In 1978 when I started a cardiology service in Doha I had no permanent house officers to work with me. Any medical house officer on duty could admit cardiac patients to cardiology. Some or all of the following laboratory tests were requested routinely: CBC, BS, LFT, UA, and CXR. To standardize the admitting orders for cardiology, I developed a routine order sheet for cardiology patients. The House Officer had to sign the bottom of the page for the nurses to carry on the order. I added RPR test to the laboratory workup for all cardiology patients. That is because, at the University of Oregon where I had my internal medicine and cardiology training, RPR was a routine admission test for medical patients.
We picked up several patients with positive RPR in Rumailah hospital and evaluated them for syphilis. In 1982 when we moved to Hamad General Hospital (HGH) we continued to order RPR for all new admissions to the cardiology service. The rest of the hospital did not adopt such a procedure. In HGH we referred all the positive RPR to infectious disease for consultation, a luxury that we did not have in Rumailah hospital. This procedure went well until one day we got stuck with a patient.
The patient was a 60-year-old Omani gentleman who was admitted to the CCU for congestive heart failure. Physical examination revealed moderately severe aortic regurgitation, pulmonary rales, and
mild pitting edema of the lower extremities. The CXR showed enlarged cardiac silhouette and dilated aortic arch shadow. The routine RPR was positive and VDRL was positive with significantly high titer. His symptoms improved with oral Lasix and ACE inhibitor. The infectious disease team performed spinal puncture and obtained cerebrospinal fluid for analysis. The test confirmed that the patient had syphilis earlier in his life. He was in danger of developing tertiary syphilis with its dreadful CNS complication. He could become insane if not treated.
An enlarged aortic arch and aortic regurgitation are part of the cardiovascular manifestations of syphilis, which may be manifested before the onset of neurological symptoms. Syphilis produces destruction of elastic tissue particularly in the ascending and transverse segment of the aortic arch resulting in aortic regurgitation and aortic aneurysm.
The Infectious disease team recommended starting the patient on Intravenous (IV) aqueous penicillin G. The patient, however, refused to accept any form of IV therapy. Neither the infectious disease team nor the cardiology team was able to convince the old man to agree to the plan. He refused to reveal to the doctors the reason for his refusal. The cardiology staff informed me about the “ignorant and uncooperative Omani old man”. The patient was reportedly pleasant if the topic of IV therapy was avoided. The plan was to discharge him with a note in his chart that “he refused treatment.”
I was curious about the reason for his refusal. I also had a feeling that I may be able to convince him to accept the treatment. I decided to try my
luck. I went to his room alone. The patient was sitting over his bed leaning over a pillow and listening to a small radio on his lap. He was, thin, tall with a gray beard. His colorful Omani ‘omama’ (cloth wrapped around the head) gave him a distinguished appearance. I introduced myself. He turned off the radio and stood up to shake hands with me. We had a nice social conversation away from his medical problem.
He had come to Qatar only recently to work. He had been a sailor 20 years earlier. Outside the Arab harbors, he had visited India, Africa, and Iran. “I have several Omani relatives in Ras Al Khaimah,” I told him. (Ras Al Khaimah is one of the states comprising the United Arab Emirates (UAE). Before 1970 citizens of present-day UAE were referred to as Omanis also).
“All the Gulf people are brothers, he said. I agreed with him. After I felt that he was comfortable talking to me like a relative. I told him that I had a long discussion with my colleagues about his medical problem. “You are fine now but without treatment, you will have dangerous complications. Refusing the IV treatment is not fair to your self and to your family”, I said, adding, “God said in the Qur’an: ‘Do not throw yourself to death.’ ” “I know, but I am not allowed to accept the treatment.” He whispered, while sitting up, and leaning towards me. “Who prevented you?” I inquired. “Genii.” He replied. Then he shared with me his secret. A few years before, he had been very sick with a fever. A local traditional doctor in Oman treated him with cautery on his back and abdomen. He lifted part of his cloth to show me the cautery scars on his abdomen. The cautery did not help. So, he was taken to an old Mutawa in Sharjah, UAE. The Mutawa had announced that he was sick because he was possessed by a Genii. A “Zar” party was arranged. Zar in Arabic means “visit”. Here it is meant the visit of the Genii.
