targeted, pubic health-oriented clinical decision support for ambulatory providers, delivered at the point of care through Electronic Health Records;
  • Supporting Stroger Hospital of Cook County and two major Federally Qualified Healthcare Center (FQHC) networks (ACCESS Community Health Network and the Alliance of Chicago) in their efforts to establish robust transmission of immunization administration data to the Illinois immunization registry;
  • Engaging with the Illinois Office of Health Information Technology in statewide efforts to build a sustainable Health Information Exchange (HIE);

What is the future of public health in Chicago?

[Slides 6 and 7]

During my tenure at the Chicago Department of Public Health, which has been about a year and a half so far, I have stressed the importance of focusing on public health strategies that effectively address the actual causes of death, rather than what is found on a death certificate. Groundbreaking work done by McGinnis and Foege at CDC in the early 1990’s, and fine-tuned since then, demonstrated that the actual causes of death are largely related to individual health behaviors and social circumstances — not genetics, not access to health care.

Dr. Thomas Frieden, Director of CDC, looked at these, took it all in, but then went further and asked:  “now that we have a better understanding of the actual causes of death, how can public health, charged with improving the health of the population, best intervene?”

[Slide 8]

The most effective interventions, at the base of the pyramid, address the social determinants of health and the way that our society is structured.  Taking this approach to heart, I challenged our team at the Chicago Department of Public Health to develop a draft of a public health agenda that best meets this current understanding of effective public health interventions. And while our emphases have been near the bottom on the pyramid, I recognize that there is a need for effective programs at each level.

If you follow Chicago government, you might know that Mayor Emanuel committed to releasing a public health agenda for the City of Chicago in the next 100 days (well, 97 days by now since he’s been in office for 3 days already!) Our public health agenda is a blueprint for action intended to serve as a framework for a focused, yet comprehensive, approach to how the Chicago Department of Public Health will lead and work with partners to improve the health and well-being of the people in Chicago.

Our public health agenda:

  • identifies priorities to guide our public health work over the next five years;
  • sets measurable targets, achievable by 2020, to improve the health and well-being of Chicagoans;
  • sets policy, programmatic and educational & public awareness strategies that can be measured and monitored; and
  • serves as a vehicle to engage communities, partners, and other public health stakeholders in health improvement efforts.

The priorities presented in this agenda were identified through an assessment of public health data and resources, as well as current or potential stakeholder involvement. Reflecting a multi-tiered public health approach, for each priority area, this agenda presents strategies organized into three sections:

  • ·      Policies, including regulatory changes and laws that will be pursued to improve the public’s health;
  • ·      Programs and services that will be delivered, and
  • ·      Education and public awareness

I am sure it is no surprise to anyone if I share our priorities with you. I am talking about Obesity Prevention, Tobacco Use, HIV Prevention, Teen Pregnancy Prevention, Cancer disparities with a use case on breast cancer disparities in Chicago. I am also talking about heart disease and stroke, about violence prevention and about access to healthcare among others.

These are exciting times in Chicago. In 97 days, our City will have a clear public health agenda. We will have a focused set of priorities. We will make our targets public. We want the public to hold us accountable. Chicago invests around $200M every year in our public health system. We owe it to Chicagoans to do our best to stretch those dollars and get the best return on investment. This is my commitment to you today. As you get ready to start the next phase in your career, I call on all of you to join me in this journey. I guarantee you it will be a lot of hard work but a lot of fun and we will get a healthier city.

 

There are many ways to have an impact on health:

  • ·      Treating the sick –
  • ·      Preventing the illness in the first place through screenings
  • ·      Population-based prevention strategies

I hope in your work in public health, regardless of the setting, you keep in mind the concept of the “third revolution” (Breslow) in public health. Now that we have made significant progress in addressing communicable disease (first revolution) and made progress in chronic diseases (second revolution), we are poised to embark on the third, where communities are healthy and the goal is promoting health and not just preventing disease: “Health promotion reaffirms considering not only how to avoid being sick, a negative concept, but also how to expand the potential for living, a positive view: The main difference between health promotion and disease prevention is the premise of health promotion regarding health as a resource of everyday life”.

