PHYSICIANS IN ALEPPO

PHYSICIANS IN ALEPPO

First I want to apologize for not posting for the last several weeks, we had a sickness in the family but things are back to normal Alhamdulelah


Now back to posting,

We have reached to talk about the private sector in Medicine in Aleppo

We have always heard the rhetoric that Aleppo is saturated with physicians and today I will try to clarify that point

As we have said before that the population of Aleppo City itself is around 2.4 million although the majority of People living in greater Aleppo do depend on the city itself for at least there advanced medical care

  

Below is the numbers of physicians currently registered as practicing in Aleppo in different specialties (up to 2010).

to give some meaning to those numbers I am comparing them to the numbers in Cleveland Clinic Health system. As you know CCHS covers the are of north east Ohio where 2.2 million people live, and at best the CCHS covers 75% of the need in that area, so this resembles the population of Aleppo City (although as I said on all practical levels almost the whole 4 million people in greater Aleppo do seek medical care in Aleppo at some point)

(the number in CCHS is obtained though there website keeping in mind that those numbers do include nurse practitioners and some shared physicians between different departments)

Number of physicians:

                                                Aleppo                       versus                        Cleveland Clinic

Internal Medicine                        278                              -                                  159

Cardiology                                  61                               -                                   158

Lab.                                          196

Pulmonary                                  26                               -                                    56

Thoracic surgery                        27                               -                                     44

General                                     183                              -                                   73 (family physician)

Neurology                                 32                               -                                   106

Neurosurgery                           22-                                                                    30

ENT                                         91                              -                                      49

Rheumatology                          14                               -                                      37

Gastroenterology                     37                              -                                        60

Gastro-surgery                        21-

Endocrinology                        15                              -                                         46

Nephrology                           12                               -                                        31

Urology                                82                               -                                         80

Anesthesiology                      29                               -                                       221

Pathology                             11                               -                                        35

Plastic surgery                      20                               -                                         15

General surgery                    224                                                                       45

Ob-Gyn                              238                            -                                         101

Psychiatry                           14                              -                                           58

Pediatrics                           253                             -                                         221 (mostly-subspecialty)

Pediatric surgery                 13                              -                                         12

Orthopedics                      150                            -                                          101

Dermatology                      74                             -                                          49

Ophthalmology                 91                              -                                            48

Hematology-Oncology     18                             -                                             37

Radiology                        100                           -                                            177

So what does that tell us?

First that with the exception of Pediatrics, Ob-Gyn, Gen Internal Medicine and Gen Surgery, all other sub-specialties are much underserved. And even for the ones that are served, remember that we are only comparing with CCHS and we are not talking about the quality yet. So the bottom line I do believe that regardless of the specialty we are talking about it is needed

Second is the issue of distribution

there is what I call the east-west phenomenon. Most general specialties (pediatrics, IM etc....) are distributed in the eastern part of Aleppo (which is more condensed) and the more specialized the physician is the higher the chances that he moves to the western part of Aleppo (see the attached picture where I plotted all the Hematology-Oncology doctors in Aleppo with red dots)





As it stands right now, almost all of those physicians are practicing in a single specialty clinics style, and although the medical center law has been around for several years but only dentists have actually taken advantage of it (compared to Damascus where multi-specialty clinics are picking up pace)

Obviously many factors do play roles in the mechanisms of choosing a place for a private clinic but in general the are certain rules:

1. following the dense population: the most famous examples of this include

• قهوة الشعار: This providor for health care in the eastern part of the city
• شارع سيف الدولة where this serves the whole area of south western and southern parts of the city and this a very very condensed area