Mutawa is a Qur’an teacher or a religious man who leads the prayer, like a priest. Some practice traditional medicine using Qur’an readings, herbs, and protective prayers. Some Mutawas claim that they could drive away gin or spirits. Islam accepts the existence of gin but Islamic scholars do not support Mutawa claims about being able to communicate with Gin [Gin: plural of genii] and they preach against zar parties. They consider the stories of lay people about Gin as myth. According to one great Islamic scholar, Alshafiai, a person who claims to have seen the Gin cannot be accepted as a witness in court.
The zar party consists of a group of people who sing and dance vigorously until the genie comes out to communicate. Some behave in a bizarre fashion;
some faint and some shout in a "foreign" language as proof that a gene is coming.
The Zar party is African in origin. In fact, most of the gulf singers and dancers during zar are of African descent. Some authorities believe the practice was brought to the Gulf from Christian Ethiopia in Africa during the slave trade. So, we Arabs could blame the Africans rather than our Arab ancestors on such strange practice. But some historians ruined that theory by claiming that the Ethiopians migrated from east Yemen thousands of years ago. This is very possible because their language is Semitic. Many Ethiopian words and Arabic words have the same root. The Arabic Genii, for example, is Ganen in Ethiopian language. Furthermore, the Eritreans who separated recently from Ethiopia are Arabs. Their language is an old Arabic that I do not understand. It is still spoken in some parts of West Oman and East Yemen.
Other Arab countries outside the gulf also practice Zar. The zar parties in rural Egypt where
illiteracy and ignorance prevail, are famous. A sheik (instead of the Gulf Mutawa) and his followers will perform the zar party. They bring out the Gin by beating drums noisily, dancing, and shouting. They make their living by deceiving the poor farmers with trickery and witchcraft. They promise sick patients that they will cure them of their diseases with the help of Gin masters. They claim they could drive away bad genii or cure diseases. The Gin masters reportedly dictate their conditions through the sheik. They may ask for money in addition to food. The people who communicate with those Gin masters can be guaranteed with generous feasts that may last several days at the expense of the victim. The Gin’s conditional menu consists of lamb, calves, chicken, etc. The Gin’s appetite and taste for food as communicated by the sheik is exactly identical to the taste of the group performing the party!
Since I was the only Qatari physician in the cardiology department then, and a Gulf citizen like him, the patient felt comfortable talking to me about his Genii problem. He whispered: “Those foreign doctors would never understand my problem. If I tell them my story, they will think I am mad.” Then he asked me if I had ever seen a zar party.
&nsbp; I told him that I did when I was 8 years old. I knew a boy in our neighborhood, a playmate of mine, who was beaten with a stick to drive the genii away from his body. He cried while he was being lashed over his bare skin. I felt very sorry for him.
“It must have been very painful,” I said. The Omani old man seemed fascinated with my story.
“No the boy would not have felt the pain, the Genii felt it.” He said.
“Why did the Genii not kill the Mutawa?” I asked.
&nsbp; “The genii cannot do anything against the Mutawa because the Mutawa reads a special Sura from Qur’an before he challenges the Genii. The Mutawa is protected from any harm from the Genii. Sometimes the Genii will agree to leave immediately after he hears the Qur’an”.
I asked the patient if he was hit to drive the Genii away.
“No, my Genii agreed to come out during the zar party on two conditions: I kill a black sheep and never allow doctors to give me injections. The Mutawa agreed. The Genii left me. A few days later, I was completely cured. If I break the agreement I will be punished. The Genii might retaliate against me or my family.”
I told the patient that I understood the problem very well. “You have the right to refuse the injection, but only during your last sickness; not this one.”
The patient was puzzled with my conclusion.
I continued: “When the Genii was inside you, he was afraid the medicine that goes in your vein might reach him. He made that condition to protect himself then. Now that he is away from you for many years, any medicine that we inject in you will not reach him.”
The old man became more puzzled. He was silent and sweaty. After a few moments of thinking he said:
“I am not sure that the Genii will not harm me. Discharge me from the hospital. I will fly to Sharjah. I will go to the Mutawa. I will seek permission from the Genii to take the medication. If he agreed, I promise you that I will come back to you for treatment.”
I agreed and discharged him on oral medication for heart failure.
To explain the above Genii problem in detail is beyond the scope of this article. I do not know how much my colleagues know about such “medical problems.”
The word Genii is Semitic or Arabic in origin. In the English language, I came to cross the following synonyms of Genii: “Demons, genii, fairies, and spirit.”
