Malak Al-Shaikhali is a doctor from Gaza who completed an MSc in Immunology at Somerville last year as an Oxford Qatar Thatcher Scholar.
Dr Malak Alshaikhali (2018, MSc Immunology). photo (c) John Cairns
It’s not easy to become a doctor in Gaza. You have to be in the top 2% of pupils in the territory to even think about applying. Once you are a student, there are still some fundamental difficulties: rolling blackouts, difficult and expensive access to clean water, and the high cost of studying (which is hard for families to justify in a territory with a very low graduate employment rate).
Gaza’s situation with Israel affects things too. I was a 4th year medical student during the 2014 Israel-Gaza Conflict. It was too dangerous for me to leave the house and make the journey to assist – some medical workers could be caught up in the violence and I didn’t want to add the burden of transporting and protecting me to everything else.
I grew up in Gaza to a family of refugees. We came from the nearby city of Ashkelon before being displaced in the 1948 war. Refugees in Palestine carry a different identity card and in the past were treated as lower status by the Gaza locals, but this thankfully has changed a lot in my lifetime.
After finishing my training, I worked for the UNRWA (United Nations Relief and Works Agency for Palestine Refugees in the Near East), who amongst other work provide primary health care in the Gaza Strip. I could see 90 patients on an average day, and some days as many 130 in 7 hours. By comparison, a GP in the UK sees on
average 41.5 patients a day, an amount many say is too high.
I was a family doctor, which meant treating all sorts of issues ranging from type 1 diabetes, to maternal and child healthcare, to infectious diseases. The workload is very high, and is only getting higher thanks to a worsening financial and humanitarian situation in Gaza. But working with families allows you to build up a very close relationship with your patients. You understand how you are making a difference to them.
I remember my first patient. He needed stitches on his face, so he was quite anxious. I did my best to calm him down and carefully treat him. A week later, I had a visitor: the very same patient, bearing a thank-you gift. After years in a science classroom, it suddenly hit me that doctors really do make a difference to people’s lives – even if it’s only something small like a few carefully done sutures.
Although I had always wanted to study in the UK, I didn’t dare think of Oxford. Meeting the Gaza Group was what started to push that dream towards reality. The Gaza Group are a team of Oxford University doctors who visit the region every summer for a week to teach and take part in a research conference. One of them asked me why I hadn’t applied to Oxford. I told him I hadn’t even thought about it, but he simply said “send off an application, and I’m sure you’re going to make it.” Luckily, he was right.
I still had to clear some significant hurdles. The visa situation in Gaza is tricky, for instance. All of the paperwork has to be sent from Jordan via Israel, which is very slow. Once you get your visa, travelling internationally from Gaza is complicated, as Palestinian refugees who seek to travel into Israel require a permit.
Unable to get permission, I had to cross the Sinai desert by car. There are many military checkpoints on the road to Cairo due to the Islamic terrorist activity in the region and travel at night is impossible. My journey to Somerville took 4 days. Finally arriving here felt like a miracle.
Without financial assistance from the Margaret Thatcher Scholarship Trust, and the generosity of the Qatar Fund for Development for funding the scholarship, there is absolutely no way at all I could have studied here. Dr Claire Cockcroft (Director of the Thatcher Development Programme) encouraged me to apply to the MTST for help and they were eventually able to award me a full scholarship, which was such a huge relief.
I was inspired to discover Somerville’s history of educating amazing women. And on arriving here, I found an international, welcoming and inclusive community in the MCR.
My research at Somerville focused on obesity. It’s a huge issue in modern healthcare – 28.7% of adults in the UK suffer from the condition and the number is set to increase over the next decade.
You wouldn’t think that immunologists could help with this illness, but our understanding of obesity has come on leaps and bounds. We now realise that it’s not simply nutrient overload – obesity is a complex metabolic disease, and immuno-endocrinology is a new way of approaching it.
We were able to show that obese patients have generalised, sub-clinical inflammation across their body. We still don’t exactly know what triggers this inflammation and how it correlates to obesity, but the potential is that we might be able to develop new drugs to treat this. We are also gaining a better understanding of why the outcomes vary so much between different kinds of obesity treatments.
Somerville and the MTST continue to help me find my next steps in medicine. I’m currently on an internship in Oxford at the Department for Physiology, Anatomy and Genetics. I want to specialise in oncology going forward. Immunologists are becoming more and more involved in cancer research and treatment. Seeing patients while also conducting research is the perfect combination because you never lose sight of why you’re doing this.
Without more specialist qualifications and training I wouldn’t be able to help in Gaza in the way I want to, so I’m not planning to return yet. We have a real shortage of oncologists in Gaza. People with cancer are regularly forced to go to hospitals in Israel, the West Bank, or abroad for treatment at the moment. If I become trained as an oncologist first, I can make a difference.
But as long as I am connecting with people, I will be heading in the right direction, whether it’s a doctor from Oxford seeing the potential in me that I couldn’t – or simply a man who needs his eyebrow sutured.
This piece was originally published in the 2019 Report for Donors.