Is There a Doctor in the House?

The Arab village of Kara holds the national record for the number of physicians relative to the population - twice the average for the Western world.

On the wall of Dr. Nawaf Masrawa's home in Kafr Kara hangs a framed reproduction of Picasso's "Guernica." "That's the world," he says. "We always have to look at it and understand what happened there, and what is happening to us." Masrawa, 52, went to Spain in 1975 to study medicine. "I love the profession," he says. "It has an element of helping others as well as status and prestige."

Masrawa is a family doctor. He has two clinics in Ara and a medical center in Kafr Kara, in Wadi Ara southeast of Haifa. In addition, he completed a master's degree in health administration and is completing another in law and health at the University of Haifa. "Only working is somewhat depressing," he says. "My goal is to focus on academia and to do a doctorate."

His daughter Abir, 20, is in her fourth year in medical school in Irbid, Jordan, and his son Issam, 19, started studying this year at a medical school in Budapest, Hungary. Masrawa has six children and he is afraid, he says, that this is not the end of the story, and that he will have other medical students in the house.

What do they put into the children's food to make them all want to study medicine?

"They got it into their heads that they have to study. The problem is that they all look at one another; on the one hand that's good, and on the other, not everyone can afford to pay so much. I manage somehow. I hope that my daughter will finish and come to work with me."

But Masrawa and his children are not the only doctors in Kafr Kara. Under the layer of neglect, there is a fascinating phenomenon: In every other house there is either a doctor or proud parents of medical students. According to statistics from the local council, there are 100 doctors and 37 dentists in a village with a population of 14,500. In other words, a doctor for every 145 residents - more than twice the average in the Western world, which is a doctor for every 330 residents. There are also 50 medical students in the village, most of whom are studying abroad, mainly in Jordan. "Everyone looks at his neighbor and wants the same thing, as with the Jews," explains Jemal Abu Ata, whose daughter Mais finished her medical studies at Irbid University in Jordan last year.

High expectations

The local record belongs to the Baidusi family. Abd al-Khader Baidusi, 62, a teacher who always wanted to be a doctor, has six children, two sons and four daughters. Three of them are doctors, two are medical students finishing their studies this year, and one daughter is a pharmacologist.

"When I was a student in the 1950s," says Baidusi, there were almost no doctors in the village, and to be a doctor in the Arab sector was a big deal. I was a good student, so my parents always said, 'He will study medicine.' In 1963 I finished a scientific track in a high school in Nazareth and applied to the medical school in Jerusalem, but there were qualifying exams, and they accepted 63 students, among them maybe three Arabs, who were doctors' sons. I studied mathematics and physics for one year and again I took the exam and again I wasn't accepted. So I studied general history and Hebrew language and I went into teaching. My children were all good students, so I sent them to an [Arab] Orthodox high school in Haifa, they finished with excellence, got high grades in the psychometric exam and were accepted to medical studies in Israel."

Doesn't it seem strange to you that they all chose the same direction?

"They were influenced by one another. The eldest began and then the others continued and there was some competition among them because they all wanted to be doctors."

Dr. Masalma Baidusi, 30, studied at the Technion - Israel Institute of Technology in Haifa and is presently doing an internship in cardiology at Soroka Medical Center in Be'er Sheva. "I registered him for Tel Aviv, Jerusalem and the Technion, and he was accepted everywhere, but we preferred Haifa because of the distance," says his father.

"Most of the outstanding students among us go to study medicine," says Masalma. "It's a natural and interesting choice, and there is social status. Just as your best and brightest become pilots, ours go into medicine."

Why did you go?

Masalma admits that "there was clandestine pressure on Dad's part. He had expectations of me, but I like it and I'm not sorry."

In other words, you didn't have a burning desire from the age of three?

"That's what they always say in interviews."

Dr. Masalma Baidusi's brother, Dr. Amjad Baidusi, 28, also studied at the Technion and is presently interning in ophthalmology at Soroka. As opposed to his elder brother, he remembers himself taking an interest in medicine from a very young age. His sister, Dr. Maysun Baidusi, 27, recently married, and her husband is completing a master's degree in engineering at the Technion. She is working as a substitute doctor at Clalit Health Services and waiting for a place to intern in family medicine or pediatrics. She also studied at the Technion.

Did you go into medicine because of your brothers?

Dr. Maysun Baidusi: "There's a certain connection, but it's not the main reason. Already as an adolescent I had the idea that I could take care of women from our sector. There are conservative women among us who avoid going to a doctor or don't tell the doctor the whole truth, and that delays proper treatment. They often come to me and say: 'It's good that you're here, so I can talk.'"