1. Being accessable and near public trasportation: this is a very important factor, we have to remember that not all people have cars and that Taxis are not cheep (example, if a person lives in الميسر and wants to go and see a doctor in حلب الجديدة then this is an extra 100 SP on the top of the consultation cost). The most famous examples would be the old and traditional center of the city concept 9العبارة - الجميلية- العزيزية ) where for a long time those were considered the hottest areas for clinics. Then with the movement of the كراج الشرقي  which is the landing station for anyone coming from the eastern part of greater Aleppo and further (نبل - منبج ) hd been moved to قهوة الشعار that boosted the market there
2. Serving people with similar ethnic back ground (armenians in الميدان )
3. Being near a Hospital (mainly private hospital) and this is usually when the physicians owns shares in those hospitals and they want to be near it (the exmaple would be the physicians sharing the Al-Shahba hospital who moved near that area even though it was considered a Helath Market)
4. And Fianlly Emerging areas where they share several of the above mentioned factors, the most famous would be the AL-Razi Street and سوق الانتاج area. This is curretnly the hottest are for physicians, and considered the new الجميلية if you want although it a much higher scale. And still very accesable by public trasportation

One thing to mention is the fact that it is hard to defy the rules of the Market. for instance, although the شهباء area has the highest level of living standards if you want but it is not a health care providing area and altough many doctors can buy there and open if they wanted to but usually they dont and we have some examples for people who tried and failed,

this is only my personal opinion

The Health Sector Sservices In Aleppo - 1

First, I apologize for delay in posting; I have been in a couple back to back conferences and had a deadline to submit medical software I was working on.

Starting on this post I will try to cover all different aspects of the health sector in Aleppo.

Let us start with Hospitals:
As you know there are several categories for hospitals in Aleppo:

1. Governmental –

1. related to the Ministry of Health-:

مشفى زاهي أزرق: /120/ سرير

مشفى الرازي/ 200/ س

مشـــــــفى ابـن الـرشــــد /44/ سرير

مشـــــــفى ابـن الـرشــــد (( جراحة القلب : 140

مشـــــــفى التوليـــــد /100/ سرير

مشفى حلب الوطني (not sure about # beds)

مشفى العيون/ 60 / سرير

مشفى الأطفال التخصصي/120 / سرير

مشفى أبن خلدون للأمراض النفسية

Total beds= around 1000 +


2. Related to Ministry of higher education

مشفى حلب الجامعي (603 سرير)

مشفى الكندي (362 سرير)

مشفى التوليد و الأطفال الجامعي (175 سرير)

مركز جراحة القلب بحلب (75 سرير)


Total beds= around 1100 +

3. Others:

1. مشفى شيحان part of labor union

2. Private sector Hospitals:

Cannot mention them all, you probably know most of them. In another post I will dedicate one post for the “Syrian Hospital” which I think is worth discussing more.

Total number of private hospitals in Aleppo: 83 (YES 83)……….(this include all the charity hospitals as well)

I don’t have an accurate number of beds for those hospitals, but as most of you know the vast majority of those hospitals are small hospitals with around 20 beds total. For the sake of this discussion we will presume that each has 30 on average (this is a very optimistic guess)…so the total number of beds would be = 2490

The following is a map for all health services in Aleppo City taken from the Ministry of Health website.

Given the above mentioned number, and at best, the total number of hospital beds in Aleppo is around 5000. Given the number of Aleppo city inhabitants are around 2500000, so this brings the ration to 1 hospital bed for each 500 individuals. Although the number is even higher since as mentioned in the previous post a good number of the other 2.5 million in Aleppo Governance do depend of Aleppo city itself for their medical care. And also, here we are discussing numbers only; we have not really gone much into the quality, which (mainly in private hospitals) have a great room to improve.


Not to compare, but the ration of (population to hospitals beds) in the US was 3 TO 4 beds : for each 1000 per WHO data in 2006.




Next post: Detailed picture of physicians

Why Aleppo City? Not only because my city

It has been said that the natives of a place are the least who actually know about the same place they have been living in for almost all their lives. I have to say that I do believe this is, at least partially true. Our knowledge of Aleppo is mostly based on a collection of memories ad life experiences that will most likely reflect the true nature of the city. It get even worse for those who left Aleppo years ago and live outside and only visit from summer to summer only to stay for 2-3 weeks period…….

I will try in this post to shape a general description of the city –demographics point of view) - in the next post I will shed light on the current status of the health sector in Aleppo.

Aleppo governance has a population of a little more than 4 million, which is the largest in Syria (based on 2004 census). A little more than 50% are males, with a total number of families of 705000.

