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In 1998 while I was conducting CCU round, I saw an old fragile looking female patient. She sat up in her bed when I entered. I said good morning to her. She answered me warmly and stretched her hand. When I stretched my hand to her she tried to kiss my hand, so I withdrew my hand quickly. I felt

embarrassed; I did not know why that old patient wanted to kiss my hand. I did not recognize her. I quickly checked the name on her file and realized her identity. I knew her well but I have not seen her since I was 6 years old. She was my preschool Qur'an teacher.

My memories of the old days with my teacher reflects the social and medical history of late 1940’s and early 1950’s in my birth place, Maareed, a village in Ras Al-Khaima, UAE. Those social and medical events that I will narrate in this article seemed now so primitive and ancient in comparison to our modern era. The reason I write such real stories because they are part of history of medicine in the Gulf that the new generations do not know.
The irony of the story of my teacher is that although she was semi-illiterate, she worked as a teacher. She could not write but could read the Qur'an and teach the children how to read it. That was not unusual for her generation. It was a combination of memorization of the Qur'an with letter recognition. Such a person could not read a hand written letter but may read a book with some practice if the fonts are close to the Qur’an’s fonts. A non-Arabic speaking Muslim similarly could read the Qur’an but could not understand the meaning of the Arabic words.

When I was five years old, my parent arranged with my teacher to be a private Qur'an teacher for me and my eight-year- old sister. She was an exclusive teacher only for both of us and taught us in her house. Hajia, who was like a baby-sitter for me, took us to my teacher’s house on the first day of school. She delivered the usual Gulf parental message to the teacher on the first day. She said to my teacher: “The flesh is yours and the bones for their family”. That statement meant that the family gave the teacher the permission to hit their children as much as needed to teach them. So the flesh is for the teacher to hit and destroy but the remaining bones will be returned to the family. The purpose of that statement on the first day of school was actually for the children to hear that the teacher will be in full control and they must obey. They cannot complain to the parents if the teacher hit them.

In the CCU my teacher apologized for hitting me when I was her pupil. Her attempt to kiss my hand was a reflection of her regret. She asked me if I had any ill feelings toward her. Of course I did not, I felt sorry that she felt bad about the old school days. In reality her stick never touched my flesh. She acted angry with me and took her stick to scare me but she purposely made enough noise for the baby sitter Hajia to hear her and come for my rescue. Hajia would prevent her from hitting me. They were very close friends, I am sure it was a game they planned together to force me to memorize the Qur'an. That act was done if I did not memorize the required pages of the Qur'an on the oral exam day. The exam day was always Thursday, our last day of the week then. It was also the day that the child brings the weekly fees for the teacher. That fee was only one Indian Rupee

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Fig. 1 Palm Stick Room

Hajia’s palm tree stick house was adjacent to the house of the teacher whose house was constructed similarly. All the houses in that neighborhood were made from palm tree sticks (Fig.1). A person could have conversations with his neighbor across the wall with out the need to exit the house. On the moonless nights, the village was very dark and quiet; there was no electricity, cars or machinery to make noise. By ten O’clock at night, most of the inhabitants are asleep. Because our house was near the seashore I usually could hear the sea waves at bedtime unless, of course, the sea was calm. On rare occasions when the tides were high, the sea crossed our palm tree sticks boundary wall (Fig. 2) a few meters into our house. It did not affect us except for one incident when the newborn puppies of our dog drowned near the fence. Dogs had to stay within the boundary wall but never inside the house because they are considered dirty animals in Islam.

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Fig. 2 palm tree sticks boundary wall

Before five in the morning, the village would be active again when the rooster’s cry would wake up the village. By sunrise children must have breakfast and walk to school. Three and half hours later the children are allowed to go home for half an hour to have light snacks of dates and diary products for most of us then. At mid-day the school would be over and we would go home. I had more details about both Hajia and my teacher in a previous Article (1).
When I was a child our society expected boys to be smarter than girls, but I had a hard time competing with my sister since she was three years older than me. I was five years old and she was eight, capable of memorizing the Qur’an faster than me. The teacher thought that since I was a boy then the “maleness” should have made up for the three years difference in age. She sent a message to my parents that Hajar is not as smart as his sister! That disappointed my parents because they believed the teacher must have good judgment in evaluating the pupils. Traditional herb “doctor” Shaikh Abdul Aziz Al-Rajbani was consulted to prescribe treatment that makes children smarter. He prescribed for me seven raisins soaked in water, which I had to eat first thing in the morning until I become smarter. I did love that therapy. Soaked raisins tasted very good in the morning. The only raisin available then for us was the black type. The dried raisins absorb water and become larger in size and softer.

