Audio Upload | Nov 2, 2023 4:37 PM
Nov 2, 2023 • 3:52 PM - 4:37 PM • Denise Billen-Mejia • Audio Upload
Denise Billen-Mejia 00:06
Welcome again to Myth, Magic, Medicine. This season, 3, "immigrant physicians".
Heba Ismail 00:11
Thank you.
Denise Billen-Mejia 00:11
Two doctors who are both immigrants, talking about their experience. Hi Heba, so kind of you to come back. Heba was in Season 2 as
well, talking about her professional life, but she is also from Egypt. So please say hello to the world and explain what brought you here
from such a lovely country.
Heba Ismail 00:32
Yeah, thank you. Well, happy to be back and yeah. Hello, world. This is Heba. I'm originally from Egypt. I was born and lived there part
of my life. Also went to medical school there and then decided to
Heba Ismail 00:53
that, the ceiling was too low and I needed to spread my wings a bit more. And I was actually looking, back then, at going to the UK
versus coming here to the US. But a lot of things worked out in favor of me coming here, so here I am.
Denise Billen-Mejia 01:13
Let's start a little bit earlier than this. You were born, obviously, which town or city do you come from in Egypt?
Heba Ismail 01:21
I was born in the capital, in Cairo, Egypt. So the big city was like, 20-30 million people. So I'm used to feeling like it's okay to be in
everyone's space, but yeah, so I was born there, but, we left when I was less than a year old. We went to Paris, France, lived there for a
couple of years. My father was getting his master's degree in business, and then he had another, so those were government
scholarships at the time, so he had another scholarship for a PhD.
Heba Ismail 01:56
And then we left to go to Glasgow, Scotland. So lived there for about, oh, which Uni. One of my sons went to Uni there, I think University
of Glasgow isn't, I think I think it was the University of so I have very fond memories of growing up there. And then after that, I think we
went back to Egypt for a year or two. It was really hard to live there, I think, for my parents. My brother and I were kids. But yeah.
Heba Ismail 02:27
So then we went to the UAE before it got so pretty and famous. We lived there for five years, I think. It was in a small college town. But
it was great because that's where my brother and I went to an international school. So we had this exposure to all those kids from
different countries, which was amazing.
Denise Billen-Mejia 02:58
So there were diplomats kids?
Heba Ismail 03:00
Yeah. Or they're visiting faculty like my father or something like that. It was a small college town. Yeah.
Denise Billen-Mejia 03:11
So they still had to be based somewhere. Was it international, out of the British system or the American system?
Heba Ismail 03:17
It was the British system, but it was a school that grew out of Lebanon, of all countries. But yeah, it followed, I think, now that I'm
thinking about it, actually, the American system. Scratch that. Now that I'm thinking of the books, my algebra books and whatnot, they
were all, like, American. Yeah.
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Denise Billen-Mejia 03:41
So your English was pretty good because I assume the school was teaching you in English at that time.
Heba Ismail 03:46
Yeah, and I wonder if I think I have a good ear for accents, because I had a British accent for a long time, and then as soon as I came
to the US. I just started this.
Denise Billen-Mejia 03:58
Yeah, mine kind of went away, too. You can hear it sometimes, when I get upset.
Heba Ismail 04:02
Yeah.
Denise Billen-Mejia 04:05
Now, when you were in France, did you pick up French as well?
Heba Ismail 04:08
I was little, but I can...so it was taught as a third language also in the other schools I went to. But if I read or if I want to speak in
French, I have a very good accent, so that's where I think also my ear helps.
Denise Billen-Mejia 04:26
I mean, that's not what this is about. But one of the great things is if you can get those phonemes into children when they're very little,
they'll have so much easier time learning a language.
Heba Ismail 04:37
Oh, true. Yeah.
Denise Billen-Mejia 04:40
Do you still mix up your P's and B's?
Heba Ismail 04:43
No, that's true. I didn't stop think about that, but yeah.
Denise Billen-Mejia 04:53
So you were in school through until high school.
Heba Ismail 04:58
Middle school in the UAE and then we went back to Egypt. Yeah, right towards the end of middle school. And then from there, the
system is you go from high school right into your college of choice and grad school. So from there I went into med school there in
Eygpt.
Denise Billen-Mejia 05:19
Did you realize that you wanted medicine early on?
