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Health Informatics
Eta S. Berner Editor
Informatics
Education in
Healthcare
Lessons Learned
Second Edition
Health Informatics
This series is directed to healthcare professionals leading the transformation of
healthcare by using information and knowledge. For over 20 years, Health
Informatics has offered a broad range of titles: some address specific professions
such as nursing, medicine, and health administration; others cover special areas of
practice such as trauma and radiology; still other books in the series focus on
interdisciplinary issues, such as the computer based patient record, electronic health
records, and networked healthcare systems. Editors and authors, eminent experts in
their fields, offer their accounts of innovations in health informatics. Increasingly,
these accounts go beyond hardware and software to address the role of information
in influencing the transformation of healthcare delivery systems around the world.
The series also increasingly focuses on the users of the information and systems: the
organizational, behavioral, and societal changes that accompany the diffusion of
information technology in health services environments.
Developments in healthcare delivery are constant; in recent years, bioinformatics
has emerged as a new field in health informatics to support emerging and ongoing
developments in molecular biology. At the same time, further evolution of the field
of health informatics is reflected in the introduction of concepts at the macro or
health systems delivery level with major national initiatives related to electronic
health records (EHR), data standards, and public health informatics.
These changes will continue to shape health services in the twenty-first century.
By making full and creative use of the technology to tame data and to transform
information, Health Informatics will foster the development and use of new
knowledge in healthcare.
More information about this series at http://www.springer.com/series/1114

Eta S. Berner
Editor
Informatics Education
in Healthcare
Lessons Learned
Second Edition
Editor
Eta S. Berner
University of Alabama at Birmingham
Birmingham, AL
USA
ISSN 1431-1917 ISSN 2197-3741 (electronic)

Health Informatics
ISBN 978-3-030-53812-5 ISBN 978-3-030-53813-2 (eBook)
https://doi.org/10.1007/978-3-030-53813-2
© Springer Nature Switzerland AG 2014, 2020

