The streets of lower galilea by me

Dr. Roxana and I just packed our not too sophisticated equipment to measure blood pressure, change bandages and som alcohol and left the clinic to do a house call. Sohpia is an 82 Russian immigrant that medicine desribes as a classic picture of a diabetic patient: diabetic neuropathy, diabetic retinopathy, and now having had her right leg ambuted below the knee two weeks ago. She lives with her brother who is taking care of her. We drive through the durved streets in the neighborhood of Givat Hamoreh, as the Jezreel valley faces us. "Here is Beit Or, where Down Syndrome patients and mentality retarded peopel are dropped off by their family members at the beginning of the day, to be taken care of, to do many activities, and then at the end of teh dya, their famillies come to pick them up," pointed Dr. Roxana to a house on top of one of the hills. "Here, is a beit noar. Boys that came from Russia, Ethiopia and other countries without their parents from a young age until they are teenagers stay here, study until they graduate," was her comment five minutes later.

Dr. Roxana pulled the car on the side of the road, and we walked on the street olazanarov, an old buildling number 26, down the stairs two floors, an man in his 80s welcomed us in Russian. I followed Dr. Roxan, looking at my own lab: the house. There is a sitting room, two bedrooms, a bathroom and a kitchen, very little furniture and old frabric covering the couches. We make it to the room of Sophia, and she is laying in bed, saying hello to Dr. Roxana. I continously hear the one word I recognize in Russian "Da", as the doctor puts on her cloves, changed the bandages, adds antibiotic to the woung, and chats to the patient. I take a look at the room, in front of me is a tank of oxygen near a plant, a poster of "Duet" (they must be a couple from the picture), and behind me is a closet with things packed on top of it. Da. Da. Da. Da. I take a look at Sophia, speaking to the doctor, and yet no focused gaze, a gace I am used while talking to people. The ceiling and the doctor seem to be the extent of her view. She passed chocolate to the doctor. "Practica" is another word I catch. I wonder what they are saying about me. I smile. She passed another paper to the doctor who is still busy with changing the wounds. "Diabetic retinopathy" is the first words that I read.On the way out, the brother shakes hands with the doctor, "Davina," he says. I smile, following the doctor on the way out, who chats with another lady who just came out from the apartment next door.

We walk to the building next, and go up to the second floor. Ethiopian children open the door for us, and the doctor walks purposefully to the room at the end of the house, without giving me time to eye my own lab. We see a lady in her 80s, dressed in a white dress with a pillar of color of blue and red in the front, her head is covered, and she is staring at the wall. We stand there and the granddaughter comes, speaking in Hebrew to her grandmother, asking her to lay down to be examined. The doctor was called because the grandmother was complaining of leg swelling. The grandmother does not move, the daughter comes and speaks in Amaheric to her. Having moved the wheel chair away, we approach her, taking a look at her right foor, always fearing a DVT in an old lady who does not walk much anymore. There is swelling but there is also redness- a skin infection. The doctor asks the daughter to come by the clinic to pic any fungal and steroid antoiment. The grandmother's blood pressure is 130/80. I follow Dr. Roxan, and only eyeball the three little children on the couch, watching TV.

Outside of the dark old building I am faced again by the beautiful shades of green and yellow in the jezreel valley. We drive back to the clinic in Givat Hamoreh that has been there for the past thirty years, serving its low socioeconmic population mainly made up of immigrants. Today, I saw immigrants from North Africa, Russia, Ethiopia but because of passover coming up, the busy clinic was quieter, giving me time to absorb the beauty of the Galilea that was imprinted in my memory when I was a child. I sit back and continue reading an article from IMAJ, "Chossing Primary care? Influence of Medical School Curricula on Career Pathways."

The abstract reads..."in countries in which a primary care-oriented system has developed, general practioners, family physicians and other primary doctor are the keystones of an approach that waims to achieve high quality and satisfction with relatively low cost. Despire this new trend, medical schools still produce execessive numbers of subspecialitists rather than primary care physicians. Among multiple reasons influencing a career choice either towards or away from primary care) instittiona, legislative and market pressures), the present article discusses ways in which medical school curricula may affect students in their preceptions of the role of primary care physicians. Since students are greantly influenced by the cultures of the instutions in which they train, the negative attitude of univeristy towards family medecine may negatively affect the number of students going into this speciality.

Dr. Roxana welcomes another patient, complaining of fever and a sore throat. We take a look at her throat- swallen tonsils and a stong smell comes out, indicating a bacterial cause.

My day is over, and I take a walk back to Afula, with Nazareth on top of a hill behind me, the Jezreel valley to my right and egged buses passing by. That is my lab: an Ethiopian grandmother, a Russian sister, a North African Immigrant, living in old buildings, accompanied by the flowers of april, facing the Jezreel valley. I contemplate whether I am going to walk the Afula curves I had driven through when i was a child to reach Nazareth, if I want to go to Haifa, or if I just want to lay in the grass in Migdal ha emek.