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The Lebanese Doctor in Diaspora

By Philip A. Salem, M.D.2
September, 2012

One of the distinctive features of our Lebanon, which is geographically crucified in the Orient between Israel, Syria, and the Mediterranean Sea, is its permeating presence in the world and the impact of this presence on world civilization. There are very few countries that could boast about the impact they made on world science, culture, and economics as much as Lebanon, and there is no other country of its size that has contributed as much to mankind.

It is generally believed, for example, that the Phoenicians invented the alphabet, but there are some history scholars who question the alphabet being the work of the Phoenicians alone, but irrespective whether it was the work of the Phoenicians or whether Egyptian hieroglyphics and Mesopotamian Cunieform contributed to its evolution; it is a historical fact that it was the Phoenicians who introduced the alphabet to the Mediterranean world.

The ancient Greeks adopted the Phoenician alphabet and modified it. The new alphabet enabled the philosophy of Socrates and the great works of the Greeks to survive. Later, the Etruscans in Italy became familiar with the Phoenician alphabet. They modified the Greek version and, in turn, passed it along to Rome. The Romans made their own refinements and this led to the modern alphabet that we use today. From the beginning of recorded history, the Phoenicians were the masters of the Mediterranean Sea and they established colonies on its’ shores. Carthage was only one of those colonies. By doing so, not only did the Phoenicians trade goods, but also culture and civilization. From the time of the Phoenicians to the present time, the Lebanese had ambitions far beyond their own geography. They immigrated to the various corners of the world, not only to accumulate material wealth, but also to share in the making of other civilizations. Wherever you travel, you meet people of Lebanese origin. They are in all segments of life. Because of war and turbulence in Lebanon in the last half century, many Lebanese immigrated to the Gulf countries, Africa, Canada, Australia, the United States, and Latin America. Industrious and tenacious, they worked hard to succeed and prosper. In spite of immense economic difficulties, you would never find a single Lebanese refugee living in a tent at the expense of the United Nations, or see a single Lebanese beggar in the streets of Paris, London, or New York. This is a question of pride and dignity for them. A rough estimate is that there are 4-5 million Lebanese residing in Lebanon, itself; and there are approximately 20 million residing outside.

The story of the Lebanese doctor in Diaspora began in the Americas. The first wave of immigration from Lebanon was in the middle of the 19th century, and most of the immigrants went to the United States and soon thereafter to Brazil and other Latin American countries, like Argentina and Mexico. These immigrants had no skills and were not educated. The only language they spoke was Arabic, but they worked hard to make a living in their new adopted countries. They all had something in common: the determination to build a new life, and the determination to provide their children with a good education. Not themselves the product of education, they realized its importance and ensured that their children had that of which they were deprived. Many of these children became doctors, and at least two made it to global fame: Peter Medawar of Brazil, and Michael DeBakey of the United States.

Medawar was born in Brazil on February 28, 1915. His mother was British but his father was Lebanese. The name of his father was Nicholas Medawar. He was a Maronite Catholic. Although Peter Medawar was born in Brazil, he was educated and lived most of his life in England. He was Professor of Zoology and Biology at the University of Burmingham and University College of London. In 1960, he was awarded the Nobel Prize in Physiology and Medicine with Sir Frank MacFarlane Burnet. The prize was given in recognition of his work on the immune system, including graft rejection and the discovery of acquired immune tolerance. His research in immunology was fundamental to the understanding and practice of tissue and organ transplants. Soon after he was awarded the Nobel Prize, he was appointed Director of the National Institute for Medical Research and became Professor of Experimental Medicine at the Royal Institute, and President of the Royal Post-Graduate Medical School. Medawar was knighted in 1965 and was appointed to the Order of Merit in 1981. At the relatively young age of 54 years, he was partially disabled by a stroke and died on October 2, 1987. Medawar’s mind was very inquisitive and even a stroke could not stop his inquiries and research. His knowledge was not limited to science, but he applied the knowledge he acquired in science to other areas of learning. He was an established author and a first-class scientific writer. Like most men with great minds, his interest and curiosity extended far beyond science to art and philosophy.

The other Lebanese doctor who made it to the world stage and who stands as a monument of pride to all Lebanese doctors around the world is Dr. Michael DeBakey.

This man undoubtedly represents the peak of fame and achievement in the world of medicine, and I feel profoundly privileged to have been one of his closest friends. Michael Elis DeBakey was born on September 7, 1908 in Lake Charles, Louisiana. Both parents were Lebanese immigrants. His father’s name was Shaker and his mother was Raheeja. The family’s real name was Dabaghi, but was later anglicized to DeBakey. He was known to his family and friends as Michel. When he was 10 years of age, he visited his parent’s hometown of Jdaidat Marjayoun in Lebanon, and he lived there for 10 months. In our personal conversations, his favorite subject was his parents. He spoke endlessly and lovingly of them, and of their great qualities. His father was a highly intelligent and prosperous entrepreneur who instilled in his children the highest human values and emphasized the importance of education and diligence. His mother, whom everyone called “the queen,” radiated love at home. More than any other human being, his mother was the center of his life. He repeatedly told me how fortunate he was to have such model Lebanese parents who cherished family, high principles, and education.

