This blog series will be slightly different from my others, mainly due to the collaborative nature of this project with a military entity. Photographs from within their facility and finer points of dialogue with military staff I will keep to myself. This is the nature of things.

The head of maternity, like nearly every Jordanian I would go on to meet in my time here, was incredibly warm hearted and welcoming. Having not spent much time in the Middle East before this trip (Qatar was my only foray, documented in Community), I wasn’t sure exactly what to expect. I was struck by several things. Everyone I met asked me if I wanted tea or coffee. Doors were always open. Regardless of where I went, what office for this department or that department, meetings took place in the open with whoever was present in the room. If there were several meetings back to back, everyone still sat on the couches sipping their tea while the meetings took place in series. It was a welcome cultural shift from the west, where we seem to try to do everything possible to protect the sanctity of our own bubbles. The head of maternity himself and I became friends. Every morning before teaching I would sit in his office for a time, having coffee and chatting about all manner of things. He even took me out to dinner before I left, and it was only then that I found out he was not just the head of maternity, but also a Brigadier General.

That first morning though, I introduced him to my ultrasound probes. He was an advanced obstetrician so knew how to use the tool, but was shocked to discover that portable devices like this existed.    

‘Anyone can download the app?’ he asked.

‘Of course!’

So that morning, he assembled six of his OBGYN staff physicians in military garb for a teaching session. We commandeered a classroom and I spent no more than twenty minutes showing them how to turn it on, log in, import and export images, and use the settings on the device. At one point I asked them a question.

‘How many of you are being deployed to Gaza?’

Every hand shot up.

Then we took the probes to the wards and I got all of them to do a series of scans and save the images for review. We spent maybe an hour to 90 minutes there before we wrapped up. On their way out they thanked me with a round of handshakes.

To think that in two weeks’ time, I would be on vacation after this project and they would be face to face with the unspeakable horrors of war was unsettling. To think that in their hands would be this same probe I taught them to use was also a strange feeling, almost like I didn’t want to give myself credit; I got to show up and be the white guy running a class and telling myself I helped, but they would be the ones really in the trenches putting their lives at risk to bring solace to the sick and suffering. Everyone has a part to play I suppose, and for now this was mine.

After the first session, I sat down with the head and we made a plan to deliver more formalised teaching for midwives and nurses. I am a big advocate for this, even if it doesn’t fall under the usual responsibilities of a nurse or midwife; it’s an additional skill that’s easy to learn and can make a difference, especially when the doctors themselves are spread thin in the operating theatre. After we laid out our plan, I had not much else to do in that building for the time being, so Tayseer came by with the driver and we went to our caravan facility site.

Within the hospital complex, a big parking lot had been designated as the assembly site for our project. Around 30 caravans (or portables, as they might be called in Canada), were arranged in a U shape, with a collection of rows in the middle of the U. Construction staff were hard at work, welding steel rods to roofs and hoisting up large panels to equip the solar grid. Truckloads of supplies, bricks, medical equipment in boxes, and all manner of cabinets and shelving materials were set aside. Walking around the whole thing took ten minutes.. Still in its raw form, I could tell there was a lot of work to be done. My time spent teaching ultrasound was never going to take up the whole day everyday, and so I relished the chance to be a makeshift apprentice to Tayseer, soaking up as much as I could about humanitarian coordination and how these projects come together. As physicians we seldom appreciate that we are the equivalent of a factory worker, at the very tip of the process that goes into providing the service. Someone has to build the infrastructure, get the permits, pay the licenses, and hire everyone else that supports the process. I was getting a small window into how that all came together.

The next afternoon when I had some empty time in the schedule, I got Tayseer to let me help write the media briefing on the details of the project. It was essentially an information booklet with the blueprint of the entire process, and it was only then when I truly gained appreciation for the painstaking nature of this work. It started with a needs assessment using available UN data, which was likely still missing pieces. My experience from both Panama during covid (Ensenada), and in Kyangwali Refugee camp taught me that maternity and neonatal services suffer greatly in crises, arguably more than other domains and with a higher long term disability. So it was decided that in order to best serve the people in Gaza, a maternity hospital would pack the biggest punch. The objectives set were to provide comprehensive access to maternal and neonatal services to reduce negative health outcomes. Then agreements had to be reached with phone calls and negotiations abound: who would fund it, who would staff it, where it would go, how would it get there, and how the group would respond to potential obstacles. Then comes the matter of how it would be built, how many caravans, what size, what materials, and where from. The hospital needed power as well, so there comes the issue of generators, access to fuel in a warzone, solar panels, and whether the panels could be mounted, etc. A group of electrical engineers had to design the power grid and run the cables. Then everything had to be bought. Chinese manufacturers provided the panels, energy storage, and AC units. An oxygen system designed to generate pure oxygen from compressed air was also purchased, and the tanks had to be stored in a fire-safe manner. Hospital beds, defibrillators, heating blankets, catheters, instrument trays, and all of these things that I take for granted had to be ordered, delivered, accounted for, and stored by somebody. Then someone had to hire the contractors to build and install the whole thing in Jordan, before partially disassembling it for transport into Gaza. It was enough to make your head spin.