Heba Ismail 05:23
I'm not sure. My brother went into medicine before me, and I was thinking about and I don't know if this is necessarily British. Like, a
lot of things follow the British system in Egypt, but you're scored at a national level with your grades, and so you get to choose based
on your rank, what schools, what your top choices are. And so I was thinking I remember that moment, I was thinking, oh, nursing
school would be nice, or agriculture. And I remember you have this sheet of paper you put in your choices. Check the boxes. And my
mother just kept talking me out of each and every one, and it was like, oh, yeah, okay, I understand.
Heba Ismail 06:12
So it became, by default, mostly, that I went into medical school, because everything else wasn't a good choice.
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Denise Billen-Mejia 06:21
That's how she so you tried really hard not to be a doctor, but they made you okay.
Heba Ismail 06:28
Yeah. Put nicely.
Denise Billen-Mejia 06:30
So where did you end up going? Which school?
Heba Ismail 06:33
I went to Cairo University. It's the Faculty of Medicine there, and it's a six year medical school system because you don't have the
premed.
Denise Billen-Mejia 06:42
Yeah, you didn't have to do A levels. System. The British system is O levels and A levels to matriculate for university. Did you have high
school exams?
Heba Ismail 06:56
Yeah, we did actually have to do the A levels. Isn't that the higher level that you go? Yeah. So because I went to a private school, we did
the GCSE. That's what it was called. Yeah. So we had to do there were certain requirements to make it equivalent to the Egyptian
system.
Heba Ismail 07:16
So you had to do certain subjects in A level, and then other things could have been O level. It didn't matter. Right. The majority had to
be in A level. Yes, I remember now. Wow. Yeah, way back.
Heba Ismail 07:28
That was way back. Somewhere in my head where I forgot where it was.
Denise Billen-Mejia 07:36
Chemistry, zoology, physics.
Heba Ismail 07:38
Yeah. Wow, that's amazing.
Denise Billen-Mejia 07:42
So how did you feel the first day that you walked into medical school? How big a class was it?
Heba Ismail 07:49
Oh, gosh, it was like 1500 in my class. Yes.
Denise Billen-Mejia 07:55
What's the med school to population ratio? Some pretty big classes here, too.
Heba Ismail 08:01
Yeah. So that is one of the biggest universities. It's the top medical school.
Denise Billen-Mejia 08:07
And then the second one is well, as you pointed out, you got 30 million people in the city.
Heba Ismail 08:13
Yeah, but there are people who are on scholarships, there are people who are coming also from other countries. A lot of Malaysian
students and Yemeni students came, but yeah, I don't know the ratio at all. But you were sort of assigned,also, based on where you
lived. So I lived in the Giza part of Cairo, so that would be, by default, the Cairo University, even though Cairo University, it's in Giza. And
then the other one Ain Shams,. was the other,second, big one. Then there's a bunch of other ones, but not any private medical schools,
so the system is flipped. So the.
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Heba Ismail 08:54
And I know a lot of other countries are that way, so that going to a public medical school, or even any public university is considered
more prestigious than going buying your way into a private university. Does that make sense?
Denise Billen-Mejia 09:12
Well, buying your way in sounds a little pejorative, but yeah, so to point out you can buy your way in, getting out with a degree is a lot
harder.
Heba Ismail 09:24
Yeah, that's so true. That is so true. But, yeah, it's sort of considered the backdoor, at least in Egypt, to go to a private university just to
get a degree because you're paying for it, basically. But, yeah, those are public universities. And then everything is subsidized, which is
nice, but at the expense of huge numbers, right? So then you end up having to take all these private lessons in small groups so that
you end up with a class of 20 and an instructor.
Heba Ismail 09:58
It's basically you making up for that system.
Denise Billen-Mejia 10:07
What was the anatomy based on? That sounds so silly, if you're not a doctor. What do you mean? Anatomy is the same everywhere,
but they use different naming systems. When I went to school, I went to school in Spanish. Not in Spain, but in Spanish.
Denise Billen-Mejia 10:22
And they used a French system, which is different from Grey's Anatomy. Which system does Egypt use? Because you've got a pretty
heavy French influence there too?
Heba Ismail 10:32
Yeah, that's a good question. I don't know. First two years were anatomy very hands on, actually. Like they had those formalin
immersed bodies that no one claimed, right, or were past criminals or whatever. And you were supposed to dissect yourself with your
own hands, and the stench was just horrible. But yeah, that's how we did anatomy. I'm not sure if I remember the book.
Heba Ismail 11:08
It was all like British system, really, but yeah, I assumed at least.