The old man, Shaikh Al-Rajbani was also known for driving Genii (bad sprit) from seized patient. He said that he was sure that the raisins treatment will work. I wanted to have the number of raisins increased for my breakfast but the family refused. It must only be seven, as the Shaikh had specified. I wonder if he had concerns about raisin overdose! Number seven is a holy number for our society. God created the earth and the sky in seven days. Anyhow the seven raisins did work and the following year I was doing well. The teacher was happy with my performance and praised me as very smart. Unfortunately, the teacher’s praise made me loose my sweet raisins for breakfast.

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Fig. 3 Mats

Even though my teacher did not know how to write, her husband did. He taught me and my sister how to write the Arabic Alphabet. Because we lived in a seashore village, the houses were built over clean sand. People usually sat directly over the sand in most of the informal gatherings; otherwise they sat on mats made of palm tree leaves (Fig. 3). As long as there was a wall or a room shade, Qur’an school children would sit in the shade over the sand with the holy book in front of them. The book was raised over an x shaped wooden support (Fig. 4). When the shade shrank the children were moved inside a room over a mat. Another relative of the teacher was Um-Mohammed. The later was known as a good, wise and kind old woman, but I felt uneasy when she walked near me. I avoided coming close to her because I did not like her. Actually it was more than that, I was afraid of her. My feeling toward Um-Mohammed was similar to the feeling of a child to his dentist. Um-Mohammed was an old-fashioned midwife and local primitive tonsillitis therapist. We had three well known tonsillitis therapist ladies in the village. Each had her own method of treatment.

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Fig. 4 X-shaped Book wooden support

One therapist used the Bedouin method of treatment. She would put one hard dry camel stool ball (Fig. 5) over each side of the neck, over the area of pain and press them with a piece of rug. The other therapist used cotton over a fine flexible twig. The cotton was covered with turmeric powder. The tonsils and the uvula was rubbed with the cotton and painted with turmeric. I was aware of one infant death during such manipulation. I would assume now, in retrospect, that the cotton became loose and dislodged into trachea causing suffocation and death of the infant.

The third therapist who treated my recurrent tonsillitis was Um-Mohammed. Her method was the most painful but probably the most effective. She covered her first finger with dry pomegranate peal powder. She got the family to restrain the child while she inserts a thumb-sized stick between the child’s teeth to prevent biting. Then she inserted her finger in the child’s mouth and squeezed each tonsil hard until pus and blood came out on her finger. It was a form of abscess drainage. If no drainage occurred then she concluded that the tonsillitis was mild. I did have improvement after her painful finger treatment of my tonsillitis. We had no antibiotics then, so her drainage was useful for severe streptococcal bacterial infections. If my tonsillitis was due to virus infection her finger would have done no harm. The virus would resolve by my immunity and Um-Mohammed would get the credit for it anyway. It is important to add that none of those therapists were paid for their work. It was appreciated as respectful voluntary service to the community. But people send them gifts.

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Fig. 5 Camel Stool

It took me two years to finish reading the Qur'an. A celebration was conducted with other Qur'an student from neighboring schools. We went singing special songs for that occasion from door to door in our village and the people gave us coins which we gave o the teacher. This was the custom for any child who completed his Qur'an reading. After finishing the Qur'an I started in another school where writing the alphabet and math as well as Qur'an were taught. In that school we used papers and pens. At that time, the ball pen was already invented but did not reach our area yet. The pens we used where primitive. Each pen was composed of a wooden stick that had a groove on the top and an exchangeable metal plate with pointed tip in the groove. The metal has an ink reservoir and a capillary feed.