Dr. DeBakey received his M.D. degree from Tulane University School of Medicine and he served on the faculty of surgery in Tulane until 1948. At age 23, while he was still a student at the medical school, DeBakey invented the roller pump, which provides continuous blood flow during surgery. It is because of this pump that open heart surgery became possible 20 years later. Although most of his professional life revolved around heart surgery, in 1939 he and his mentor Alton Oshner of Tulane, postulated that there is a strong link between smoking and cancer of the lung. This postulate became a milestone in the history of medicine. From 1942 to 1946, Dr. DeBakey was on military leave as a member of the Surgical Consultants Division of the Office of the Surgeon General of the Army and, in 1945, he became the Director and received the Legion of Merit. Dr. DeBakey significantly contributed to the development of the concept of Mobile Army Surgical Hospitals (MASH), and later helped establish the Veterans Administration Medical Research System. For this reason, the Veterans Affairs Hospital in Houston was recently named after him. He came to Houston and joined the Faculty of Baylor University College (now known as the Baylor College of Medicine) in 1948. From 1969 to 1979, he was President of the College, after which he was promoted to Chancellor.

DeBakey’s contributions to heart surgery were immense. He was one of the first surgeons to perform coronary artery bypass and, in 1953, he was the first to perform a successful carotid endarterectomy. He is known all over the world as a pioneer in the development of the artificial heart and was the first to use an external heart pump successfully in a patient. He repeatedly told me that his pioneering use of the Dacron graft to repair blood vessels stemmed from his learning the art of sewing from his mother. DeBakey was the boss of Denton Cooley while they both practiced at Baylor College of Medicine, but they had a feud associated with Cooley’s implantation of the first artificial heart in a human. There are several versions of this story. The one I know is that Debakey had initially scheduled the surgery for Friday, April 4, 1969. However, because of a conflict in schedule relating to a speech he was giving in Corpus Christi, Texas, DeBakey rescheduled the surgery for the following Monday. While DeBakey was in Corpus Christi, Cooley performed the surgery without the consent of DeBakey. The actual sequence of events that preceded Dr. Cooley's September 1969 resignation from Baylor College of Medicine and censure by the American College of surgeons is presented in this brief 2012 Houston Chronicle Op-ed article published by Dr. DeBakey's son, Denis DeBakey. Cooley's memoir conflicts with study of events - Houston Chronicle. The press covered the event and Cooley gained much publicity and fame. DeBakey was very angry at Cooley for his actions. As a result, Cooley left the Methodist Hospital and joined St. Luke’s Episcopal Hospital across the street and established the Texas Heart Institute. Their disagreement about this incident turned into a bitter feud. I personally lived that feud as I was a friend of both. The two men reconciled in 2007. I have known Dr. Cooley for more than 22 years since I joined the St. Luke’s Episcopal Hospital staff. He is a great surgeon, teacher, and innovator. DeBakey had a panoramic and unique mind. Not only was he versed in medicine, but he was also versed in many other areas like history, philosophy, music and literature.

Dr. DeBakey received the Presidential Medal of Freedom in 1969. In 1987, President Ronald Reagan awarded him the National Medal of Science, and on April 23, 2008, he received the highest honor, the Congressional Gold Medal of Honor from President George W. Bush. Dr. DeBakey continued to practice medicine into an age well after most others had retired. He used to tell me that most of his students had already died. He was fortunate that one of those students, Dr. George Noon, was still alive. On December 31, 2005, when Dr. DeBakey was 97 and suffering from an aortic dissection, Dr. Noon successfully operated on his former teacher.

During the last 20 years of his life, Dr. DeBakey was one of my closest friends, and he was a father figure to me. We used to have lunch every other week. The feast had to be Lebanese and the conversation always gravitated to Lebanon and our Lebanese parents and families. Although he had lived in Lebanon for less than a year, he was very Lebanese. After his death on July 11, 2010, I wrote an article depicting our friendship, “The Real Man Behind the Genius.”3 Michael DeBakey was a world-renowned Lebanese-American heart surgeon, a first class scientist and innovator, but par excellence, he was a medical educator. He also had an incredible ability to bring his professional knowledge in medicine to bear on public policy, an ability which earned him the reputation of a medical statesman. He will probably go down in history as the greatest surgeon of the 20th century.

