University of New England

“While Empty Barrels Shout”: Firas Naji, '10

[Editor's Note: The following profile originally appeared in the October 2007 COMmunicator]

A man in Syria contracts a disease.

Let’s say he has Type II diabetes caused from the exploding fast-food market imported from the United States. He’s reluctant to visit the public hospital because a rumor has spread that a visit to the hospital means certain death. Doctors there earn less than the local garbage man. So he waits out an illness he knows nothing about until his legs become diseased and gangrene threads its green cauliflowers up his calves and then he finally goes to the hospital but there is nothing they can do. So he dies. In the hospital. And his 11 brothers and sisters suck their teeth and tell their neighbors, “He died in the hospital, you know,” and the neighbors all swear that they would rather face torture than go there. 

Firas sighs. “You see, then, that the problem is not the actual state of the healthcare system in Syria, but the lack of proper education of the public.” Most of his extended family lives in Syria, and Firas is working on a Master’s in Public Health from UNC and will soon earn his Doctor of Osteopathy from UNECOM. “I think I can make a difference,” he says. “It is my duty to relieve suffering, both as a doctor and as a Muslim.”

Streams Like Jade

Sometimes it takes an effort to figure how UNECOM, tucked as it is on the coast of Maine, might engage a global role in healthcare. Other times, engagement comes walking through the door. Firas Naji is a second-year medical student who puts a friendly face on the concept of globalization. The ethnic Syrian from Raleigh, North Carolina, attends medical school in Southern Maine and intends someday to apply what he’s learned here to practice medicine in Syria. Last summer he completed research in Damascus and started a club on Facebook for Syrian youth who want to revitalize the ancient country’s crumbling healthcare system. The “Syrian Youth Development and Revitalization Association,” or SYDRA for short, is a non-profit group that Firas sparked with a simple question, “What would you change about Syria?”

It is worth mentioning first what is right about the country. Western media have done a fine job of presenting an imbalanced view of the region, Firas believes. While newspapers talk about Syria’s support of Iran and Hezbollah, they rarely highlight the cultural treasures and natural beauty of the state. Streams the color of jade course through the valleys, while ancient villages inhabited since biblical times perch upon hills and stone walls tumble beside groves of olive trees. Steam and spice fill bazaars as merchants sell kabobs, colored cloth, glassware, electronics, and yogurt. Hibiscus and bougainvillea adorn roadsides and gardens. To Firas, the climate is home and Syrians are friends and neighbors. “There is a preconception that the Middle East is unstable and shaken,” he says, “but I have gone to Syria every other summer since I was a child, and their people are no different than the people here.”

Most Muslims, says Firas, are generally concerned to live dignified and pure lives, with refined morals and high family values. His own family is large - each parent has at least half a dozen siblings - and many relatives are either physicians or engineers. Education is highly valued in Islam, Firas says, since seeking knowledge is a sacred duty of all Muslim men and women. Many Syrians are also socially conservative, including Syrian Christians, and they eschew questionable dating relationships. A moral lifestyle promotes hard work, Firas says: “If you don’t have to worry about dating or pop culture [as a young person], your priorities become your education and personal morality.”

Firas’ family emigrated from Syria in the mid 1980’s. Firas himself is a particularly observant Muslim who holds to an interpretation of Sharia law that includes a kosher diet, regular prayers, personal piety, and the acquisition of merit based upon good deeds. He finds that his classmates at UNECOM are open to learning about other faiths and are supportive of him as a person.

His father is an ER doc who performed his residency in Wilkes-Berry, Pennsylvania. Firas first decided he wanted to become a doctor after observing his father and talking with his physician friends: oncologists, anesthesiologists and family practice doctors. “We should all use our God-given gifts to help relieve others’ suffering,” he says. “Islam encourages you to relieve another person’s suffering or hardship, not only because that is righteous, but because it makes you more humble, more grateful, and strengthens your love for God.”