The pens held only a small amount of ink at a time and had to be repeatedly dipped in ink for almost every word. We, the children, made the ink. We used to catch squids from the shallow sea at night with spears and flashlights. We walked in knee-level water searching for squids. When we found a squid, the flashlight probably blinded it so it stayed still in the water over the sand for us to hit with a spear. We learned how to avoid having the squid spray us with its ink. We cooked and ate the squids but kept their ink sac and dried it. Then we grinded the dried ink crystals and dissolved them in water in an empty bottle. It was good black ink but had a fishy smell.

After a few months in that school we moved to a modern elementary school where we were given pencils for writing. At that time my father gave me a bottle of imported blue ink and a fountain pen that had an ink reservoir. With that pen I felt like a skillful writer of letters and very proud. My former teacher and other women who could not write letters to their husband asked me to write letters for them. Some of them rewarded me with a coin, which was a half of an Indian Rupee. The women dictated what they wanted to say to their husbands. I quickly learned to edit and rephrase their very local slang language. Sometimes women wanted to tell their husband detailed information about what happened to their goats, cats or chickens. I had to modify their long stories.

There was one special lady in our neighborhood that I never rephrased or modified her dictation. Her name was Afra. She was a very well respected lady, who was not only a Qur’an teacher but she also was cable of reading books and letters. She could read what she dictated to me. She read storybooks for the neighboring ladies at night using kerosene light because we had no electricity then. When I was between five and seven years old, my mother used to take me at night with her to listen to the old Arabic stories in Afra's house. That evening gathering of the ladies to listen to literature stories made me familiar with some Arabic fairy tales, love stories and the great myths of Alf Lila wa' Lila (One thousand and One Nights). My aunt used to help Afra in reading when she got tired. It is sad for me to realize now that in the old days, during my childhood, when most of our people were illiterate, the ladies had their literature gathering for entertainment. Nowadays when illiteracy is almost eliminated from our societies in the Gulf, no such activities take place. 
Teacher Afra who read books could not write one word. She had a book of letter templates that she selected phrases from while she dictated to me letters for her husband, Joma, who was working in Kuwait as a carpenter then. Afra's great love for Joma was well known in our community. The love stories like the story of Majnoon Lila that she read at night for us may have been echoing her own inner feeling of love for Joma. She said to me, write: “My dear brother Joma…I hope you are in good health and happiness... We are all fine here... we do not need any thing... we do not miss any thing except your presence... I pray to god that I will see you home soon... ”. Some tears were clearly seen in her eyes behind the Burqua (small veil covering the mouth and the cheecks) when she finished dictating. I could not forget Afra’s letter until now. It was not normal to call a husband a brother but Afra made a mistake by following a wrong letter template.

When I saw my teacher in the CCU she was admitted due to seven hours of retrosternal chest pain radiating to both arms and the back with nausea and vomiting. The Echocardiogram and serum cardiac enzymes confirmed acute inferior myocardial infarction (heart attack). She looked so old but was not in distress. She was recovering well.

  It was amusing to see that my teacher, who is older than my mother, had her birthday in the file written as 1940 while my birthday was in 1943. Her real birthday must have been at least twenty years earlier. Birthdays or age estimations for the older generation in the Gulf were and still are guessing games. Most of them do not lie about their age, but they had no records, birth certificates or hospitals to be born in then. An old patient told me once that she was fifty years old, but when I asked her later, about the age of her son, she said he might be above fifty! 
My teacher refused to undergo coronary angiography at first, but agreed a month later. It revealed severe three-vessel disease, but she refused surgery or intervention. She was asymptomatic on medical therapy for a while. A year later due to recurrent chest pain she had three coronary stents implanted successfully, after which she no longer had chest pain. She had several admissions for hypertension, fracture of the femur, inappropriate ADH, urinary tract infections as well as depression. The psychiatric illness deserves more discussion.

Few years after I graduated from her Qur’an school, her husband died and she became depressed. I was told that she had an episode of depression earlier before her marriage. She was in love with a man in the neighborhood who was also in love with her, but her family refused to let her marry him because she was “reserved’ for a cousin. A relative gets the priority in the society for marriage. Therefore, she had a love depression in her early life and grief depression later. An older relative of my teacher who was living in Bahrain with a wife and children married her a few years after she lost her first husband. He took her to Bahrain with him, but his wife resented and hated her. My teacher got worse and became psychotic.