Denise Billen-Mejia 11:14
What was your favorite subject when you were. What preclinical? What was your favorite subject? And then once you got to clinicals,
what was it?
Heba Ismail 11:23
Good question. I think interestingly, it was actually microbiology, which is interesting because now I came back full circle. And you're
microbiome.
Denise Billen-Mejia 11:36
Yeah.
Heba Ismail 11:37
Isn't that interesting? Yeah, I really enjoyed it. The one I struggled the most was always biochemistry. I couldn't understand these
equations. They seemed like a given to everyone else. But I'm like, I don't know what affects what and how that goes in that direction. I
get the enzyme piece and the slowing down and the catalyst effect, but I don't I don't want to calculate it.
Denise Billen-Mejia 12:04
I just want to memorize it.
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Heba Ismail 12:06
I can't hard, but yeah.
Denise Billen-Mejia 12:10
And what was your favorite once you got into clinical work? When when do you switch? Is like, between third and fourth year.
Heba Ismail 12:17
Yeah. So third year starts to prep you. There's a lot of public health stuff, which is really fun because we live in the city. We're kind of
also still in a silo, but they take you out these field trips to the small villages. You understand, like, oh, how they use the canal water, or
they have their sewage system is in a tank. All these things were like, really? People live like that?
Denise Billen-Mejia 12:44
Exactly. A lot of places in the world, the students have a different world that they're living in than many of the people in the town. It's
terribly important as a physician to understand, really understand not just on paper, but really understand where your patients are
coming from.
Heba Ismail 13:04
Absolutely. Yeah. So it was really eye opening and it was fun. I enjoyed that. But yeah, so that was sort of the transition there in the
third year and then fourth is where you start your clinical rotation. So 4th, fifth, and the 6th year are all clinical heavy. So let's see of the
ones that I enjoy th well, I enjoyed pediatrics.
Heba Ismail 13:31
I knew that.
Denise Billen-Mejia 13:32
That's good, considering what you wound up doing.
Heba Ismail 13:36
Thankfully, that worked out. Um. And then I think Ophthalmology was another interesting oh, really?
Denise Billen-Mejia 13:43
That's usually an elective here, I think, yeah. Is it a requirement? It was an elective.
Heba Ismail 13:48
No, I think it was an elective, like, just like dermatology and all those subspecialties, but yeah, I think I chose it as one of my electives.
You're right.
Denise Billen-Mejia 14:00
Do you do an internship as part of the graduating requirement?
Heba Ismail 14:05
Yeah. Total seven years, really, before you can start a residency? Yeah, basically.
Denise Billen-Mejia 14:12
Right. But here you are done, and you are officially a doctor. And then you go find yourself. Most people just do a straight internship
these days, but a few specialties need a transition.
Heba Ismail 14:23
But you can't get sorry. Your license until you right.
Denise Billen-Mejia 14:26
You can't get your license until you've done.
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Heba Ismail 14:27
It do.
Denise Billen-Mejia 14:31
So you did your six years. You had a nice little ceremony to say you'd finish all that sort of work, but then you had to really go and
actually feel like a doctor, when sometimes it was your choice what you were going to do rather than be told, where did you serve that?
Was that also in Cairo?
Heba Ismail 14:50
Yeah. So my first pediatric residency. Residency number one. Yeah, that was at Cairo University. And then they don't have fellowships,
like formal fellowships, so you just join a subspecialty. So at first I went to ICU. Pediatric ICU.
Heba Ismail 15:09
Um, sort of informal training, but that quickly realized it wasn't the quality of life I was looking for. And then by default, went into
pediatric endocrinology. I think we talked about that.
Denise Billen-Mejia 15:22
We did a little bit, but not everybody will have listened to season two. And when did you decide you were going to come to the States
or somewhere? And how did you make that decision? How did you make the decision of one English speaking country over another
that speaks a different English.
Heba Ismail 15:39
That's true. So I knew I kind of had the urge to leave and felt like, if just given the opportunities, I can do more. And I was really
interested in research all along. And part of the training, like, to get your master's degree or PhD, you still have to and even your final
MD. Not like the MD when you graduate here, but MD. Yeah.
Denise Billen-Mejia 16:08
And a lot of people don't realize that an MD is a secondary designation. It's a higher medicine is a bachelor's degree because you go
straight from high school. It's a six year bachelor's degree.
