As Susan Sontag has argued convincingly, illness is a medical condition, cultural production, and literary trope. In Chief Complaint: A Country Doctor’s Tales of Life in Galilee, ‘Israeli-Arab’ Hatim Kanaaneh uses his medical and literary skills to explore these expressions of illness through seventeen chief complaints (patient statements of symptoms or problems that lead to a clinical visit) crafted as short stories based on his medical practice in the village of Arrabeh.
With intimate ties to his Palestinian heritage and his community in Galilee, a western education, and marriage to a Hawaiian Christian, together with his employment in the Israeli Ministry of Health and founding of an NGO to address inequitable medical care, Kanaaneh is well equipped as ‘the first indigenous physician in [his] village’ (p. 17) to bear witness to the unheard struggles of Palestinian life in Israel. His vivid and often poignant sketches will engage readers of narrative medicine, medical memoir, and Israeli-Palestinian relations.
Kananneh’s earlier book, A Doctor in Galilee: The Life and Struggle of a Palestinian in Israel (2008), describes his work in public health and ‘civil society efforts’ (Chief Complaint, p. 17). His newest work focuses primarily on others’ traumas, tragedies, joys, and triumphs occurring in the midst of structural violence and loss of ancestral land. Medical visits immerse us in village life – its political debates, struggles with modernity, survival strategies, and rich Arabic and Islamic traditions. Kanaaneh addresses a broad audience, choosing English rather than Arabic in order to:
‘bring our existence to light, to sing out our pleasure and pain, to echo our sense of alienation and dispossession, to face up to the dilemma of our schizophrenic identity, and to hail our occasional successes and our trust in the future’ (p. 14).
Structured as a ‘review of systems’ – ‘the classic [diagnostic] tool of the medical profession’ (p. 18) – Chief Complaint’s narrative scaffolds a pastiche of vignettes, suggesting both the random schedule of patient appointments and vicissitudes of village life. Titles reflecting this review are accompanied by poetic epigraphs from the Qur’an or notable Palestinian love songs, poetry, sayings, and axioms. The complaints begin, conclude, or appear in a chapter’s midst.
Chief Complaint begins with the two opposite conditions – the excess and absence of heat – demonstrating that loss of health bears witness to ample courage and vitality. In High Fever (pp. 21-30) an elderly man of ‘legendary prowess’ (p. 30) encapsulates his community’s struggles to access medical care. In Chills (pp. 31-44), the first of many strong women who populate the book shatters Orientalist stereotypes of Islamic women. Kanaaneh schools us on Othering: both a feverish elderly man and an elderly widow with debilitating chills are shown as more than medical problems: they represent, as he writes in the Preface, ‘achievements uncelebrated and […] promise untested’ (p. 13).
The connection between individual and collective struggles is taken up throughout the book. Hair Loss (pp. 45-56) chronicles a diverse set of associated losses: hair, heritage, land, allegiance, and identity. It concludes with judgments on Zionist appropriation of land and Palestinian collusion with ‘Zionist Jews’, joining Jewish groups, and adopting western identifications (pp. 55-56). The complex relationship between Palestinians and Israeli Jews continues in Headache (pp. 57-68). A medical complaint connecting headaches to heart medication becomes an occasion for poetic descriptions of a vibrant yet struggling village life while land and livelihoods disappear. A disability can also be domestically and politically strategic. In Hearing Loss (pp. 69-81): Salim’s impairment enables ‘selective hearing loss whereby he ignored much of what he actually did hear’ (p. 70) and Abu Zrayq, fluent in Hebrew, plays deaf to ascertain Haganah strategies from officers unaware of his bilingualism.
As often happens, a medical visit includes reminiscences and politics. In Painful Swallowing (pp. 83-97), Fayza, another strong woman, relocates to Arrabeh following relentless discrimination while living amongst a Jewish community. Her difficulty swallowing, due to a ‘painful lump in her throat’ (p. 96), reminds one of the colloquialism that something is hard to swallow. In Neck Swelling (pp. 99-110), a mass pressing on Anisa’s windpipe becomes a political symptom:
“How long have you been coughing?”
“Two or three days”.
“And when did your headache start?”
“To tell the truth, it started m’a ihtilal Isra-eel,” she said, dating it back to Israel’s  occupation, “and never stopped” (p. 104).
