Dec 24 Medicine, Food and Berbers-High Atlas

Visiting a hospital:  My colleague from Children’s, Craig Sable is a cardiologist and directs our telemedicine program.  This includes a weekly echocardiography and consultation session with the University of Marrakech Medical School and its Director of Cardiovascular Surgery, Dr. Drissi Boumzebra.  Craig arranged for me to spend time with Drissi who invited us to his home for dinner.  We had a lovely classic Moroccan dinner which I will speak to in a moment.  The conversation was very interesting.  They have 4 lovely children, fraternal twin daughters age 16, an 11 yo daughter and an 18 month old son.  Drissi’s wife is an oral surgeon who continues  to practice in the public hospital.  The girls go to private school and have very long days and a lot of homework.  They learn English and French beginning in 2^nd grade and have a STEM based  program.  The older girls would not consider dating at this age and go out with a group of girls.  The family was very closely knit and described themselves as conservative and nationalists.  Drissi returned from a more lucrative practice in Saudi Arabia to lead the program here.  His grandfather was one of the fighters for independence in the 1940-50s.

Drissi also invited me to visit his hospital.  It was built in 1936 and looks its age.  A new hospital has been built but not occupied yet by his department because they have to get the money to buy needed equipment.  We then went to the medical school and I got to speak to a few students in French.  They enter Medical school at age 18-19 and go for 5 years and then 2 years of general internship.  They can then specialize.  They were studying for finals using powerpoint printout.  There were about equal men and women I saw in the library.

It is interesting that the philosophy has changed about sending trainees to Europe or the US for advanced training.  Drissi points to one of his residents who has come from Benin and will be the first cardiovascular surgeon in that country.  If he went to the US, what use would he have for learning heart transplant surgery or other of the complex operations that could not be realistically done in Benin.  So now most African countries are developing a collaborative network of training the practical skills most needed and sharing this knowledge and training.  This also makes a brain drain less likely to occur.  The question is what will happen when Europe and Africa are physically connected.  It is only 14km across the Straits of Gibraltar to Spain and they are moving forward with plans for a tunnel/bridge to connect the two continents.   

Salaries of physicians are not very high and it is interesting that all specialties get paid the same.   So Drissi as a cardiovascular surgeon earns the same as a general pediatrician working in the public hospitals/university hospital.  Although he does get and additional $138/month for being chairman of a department and having major administrative and teaching responsibilities!  Also, there is a mandatory retirement age of 62, increasing shortly to 65.  There is clearly a need for more physicians but there is the loss each year from the retirements.

Finally, we visited the emergency department which was packed.  However, I saw one patient go in and 20 of his family members accompanied him so it was hard to tell how many patients were actually there.  There are specific visiting hours so there was a long line of family members waiting to get into the hospital at 4pm when the doors open.  I should note that all the signs we have seen in Morocco are in French, sometimes with English below.

A classic Moroccan meal: We have had a number of these meals since arrive but nowdays they are reserved for special occasions.  You start with almonds and raisons with a juice drink (fresh orange-mango).  This is served in the sitting room.  You than move to the dining room where you recline on couches and mezze are served.  Last night there were 10 small plates including olives, a sweet relish, eggplant, peppers and tomatoes, carrots, zucchini, small envelops of filo dough filled with lamb or cheese.  Then the main course: a pastille of pigeon and a tagine of lamb.  The dinner ended with sections of orange sprinkled with cinnamon and confectionary sugar and small pastries. 

Karen: It has been four days and we have been served variations of the same dishes every day. The tagine can be chicken, lamb or beef. Most of the time we are served lamb tangine.   The other dish we are served is pastille which is filo dough stuffed with chicken or pigeon, with ground nuts, topped with cinnamon and sugar. It’s quite good but not for lunch and dinner every day. They don’t call the appetizers mezzas but they are similar to middle eastern mezza.  So far there has been very little dairy, so no yogurt dishes.

Most women we have seen have covered hair, and caftan kind of dresses.  I’ve also seen young women with covered hair and tight jeans, which seems kind of weird.  Seen lots of houses that are ochre colored and look similar to our adobe.  Also lots of cactus which are in the middle of other trees, which is different than what we see at home.

We had purchased a phone plan that was supposed to work in Morocco, but it doesn’t, so no I phone which is causing some withdrawal but also some peacefulness.  Lots of olives here, but so far I haven’t found them as good as Greek olives, and for those of you who know me I do have a fondness for all things Greek.  Seem lots of olive trees. Their oil which is supposed to be good (every country says theirs is the best) needs to be diluted with water because otherwise the taste is too strong, We had Argane (oil which is what morocco oil for body and hair is made of. For actual eating it has a strong almond taste because it’s made from ground almonds. We bought it at a women;s cooperative, which of course I wanted to support. We bought some of the oil mixed with honey for eating and it was extremely expensive.

High Atlas mountains:  They are a “new” mountain range and as noted previously are connected to the Pyrenees and Alps so the separation of continents is actually not real-it is just that water is covering the mountains between the land masses.  In any case they are high but not as majestic as other ranges I have seen.  They are mostly clay with some date palms growing in the valleys.  There are few trees because of the Arad land and desert climate.  It still feels somehow inconsistent to see snow in Africa.  We are not seeing animals or birds here, other than mountain goats.

Kasbah: I had thought this meant a mansion but it actually means a fortress.  We visited one from the 16^th century built into the mountain side.  There is a chief of the clan who is in charge and there are sections to the fortress including a ghetto for the Jews, called the melea.  These fortress were built because of the almost constant invasions starting with the Phoenicians in 400BC, the Romans in 50AD and then the Portuguese, Spanish, French and everyone else from various African countries.  Where these Berber people came from remains a mystery and it seems likely they ended up here from various places.  The Berbers in the High Atlas are tall, often with red hair and blue eyes, probably coming from Europe; the low Atlas Berbers are small and darker, middle eastern looking.