Aleppo consists of several “مناطق" -municipalities-” (FIGURE ONE)which include:

1. منطقة عين العرب

2. منطقة جرابلس

3. منطقة منبج

4. منطقة الباب

5. منطقة دير حافر

6. منطقة السفيرة

7. منطقة اعزاز

8. منطقة عفرين

9. منطقة اتارب

10. منطقة جبل سمعان

11. مدينة حلب


Aleppo city itself has a population of some 2.4 million (which means the rest 1.5 million live in the other municipalities). But as you all know, the total 4 million are frequent visitors of Aleppo City with good number of them depend on Aleppo Health System in case of sickness.


Important numbers to understand the composition of Aleppo City itself:

• Total number of families: 462000 families

• Percentage of population less than 15 years old: 40%

• Percentage of population between 15-65: 57%

• Percentage of population above 65: 3%

• Unemployment percentage: 7.43%

• Percentage of people with a regular paid job: 63.39%

• Percentage of people with a governmental job: 21.08%

• Median number of persons/family: 5.37

• Illiteracy percentage in people >15 years age: 17.29 %

(More than 20% of females >15 years old are illiterate)

• Percentage of population with higher education: 5.24 %

(College and University Education)

If you are really interested you can get more numbers on the official website of The Central Bureau of Statistical Tasks: http://www.cbssyr.org/


Looking at such numbers is important, especially if you are planning to start a “health sector project”. As we will see in the coming posts how to use such numbers in defining your brand values and the whole branding effort.

For me the most important conclusion from those numbers the huge need for medical services in Aleppo Area. You have around 2 million “baby boomers” if you want, within the next 5 10 years they will be flooding any health system providing services for adults. On the other hand, it has been reported that the annual population growth rate in Aleppo has recently dropped to 2.9% per year with projections for a further drop to 2.6% over the coming decade.

Other important aspect to look at is the current population density in Aleppo City, although I will cover this again when I discuss where to choose the place of your medical facility. Almost half of the 2.4 million people living in Aleppo are estimated to live in 22 informal settlements (IS) of different types and sizes. The city grew dramatically in the 1970s and early ’80s largely through migration from small towns and rural areas mostly in Eastern Syria. Those (IS) are in general highly dense areas and are usually under served areas when it comes to medical services. (Figure 2)  (GTZ website)




In my Next 2 posts I will discuss the current health system and available services in Aleppo.

Moving, Why Now and How

First, I have to apologize for the delay in this post, I have my parents visiting and It has been a little busy.

Second, I know that some of you following may be getting a little board with my personal story and want to get quickly in the relevant information; but as I said before; I have to mention this background in order to set the stage for what is coming next.
We have reached to where I am now, a Consultant Physician (Hematology-Medical Oncology-BMT) at a major referral center in Saudi Arabia. I consider myself successful in what I am doing but I do believe my personal growth potential will eventually slow down.

My options for now are either:

1. Why bother, continue doing what I am doing (what you better than what you don’t)

2. Consider moving to a different Hospital, but same setting

3. Consider Moving back to the US (I have been contacted several times by my original center in the US to consider coming back and working there), at least now my visa is less of a problem

4. Finally going back home

For option one, I presume you already know my take on that. But, If i was 10 years older and had to take the same decision I would probably opt to take this option. As we get older other factors start playing a more important role in our decisions (such as our kids, social stability, financial stability, our risk taking ability), and putting the whole picture together I think my situation would be ideal (given other options in the region). This is not only a personal analysis this more like an observation, I know several excellent Syrian Physicians in their 40s - 50s who although not 100% satisfied with their jobs in the Gulf Region but don’t want to take the risk of going to another situation which is a little more hazy. But for now I consider that if I do so I may end up with burn out syndrome earlier than I thought.