A bad Genii is called satton. A good and pure Genii is called an angel. The rest of Arabic classification of gin is dependent only on the genii level of physical strength. A strong genius is called Marid; a stronger one is called Afreet and the strongest is Abqeri. The last term is also used in Arabic to describe a very smart person. It is equivalent to genius in English. What a coincidence! Webster’s Third New International Dictionary states: “Genie also genii of Arabic jinni, demon, spirit. Genii pl of genius or genie. Genius: pl geniuses or genii. A person endowed with transcendent mental superiority, very highly intelligent.”
Some Arab stories assert that the Gin is a tribe of angels. Their name was derived from their function. They were the keepers of Jenna (paradise). Some stories allege that Iblis (the devil, Satan) descended from the Gin tribe; others claim that Iblis was the chief angel before he disobeyed God. When God created Adam he ordered all the angels to kneel down before him. They did, except Iblis who declared that he was better than Adam because he [Iblis] was created from fire whereas Adam was created from clay. Fire is superior to clay. God, then, banished Iblis from heaven.
The ‘Arabian Nights’ or ‘One Thousand and one night’ as we, the Arabs call it, is full of Genii stories. I read all of them several times as a child. I was fascinated with those stories. In Arabic, Gin is the plural of genii. Everyone in our society believes in Gin.
Because in articles like these, I am reflecting on the past, especially my own past, I will share with the readers some memories and thoughts about this topic: Genii.
I grew up as a child in a town that had no electricity. At night the whole town was submerged in sea darkness except when the moon was full. Most of the houses were made of palm tree branches. Kerosene lamps were used to light the houses. Every person in our society assumed that every dark room, street, seashore, graveyard, etc, was occupied by the Gin. They share the earth and live with us. Some of the Gin live “under the earth” and may come out at night. Just like people, some Gin is good; others are bad. Some are Moslems, Christian, Jews or non-believers. Some live in corners of our houses. They are transparent creatures, like air. We cannot see them unless they wished to be seen. They could assume varieties of forms and shapes but most often they appear as animals such as black cats, birds, donkeys, etc.
Taha Hussain, a famous blind Egyptian author, born in the early 20th century, and considered the “president” of Arab literature, describes his fear of Gin during his childhood in his book, Al-Ayyam:
“Afreets stayed under the earth during the day. After the sun goes down and people turn off their lamps and settle in their beds, quietness prevails. Afreets then, ascend from under the earth to fill the space with their movements and whispers. I used to go to bed with anxiety and fear from the Afreets. I used to be afraid at night to uncover my face or limb during sleep. One of the numerous Afreets that filled the house might take over my limb. That anxiety was relieved only when I hear the sound of ladies singing as they return home from the canal carrying water in clay pots. I realized then, that it was dawn and the Afreets must have descended to the lower earth.”
His descriptions of his fear of Gin during his childhood reminded me of my own similar fear.
Our Holy Book, The Qur’an, mentioned prophets who dealt with Gin. King Solomon had power over the Gin. He used them to work for him. He died standing while watching the gin working. He was leaning on his stick when he died. The Gin did not know that he was dead because he stayed standing with the support of his stick. He fell only after the termites ate the stick. Moses had to face Egyptian pharaoh’s magicians and witches. When they started their witchcrafts he threw his stick, which turned into a snake. His snake swallowed all the Egyptian witchcraft. The pharaoh admired Moses’ power.
I used to hear a Genii story every night before I slept. Some were very frightening. Such stories might have contributed to my bed wetting at night as a child. I never entered a dark room or stayed in a dark room alone. I used a flashlight if I had to walk alone a few meters between houses.
I heard numerous stories from friends and relatives about their experiences with Gin. My mother still insists on her encounter with Gin long ago. Once, she said, she was sitting in front of a room with my paternal grandmother late at night. It was summer and the moon was full. The house fence door was closed. Suddenly, a white donkey appeared running in the courtyard. That was a Genii, she claimed. My grandmother started reading the Qur’an. The donkey disappeared after a few minutes. My mother would not listen when I surmised that the gate might not have been locked properly.
Another incident happened when I was a baby. The family went out one evening. They left me with a relative at home. That relative was well known for his exceptional “bravery”. He was not scared of the Gin. He used to see them frequently. While he was alone watching over me one rainy night in winter, two black cats appeared in the room while the door was closed. They kept him company for a while then left. When the family returned home they found the door of the room closed on us from outside. The family insisted that the two cats were Gin.