We all know the impact of clinical medicine on public health.  To promote health, we need to think beyond just clinical medicine. We have to be involved in social policy.  All social policy is public health.  Fiscal policy is health policy.  Education is public health. Housing is public health.

Perhaps in your schooling, or on your own, you saw the film “Unnatural Causes: Is Inequality Making Us Sick?” Through four hours of excellent documentary film making, it makes crystal clear what needs to change in our society if we are going to be truly healthy:

  • ·      It’s less poverty
  • ·      It’s quality housing
  • ·      It’s quality education
  • ·      It’s viable communities filled with resources geared to the needs of the particular population

I grew up in Lebanon in the midst of a civil war. I saw the impact of violence on individuals, on families, on community and on the whole country. I suffered the impact of violence myself.  I saw the impact on my own family, in my own community.

In medical school at the American University of Beirut, I spent time seeing patients in Palestinian Refugee camps in Beirut. I talked to so many people who lived their whole lives in an environment where I might not choose to live.  I saw firsthand the impact of forced migration on health.

In Houston, at Baylor College of Medicine, I trained in a community health center serving mostly Mexican immigrants who struggled to make a decent living. I learned about homelessness by providing clinical services to people living in shelters, under bridges, in cars and on the streets.  I saw firsthand the impact of poverty and lack of housing on individuals.

In Rockford, at Crusader Community Health, I served as a medical director of a community health center network. I learned about more migrant communities. I learned more about public housing. I learned more about HIV/AIDS.  I saw firsthand the impact of poverty on different communities.

At Heartland Alliance for Human Rights and Human Needs, I worked with immigrants and refugees on the North side of Chicago. I also worked with many of the Heartland Alliance global health team:

  • ·      the team working on HIV Prevention among Men who have sex with men in Nigeria
  • ·      the team working on sexual and gender-based violence in Sulaymaniyah, Iraq,
  • ·      the team working on torture and trauma treatment in Momostenango, Guatemala
  • ·      the team working on Maternal Child Health in Patzcuaro, Mexico
  • ·      the team working on child soldier reintegration in Srilanka

I visited with some of these sites and learned from the Heartland staff and most importantly I learned from the participants in these programs.  What I learned from all of these experiences is simple.

To empower individuals to achieve their human rights, and to empower communities to achieve their potential, we cannot think about health care alone. We have to think about healthcare. We also have to think about housing. We have to think about economic security. We have to think about legal protections.  This is what public health is all about.  This is what we need to address as public health people.

I hope that with your public health education and approach you will keep in mind that a healthier society is a society where healthier choices are the default choices.  A healthier society is a society where children have good schools to attend, and safe neighborhoods to play in.  A healthier society is a society where parents have enough resources to provide their children with a rich experience in life.

What do you need to do to be a better person?  What will you do to build a healthier society?  How can you contribute to social justice?  What role will you play to advance human rights?  Join me today in dreaming big for our communities.  I always did. I always will.

From being a little kid playing on the beach of a small Mediterranean town in Lebanon, dreaming about a safer Lebanon to the conversation I had the last week with Mayor Emanuel when he asked me to stay as part of his Cabinet, I always dream big for our community.

Today is a milestone in your career. Please join me in dreaming big.

The Children of Arna”: Who is Juliano Mer-Khamis?

Arna Mer-Khamis (1930-95) was Jewish who married a Palestinian from the neighborhood of the Palestinian Camp of Jenine in the West Bank. The couple had three children, two boys and a girl who were brought up to live in freedom and among plenty of other children of different religious affiliations and nationalities.

Arna founded the “House of kids” in Jenine.  The children in the camp enjoyed a place to get together, laugh, run, play games, dream of a better future, and be creative.