Heba Ismail 16:19
Yeah. It's MBBCh. Yeah. So, yeah. I was enjoying doing that research. And then I know a lot of my mentors at Cairo University, they
were all very strong women.
Heba Ismail 16:39
I know I say that. And people are surprised, really? So you have women doctors that are senior there? I'm like yes. So they're very
strong women, and they knew I was interested in research. And so they started looking for more opportunities for scholarships or
training grants.
Heba Ismail 17:01
Third World countries like us, and there was something through the European Society of Pediatric Endocrinology at the time, but they
would sponsor you in any country in the world so long as you had a sponsor/mentor who is going to take you in their lab. So that's how
I ended up here, because
Denise Billen-Mejia 17:23
Oh so you came in originally as a researcher?
Heba Ismail 17:27
Yeah, I came in as a researcher. I actually did not get that grant funded, but the person who sponsored me, he really thought there was
hope in me, and he said, I really like how you communicate, and you're really on this. And he saw me write-up a grant, too, and gave me
feedback. So he was like, you know what? I have a grant. We can bring you over. You can come work in my lab.
Denise Billen-Mejia 17:58
Where was that?
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Heba Ismail 17:59
That was in Seattle, Washington, at the University of Washington. It's quite different scenery and weather Oh, I know, but it's so yeah, it
grows on you, it's just an amazing area. Yeah.
Denise Billen-Mejia 18:15
And how long were you in Washington?
Heba Ismail 18:17
So for that postdoc, it was like a year and a half. And mind you, I was thinking initially, okay, I'll learn some research techniques and
then go back and see if I can apply that in Egypt. But then I started feeling two things. One was the itch to see patients even attending
grand rounds or whatnot I'm like , It is. It's very hard. And the second part was like, actually, I do like it here, and I like the system, and I
want to be a part of this system.
Heba Ismail 18:53
Maybe I'll go back. You have a faculty position there you have to go back to after you get your MD, PhD, whatever you want to call it. So
I had to go back for that. But at the same time, I was like, maybe I'll just take my USMLE and see if I pass. This is really naive. I don't
know if I told you that, but if I pass, then that's my sign. I'll schedule them all back to back.
Denise Billen-Mejia 19:25
Oh really? Did you wait for the results before you got the next one or you just went through?
Heba Ismail 19:29
As long as you can schedule all of them. So I think the clinical one and step three, you have to wait for the results. So I scheduled them
back to back, and I was like. And I was full time back at work there and I was like, It's just it's going to be a sign for me, I guess, came
true and I came back.
Denise Billen-Mejia 19:52
So you went home, you finished the postdoc and you went back to Egypt.
Heba Ismail 19:56
I went back to Egypt, went back to right.
Denise Billen-Mejia 20:00
So that you took all of your exams there, except for CS, of course, which is no longer being given post-COVID, you physically had to be
here and you only have six places that you can go to take that exam, so it's hard. Did you come over to take CS here?
Heba Ismail 20:17
Yeah, I came over to take CS, then went back. So that was a very short trip. And then when I came back to interview so you don't need
to take step three to go into residency, but took that while I was interviewing, because obviously I'm paying for all of this international
travel, and I was like, this is so expensive, let me just take it while I'm there. Yeah.
Denise Billen-Mejia 20:42
Did you fly back to Egypt to find out if you had a space, or did you wait around here to find out?
Heba Ismail 20:46
Oh, no, I had to go back. Yeah.
Denise Billen-Mejia 20:49
When you were back, were you working?
Heba Ismail 20:52
Yeah. Yeah.
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Denise Billen-Mejia 20:53
Okay. As in research or were you seeing patients?
Heba Ismail 20:56
No, faculty, so teaching mostly and seeing patients. So Cairo University hospitals are like quaternary centers, so they serve other
countries as well. So it's a huge patient volume. So they really want us to focus mostly on seeing patients and teaching. And then
clinical research, any sort of observational or collection of data or chart review sort of research is also important, and it's part of the
promotion process. But you have very limited resources.
Denise Billen-Mejia 21:36
You got to find your own time for it.
Heba Ismail 21:38
Yeah, you don't have your own lab. Exactly. So I did a few surveys here and there and did a case report or whatever, but it wasn't really
that impactful.
Denise Billen-Mejia 21:50
And then you entered the match for here?
Heba Ismail 21:53
Yeah, actually, I went outside the match at the time.
Denise Billen-Mejia 21:58
Not always an option, but sometimes it is.