For option 2, that is not a bad idea. Moving from one place to the other in the Gulf region improves your chances of climbing up the ladder of Administrative Responsibilities (for example eventually finding yourself a head of a Department). But on the other hand, there are many downside of this. First, we are not talking about the US here, there are sometimes considerable differences in the quality between different hospitals, and the good ones are very well know but they are very few, so just being a "Department Head" is not that impressive if you were practicing in a bad place. Second, you local experience will never be taken with the same weight as someone coming fresh from the west (you will not be surprised that after 10-15 years of experience in the region there will be someone with less experience but just coming from the US would surpass you). Finally, moving in the same country is not always easy, there are some "restrictions" regarding switching employers and shortly, if your previous employer wants to complicate your move to the next one he can.

For option 3, that is a difficult one to decide about. You when I think about it the most? This happens mainly when I go and attend a conference. In International conferences there are two types of attendees; the majority (people like me) are listeners who the drug companies want to talk out for dinner so we would prescribe their medications, and the other type (the minority) are the ones setting at the podium who are "the talkers" who most likely look at the listeners as a bunch of lazy physicians who care mostly about the dinner they are going to have after the lecture. I hate the feeling of being a "listener" and many times it comes to my mind that the only way to be a "lecturer" is to go back to the US. In the medical systems Gulf region there is "inferiority complex" for physicians coming from the west, we get many of those visiting professors who whatever they say is taken is a "holy script". Well, maybe I am exaggerating a little bet, but there is a part of the truth in that. I have to add though that on a regional level you would get the opportunity to be the "lecturer" if you work in a good place and have connections. So why cannot I go back? Simply, because I cannot. I cannot do (not physically but emotionally) I don’t have the enough guts to take this decision. I remember back when I was out of medical school coming to the US for specialization was a little difficult decision but it was like a "given". But now I find it difficult to "justify" the amount of pain I will cause for myself and people around us to take this decision. My parents, my kids, my wife and all the people who I feel are in need, I cannot......

So, we come to the last option.........this is the riskiest of all, it is the one that I am not really sure where start from. I am going to propose a theory; if you ask anyone about going returning to Aleppo to work, the statement will be most likely posed in "returning back"; I guess that is were part of the problem is. We think of this as a step "backwards"; is a "Regression" and a sacrifice we are doing. So most people believe they are giving up a better situation and downsizing for a lesser one because they have to do so for their "parents, kids, etc....). I believe that is wrong. The minute we start thinking it about i those terms that is the minute we will be heading for a failure. "EMOTIONAL DECISIONS" enigma last only for a short period of time and will never be a driving force on the long run. I will prose calling this return "moving forward to Aleppo"; let us think about it as a step forward, a move that will help in our personal and professional growth. The growth and success will not necessarily be "financial" or "academic" but it could be something else. We just have to study all aspects of possible growth opportunities and try to build a scenario of a successful move.


This is what I am personally trying to do, and the minute I started thinking about that way I start seeing things I was not seeking before and most important my level of anxiety has lessened. During this journey I will explain how I reached that point and what the things I found are.



Next post

"Why Aleppo, in general as a city not only my city"

My Saudi Arabia Experience

Now, and after spending more than 3 years working in Saudi Arabia (KSA) I guess I can summarize my experience in a way that can benefit others.




We have to agree though, that life experiences remain personal and unique and are totally "in the eyes of the beholder". For those of you know me also know that I have spent most of life in KSA. I came to KSA when I was 6 months old (obviously with my family) and stayed here until I finished my high school; after which I left only to come back again to work. Both of those experiences are different and I cannot it really make any connections between them. I will focus my observation on the most recent experience.



Also, another general rule when evaluating a life experience has to do with our tendency to fall in the trap of "comparison" rather than "objective Evaluation" and that is where confusion and contradiction start. Comparisons are a very bad way in evaluating anything in life in general, and it is even more when you want to evaluate complex structures such as a life experiences.



So for an "objective Evaluation" of this experience I will cover the following Domains:

1. Current Work Experience

2. Professional growth potential

3. Financial

Other Domains that have to be considered when moving to a new place include:

1. Social-Familial

2. Personal

3. Same factors in relation to spouse

Those are really personal and vary between a person and another and cannot be generalized



• Let us with my work experience.



I have to start with this because I can feel how important it is. The satisfaction that you get when you serve in a place when you are “needed” is immeasurable. When you see how a patient prays for you because he feels that you gave him/her something that he could not find at any other place……….this feeling – I can testify for that- is even greater when you are in Syria, it is the “NEED” factor.