As a child, I heard an old man telling my father that since the death of his wife, a beautiful blond girl would come every night to sleep with him. She was a Genii girl in love with him. He married her. No blond girl ever existed in our society then.
How did our people inherit these Gin stories? The origin of this concept came from the ancient people of Mesopotamia, the present land of Iraq. The Sumerians were the fathers of the Gin mythology. The Sumerians were not Semitic people but the Babylonians who inherited their culture were Semitic. From the Babylonians, the concept of Gin and spirits spread to other cultures such as the Greeks, until it became part of all human cultures. The ancient Egyptians believed in the Gin as a cause of disease, but their Gin myths are not as elaborate as the Mesopotamians. The Arabs, in whose geographic area where all the three great religions arose, had preserved not only their own heritage but also kept many of the Mesopotamian and Semitic heritage. Any scholar who wants to study some ancient mythologies such as the stories of Gin will find abundant information in Arab literature.
The Mesopotamians thought that diseases are punishment by the gods inflicted on people for their sins. Judaism, Christianity, and Islam accepted this belief later. Some diseases, the Babylonians thought, were transmitted to people via environmental agents such as dust, dirt, food or drink and some diseases were transmitted by supernatural agents – invisible creatures, the spirits. Asu treated patients with organic problems. (Asu means physician. The root of this Babylonian term is still used in Arabic for physician: Asu). Asu referred patients who had no organic causes for their illness, as he could determine, to the ashipu, a priest who used magical methods and prayers to drive away the spirits or exorcize demons. So, the Mesopotamian ashipu was like our local gulf traditional Mutawa of the old days or our psychiatrist of today’s medicine.
In the pre-Islamic era, the Arabs believed that at night the Gin occupied valleys. When they came upon such a dark, scary valley at night, one of them would stand and shout: “We are requesting protection from the master of this valley”. Then they would feel secure the whole night. This stems from an old Arab tradition. If a person requests protection, even if he was from an enemy tribe, he must be protected. It is shameful and dishonorable not to protect such a person. Therefore, they expected that the Gin would adhere to the same code. I read about an old Arab sheik who went too extreme with this old Arab code of ethics. A party of grasshoppers landed in the desert in front of his tent. He did not allow anyone to catch them while they were in that location. He took his sword and stood to protect them until they flew away. “They came to seek my protection”, he said The ancient Arabs believed that every great poet has a Genii inspiring him. They even gave each poet’s genii a name for a companion. This was a deep-rooted myth in our literature. I used to claim that I have a genius of my own inspiring me to be a poet. In 1998, I accompanied His Highness, the Amir of Qatar, on a state visit to Mauritania. During the state dinner, as expected, several Mauritanian poets delivered poems to welcome us. Mauritania is an Arab country in Africa that is known as the “land of one million poets”. Fortunately for me, I succeeded in preparing a poem for that occasion.
&nsbp; In the poem that I delivered during that ceremony, I told the audience and the poets, that as I listened to their poems, my Genii companion who came with me from the east was quiet (Qatar is in Asia, eastward from Mauritania). He used to write my poems. This time, my Genii was silent, not telling me what to say. When he noticed that I was angry at his silence; he told me his problem. He had fallen in love with a dark Mauritanian female Genii. Now he would like me to read his love poems. His poems may upset your Gin and cause trouble for us, so I had to tie him and lock him in the hotel room until we leave.
The Mauritanian poets enjoyed the story. Some told me that they still believe that every good poet has a Genii companion.
Our Omani patient did come back a week later. He told me that the Genii gave him permission to be treated with IV drugs. Some of our junior staff commented privately: “He may be insane due to tertiary syphilis”. I told them that I had enough experience to believe that he was not insane and that the patient believed in it sincerely. The patient had no manifestation of tertiary syphilis.
My final comment is that medical history tells us, that despite all our progress in science and technology, the old theories and concepts stay with us. Some are still valid. Remnants of primitive beliefs about the causes and transmission of the disease still persist. The Omani patient is a good example. The patient still carried the Mesopotamian belief in Gin as the cause of his problem. Our junior staff wanted to blame the spirochetes, the syphilis bacteria as the cause. Do not forget that the Mesopotamians believed that invisible creatures caused disease. Now over five thousands years later, we call those Mesopotamian invisible creatures “Micro-organisms.” These micro-creatures are certainly not angels - they might be the Gin.