In 2002, during the “Second Palestinian Intifada”, the still in coma Ariel Sharon PM, savagely and bloodthirsty invested the camp and the Israeli tanks moved over live children, women, and Palestinian civilians. The UN didn’t dare investigate this crime against humanity:  Over 500 were killed and thousands injured.

After this massacre in Jenine, the elder son of late Arna returned to Jenine searching for the children of Arna.  Most the adults of the House of the Kids were killed in the massacre and the few remaining surviving were more familiar with weapons and explosives, as part of the new reality.

Juliano also founded an institution for the Palestinians in the camp called the Theater of Liberty in 2006. Many Palestinians were trained and participated in Juliano’s movies. Juliano had directed several films, one of them is “The children of Arna”, in 2003.

This April 4, 2011 Juliano was assassinated.  Gee, I thought Israel always discovered the murderer of a Jew, but not this time around.  Most probably, an Israeli sniper did the job, getting rid of a most turbulent and dangerous non-violent Jewish/Palestinian activist.

Note:  The movie “The Children of Arna” is produced by Osmat Trabelsi and Pieter Van Huyster; 84 minutes.  Check http://www.momento-films.com

Prophesies of “end of time”: In “Rainbow over the Levant”

Note:  This article is a section of chapter 17 of  the fiction novel “Rainbow over the Levant”: The Exile

In 1400, Timorlank was closing in with his Tatar hordes toward Northern Syria. The Viceroy of Aleppo was frantic and sent messengers after messengers for directions from his master the Mameluk Sultan of Egypt.  He requested reinforcements and financial support but Cairo did not stir.

The Viceroys of Damascus and Hama were of no help either, and as completely in the dark as to the policies of the Sultan of Egypt.  The agents of the First Emir of Lebanon reported that Egypt’s position was not to intervene at this stage either financially or militarily and to concentrate its resources in Egypt for the time being.

It seems that the advisers to the Sultan reminded his Majesty that these hordes, like the Moguls before them, never ventured into Egypt, and most of the time they retreat after capturing Damascus. They also reminded the Sultan that when Holago the Mogul decided to advance to Palestine a century and a half ago the Mameluks defeated him easily in 1260 at two major battles.

These counselors assured the Sultan that the Mameluks would repeat the previous military feats if Timorlank dared advance toward Palestine with his already exhausted forces and stressed on the facts that the previous Fatimide and Ayubid dynasties had deteriorated and their hold on power had begun to decline when they had tried to stretch their dominions into Iraq.

The Mameluk’s Viceroys in Damascus and Hama decided not to put up a fight against the Tatars and invested their time in hoarding as much money and riches as they could gather and flee in due time.  Aleppo was destroyed and Timorlank entered Damascus in 1401 without a fight and transferred all its remaining artisans to Samarqand, his Capital, within a year.

Prophesies of the end of time

There were other factors accounting to this social uneasiness, apathy and helplessness.  Any society facing changes in its structural order is usually ripe to the cyclical apocalyptic prophesies of the ultimate end of the World.  The Levant (people living in Syria, Lebanon, and Palestine) had already experienced one such depressing mood during the lifetime of the First Emir and twice in the previous century, with a slight delay of such rumors since they were emanating from Europe.

The Fatimide dynasty in the 11th century reigned in Egypt and claimed its right to the Caliphate of the Moslems by proclaiming the imminent coming of a disappeared Imam. The decline of the Crusaders’ hold on the Levant, and lack of subsequent infusions of men and financial support, combined with the occurrence of pests or plagues prompted one of these cataclysmic beliefs within the Levant Crusaders.

The other period happened when news of the Mogul invasion were imminent and the fact that indeed Holago erased the Capital Baghdad in 1258.

In the mid 14th century, society remembered the plague that devastated Aleppo half a century before, a catastroph which added to the fear of an imminent recurrence of a Tatar invasion led by Timorlank toward Syria.  These apocalyptic prophesies were shared by both Christians and Moslems.   the Shiaa Moslems would preach the coming of either the 6th disappeared Imam or the 12th Imam to unite the Moslems to some kind of victory and the Christians would rely on the eschatology of Christ returning and reigning for one thousand years over a peaceful and happy World before the end of time would take place.