By the grace of Allah, all of that for this project was done by one person alone: Tayseer. This is part of why I was desperate to lend him a hand. So I did. I took on the mantle of a junior apprentice and helped beef up the media briefing. I did some spreadsheets. I even generated paperwork for the next project in Afghanistan, looming in the distance against the backdrop. It was mind numbing work at times, but someone had to do it. All the more appreciation for the support staff that prop up us self-absorbed clinicians who get to place hands on patients and take all the credit.

That night, I went to dinner with the group of engineers. We went to a Syrian restaurant, (which I have learned may be one of my favourite types of food). I learned that all of them, Jordanian nationals, were of Palestinian origins. I would learn that 65% of Jordan is of Palestinian descent, and about 15% are from Syria. It is a country made up of displaced peoples. When we sat around the dinner table, we spoke about the plans for the project. Two of the engineers were planning on entering Gaza with the hospital to make sure the grid was up to snuff, and excited to do so.

‘You will be joining us?’ they asked.

‘I won’t be,’ I answered. ‘I don’t know that I would be of much utility there. I don’t speak Arabic, I am not a maternity doctor, I would wind up being another mouth to feed. I also promised my mother I would stay out this time.’

‘You don’t have to explain,’ they told me. ‘It’s not worth dying for. This is not your fight.’

That hit me hard.

This world is so fucked up, and we cannot even begin to comprehend these realities in the West. I thought about my networks back home. The people I grew up with outside Toronto, the people I worked with in Philadelphia. Imagine sitting in your house in New Jersey, or Burlington, and all of a sudden airstrikes begin blowing up your neighbours. People you’ve known for 20 years, obliterated. The communication grid goes offline and the economy collapses in one fell swoop, and you have only the clothes on your back and the food in your pantry. You get your family loaded into the car and drive as far as you can in any direction, not knowing where to or what you will do when you get there. Your friends and extended family are unreachable, unclear if dead or also displaced. The roads are jammed. You run out of fuel. You take the family and walk, sometimes for days. Maybe you find something, a school, a building, where at least you can sleep on the floor. More shelling now rumbles in the distance. Some people are scared and try to run but get shot or hit by shells in the process. You don’t know where the food will come from. Soldiers speaking a foreign language raid the building, they take some people, and kill others. You get to another shelter somewhere, but they are full, or deny you entry because of your race, ethnicity, or religion. All along the process you watch the kids lose weight, and people around you get sick. The horrors of war litter the streets in front of you every day. This has been the lives of millions of people in this region for years. Syria, Yemen, Gaza, now Lebanon. Not just here: The Congo, Myanmar, Sudan, Ethiopia. This is the reality of life for millions. I read about it every day, I work with people who have seen it, treated patients who have lived it, and even then I cannot fathom the harrowing darkness that it must be to live that experience.

These wars, conflict, displacement, famine, and mass migration crises are a world’s distance away, and the bubble of the Occident keeps us sheltered from the realities that the majority of people face. Every time I open my phone to Al Jazeera or the BBC and read another headline about another group of people displaced, I can’t help but think of all those people who get to live so safe. I am one of them myself.

Truth is, I didn’t want to go to Gaza, I was scared. Where did that leave me then? A firefighter who doesn’t want to get burned? A police officer that doesn’t want to face danger? Tayseer was going, he was 46 with three kids. The engineers were going, they were married and had families. What was my excuse? Self-preservation I suppose, but tied with it comes some shame. I know it’s not fair to punish myself for my privilege, but of course these things still cross my mind. For the Jordanians though, this was their fight. Imagine believing in something so powerfully you’d be willing to die for it. Maybe if this conflict was in my backyard I would feel different.

Sometimes though, I worry that once I spend too much time in these darker corners that living in the bubble won’t feel right anymore. I would come back to chatting over beers trying to make conversations about fantasy football with people who could never understand the world that I moved in or the things it planted in my mind. It is a future that Tayseer warned me about. I would throw away a life of peace for what, I mean how much of an impact was I really making here? Teaching doctors to use an ultrasound probe seems like a drop in the ocean. A younger version of me would have chosen heavy metal all day with no compromises, but I just don’t know anymore. I kept these thoughts with me as I rode home in my taxi that night.

The good news was that I still had the freedom to choose my path. My fate wasn’t sealed. Too long in the field and it’s impossible to come back, too much comfort in the bubble makes it impossible to leave. Maybe I could have both somehow, someday. A family and a job that pays, with the chance to leave the bubble when possible for the sound of metal. Sounds tempting doesn’t it? Only time would tell.

All part of finding my wings.