Successive generations of doctors of Lebanese descent led to the establishment of great medical institutions abroad. Two of which are in Latin America: the Syrian-Lebanese Hospital of Buenos Aires, and the Syrian-Lebanese Hospital of Sao Paolo. In 1978, while attending an international cancer conference in Buenos Aires, I was invited to speak at the Lebanese-Syrian Hospital on advances in cancer therapy. This hospital is one of the best community hospitals in Buenos Aires and the bulk of the staff, doctors, and nurses are of Lebanese origin. My own paternal grandfather died in this city in 1928. Before I gave my lecture, there was a reception in my honor, during which I met the Director of the hospital. She turned out to be a childhood friend from my village of Bterram. We had not seen each other for 25 years.

The Syrian-Lebanese hospital in Sao Paolo (Portuguese: Hospital Sírio-Libanês) is one of the most famous hospitals in Brazil. It was established in 1931 by major contributions from wealthy Lebanese families, most notably the Jafet family. One of the best cancer treatment and research programs in Latin America is now at this hospital. Both the former President of Brazil, Lula Da Silva, and the current President, Dilma Rousseff, have received cancer therapy there. I have personally visited it many times and have given lectures there on several occasions. I know some of the cancer physicians who work there from the time they spent as trainees or faculty at M.D. Anderson Cancer Center in Houston.

The largest Syrian-Lebanese communities in Brazil and Argentina are predominantly comprised of Christian families who fled the Middle East after the Turkish occupation. Because they came from countries which were under the Ottoman Empire, they were referred to as Turcos. The word “Turco” did not distinguish Turks from Lebanese, Syrians, Palestinians, or other Middle Eastern nationals. However, the overwhelming majority of these immigrants were Lebanese. Also, at that time, Lebanon was part of Greater Syria and Latin-Americans could not distinguish those who came from Lebanon proper from those who came from Syria; thus, they were all called Syrian-Lebanese. It is now estimated that Brazilians of Lebanese descent number between 8-9 million. In Sao Paolo itself, there are 5 million. Also, it is estimated that Argentinians of Lebanese descent number between 4-5 million.

In Mexico, the Lebanese presence is very palpable, but mostly in the business sector. Carlos Slim Helu, the richest man in the world, is of Lebanese descent. Both his father and mother were Lebanese. There are no Lebanese hospitals in Mexico, but there are two Lebanese clubs which are among the most prestigious in the country. There is the Central Club in downtown Mexico, and the Freddy Attalah’s Lebanese Club in the suburbs. One of the Presidents of Mexico, Gustavo Diaz Ordaz, once said “if you don’t have a Lebanese friend, make sure you find one”. Not only are the Lebanese influential there, but they are very well liked. In regard to medicine, there is a medical society for Mexican doctors of Lebanese descent. This society is very active and I have been to Mexico on many occasions to contribute to conferences sponsored by it.

In the United States, one of the biggest achievements the Lebanese have made in medicine is the establishment of St. Jude’s Children’s Research Hospital in Memphis, Tennessee. The hospital was established by the Lebanese entertainer, Danny Thomas, who made a vow to St. Jude that, should He make him a rich man, he would establish a hospital in His name. In 1962, he delivered on his promise, and St. Jude’s has now become the best cancer research and treatment center for children in the world. In 1996, Peter C. Doherty of St. Jude’s was co-recipient of the Nobel Prize in Physiology and Medicine for his work on the immune system and how this system can kill virus-infected cells. Acute leukemia in children is now curable in 90% of patients mainly due to the scientific discoveries and advances made at St. Jude’s. This hospital is not only a shrine to St. Jude but also to cancer research in children all over the world. Although the hospital was named after Thomas’ patron saint, it is not a Catholic hospital and is not affiliated with any religious organization. Any child of any color, religion, or geographical origin can be admitted to it. Also, St. Jude’s has an international outreach program to improve the survival rates of children with cancer diseases all over the world, and consequently it has established many satellite programs. One of these programs is in Beirut at the American University of Beirut. It was established on April 12, 2002. There are now active negotiations to explore the possibility of establishing another such program in Jordan. Danny Thomas, himself, was not a doctor, but he has contributed immensely to the field of medicine. The Board of Trustees of St. Jude’s has always been composed of business people of Lebanese and Syrian descent. A unique feature of St. Jude’s is that all medically eligible patients who are admitted to its facilities are treated without regard to their ability to pay. Families never pay for treatments which are not covered by insurance, and those families without insurance are never asked to pay. The treatments of these patients are supported by charitable donations.

