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Personal warmth, hostile slogans for medical delegation to Iran

Yale Medicine Magazine, 1998 - Fall


On their arrival at a hotel in the Iranian desert city of Shiraz, members of a medical delegation from the West, including three Yale physicians, were greeted by a banner declaring, in English, “Down with USA.” Inside the hotel, however, a friendlier reception awaited. “You’re from the United States?” the clerk asked the physicians. “It’s nice to have you here.”

The physicians were members of a delegation sent by the International Society of Nephrology in March. It was the first exchange involving nephrologists since the society sponsored an exploratory trip three years ago. Other scientific exchanges are planned over the next two years.

“There had been a lot of concern in Iran about scientific isolation,” said Asghar Rastegar, M.D., associate chair for academic affairs in the department of medicine, who three years ago made the exploratory trip on behalf of the society. “The society then decided to support scientific exchanges with Iran.” The March trip was at the invitation of the Iranian Society of Nephrology and was timed to coincide with their annual scientific conference in Tehran.

The delegation included Dr. Rastegar, Fredric O. Finkelstein, M.D., clinical professor of medicine; Michael Kashgarian, M.D., ’58, professor of pathology and biology; Saeed Fatenejad, M.D., assistant professor of medicine; Bernd Sterzel, M.D., chair of nephrology at the University of Erlangen in Germany. Also on the trip were Dr. Finkelstein’s wife, Susan H. Finkelstein, M.S.W., an assistant clinical professor of social work and psychiatry, and Dr. Sterzel’s daughter, Hannah. During their two weeks in Iran, the physicians traveled about the country, met with fellow nephrologists and gave lectures at nephrology and pathology conferences in Tehran and Shiraz.

Although a U.S.-imposed economic embargo never barred scientific exchanges, American academics have been reluctant to travel to Iran over fears about conditions there and a perceived hostility towards Americans. The embargo has also denied the country the economic wherewithal to import modern medical equipment.

“Medicine in Iran has always been very sophisticated,” said Dr. Finkelstein. “There is an artistic tradition and education is really revered in Iran. The problem is the rigidity of the Islamic government and the limits placed on Iranian access to knowledge from the outside world.”

Dr. Finkelstein and Dr. Rastegar first met in Iran in 1978, when Dr. Finkelstein was visiting on a three-month exchange. Five years later, Dr. Rastegar left when religious fundamentalists dismissed him from a university post. Over the past nine years, however, he has made regular visits to Iran to maintain contact with Iranian physicians and to see his family.

“Iranian scientists look to the United States and many of them have trained here,” he said.

Dr. Kashgarian offered a mixed assessment of Iranian medicine. “The quality of care is probably equivalent to care anywhere in the West,” he said. “Some of the facilities are not quite up to date. Their access to the latest drugs is more restricted.”

The physicians said the Islamic regime’s dictates have changed the teaching of medicine. The student body is of mixed caliber, Dr. Kashgarian said, because it is divided into students who compete for admission and those who are admitted, under lower standards, because of links to religious or revolutionary organizations. Also, because the Islamic government rapidly expanded the number of medical schools from seven to 34 and the number of graduates from 800 to 5,000 each year, the quality of education has fallen, Dr. Rastegarsaid.

The role of women in medicine has also changed because of religious dictates. Only women should examine women, according to religious leaders. As a result, more than half the medical students are female. They are expected to enter certain specialties such as obstetrics and gynecology, but Dr. Rastegar noted that women also study neurosurgery. “It has opened certain doors and closed certain doors,” he said.

Medicine is not the only area where women’s status has changed. Ms. Finkelstein contrasted the oppression she felt as a woman with the vibrant, intelligent Iranian women she met there. On the plane to Iran, she said, women wore fashionable Western clothing—until they entered Iranian air space. “Out came the scarves and the coats,” she said, referring to the clothing women, including foreign visitors, must wear in Iran. Even in a Tehran hotel she was expected to cover all but her face every time she ventured outside her room. Some Iranian women, she said, turn their clothing into a political statement by including brighter colors than religious law permits or wearing scarves looser than allowed. “Things are loosening up a little bit,” she said. “There really is a kind of cohesive society, wonderful family life, wonderful food, a rich culture that people really enjoy and appreciate. There is a lot there that is truly very positive.”

According to Dr. Rastegar, to understand the attitudes of Iranians one must place the events of the past 20 years in the context of the revolutionary changes that have occurred. Although he is quick to acknowledge that Iran is not a democracy, he finds that debate about the nature of politics and society is more open than it was under the repressive regime of theShah Mohamad Reza Pahlavi. Television images of mobs storming the U.S. Embassy, however, have created a “scar” that taints American perceptions of Iran and defines relations. “For the American people to deal with that scar they had to demonize the people behind it,” says Dr. Rastegar. “This can only be broken if there is face to face contact between individuals. This trip was a step in that direction.”

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