Laurel Soap for Errant Knights

Ethnically mixed, Syria is 70% Muslim, 12% Christian, and 18% other minorities including Jews, Yazidis, and Druze. Its capital of Damascus is the oldest continuously inhabited city on the planet. Firas once visited Ugarit, where the first recorded alphabet was developed. Small villages throughout Syria still cherish relics and artifacts from the Roman Empire and before. In fact, the village of Malula is one of the last places on earth where Aramaic is still spoken - the language of Jesus.

On the border of Turkey, in the 2,000-year-old Armenian village of Kassab, Firas encountered villagers who spoke five languages. Their family-owned businesses, dating back 400 years, produce olives and some of the best soap in the world, made from laurel leaves. In fact, it was at Kassab that Crusaders from Europe were first introduced to soap during the 11th century. Personal hygiene has rarely been a strong suit of men in mail.

Syria is hot in August. Many people take a siesta in the afternoon, then stay up late in the cool of the evening. “Once, I went outside at midnight in my pajamas to take out the trash,” Firas recalls, “and I thought, ‘No one will notice.’ But when I reached the street, it was like midday with all the people.” He feels that most Syrians live pleasant, social, and simple lives.

The Echo of Emptiness

Not that the Middle East is without complication. The fact of the matter is that both East and West have grappled with each other in the Age of Globalization, and the skirmishes have left their wounds. Some, of course, are gaping. Americans point to the blistered side of the U.S.S. Cole or the iconic images of a jetliner dissolving into the reflective glass of the World Trade Center’s South Tower. Many Muslims note the civilian carnage and instability wrought in Iraq during the Coalition occupation, or the seeming unconditional support of Israel during its pulverization of Lebanese infrastructure last summer. For each of these events there are conflicting voices, alternate interpretations, and plenty of anger to go around. Most sane people view all of it as an ongoing tragedy.

Sound remote? All of this becomes intensely personal for Firas, who - as an American with a Syrian heritage - seems caught in the middle of a culture war. It is a painful reality that his native country seems often misperceived by Western media and governments. “They think that all Muslims are the same, that what the Taliban does and what al-Qaida and suicide bombers in Iraq do are what I would do,” he says. Firas has large brown eyes and is soft-spoken and almost apologetic in conversation.

“There is a proverb that says, ‘An empty barrel makes the most noise,’” he reflects, “which means that the person with the least knowledge often makes the most impact or causes the most harm. Suicide bombings disturb me. That is a corruption of Islam. You are only allowed to fight someone who attacks you. In war, you shouldn’t even cut down a tree.” His voice, soothing in its argumentation, sounds incongruous for the topic. “Suicide bombers are a very small proportion of the population,” he continues. “It is one small minority’s opinion. They feel justified because of intolerable circumstances. Unfortunately, they are making the most noise.” And the sound echoes loud.

Silent, Indiscriminate Killers

Yet while the empty barrels of society continue to shout, Firas chooses to focus on educating the Syrian population about the risks from other indiscriminate killers. “Diabetes and various forms of cancer have increased dramatically in Syria over the past 10 years,” he says. They are the silent killers that have begun to take a truly staggering toll on modern Syria. “Previously, most Syrians cooked at home with olive oil and animal fats. Today, 70% of people are resorting to cheaper options,” Firas says. “Foods that are high in trans fats and hydrogenated oils have resulted in increasing rates of obesity, Type II diabetes, and various forms of cancer.” Such a marked increase in disease incidence would put a strain on any country’s medical infrastructure, but it is only one of several major factors currently at play in Syria.

A good chunk of Syria’s population lives in Damascus – 5 million people – of whom 1.2 million are recent refugees from Iraq. That means that in the last four years, the population of Damascus has increased by 30%. “It exhausts the infrastructure and civil fabric of society,” Firas says. “There is no way that the hospitals can keep up with such large numbers. Although the public hospitals give free treatment, even to Iraqis, sometimes the quality of the healthcare is sacrificed.”