As I have mentioned in my previous post, when I came to Saudi Arabia I did not even have my Hematology-Medical Oncology Boards with me. That meant I would not be eligible for a full consultant level (you should have a specialty Board and a 3 years experience beyond the Board). So I had to compromise, and that was a little tough in the beginning. In that position I had to accept to work “under” other physicians whom I considered at a “lower” level of competency. Although as soon as I passed my Board Exams I got promoted for a full Consultant Level for the reasons mentioned below.

With no other option in site I had to figure out how to solve this and fast. And the most efficient and time proven method is “working harder”. The nice aspect of working here is what I call “easy competition”. I remember my days back at the Cleveland clinic how it was a little challenging to compete with others who are already functioning at their extremes. Will, here it is different. Maintaining a step ahead of others is not hard. Don’t get me wrong, obviously it is not a piece of cake but not impossible.


As physicians, and for many different reasons, our most valuable “merchandise” is our “clinical competency”. You can be a great “researcher” or a brilliant hospital administrator; but without a distinguished “clinical competency” you will not get the full benefits of being a physician. It is the most important tool to help our patients and for others to learn from us. Working to improve my clinical competency was feasible since our hospital is the major oncology referral center for the whole western KSA. The number of patients, complexity of cases and our resources are all advanced compared to other hospitals. I tried to establish myself as a reference in Lymphoma (not forgetting other diseases) since first I do like lymphoma and second I noticed it to be a common disease. Within relatively a short period of times I succeeded in achieving this. I was trusted in my hospital in that regards and I started being known on a national level in that regard as well. The nice thing about working in one of the major Governmental Hospitals in KSA (King Fisal Specialist Hospitals-Riyadh & Jeddah, National Guard-Riyadh & Jeddah, and King Fahad Medical City-Riyadh) is that you have the potential of being known on a National Level. You get to give lectures in National Conferences, Accept referrals from others, others calling you for your opinion, patients hearing about you and seeking to see you directly and drug companies seeking your satisfaction.


The other aspect which I liked about my current position is the opportunity to learn some medical administration stuff; and I am especially referring to Quality Improvement in Medicine. I had no prior knowledge in QI and I had to learn my way around. This is a unique opportunity since the QI field is a growing field in hospitals at the Middle East and there are not many people with QI qualifications around so many hospitals do give opportunities for their physicians to participate in this effort. The major hospitals I mentioned above are leading in the region with this effort and the ways I see the future is that many are going to follow. There are many sources and courses you can get over the internet; I specifically guide you to the Institute for Health care Improvement (www.IHI.org) which is the front runner in QI-medicine. They do offer many online courses (some for free) and for people living in the US, they do have many live courses. I encourage people to get some training in this and practice it if they can; it will be in very high demand in the Middle East in the short future. During the last 3 years I have foreseen several QI projects (some I designed by myself) including treatment guidelines, drug utilizations, improving medication safety and development of clinical pathways.

My hospital is a teaching hospital (medical students, residents, fellows) and interacting with them taught me that teaching others is a very nobel thing to do and it would be a major source of satisfaction on the long run.

Finally, I had the opportunity to explore and learn about the field of Health Informatics developing medical software, but this is a story by itself and I will devote a whole post for this story.


As you can see, what I mentioned above is “positives” or things I learned, but life is not all pink and I am sure you all have heard some “stories” that are negative. But as I have mentioned in my first post; I will try to lean toward positive thinking.


• Professional growth potential

This is an important thing to consider for physicians and in any setting. It is not only about what you are doing now nut where would you be 10 years from now. In my view’ this is the major weakness when it comes to working in the Gulf region in general. All the effort I have mentioned above may not necessarily translate into an objective professional growth. I guess if I remain in my Hospital 10 more years and put the same effort I will not be much different from where I am right know. I am not talking only about my salary but you know this factor that they use to weigh different scientific journals and they call it “Impact factor” I believe that each one also has an impact factor and your professional growth is measured with this impact factor. The individual impact factor grows by two ways; the growth of the institution in general and the personal effort. Well, here you will grow with the growth of the institution but not necessarily with your personal effort. I have to say the within the coming 10 years there will be significant growth in the health care institutions in general in the whole Gulf region and that fir sure will reflect on the people working for those institutions but that is a different talk by itself.