The three examples of Lebanese-Syrian institutions in Buenos Aires, Sao Paolo, and Memphis, Tennessee are monuments for what the Lebanese and Syrians can do when they work together. This is in contrast to recent political conflict and hostilities between their two respective countries. Like the Phoenicians who migrated along the Mediterranean shores to build new civilizations, the Lebanese and Syrians immigrated to share in the making of the future of their new countries. The Lebanese and Syrians who currently live in the Middle East should learn from the model of the great work their brothers and sisters established in the Americas.

Although the major impact of the Lebanese doctor in Diaspora was in the Americas, one Lebanese doctor made it to fame in China. He was Shafick George Hatem who was born on September 26, 1910 to a Lebanese-American family in Buffalo, New York. His father, Nahoum Salaama Hatem immigrated to the United States from the village of Hammana in the Metn Mountains of Lebanon in 1902. Dr. Hatem attended pre-med classes at the University of North Carolina and studied medicine at the American University of Beirut and the University of Geneva. While he was living in Geneva, he made the acquaintance of some students from China. On August 3, 1933, he and a few friends boarded a ship in Trieste, Italy that took them to several ports in Asia, including Singapore and Hong Kong. Eventually, the three young doctors landed in Shanghai. Hatem established his medical practice in Shanghai and he changed his name to Ma Hai-te (Ma Haide). It was in Shanghai where he was introduced to communism and he eventually joined the Communist Party of China. At some point in his life, he became the personal physician of Mao Tse Tung. Hatem remained a doctor with the communists until their victory in 1949. Thereafter, he became a public health official. He was the first foreigner to be granted citizenship in the People’s Republic of China, and many Chinese credit him with helping to eliminate leprosy and many venereal diseases in post-war China. He received the Lasker Medical Award in 1986. He died in China in 1988 and was buried at the Babaoshan Revolutionary Cemetery. During his lifetime, he was honored in his town, Hammana, Lebanon, where the main square of the city was named after him.

This was the story of the Lebanese doctor who was the son of an immigrant. Now is the story of the Lebanese doctor who was born in Lebanon and who subsequently immigrated. Most of these doctors came to the United States. I do not know of any other country that has contributed more to American medicine than Lebanon. Currently, there are a few hundred Lebanese doctors who are leaders in the fields of cancer, heart disease, and other specialties. There is hardly a university or hospital in America where you do not find a medical leader who is of Lebanese descent.

Many of these doctors are now members of the National Arab-American Medical Association (NAAMA). This is an organization of medical professionals of Arab descent. NAAMA was incorporated in California in 1975 and became a national organization in 1980. Currently, there are 27 chapters in the United States and Canada. This organization sponsors national and international medical conventions annually and it produces two publications, Al Hakeem and NAAMA News. The journal, Al Hakeem, covers a broad range of association events and educational as well as cultural topics in English and Arabic. More recently, the American Lebanese Medical Association (ALMA) was established as a non-profit corporation in the state of Massachusetts on January 13, 1994. ALMA was conceived to develop a society through which physicians and other health care professionals of Lebanese heritage may come together and undertake projects to improve the health and well-being of all of Lebanon’s diverse religious and cultural communities in America and in the homeland. Also, ALMA holds annual medical conventions in Lebanon to promote advanced training and scientific exchange between America and Lebanon. I am proud to say that I have been part of the story of NAAMA as well as of ALMA.

Most of the Lebanese doctors who are leaders in medicine and research live in the United States. A few live in France, England and Canada; but you can find them anywhere you go in the world. Even in Australia there are some Lebanese doctors who rose to prominence. Marie Bashir, Governor of New South Wales, is of Lebanese descent. She was Professor of Psychiatry at the University of Sydney before she was appointed Governor.

In Diaspora, the Lebanese doctor has always had an edge over others as he is culturally more attuned to treat the sick. In addition to tenacity and discipline, he has compassion, love, and mercy. These qualities are part of his culture and they are crucial to the practice of good medicine. Our great challenge is to use the knowledge and skills acquired by these doctors abroad for the enhancement of medical education and health care in our beloved homeland. A more important challenge is to learn from the success story of the Lebanese doctor in Diaspora, and translate it into a great success story at home. For that, we must provide the Lebanese doctor at home with all the elements necessary for success. To accomplish this, a courageous revolution must take place to radically change our current views on the role of education, science and research in the making of the New Lebanon.

1 This article was written at the invitation of the Lebanese Order of Physicians. To be published as a chapter in a book which will be compiled by the Order.
2 Philip A. Salem M.D. is Professor of Cancer Treatment and Research and the holder of the Philip Salem Cancer Research Chair at St. Luke’s Episcopal Hospital, Houston, Texas. Also, he is the President of Salem Oncology Centre.
3 “The Real Man Behind the Genius” authored by Dr. Philip A. Salem, M.D., published in the Methodist DeBakey Cardiovascular Journal, Volume 6, Number 1, 2010, Pg. 42-44.