Her sister Mirwat Baidusi, 26, is completing dental studies at Tel Aviv University. At first she wanted to study medicine, but she wasn't accepted and compromised on dentistry. Today she thinks she made the right decision. "When I see my siblings, I think that the work in dentistry is less difficult, you're on duty less often, and it's more suitable to life afterward."

Salma Baidusi, 25, will finish her studies at the Technion and wants to be a gynecologist. "When I was a little girl I wanted to study computers, but I was told that it's a very hard profession for a woman so I went into medicine," she says. "My siblings told me that it's not as rosy as it seems and now I see that they were right."

Do you have regrets?

"There's something satisfying about medicine; I have no regrets at all."

Roland Baidusi, 23 (who is named after French author Romain Roland) finished her internship in pharmacology last week at the Hillel Yaffe Hospital in Hadera and is thinking of going on to a master's degree in order to pursue research in the future. Her father was the greatest influence on her choices and those of her siblings, she says. "He spoke to us about the importance of science and about the period of the Renaissance in the West, and about progress and democracy in Israel. Education and science are something fundamental in his life. He says it's like air, that without it a person can't breathe."

Something in the air

What is there in the air of Kafr Kara that produces the desire to study medicine?

"I don't want to be dramatic and to say that it's the Polish mother," says Dr. Abid Assali, "but my mother and father have pushed me since I was a little boy. For as long as I can remember I knew that's what I was going to study, because that's what they expected of me." Dr. Assali, 46, heads the cardiac catheterization unit at the Beilinson Campus of the Rabin Medical Center and is a senior lecturer in the cardiology department at Tel Aviv University's Sackler School of Medicine. In a few months, he will be a tenured professor.

Dr. Rafik Masalha is a senior physician in the neurology department at Soroka, a lecturer in the medical school at Ben-Gurion University of the Negev, head of an epilepsy clinic and an EEG institute at Soroka and has a private clinic in Baka al-Garbiyeh. He says he was pushed by his mother, too.

"My mother was illiterate. When I was a little boy, my father fell ill and was unable to support the family, so as is customary in a large Arab family with seven brothers and three sisters, my older brothers left their studies and went to work, and they also supported me and my brothers Tawfik and Shafik, when we went to study." Tawfik, 56, was among the first in the village to go to Italy in the early 1970s and study medicine at the University of Padua.

"And I followed him," says Masalha. "I always thought of being a doctor, an engineer or a lawyer, the three professions that you believe the family expects you to study. My brother studied automotive engineering at the Technion engineering school in Haifa and didn't like it much, and then he heard stories from a friend of his who had gone to study in Italy. He was enthusiastic and said that he wanted to do the same."

Masalha says the decision was not easy; his family hesitated. The financial burden was great and two camps formed in his house. In the end, the side that supported studying in Italy won out. "My brother went, and I went two years later."

Why Italy? For two years Masalha, who graduated from a Jewish school, tried unsuccessfully to be accepted at the Technion medical school, and then he went to Padua. "My brother and I lived in the same room; we studied Italian. I completed the first year with excellence, so they let me study free of charge and paid my board, too. The two of us managed for the price of one."

But support from home was not complete. It turned out that not everyone in the village was accepting, recalls Masalha. "When I left, one of my neighbors gave me the following blessing for the journey: 'I hope that by the time these two brothers finish studying medicine, there won't be any more sick people.'"

Above average

Assali, the youngest of nine brothers and sisters, studied at a Jewish high school in Hadera. He applied to study chemistry and medicine at TAU, but was not accepted. "After being rejected, I went to the chair of the acceptance committee and told him that it was very strange that they didn't accept me for chemistry with a grade of 10 in the matriculation exam, and he said, 'I'm surprised, but your request did not even reach the discussion stage.'

"Apparently they rejected me only because of my name. After the conversation with the chair, I was interviewed and accepted. I studied for two years and each year I finished with excellence. After two years I tried once again to be accepted for medical studies and again I was rejected, but by then I had been accepted at Be'er Sheva [Ben-Gurion University] and I gave up on Tel Aviv; it was tilting against windmills."

Why medicine?

"It's the nicest profession possible, a profession that is greatly respected and admired. It's attractive to everyone, and suits Arabs."

It suits Arabs?

"Medicine has the greatest potential for advancement. I see what graduates in other subjects are doing; they have to pull strings in order to be hired. I have a brother who has a bachelor's and a master's degree in mathematics; he was a real genius, and he didn't find himself in Israel. He had to leave for Germany in order to do what he wanted. In the village we have a guy who's brilliant at computers. He did his bachelor's and his master's, at the university they appreciate him, but he didn't find work and he's working as a teacher. Medicine is much more egalitarian. If you prove yourself, you can advance with relative ease."

But the fact is that they barely accepted you for studies.