And in Cough (pp. 111-123), the connection between illness and lived conditions is reprised through tragedy. Tearless ‘fits of crying’ develop following the burial of Badi‘a’s husband, killed by ‘a sharp-shooter in a tank’ at al-Khanooq (the choked pass)’ while tending sheep (p. 115). Here Kanaaneh is at his best, letting the tensions between joyous and poignant, unfettered and choked, celebration and suffering, emerge through songs, coughs, and cries.
At midpoint, Chest Pain (pp. 125-139) takes us to the heart of the matter. Rummaneh, a victim of rheumatic fever’s heart damage, becomes the focus of a meditation on pain and love. Rummaneh (Arabic, ‘pomegranate’) is, for her father, a reminder of loss, while for Kanaaneh, the word evokes ‘abundant orchards in fertile valleys inundated with springs and flowing streams’ (p. 127). Like the pomegranate, a body’s complaint is overdetermined with meaning. However, it can also demonstrate how miscommunication and misreading, rumours and knowledge, are affected by medical power, and how medical access is controlled by power and politics. In Nausea (pp. 141-156), a community is caught between tradition and change, complicated by the pressures of poverty. Kanaaneh is asked to change birth dates so daughters might be married earlier, alleviating family poverty. Nausea within weeks of a wedding uncovers cultural and religious anxieties.
Vomiting (pp. 157-178) sketches the incomprehensibility of life in Galilee. As Kanaaneh writes, ‘In our first years as citizens of the nascent state of Israel, we hardly comprehended, much less accepted, what our new status meant’ (p. 170). Yet, this chapter is really about Jamila and her courageous struggles to support her family and ailing widowed father, and then to resist the unwelcome offers of marriage from a prominent ‘shayke of the village mosque’ (p. 174). The initial complaint, Jamila’s history of vomiting, suggests the incoherence and violence of speaking one’s pain. The body can reveal more than words by speaking on its own terms.
Abdominal Pain (pp. 179-190) follows, where Kadhim’s common duodenal ulcer, produced by bacteria infecting the body, is a treatable condition, but within the context of extreme poverty becomes a crisis. In Absence of Urine (pp. 203-216) Isa suffers kidney failure. Yet his life is a tapestry of tradition and modernity, struggle and prosperity, ‘legendary appetite’ (p. 210) and its current diminution. He is a patient, family friend, and neighbour. In recording personal histories, Kanaaneh also shows how events can be conflated and mis-remembered, and storytelling can memorialize the past, clarify the present, and transform the future.
Physical mobility has multiple symbolic applications. Back Pain (pp. 217-227) introduces an elderly character’s courage in a history of relocation; his valued place in a complex, extensive kinship system; and his role in the crucial archiving of ‘positive Palestinian traditions’ (p. 223). His injury occurs during a customary visit to ‘the only land he and his sons ever owned’ (p. 227). In Limping (pp. 229-241), an unnecessary condition, due in part to medical expenses and uniformed neighbourly advice, causes hardship for a young girl, yet because of ‘his self-image and virility’ (p. 237) a young man undergoes surgery for an undescended testicle.
In Insomnia (pp. 243-253), the final sketch, two elderly men, one suffering from insomnia, return to Israel to collect traditional coffee-making pots hidden during the 1948 destruction of Lubya. Recovery of tradition becomes instead the promise of a future. The pots ‘will stay and anchor […] descendants as they ply the story seas of their diaspora’ (p. 253). For Yunis, they ensure return, restoration, and renewal: ‘his spirit will return to dwell in one of those pots. It will issue forth as a fearsome giant every time that pot is rubbed in the process of coffee-making’ (p. 253). His sleep is now restored.
While narrative shifts can be somewhat jarring and the political messages somewhat heavy-handed, the sketches in Chief Complaint powerfully demonstrate how individual illness are embedded in historical, cultural, and political contexts. Moreover, in combining his considerable medical and literary skills, Kanaaneh bears witness to important experiences that need consideration in the enduring Israeli-Palestinian conflict.
Reviewed by Dr. Dorothy Woodman, instructor at the University of Alberta in the Department of English and Film Studies. She has presented and/or published on breast cancer and race, gender, and bodies, and is currently co-writing a series of articles on illness, superheroes, and neoliberalism.
Correspondence to Dr. Dorothy Woodman
Kanaaneh, H. 2008. A Doctor in Galilee: The Life and Struggle of a Palestinian in Israel. London: Pluto Press.
Sontag, S. 2001. Illness as Metaphor and AIDS and Its Metaphors. London: Picador.