Antichrist finger pointing, or which power was represented by Satan, was convenient and successful in fomenting pockets of extremist sects within each religion.  Actually, a century later, with the Renaissance upheaval in Europe, Luther was able to establish his religious Reforms by capitalizing on the fears spreading in Europe of the coming of the end and using the advancing Ottoman armies toward Vienna as the sign of an angry God punishing the Christians for following the teachings of the Roman Catholic Church who forgot the Word of God.

After the devastation of Aleppo, the First Emir realized that his stay might induce Timorlank into driving a hard bargain over the Levant; he determined that his high profile in the region was a liability to the Levant.  He nevertheless ordered Gergis to join Ibn Khaldoun’s mission waiting to meet with Timorlank encamping around Damascus and to try reaching an agreement that would spare the Levant from further distresses.

Ibn Khaldoun was the famous 14th century Arabic North African author of “History of Civilizations” and he met with Timorlank camping outside Damascus and made him promise not to exact his vengeance on the population; a promise that Timorlank never kept.  Most of the craftsmen and merchants had evacuated Damascus and fled to Lebanon and Egypt while the remaining craftsmen were denied exiting this city after the hordes of Timorlank sacked it and would be transferred to Samarqand the Capital of the Tatar.  In disgust at his helplessness and the inaction of Cairo the First Emir decided to travel overseas for an extended period until the political situation was stabilized.

Although the societies in Syria, Lebanon and part of Palestine suffered economically and organizationally, the Mameluks in Egypt retained their cohesion and managed to survive another century before they were defeated militarily by the ascending Ottoman Empire in 1516.

The road to Palestine: Diary of “May 15 Day” to the borders with Israel 

Who is Moe Ali Nayel? I read a post on one of the social platforms by Moe Ali Nayel , a Palestinian journalist and fixer based in Beirut, and decided to edit it and rearrange a few paragraphs: Important eye-witness diaries have to be republished, over and over again.

“I grew up in Lebanon during the civil war, particularly in south Lebanon.  Israeli occupation of south Lebanon lasted over 18 years before the Zionist State was forced to withdraw without negotiation by the Lebanese resistance.

During that time, a revolutionary song by Julia Butros, “Wayn al-Malayeen?” (where are the millions), was continually heard on the airwaves. But as a child, I never understood what she meant when she sang “Where are the millions? Where are the Arab people?”

In 2006, as the Israeli incursion in south Lebanon dragged on for 33 days, I heard the song again. I was 25: this time I understood what it meant and that line kept playing endlessly in my head throughout the war.Eventually, Israel vacated Lebanon and admitted defeat.

Last Sunday, on the way to the border at the town of Maroun al Rass, the bus driver played that song. In light of the Arab revolutions that are happening at the moment, millions of Arabs have taken to the streets to demand their freedom, to demand their right,s and to speak out for the first time (at least since I have been alive).

On 15 May, the same millions took to the streets, only this time to demand the liberation of Palestine: their freedom, their rights for a State and the implementation of UN resolution 194 for the Right of Return of the Palestinians to Palestine.

That day at 7:30 am, we gathered in front of Mar Elias Palestinian refugee camp in Beirut. There were five packed buses and on the street there were about a hundred others waiting for more buses. Finally, we learned there were no more buses and we would have to rent additional ones. I got into our rented bus full of enthusiasm and good vibes; the journey back to Palestine had started. The crowd on the bus was an interesting mix of people of different nationalities and as we sat down we were all Palestine, we were all Palestinians.

For weeks I had anxiously awaited 15 of May, what we are already calling the beginning of the Third Palestinian Intifada. Many people had started referring to May 15 as such on social networks.  I loved the sound of Third Palestinian Intifada and so this is how I would refer to it every time I speak of that memorable Day.