Heba Ismail 22:01
Yeah. Because I knew I wanted to do pediatric endocrinology and I knew there were several places interested in me. I knew I had a
little bit of an advantage to negotiate because of that. And so I negotiated a two year residency instead of a three year residency, so
long as the American Board of Pediatrics allowed it, which they did, to give me credit for my prior training. So I went outside the match,
went to this small town, Chattanooga, Tennessee. It's not so small.
Denise Billen-Mejia 22:42
I like railroad carriage hotel.
Heba Ismail 22:47
Yeah, no, it's cute. It's not so small, really. I shouldn't say that. But not a big city or capital. But yeah. So went there for residency,
sucked it up for two years because I was like, oh, man, this is hard to do. And I've practiced independently before.
Heba Ismail 23:08
And peeds is not my thing. I want pathology. I don't want well-child checkups in clinics.
Denise Billen-Mejia 23:17
It's nice to have a little bit of that. It's nice to see children be healthy too.
Heba Ismail 23:22
No, don't get me wrong. Totally great.
Denise Billen-Mejia 23:25
It's important work. Note not to diss our friends in general peds.
Heba Ismail 23:29
I'm looking for something to fix. It's just my personality. I'm a fixer that way, I guess. But yeah. No, I mean, I loved my patients. It was
sad to leave. It's always sad to leave your patients behind.
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Denise Billen-Mejia 23:46
So where did you do your fellowship?
Heba Ismail 23:48
So that was back in Seattle. So I went back to Seattle Children's University of Washington. That one, because I didn't get formal
training in Egypt, it wasn't a formal fellowship, I didn't get a waiver. So I did all three years, which I'm glad I did it was wonderful.
Denise Billen-Mejia 24:07
And then what was the next move for you after that?
Heba Ismail 24:10
All right, so I still knew I wanted to do research, but I was not a permanent resident or citizen, obviously, so I didn't qualify for
institutional K Awards and couldn't stay in Seattle.
Denise Billen-Mejia 24:26
Sorry, what visa did you have A J-1or an H-2?
Heba Ismail 24:30
I had an H-1B, actually. Yeah, it's a good visa, right? But your chances are a lot lower to try and apply yourself as an individual for
funding without institutional support. So my best option was to take a clinical job, which was my first job in Pittsburgh.
Denise Billen-Mejia 24:53
Another common. Yeah, I lived I didn't live in Pittsburgh. I lived in Latrobe. My first job coming out of New York was in Latrobe.
Heba Ismail 25:01
Oh, yeah? Cool. Yeah, that was close. Got a lot of patients from yeah, that was my first job for four years. I was clinical director there.
And so it was clinical/administrative, but I still had the urge to do research, so I did research on the side. And what was nice is I was
part of this consortium where you can do data analysis and do epidemiology kind of work, so I didn't have to recruit for a study or
something.
Heba Ismail 25:33
So that was nice. So then I built my resume that way. And then once I became permanent resident and then citizen, this research
position came up here at IU and so yeah, I moved over here.
Denise Billen-Mejia 25:50
Long road.
Heba Ismail 25:51
Yeah.
Denise Billen-Mejia 25:52
At what point did you acquire your children? Which must have impacted your workflow considerably. 'Cos they do.
Heba Ismail 26:02
It has. Oh, my so, you know, someone once told me that was actually a physician in Egypt. She know our life as physicians is mostly
medical and everything else is paramedical. That includes our kids, our family, our health. It's paramedical. So I see them as, like,
peripheral, but they're not really. But yeah.
Heba Ismail 26:27
So guess I had my son while I was ending my fellowship in Seattle and then had my daughter while I was in Pittsburgh. So yeah, they're
three years apart.
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Denise Billen-Mejia 26:42
Good. Very good. What do you miss most about Egypt? If you could design a healthcare system that would allow you to live in Egypt,
where you could practice medicine the way you want to practice, do you think you'd be tempted to go back?
Heba Ismail 27:01
Yeah, I think most definitely. So. I miss the. I think I missed the simplicity of the people, especially if we're talking patients again. Most
of my training and work was with people from villages somewhere out in the desert. Very simple. And I didn't mind at all breaking it
down for them.
Heba Ismail 27:30
And they didn't necessarily want to be informed like here, Here you want to really make sure your patient makes that educated
decision with you over there.
Denise Billen-Mejia 27:41
Sometimes that's a burden for the patients. There's an awful lot of knowledge that goes into really being informed about a decision.