Many Syrians believe that private medical clinics are better, but in fact it is the same doctors working in both sectors – public and private. Since the socialized Syrian system pays public sector doctors less than garbage men, doctors are forced to moonlight to earn a livable wage, and the end result is an over-stretched corps of physicians who have very little time to interact with or educate patients. “There is no significant preventative healthcare or public health education in Syria,” Firas notes sadly. “The only health education comes from word-of-mouth.”

Enter the Teacher

All of this has created a society plunging toward healthcare crisis. This past summer, Firas attended three separate conferences to learn about the Syrian healthcare system, research efforts, and the effect of globalization. The conferences motivated him. “I wanted to learn what it is like to be a patient in Syria, especially a patient with diabetes,” he says. “So I went to an International Medical Exhibition to meet Syrian doctors and other health workers. I was able to talk with the president of the Syrian Diabetes Association, the president of the National Syrian Diabetes Program, and the director of the Cancer Registry.”

The meetings crystallized what Firas already suspected. “There was very little being done to educate the Syrian public about diabetes,” he says. “Physicians are being educated, but the problem is that patients will not go to the public hospitals because they think that they are low-quality. They end up going to over-worked private-sector physicians who in turn advise them to go back to the public hospitals for free insulin and counseling. They go, but they aren’t receiving any counseling or information on how to take care of their diabetes. The patients are lost in the middle.” And some patients refuse to step foot in a public hospital at all. “The middle class would often rather die than go,” Firas notes. “They are afraid of complications or unsanitary conditions, but the care is actually quite good. It is a lack of educating the patients.”

To follow up on his hunch, Firas attended the Syrian Endocrine Conference where he distributed a number of physician surveys. Results indicated that Syrian physicians felt the greatest obstacle to combating diabetes was a lack of educating the patient. A second issue also emerged. Once Syrian physicians graduate from medical school, they never need to take additional professional exams. Consequently, many physicians are not up to speed on current literature about disease prevention and patient education. The cycle of misinformation or a complete absence of information is vicious.

“You? What Can You Do?”

At the Syrian American Medical Society (SAMS) meeting in June (under the auspices of the Cleveland Clinic and his Excellency President Bashar Al-Assad of Syria) Firas attended lectures on “The Effect of Globalization on Public Health and Medicine.” He met with a doctor who plans to set up a Syrian version of JCAHO (Joint Commission on Accreditation of Healthcare Organizations) within the next 5-10 years. Such a project would provide incentives for all hospitals to provide the best-quality healthcare.

A conversation Firas had with the Deputy Director of the Ministry of Health was a telling microcosm of the Syrian system, and it helps to explain why young Syrians want to change it. Firas asked the man, “How can I be of more help? How can Syrian college students improve the health care system?” The man noted Firas’ pre-doctoral status and replied, “You? What can you do? You can’t even treat people yet!” To which Firas quickly answered, “Well, treating patients isn’t the only way to help people – you can educate them, too.”

Education, Firas believes, is the key to health, and it fits with his MPH training and the overall osteopathic approach of whole-person wellness and preventative medicine. “I like equipping people with the right tools and then seeing them put those tools to use,” he says. “This is what I’ve always wanted to do. And with OMM, if you don’t have meds or equipment available, you still have your hands.” He is appalled that average Syrians would rather die than visit a public hospital. When he was living in Raleigh, Firas started a group for young scientists. It blossomed from 12 to 50 members in no time at all. He believes the time is now ripe to begin educating an entire country.

“Some Syrian doctors never go past their desks,” he says. “They aren’t motivated, they have low paychecks, and little knowledge of preventative medicine.” With such inertia to overcome, Firas hopes that other UNECOM students will get involved in global health concerns. “Any healthcare provider can make a huge impact, whether locally or abroad,” he insists. “I think that there will be many positive changes in the next 10 years.” Despite the empty barrels of society who seem intent on destroying themselves and others, Firas hopes that by educating Syrians – by filling up their barrels - a major health crisis can be averted and his country can be spared from widespread suffering and discontent.

In the end, he hopes that there will be fewer and fewer empty barrels to shout.

- Steve Smith, RSAS