However, 15 May is the Nakba Day (catastrophe) commemoration: on this date in 1948, we remember that more than 750,000 Palestinians were forced out of their homes, their land, to transfer to  new countries and for Jews coming from everywhere to relocated in our land.

To me, Palestine was and still is the central cause in the Arab world, and I always believed that the liberation of Palestine would not happen before the liberation of the Arab people from the corrupt ruling dictatorships.

The western States like to call these dictators and absolute monarchs the “Arab moderates”, but in reality this means Arab puppets. Today the Arab world is changing and the Arab people are revolting, and while they are revolting they have not forgotten about Palestine, or the suffering and occupation their Palestinian brethren are going through.

In closely following the Arab uprisings since the protests in Tunisia started, I have always seen at least one Palestinian flag among the protesters in every Arab country. Palestine has always been present during the protests. Palestine has always been present in the hearts and conscience of the Arab people. The “malayeen” or millions are speaking now and their united voice is reaching the sky.

Yesterday, the Arab people spoke again: the people want to liberate Palestine; the people want to return to Palestine.

The road to Palestine

The trip from Beirut took longer than it should, along the coast to the south.  Hundreds of buses and cars displayed Palestinian flags, and on the sides of the roads big billboards read: “May 15th: the march to return.” I have never felt so delighted looking at a billboard before.

On the windy road from Nabatiyeh to Maroun al-Rass, the endless line of buses relentlessly moved forward, people on windows waving to each other and flashing the V for victory sign. We felt like we were really going back to Palestine. On the bus, three Palestinian friends and I jokingly, but sincerely, started making plans about where in Jerusalem we were going to have a coffee, or should we just go to Haifa and enjoy the beach there, we teased, believing it somehow.

As the bus wound through the lush green valleys of the south, blooming with flowers and life, I couldn’t help but notice many buses with Syrian license plates. “Had these people come all the way from Syria?” I wondered. But no, I was told there were not enough buses in Lebanon, so some had been rented from Syria.

Contrary to our original plans, the bus had to stop in Bint Jbeil, the largest town in the region, a few kilometers away from our destination — the border at Maroun al-Ras. The village had been turned into a big parking lot for buses converging to destination; buses carrying people from a dozen refugee camps all over Lebanon and the many Lebanese who wanted to join the march to the border.

We jumped out of the bus and without asking how we would get to the border, we found ourselves joining thousands of people walking through the green fields and climbing mountains as a short-cut to our shared destination.

It was approximately a five kilometer-walk , actually a hiking trip. It was beautiful to see endless lines of people marching from different directions in the green land. Next to me were Palestinian families who had brought the children along and dressed them up for the occasion.

There were old women and men who struggled to climb the steep hills, and there was a great spirit of solidarity among the people as everyone gave a hand, everyone offered to help, and everyone smiled.

My wife and I slowed our pace at one point to listen to an old Palestinian man leaning on a cane. He was walking with his grandson and telling him the story of the time he had had to leave Palestine and carry his nine-year-old sister while escaping to Lebanon over these very same mountains and paths. The old man spoke to his grandson of the beauty of Palestine and described how their home looked.

Finally, as we gradually drew closer to the border, he told the young boy, “Soon you will go and see Palestine, the most beautiful country I have ever seen; it’s where we come from. It’s our land.”

Shooting from the valley

We finally got to Maroun al-Ras, a public space on top of a mountain overlooking occupied Palestine. There were thousands of people scattered all over the mountain top and a big screen was broadcasting what was happening down in the valley. Before we could properly take in our surroundings I heard shooting, four or five shots from below us in the valley.

I told my wife the Israelis are shooting,. A minute later, a person on the microphone called for the ambulance to bring down stretchers to the fence. I asked what was happening and people told me four martyrs had fallen and more than twenty were injured.

A wave of people stretched from the park on the top of the hill all the way down to the border fence. I found myself sliding on that wave, stopping every once in a while to catch my breath and wondering whether I should stay where I was or keep going down to the fence. I could not contain the desire to join the thousands on the fence already throwing stones across the border. From a distance, the stones looked like white birds diving to the other side.