Heba Ismail 27:48
Exactly. So they just trusted you and they believed that you could make the right decision for them. Which was a burden on me then.
But then I think it created more of a bond because there's some higher level of responsibility now that they just trust you so much.
Right. And so you're really. Watching everything and making sure they're okay.
Heba Ismail 28:18
And you're almost dragging out of them any side effects. They're just grateful for anything and everything. "Thank God! Everything is
good. Thank you, God!" I'm like, I understand. Thank you, God for everything.
Denise Billen-Mejia 28:32
Do you think there's much difference in the attitude of patients?
Heba Ismail 28:42
Depends. So where I am right now and where I've been before, and especially in Seattle, there's a lot of higher, we'd get those
engineers who came with their kids and had their own algorithm already set up. Why do you need me? You don't need you got this
figured out. But yeah, no, it depends. So maybe more in Pittsburgh.
Heba Ismail 29:07
We had people from West Virginia and western Pennsylvania. So smaller towns, very simple people. They really reminded me of the
patients that just trusted in you had a lot of respect for you as a physician and just went with whatever recommended, and they
enjoyed that you actually asked about them and how they're feeling, and they're not get out.
Denise Billen-Mejia 29:37
Do you feel you have the same do. The amount of time to spend. That's the biggest complaint I hear people insurance quotients
quotas making them go crazy.
Heba Ismail 29:55
It's getting harder and harder. I mean, it is getting very hard. And if I'm expected to chart and then put in prescriptions and then reach
out to coordinate for a prior auth or whatever, all that, let's go with what must be a very routine when the first time you tell somebody
their two year old is diabetic, how long do you need to have a conversation with that person?
Denise Billen-Mejia 30:20
How long do you need and how long do you get?
Heba Ismail 30:22
Oh, yeah. So that's a hard one.
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Denise Billen-Mejia 30:28
I was just picking the easiest endocrine subject matter. Not necessarily the easiest subject to discuss, but absolutely most people
realize that's endocrine.
Heba Ismail 30:39
I think for people with diabetes, I think it's more we do have the advantage of when the kids are first diagnosed, usually they come into
the hospital and they're admitted we have some flexibility with time, but sometimes service is busy and we have to run to see the next
patient. But, yeah, it probably takes a good 30 minutes to really go through things without rushing them to process everything. But you
have to be careful because you don't want to overwhelm them, right? There's a lot to diabetes.
Denise Billen-Mejia 31:16
Here's this boo, go memorize it, Go memorize it, come back, any questions? Do you feel you have good additional care available?
There's social workers?There are people that specialize in so they've got that. Did you have that available in Egypt?
Heba Ismail 31:31
No. So that definitely is an advantage to have here. Right. You have a psychologist all not necessarily available all the time, but social
work is definitely part of our team. We have a diabetes educator, we have a dietitian. Right. So all those people it's a team, really.
Heba Ismail 31:54
Having those people we had maybe one dietitian who served also as a diabetes educator where I worked in Egypt. And and we did a
lot of the diabetes education ourselves, and actually in a very simplistic manner, like, we use the points. I don't know if you're like,
instead of 15 grams of carbs, it's one point. It's almost like Weight Watchers. Yeah, because people does. So pita bread is like, 15 or so
pita bread, like, half is 15 grams.
Heba Ismail 32:25
That's one point. A whole pita bread is two points. That's how you had to make it simple for them. But yeah, so we didn't have that. So
they teach them in groups. Right. So they 15 people in the room all learning together.
Heba Ismail 32:42
But it actually worked out well, because, again, those are people who aren't necessarily asking a lot of questions. It's more of a didactic
kind of nature and then giving them sort of examples. Why don't you tell me how much insulin?
Denise Billen-Mejia 33:01
You get the first bout of information, you've got to go home and digest it and then come back with the questions that come from it. It's
a fairly protracted journey.
Heba Ismail 33:11
Yeah, I think.
Denise Billen-Mejia 33:12
Of course, the biggest hit has to be your child has this and it's not going away.
Heba Ismail 33:17
Oh, yeah. It's definitely right. And they need insulin for life. Right. So whether that's here or there, it's the same impact. And in certain
cultures, not all there's stigma associated with that diagnosis. Right.
Heba Ismail 33:33
So it's really hard to help them navigate that process and trying to hide that from family or it's like really yeah. Yeah.
Denise Billen-Mejia 33:46
All right, let's talk social. That's done with medicine for now. All right. What do you miss socially from Egypt?