The first wife of my teacher’s new husband was accused by my teacher’s relatives that she made “Tib” for my teacher. Tib means medicine as well as witchcraft that make the victim sick. My teacher was brought to Qatar and hospitalized in a psychiatric ward for several weeks. She developed illusions and did not recognize people. She spent weeks in the psychiatric ward praying. She thought she was living in the holy city of Mecca. Finally she was treated successfully with repeated Electroconvulsive therapy (ECT), a treatment modality that induces seizures for its therapeutic effect. She still has recurrence episodes of depression.

At the time I was a Qur’an pupil in my teacher school I witnessed her use of two unusual methods of treatment. One day the teacher's baby was crying a lot, so she sent me to the local shop with one Rupee to buy tiriac. The shop owner took a dark small cylinder that looked like Tamarind, cut a piece with a knife and gave it to me. The teacher took a very small piece of that and boiled it with tea, and then she forced the baby to drink it. It was very effective in putting the baby to sleep. I learned later on that tiriac was opium; it was available in shops for treatment only. I witnessed its application at that time to a painful area on my father foot‘s after a scorpion sting. It did help relieve the pain. My mother was proud that neither my sister nor I got exposed to such drugs. But she told me that once my sister had what they thought was stomach pain while she was an infant. An old woman made for her special combination of herbal medicine; one of the ingredients was "Khishkhash flower powder". She said that my sister became very quiet with that herbal medication. Her eyes were open but she did not cry. When I told my mother that Khishkhash was opium she did not believe it. Her generation never knew what opium was but they recently heard about it on television.

When real medicine is lacking and ignorance predominates in the illiterate society, therapeutic myths become very common. One of the pre-Islamic Arab myths was the belief that drinking a king’s blood could cure patients with rabies. Of course they did not kill kings to drink their blood, but the king may denate blood when he had Hijama i.e. blood letting treatment (2). Another bizarre therapeutic use by my teacher was urine. When her child developed whooping cough she sent me with bowl to get urine from a specific family. That family was used to donating their son’s urine for treatment. The myth was that whooping cough could be cured with urine from a boy with mixed blood; half white and half black.

Before the publication of this article I went with my mother and sister to visit my old teacher, Um-Abdulla. I kissed her on her head and sat next to her bed. She was bedridden but her memory was intact. She was very happy to see us. I provoked her by asking her if she still remember the teriac and the urine treatment of her son. She said she did and added more stories of the old days. She told me: “The urine you brought did not cure Abdulla (her son) from whooping cough. I had to use another recommended treatment then, which cured him. I forced him to drink one spoon of donkey urine mixed with one spoon of water daily until he stopped coughing”. On the way back I told my mother I am glad that you did not treat us with the kind of medicine my teacher used. She said that she new a better medicine for whooping cough from her family; boiled beach crab. (Fig. 6)

I am aware of the fact that Morarji Desai, Prime Minister of India (1977-79) was well known for advocating Urine Therapy. He was advised to try drinking his own urine when he was in his 40s to cure hemorrhoids. He did and his hemorrhoids got better. After that he continued the practice for life. With the help of his urine therapeutic practice he lived until the age of 99. The idea of drinking urine did not fade away yet. NASA is currently preparing astronauts to drink their own recycled urine.

My teacher main problem now is weakness and lack of energy. She will have further work up in the clinic soon. The fact that she and some of her age group who grew up with the primitive medical care I described above, survived to the age of 85 years, and is credit to their genes, life style and recent progress in medical care in the Gulf.

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Fig. 6 Beach Crab

Addendum: My teacher died on 31/12/2012 at the age of 90 years. We buried her on 1/1/2013. I never saw again her baby I mention above, who was given once opium until the burial day. I saw him crying next to his mother's grave. He had some gray hair at the age of 65. I introduced myself, hugged him and kissed him for condolence. He said: my mother considered you her son and she always mention you with praise. 
1. Salim: Heart Views Vol 3 no. 1, March - May 2002
2. Chairman's Reflections Part 17. Heart Views VOLUME 5 NO.2 JUNE - AUGUST 2004.

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