"I happen to have insisted on studying in Israel. My family encouraged me, they said, 'You deserve it.' At that time studying in Israel was considered to be on a much higher level. I don't think anyone stopped me or tried to trip me up; on the contrary, they appreciate the work I do."

So you're actually an Israeli-Arab success story?

"For us, when it came to advancement, the motto was that the fact of being or not being an Arab would not stand in the way, although I'm aware of the fact that as a member of a minority I have to prove myself, and that's why I invested the maximum. I assume that had I been Jewish, my life would have been easier. It's a fact that in the hospital, there are patients who ask for the Arab catheterization doctor. They don't even know my name, but they know that I'm an Arab."

That means that as far as the system is concerned, there's no difference between an Arab doctor and a Jewish one?

"I know doctors of average ability in the village who did not reach the level I reached; but I know Jewish doctors who are not on my level and went much further. An Arab doctor, in order to advance, cannot be average, he must be above average."

The future is in Berlin

Hashem Masarwa, 49, is an attorney who studied social work as well, and has a law firm in Kafr Kara (and is a cousin of Nawaf Masarwa). His brother, an anesthesiologist, studied medicine in Spain and his eldest son Hassan is a fourth-year medical student at Berlin University. "We thought of sending him to study in Jordan. About 4,000 Arab students from Israel are studying pharmacology, medicine and law in the universities of Amman and Irbid. It's a major industry. But the costs are tremendous. About NIS 60,000 a year for tuition alone, without board and travel. I estimate that a degree in Jordan costs about NIS 500,000-NIS 600,000. People from the village sold land to pay for their children's studies there."

After Irbid was ruled out for financial reasons, TAU was ruled out as well: His son Hassan's grade on the psychometric exam was not high enough, and Berlin was chosen because of the relatively low cost. "He applied to several universities in Germany and was accepted at five different places, did research and came to the conclusion that Berlin is the cheapest city in Germany: You don't pay tuition, only 140 euros per semester for the use of the library and for public transportation. Hassan pays 160 euros a month for the dormitories."

It sounds like a good arrangement.

"Yes, but at the same time he feels lonely and is making a great effort to learn the language and in general, to prove himself. The studies are very high-pressure."

Hassan has two semesters left to complete his studies, but his father is worried about the possibility that he will decide to remain in Europe. "In England and Ireland," he says, "there's a shortage of doctors, and he has already said that in future he will consider staying and becoming established, and returning to Israel only later. From my experience, all those who stayed to become established stayed and didn't return, that's what worries me."

Why does everyone in Kafr Kara want their children to study medicine?

Masarwa attributes it to the change that has taken place in Arab society: "Once everyone here was a farmer who worked the land. Today the traditional structure of the hamulas [extended families] is falling apart. The grandfather who controlled all the lands no longer exists. There isn't so much land anymore, some was confiscated, and the head of the hamula has nothing left to control. That has led people to seek other professions, free professions, because many fields are closed to us: in large firms like the Israel Electric Corporation, for example, there are almost no Arab workers. The same is true of Bezeq. Bezeq International actually has brought in Arabs because they wanted them to push their campaigns in the Arab sector. Egged and Dan are family fiefdoms. Government firms and security industries are out of the question. At El-Al there are two or three Arab stewards. Hardly anyone in Israel Railways. What's left? Lawyers, accountants, pharmacologists and doctors."

Playing doctor

Mais Abu Ata, 25, completed her studies at Irbid University last year. She is presently doing an internship at Haemek Hospital in Afula where her father, Jemal, works as a lab technician. Mais recalls her irresistible attraction to medicine from childhood. "I used to play with my friends that I was a doctor, I would bring all kinds of plants and make medicines out of them."

Her studies in Irbid were difficult, she says. The level is high. All the lecturers are from the United States and the lessons are in English, as are the books and the exams. "But it's a wonderful profession, so humane and pure. There is a great deal of pressure and I work very hard, but I enjoy it, too. I'm not sorry."

Did the atmosphere in the village influence your choice of the profession?

"Maybe the atmosphere in the village has an influence, because what happens is that when a child is young and they see that he's smart and successful, they say to him, 'If you're so smart, you have to be a doctor,' and maybe it's the way my parents raised me."

Her father, Jemal, says, "She loved this profession and wanted it from the moment she started to talk. I thought it would pass as she got older, but it didn't. She completed her studies with great success and passed the Health Ministry exam in Israel on the first try."

Meanwhile, her younger sister, Maysa, 18, has begun studying medicine in Irbid.

How does an average family manage such a large expense?

"We don't travel abroad," says Abu Ata. "Until our daughter started studying we used to travel abroad every year, but the moment she started to study I've traveled to Jordan at most. We don't go to the theater and the movies, we've given it up. I spend my vacation at home and don't buy everything I want and not everything my wife wants, and I work shifts, day and night."W