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Heba Ismail 33:54
Oh, I miss a lot of my friends, people I went to medical school with.
Denise Billen-Mejia 34:00
Did many of them wind up over here or England?
Heba Ismail 34:03
Not that many. There's friends of friends that wound up over here. But it's so huge a country that it's hard for us. We see each other on
Facebook and what we're up to, but yeah, so a lot of them are still back there and they're doing well. I visited a couple of years ago, and
they seemed happy and doing well. Yeah, I miss that. I miss the.
Heba Ismail 34:35
One advantage to the west in general is the practical nature of things, right? So you're struggling with something, okay? You take a few
days off, whatever family leave, whatever it is, and you're expected to move on after that and keep everything going, right? And it's a
really practical, good way of doing things. But on the flip side, you miss the compassion, right? That. You.
Denise Billen-Mejia 35:06
You had your three days to mourn. Now get back to work.
Heba Ismail 35:09
You know what I mean? There's certain levels of, oh, I want to feel this with you. And it's extreme too. In the Middle East, they love
being sad. I just read this recently. There's almost an addiction to certain emotions in people, and they have that addiction to, oh, let's
mourn this person.
Denise Billen-Mejia 35:37
It was the volume and the amount of distress they were comfortable showing.
Heba Ismail 35:42
Yeah, let's be practicing. So there's advantages to both. It just depends on the moment and what you need. Right. And so yeah, so I
miss that compassion. And I remember when we had visiting students from different parts of the world when I was still in high school
in Egypt, and one of the girls made this remark of, like, egyptians are really funny. When one person cries, you all person and start
crying, even though it didn't affect you.
Denise Billen-Mejia 36:14
Right. That is to when somebody dies. Certain cultures, everybody has to make a great to do about it. Again. Very British. Yeah, I'm sad
my mother died. The other people don't realize that.
Denise Billen-Mejia 36:37
Yeah, it's hurting. I'm just not going to go on about it. And it doesn't mean that you're hurting more or less than the other person, and
it's very different. One of the really nice things about you traveled a lot before you became a doctor. You don't have to become an
immigrant, but the more you learn about people all over the world, the more you can care, can show concern for your clients.
Heba Ismail 37:02
We're all the same, right?
Denise Billen-Mejia 37:04
We're all the same, but different in the way we express the same thing. We're all sad, but we all tell you about it differently and how we
do it, too.
Heba Ismail 37:12
Right? So I always say, like, the British drive on the other side of the road, and Americans say they drive on the wrong side of the road,
where everyone gets to their destination in the end. There's no problem.
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Denise Billen-Mejia 37:26
Both if you're on the same road, it might be difficult.
Heba Ismail 37:30
Oh, no, we don't want to try that. But my point is it's different ways of doing the same thing or feeling the same thing. But yeah, that's
something that I would say. I miss that. Right.
Denise Billen-Mejia 37:47
Are you. hmm You're bringing your kids up in America, so they're obviously going to be very American in many ways. My kids are very
American, but they will sometimes remember bits of their other heritages. So how do your kids respond to the world? They suddenly
say it sound quite Egyptian to you?
Heba Ismail 38:08
No, I wish. Yeah. They're still learning a few words of Arabic, and it took me a while to finally introduce that to them and introduce my
faith. Right. We had an interfaith marriage, their dad and I, so I was like, okay, well, maybe it's safe to do that now. So they're still
learning, but I'm excited that they are. They're excited about learning.
Heba Ismail 38:36
Right. And my daughter, just yesterday, all of a sudden, out of the blue, she's like, I'm so happy I'm half Egyptian because I have so
much gold. Egyptians have so much gold.
Denise Billen-Mejia 38:49
Do they? Did you realize how much you had?
Heba Ismail 38:53
That's a nice way to look at it. Yeah. Egyptians from a long, long time ago had much more gold. I was like, yeah, I never thought of that.
Have they both been back.
Denise Billen-Mejia 39:11
And you mentioned you're from Giza. Isn't that where most of the pyramids are? Yeah. You have to talk about it. We can't talk about
Egypt and not talk about pyramids. Come on, talk about the pyramids.
Heba Ismail 39:20
Educate us. We were former colony. You should know something about this.
Denise Billen-Mejia 39:26
That's why I know they're in Giza.
Heba Ismail 39:29
Oh, you're better than so many, trust me.
Denise Billen-Mejia 39:32
So how much a part of your identity as an Egyptian is colored by that old history?