The problem is simply due to this thing called “this is an equal opportunity work place” which what makes the US different, well in the Gulf region it is the opposite. Many other factors are taken into account when it comes to promotions other than your achievements.



I would site this number one reason for wanting to move on for another setting



• Financial

I will not dwell much into this point, I am sure you all have an idea about that income range in the Gulf area. I just have to mention some points:

o Unlike the US, there are not that many differences between different sub-specialties when it comes to the salary.

o The average basic salary is around 10-11 K USD per month, tax free, and the differences between one place and the other is mainly in other benefits (i.e. paying the children school fees, how many tickets per day, do they have private business patients,)

o Life here has become gradually expensive, and although what you make is more than enough to live a very high quality life but to save something significant is something different.



As I said above, there are other domains to think about before you take a decision to move to the Gulf area, mainly the personal-social-familial aspects. Those are also complex to measure and think about and certainly you could not generalize any ones experience in that regard.



I only to have to mention one thing, being in Jeddah made us close to Makkah and, you could imagine, is something that surpasses everything else. You ability to ride your car and be in AL-HARAM within 35 minutes (exactly the time needed from me to reach to AL-HARAM from my place) is indescribable. It played a major factor in making me accept everything else, and I thank Allah for this blessing.

I am also eager to hear from others who have or had a working expereince as a physician in the Gulf Region

Next post will be about “why to move on now and how”

How It all started

In 2006 I completed my hematology-medical oncology fellowship from the Cleveland clinic. I was on a J-1 visa and I found a waiver a multi-specialty clinic in western Pennsylvania. We were going to live in Pittsburgh and my wife was supposed to transfer to Pittsburgh University in order to finish her BA-education. Like many of us, I was looking forward for this new life, we even went ahead and put a down payment to buy a house. We planned everything, from the house, to the furniture, the cars, and most important the details of my work. But, also like many of us, this always comes with this sensation of feeling “uncomfortable” and wither or not we are doing the right thing. I am not sure how to explain this feeling and why do we get it, we like to say it stems from our love and obligation towards our parents; but you can try to philosophy this more and look deep inside our “psychological” composition. An “un-debatable” fact is that “immigration” is not only a “normal” human behavior; but also, “immigration” was the force behind a majority of recent human advancements. But I have also noticed that myself and many of my friends do spend a considerable time and effort “psychological and emotional” debating this point, we even started looking into different resources to help us decide. I remember myself digging inside the “Islamic literature”, reading others` experiences and asking people who walked the same path; only to look for guidance in my decision. But as I currently believe, we usually first take the decision and then we look for the evidence to support out decision. We only look for this evidence in order to deceive ourselves that what we decided was not only our decision BUT it was the “right decision”. It helps us to lower our “regret”.


I guess another defense mechanism I used was to decide to take a vacation to go to Syria prior to starting this new life. I gave myself 4 months off hoping that this was going to be enough to obtain the visa to come back. This is something I say for the first time, when I left the US I felt inside me that I will not be returning back. It is a feeling that I could not explain, I felt that something inside was telling me “Sorry, I know how much effort you have put in this move but it is not intended to you and you know what you have to do; you should not run away from it”. When the airplane was taking off Cleveland this voice inside me was so loud that my eyes started tearing like a child who did something that he was not supposed to do and was standing in front of his mommy feeling remorse and regret. Even now, 4 years later, I still can feel this inside me as I am typing those words.


What I expected actually happened, I applied for my visa and 4 months later we heard nothing. I was living at my parents house, spent almost all my money, just missed my Board Exams, And I have a house at Pittsburgh that was waiting to be custom built. This is where a backup plan is always nice to have. Prior to me leaving the US I got in contact with Dr. A. J. who was moving to Riyadh-Saudi Arabia as a chairman for the Hematology-Medical Oncology Department at the National Guard Hospital. I called him from Syria and expressed my interest in doing 2-3 months Locum (hoping by that time my Visa would have been issued).