I finally made it to what they were calling the “second line”, approximately 500 meters away from the border fence. There were ambulances parked nearby, and the Lebanese army had formed a human chain to prevent more people from joining those at the border fence.

Many Palestinians, young men and women, kept insisting on breaking the chain the Lebanese army had formed, wanting to join their brothers and sisters on the front line. Watching the faces of the Lebanese soldiers, all I could see was confusion and panic, but they were not losing any chance to threaten and intimidate the protesters with their raised batons and sticks.

All their guns were directed to the sky

Standing in front of the army were a few Palestinian men pleading with the raging people not to take it out on the Lebanese army. “This is not what we were here for,” they shouted over the chants.  The knowledge that the land in between was littered with mines did not stop the people: people kept breaking through the chain and sprinting to join the front line.

One group of courageous young women broke the chain of men and ran towards the front line and everyone cheered them on. All this time, the Israelis were shooting, a burst of two or three shots rang out frequently, and every time they shot we saw the stretchers gathering new bodies.

At 4 pm, we decided to climb up the steep mountain and walk back to catch our bus. After a couple minutes of walking, I noticed the Lebanese army moving towards the front line, to the fence.  The soldiers were after the protesters who started loudly chanting “Palestine! Palestine!” As the army made their way to the very front it looked like they had decided that the protest was over.  Suddenly, with no warning, the Lebanese army on the front and the second line started firing thousands of rounds into the air.

All their guns where directed to the sky, but the amount of shooting terrorized everyone who was there. We all started sprinting up the steep mountain; a random man pulled my arm and dragged me up with him as I struggled to keep up on my feet.

The firing intensified and there were the same waves of people scrambling and running in panic. Next to me there were lost children, crying, wanting their parents; an old man ran out of breath, crouched down; I saw an old Palestinian woman up the mountain with tears running down her face.

Looking back down to where the second line was, I could only see a line of soldiers with their M16 rifles to the sky, shooting nonstop. It was like something out of  horror movies. But something even more terrorizing happened in the middle of the shooting:  As the Lebanese soldiers fired their guns, I heard deeper shots coming from the Israeli side and bullets whizzed by me; I took a dive to the ground.

The way the Lebanese army decided to end the event made me ask myself ” who is the enemy here?”

Nothing to lose but our chains

The “March of return to Palestine”  harvested at least ten persons dead in Lebanon, five in Ain Shams (Syria) and another dozen on the borders with the West Bank and Gaza; over 300 were seriously injured by Israeli snipers.  The Palestinians in Egypt were prevented from reaching the border.

People who normally don’t care about Palestine and enjoy a life of apathy, indifference, and consumerism asked me today: “what did you achieve? What did you change? Was it worth it the death of tens of people?”

My answer is “after yesterday, things will not be the same as before 15 May”. Just like after the suicide of Muhammad Bouazizi in Tunisia, things are not the same as before in the Arab world. The Arab people, us, the Arab youth, we are not going to let the status quo continue, we are not going to be humiliated by our own people anymore. We are not going to let Palestine and the Palestinian people be humiliated and tortured as they breathe.

We are freedom-loving people and we won’t live anymore on empty promises from our corrupt governments, governments using Palestine as a pretext to repress us while they enjoy robbing us from our dignity and labor.

We won’t let rotten governments continue to make sure Israel is safe and sound, enjoying the beautiful land of Palestine, while hundreds of thousands of Palestinian refugees live in inhumane conditions in the camps.

How do you expect a Palestinian refugee to see his land being enjoyed by the Israeli occupation and not react to that? We, the Arab people, the Arab youth, the millions, have decided that we have nothing to lose but our chains and that Palestine is our prize.

I saw yesterday how much the people want to free Palestine, how much they want to return to Palestine. The Arab people are here, the Arab rage is here, the determined malayeen are here.

Moe Ali Nayel is a journalist and fixer based in Beirut.


adonis49

adonis49

adonis49

May 2011
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