Heba Ismail 39:45
That is a hard one. So Egyptians generally feel there's this certain sense, and this is just my observation. I'm not a sociologist,
obviously, but Italians are the same way, and so are Greeks. We have all these monuments, all this great history in front of us, and
we're proud of it, but at the same time we're ashamed because we have this sense of insecurity. In the sense or insecurity isn't the
right word, but this sense of. Oh, we couldn't keep it up. We couldn't be the greatest civilization till this day.
Heba Ismail 40:35
Look at us. We're a third world country.
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Denise Billen-Mejia 40:39
This is true of all history.
Heba Ismail 40:43
Yeah. So that's something that I think we know that inherently in ourselves. And I see it in who have immigrated and how they carry
themselves with a sense of pride. But there's a certain degree of, oh, man, we're so behind. What a shame our ancestors would be so
embarrassed kind of thing. Yeah.
Denise Billen-Mejia 41:13
You miss the food?
Heba Ismail 41:14
Oh, I miss the food for good.
Denise Billen-Mejia 41:18
You have you're in indianapolis.
Heba Ismail 41:22
Yeah.
Denise Billen-Mejia 41:22
So Indianapolis have a fairly good restaurant.
Heba Ismail 41:29
There's maybe one restaurant where I like their food. See, we say Middle Eastern food is hard to commercial wise and franchise. So if
you have falafel in some of these very kind of fast foodie places, it never tastes right and the texture is wrong and everything. So the
best Middle Eastern food is to really eat, to try is in someone's home. But yeah, there's one place that I've liked, but not a big influence.
Denise Billen-Mejia 42:00
Can you buy the right ingredients?
Heba Ismail 42:04
Yeah. Every place I've lived in the US. There's always the one or two Middle Eastern stores that sell that stuff. Right? Yeah, there's a lot
of I don't I don't generally cook Middle Eastern. It's like hours. It's crazy.
Denise Billen-Mejia 42:18
And then they eat it, and you start all over again.
Heba Ismail 42:20
Yeah, I know. You have to spend so many hours in the kitchen. That's why it's hard to commercialize, probably.
Denise Billen-Mejia 42:29
I think one of the biggest realizations food wise, admittedly well into my middle age, was discovering at Ramadan. If you buy dates at
Ramadan, boy, those are good dates. The things I used to eat at Christmas time in England when I was a kid, it's like desiccated. Not
even close.
Heba Ismail 42:50
Yeah, no, that's true. That's true. And especially if you're fasting. Everything tastes so good, right? Yeah, but yeah.
Denise Billen-Mejia 43:01
No. Do you have any parting words? Do you think you'll go back and lecture when the children are things are more stable for you?
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Heba Ismail 43:15
I'd love to help medical students there, help my country in any way. I don't know that I would ever go back and live there. Maybe after I
retire, I'd go live in a resort or something. They have some really nice resorts, but I can't go back to their traffic and the hustle and the
bustle and the crowdedness that's just kind of have I'm sad, but I have never been to Egypt, but I have been to Turkey.
Denise Billen-Mejia 43:41
And if your traffic is anything, like, just I don't understand the rules. Are there rules?
Heba Ismail 43:47
No, no, it's a video game, and you're trying not to get shot. Right?
Denise Billen-Mejia 43:52
You're just like but everybody stops for the little old lady who decides to walk across the street.
Heba Ismail 43:59
Yeah, the way you cross in Cairo, they say you just put yourself in front of the car, and they'll stop. And that's true. You can't wait for
them to stop for you. You got to step in on the road with prayer and walk and don't even make eye contact. Just crazy. But yeah, it is.
And I can't believe that some years ago I actually drove there, because if you tell me to drive there again, it's like, there's no way.
Heba Ismail 44:34
That's crazy. Yeah, it's scary, but, yeah, they make it happen. They get to their destination. Same idea.
Denise Billen-Mejia 44:48
Well, thank you so much for joining me and so nice to talk. We'll talk again soon. Yeah, we probably won't record it, but we'll talk again
soon.
Heba Ismail 44:56
It's always fun. It's always fun to talk to you. Thank you.
Denise Billen-Mejia 44:59
Thank you for joining us at Myth Magic Medicine. If you have found this episode useful, you can apply for free CME credit through the
link provided in the transcript. If you're not a medical professional, please remember while we're physicians, we're not your physicians.
So please consult with your own healthcare professional if you think something you have heard might apply to you or a loved one. Until
next time. Bye.
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