3 months passed in Riyadh, and yes, no visa arrived. The hospital in Riyadh was good, in fact the system is very close to what you may be used at in the US. But for me living in Riyadh was a problem. On one hand, my wife will lose the opportunity to finish her studies, since there are no private Universities for females in Riyadh. Like many decisions we take in our lives, we can always trace the roots for one single event “the tipping point”. Will, for me that was when I went to Ikea in Riyadh. For you who know Pittsburgh; also know that there is an Ikea store there. Our future house was just a walking distance from that Ikea. When we were going often to Pittsburgh for various reasons the most that we would enjoy is the moment when we go to Ikea, set at their restaurant and enjoy the nice scenery of Pittsburgh hills. The memories of that scene in my mind are connected to sunshine, feeling fresh and a lot of green color. Will in Riyadh the story was different. One day my brother, who lives in Riyadh, took me and his family to Ikea to have dinner there and the simplest way to put it “I was shocked”. There I found myself strangled in a small cubicle (probably not more than 2x 2 m.) separated from the surrounding with partitions, staring at the food in front of me and hearing babies in the cubicles around us crying. Next day I went to work and told them that I want to stay in the National Guard Hospital but I want to be transferred to Jeddah; I put the main reason as there is a private University for females in Jeddah which offers a BA – Education (obviously did not tell them about the Ikea story).

It was the right decision, since simply my visa took 22 months to be issued……..

And , alhamdulelah, although I missed my Board Exam the first year but the year after was the first time the ABIM started offering it outside the US, I did them both (Medical oncology and Hematology) and passed.

My next post will be about “living and working in Saudi Arabia). I will cover it all in one post just trying to highlight

What is this and Why

بسم الله الرحمن الرحيم

I have never bean a big fan of people who write their memoir, I always thought that a person`s life is something that can never be transcribed on paper, and the minute it is; it becomes a prisoner of those words and it runs the risk of destorting those esperiences in ways that were never meant to be.

On the other hand, events that happened to me over the last 4 years had left me in a position deprived from some of my closest friends and people who I used to share those thoughts-expereinces. This "sharing" process played a major role in shaping who I am as a person, and the way others currently see me is explained, at a large part, by previous acts of "human interactions". Unforutnatly, most of this "luxury" has been down-sized to a phone call done through a crappy service provider "by the way, I have read several times before in many of coolshababs E-mails, how people are discussing the best long distanse phone service provider and NO one mentioned how the people at the other end hears him/her.....I can now feel how my parents used to feel when I used to talk to them from the US" or through an E-mail where I try to find the "best" words to inject my emotions into, but most of the time I fail. (this has some few execptions like our recent VERY SHORT get together during hajj).

I describe myself as a "data driven" person, ORDER is what gives us comfort, predictability "even for things that we dont like" makes us feel safe; it is only unfamiliarity that brings pain and confusion. It is this "hazziness" that I think plays the major role in holding many people from coming back to work and live in Syria.

I have taken the decision to go back to Syria almost 8 months ago, and during this process I have tried to get the best "data" availabe to guide me through this process, and when this data was not readily avaialbe I would try to look for it myself; the propose is to make the best informed decision in every diffrent aspect of moving back home. The process will cover everything from work, home living, schools and social life. Many of the events have already occured and will only be documenting them retrospectively and as we move along we will be matching what is currently going on. I am starting this post 6 months prior to my planned moving date and my plan is to run it for a total of 1 year (so 6 months before and after). I will be posting once weekly (each friday) and more often if needed.

The main purpose is to make this a rich and informative post where we can discuss diffrent issues that are related to people with situations similar to mine. I will share with you all my expereinces, with most of the "objective data" I was able to collect and I will be asking your help in taking some of the decisions and open to your suggestions.

Finally, I try my best to maintain a positive attitude and try to look for the full half, this will not be a post for negativity or pessimisim and if you are one of those I am sure you will find MANY OTHER resources over the internet to fullfill your satisfaction.

thanks for following