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A Culture of War

A few days ago, a 45-year-old relatively handsome but badly dressed and dirty patient came to the clinic with a peculiar accent, complaining of a burning headache. In just a few moments, he would change the way I looked at the world around me.

The Middle East is a tricky part of the world, and so is the Persian Gulf. Iran, having the privilege of being both a Middle-East country and owning the entire northern coast of the Persian Gulf, has been through a lot in the past few decades. Unlike what you might think, though, Iran has always been looked at as a safe haven in the region. That's why, after 30 years of war in Afghanistan and the first Persian Gulf War, Iran found itself sheltering 3 million refugees! That's right -- more than any other county in the world. Mashhad, where I live and study, is the major urban area in northeastern Iran and so is home to many of the Afghan refugees.

Enough of the history books for now. Let's get to the point. If you have been through your psychiatry rotation, you probably know that a great thing about it is that you can poke your nose into everyone's most personal business and get away with it. And, interesting things do turn up. Which brings us back to the 45-year-old patient. You might wonder what a headache patient is doing at a psychiatry clinic, but that's the cool (funny) thing about Iranian healthcare: patients get to pick the specialists themselves. Someone might even go to a psychiatrist for GI problems while seeing an internist for inability to sleep!

The initial examination looked like a routine tension headache, one of the most typical I had ever seen. He had a pressure sensation spreading through the forehead from one temporal region to the other. It got worse with noise and environmental stress and did not have any recognizable pattern. However, the good thing about psychiatry is that, unlike neurology, you get to go deeper than that. So, the personal questions where unleashed.

He was an Afghan refugee living in Iran as a construction worker. He had 10 children and 2 wives. When asked about it, he showed obvious signs of depressed mood and tinnitus; but, the most interesting part was his nightmares (or "dreams," as he insisted). In them, he finds himself in the middle of a battle resisting a siege and trying to organize the defense. You guessed it! This guy has been a member of the Mujahideen for the past 30 years. He has fought the Russians and the Taliban, and has been a captive under both regimes. He insists that the dreams don’t disturb him but is always awakened either by palpitations or by his wife complaining of him shouting in his sleep.

By this time, the physician was thinking of PTSD, so the personal questions continued (boy, this is fun). Obviously, the inquisitive minds of a group of young med students could not let him leave without asking about his experience as a captive. To no one's surprise, he had been tortured many times. He talked about being beaten unconscious while being interrogated by a Taliban officer and also of the Russians tying him to metal rods connected to an electrical generator (I had only seen such a thing in "Rambo," but this guy was sitting a few meters away and describing the feeling). This was no fun anymore, but the real surprise was yet to come.

I asked him about the war and the current state of his country. "I miss the war," he replied. OK. Let me get this straight. This guy's been wired up to low-voltage electricity by the Russians, been beaten unconscious by the Taliban, has spent 2/3 of his life running around valleys and mountains trying to resist the enemy, and HE MISSES THE WAR!

I can tell you he wasn't joking. He was insulted when we called his dreams "nightmares." He talked so passionately about the feel of a gun in one's hand and its smell that some of my fellow externs were tempted to try it out (thank God that's illegal here). He kept saying, "If someone came to me right now and asked me to go off to war, I would do so without hesitation."

There you have it. That's the problem with war. After a while, it becomes a culture. He is right. When all you've done since the age of 15 is shoot your enemies dead, changing your lifestyle can be difficult. War is one of those cureless diseases, which can only be prevented. Let's just hope his 10 kids don't grow up with the same culture.

December 5, 2005 | Permalink


Thanks for opening up our eyes to what it is like to practice in a very different part of the world. Your posts are very, very interesting. I look forward to hearing more about medical student life in Iran.

Posted by: MYN | Dec 7, 2005 10:02:58 AM

I do not agree that war is a disease that can not be stopped.

Posted by: Brian | Dec 7, 2005 10:20:50 AM

I am so happy that you will be sharing your experiences as a medical student in Iran through your blog!

I have found, after reading medical and nursing blogs from all over the world, that we, as doctors and nurses, have so much in common. Our health care systems may be different, but we are not!

I am looking forward to future posts!

Posted by: Kim McAllister | Dec 8, 2005 1:55:46 PM

I enjoyed too much,go on Ali,I'm looking forward to read more of you here.

Posted by: saleh | Dec 12, 2005 6:17:50 AM

Always interesting. One of the only blogs I read. Keep them coming. :)

Posted by: Robin | Jan 8, 2006 11:19:07 AM

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