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
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The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
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To our students, from whom we have
learned much
Preface
Twenty-five years ago almost the only individuals involved in healthcare who had
even heard the term “informatics” were those who identified themselves as medical
or nursing informaticians. Today, we have a variety of subfields of informatics
including not just medical and nursing informatics, but informatics applied to other
health professions (such as dental or pharmacy informatics), as well as health infor-
matics, biomedical informatics, bioinformatics, and public health informatics,
among others. In addition, there has been growth of a spectrum of informatics edu-
cation programs, from new undergraduate majors to medical subspecialty fellow-
ship programs. There are even informatics summer programs for high school
students.
This book addresses the broad range of informatics education programs available
today. My own background in health professions education over 45 years ago at the
beginning of my career and in online informatics education in my work today has
provided me with a tacit understanding of the breadth of content, pedagogical tech-
niques, strategies, and approaches to informatics education in a wide variety of
areas. As a leader of UAB’s Center for Health Informatics for Patient Safety/Quality
and the UAB Curriculum Development Center that was part of ONC’s health IT
workforce development program, I have seen the rapidly growing interest in the
development of new informatics education programs and the growth of informatics
as a profession.
The aim of this book is to make the tacit knowledge explicit and to share some of
the lessons learned by a group of very experienced informatics educators. The con-
tributors to this volume are internationally recognized informatics educators, and
this short preface cannot do justice to their expertise. However, to give the reader a
snapshot of their knowledge and experience, the following is a description of the
contributors’ expertise as related to the particular chapters that they wrote.
Dr. Jacqueline Moss, who coauthored the overview chapter with me, is an expe-
rienced nursing informatics educator, who has been integrally involved in informat-
ics education at the national level and throughout her institution in other areas in
addition to nursing informatics.
vii
viii Preface
The authors of the chapters describing different training programs in the USA
have direct experience with the programs they describe. Dr. Valerie Florance is
Associate Director of Extramural Programs at the National Library of Medicine
(NLM) at the US National Institutes of Health (NIH). Dr. Florance has been respon-
sible for oversight of the many NLM-funded informatics training programs. She
describes the NLM programs in Chap. 2 and the NIH Data Science training activi-
ties in Chap. 10. In addition to Dr. Moss, Drs. Marisa Wilson and Beth Elias are
coauthors of the chapter on nursing informatics (Chap. 3). Dr. Wilson and Dr. Elias
have taught nursing informatics in a variety of institutions and are involved with
national efforts in nursing informatics education. Amanda Dorsey, Meg Bruck, and
Sue Feldman bring the perspective of health informatics students, instructors, and
program directors to Chap. 4. Ms. Dorsey and Ms. Bruck were both students in the
University of Alabama at Birmingham (UAB) MSHI program and have gone on to
become broad-based informatics educators. Ms. Dorsey led the transition of the
MSHI program to an online format, and she and Ms. Bruck developed a variety of
courses in health informatics as part of the ONC workforce development program.
Dr. Feldman is currently program director of the UAB MSHI program. She also
brings experience as a member of the Health Informatics Accreditation Council
(HIAC) of the Commission on Accreditation for Health Informatics and Health
Information Management Education (CAHIIM). In addition to her contributions to
Chap. 4, she is the lead author of Chap. 17 on accreditation of HI programs and is a
contributor to Chap. 6 on undergraduate informatics education. Dr. Saif Khairat is
the lead author on Chap. 6. He is chair of AMIA’s Education Committee and has
conducted an extensive review of the growing number of undergraduate informatics
programs.
The growth of programs to educate specialists in bioinformatics has also been
developing rapidly. While some of these programs have been more focused on com-
putational biology, many of them have focused on translational bioinformatics and
are often incorporated within broader informatics training programs. The authors of
Chap. 5 focus on translational bioinformatics and bring multi-institutional expertise
in education in translational bioinformatics. Dr. Susan Fenton oversees the infor-
matics education programs at the School of Biomedical Informatics (SBMI) at UT
Houston. Dr. Assaf Gottlieb, also at SBMI, is actively involved in its Center for
Precision Medicine. Dr. Meredith Zozus has led bioinformatics education at Duke,
the University of Arkansas, and the University of Texas at San Antonio.
The contributors of the chapters on informatics education programs for other
health professionals bring a similar breadth of experience as those for the dedicated
informatics programs. Dominic Covvey is internationally recognized for leading the
development of competency descriptions for multiple roles including informatics
researchers, applied informaticians, and clinician users of informatics applications.
Margaret Schulte was the leader of the HIMSTA project described in Chap. 8 and
also has years of experience as a leader of HIMSS’ education activities and in her
work with the Commission on Accreditation of Healthcare Management Education
(CAHME). Drs. Peter Embi and Philip Payne are widely recognized as major lead-
ers in the USA in the area of clinical research informatics (CRI). Dr. Embi led the
Preface ix
first AMIA CRI conference and also developed an AMIA 10 × 10 course in this
area. Both authors have published seminal articles in this domain.
The chapters on informatics education outside the USA have been expanded
significantly in this edition. In the first edition, we had a single chapter on three dif-
ferent regions: Latin America, Sub-Saharan Africa, and the Asia Pacific region. In
this edition, we have separate chapters for each region with the informatics educa-
tion activities in additional countries within regions described. All of the chapter
authors on worldwide informatics education are experienced educators within their
own country and around the world.
Dr. John Holmes and Jeffrey Williamson were instrumental in working with
AMIA’s Global Health Informatics Partnership that was involved with disseminat-
ing informatics educational materials to countries around the world. Dr. Paula
Proctor and her colleagues (Drs. Ursula Hubner, Elizabeth Cummings, Jen Bichel-
Findlay, Michelle Honey, and Karen Day) who authored Chap. 12 represent nursing
informatics from multiple continents. The authors of Chap. 13, on informatics edu-
cation in Latin America (Drs. Paula Otero, Mariela Leikam, Zulma Gonzalez,
Heimar de Fatima Marin, Ignacio Pérez Aravena, and Saadia Zawadzki), are lead-
ers within their countries and have also engaged with each other in collaborative
informatics activities across countries in Latin America. Ngai Tseung Cheung,
Juanita Fernando, Oomen John, Alvin Marcelo, Iris Thiele Isip-Tan, Cheng Ooi
Low, Daniel Li, and Vajira HW Dissanayake developed highly regarded informatics
education programs in a variety of countries in the Asia Pacific region. Finally, Drs.
Caroline Perrin, Cheick-Oumar Bagayoko, and Antoine Geissbuhler have years of
collaboration with colleagues in Sub-Saharan Africa.
This edition also has two new sections that contain updates of some of the chap-
ters in the previous edition as well as additional chapters. The section on assessment
of individuals and programs contains the chapter on the clinical informatics subspe-
cialty certification (Chap. 16), which was updated and expanded. Drs. Reed Gardner
and Charles Safran were leaders of the task forces that led to the approval of the
clinical informatics subspecialty, and lead chapter author Dr. Christoph Lehmann
has led the Clinical Informatics Examination Committee now that it has been estab-
lished. Dr. Howard Silverman runs a Clinical Informatics Fellowship Program and
has been a leader nationally of the Clinical Informatics training directors. Dr.
Cynthia Gadd was the leader of the team that did the initial work to establish an
advanced health informatics certification examination for those who are not eligible
for the medical subspecialty exam. A new chapter (Chap. 17) in this section includes
discussion of CAHIIM’s informatics education program accreditation. It was writ-
ten by Dr. Sue Feldman (described above), Dr. Suzanne Austin Boren, Linde Tesch,
and Dr. Annette Valenta, all of whom have been directly involved with CAHIIM’s
accreditation activities. Dr. Boren leads the Health Informatics Program at the
University of Missouri and has also led CAHIIM’s Health Informatics Accreditation
Council. Ms. Tesch is Senior Education Officer at CAHIIM, and Dr. Valenta was
chair of the AMIA Accreditation Committee that developed the foundational
domains used by CAHIIM in their accreditation process. Dr. Valenta is also an
author of Chap. 19 bringing her extensive experience in teaching online informatics
x Preface
programs. She was program director of the online health informatics masters’ pro-
gram and developed the AMIA 10 × 10 program at the University of Illinois at
Chicago (UIC).
The last section on online informatics education contains updates and expan-
sions of three chapters in the previous edition. The authors of Chap. 19 have taken
the insights gained by years of experience in online education and articulated them
in a series of strategies that will be useful for others, especially those who have
struggled with the issues that are raised. In addition to Dr. Valenta’s and my own
expertise in online informatics education, the other authors bring additional exper-
tise and experience. Ms. Lorrinda Khan has years of online learning experience,
both as an instructor and as an instructional design expert. Dr. Michael Dieter was
program director for the online master of health informatics program at UIC.
The other chapters in this section (Chaps. 18 and 20) are written by Dr. William
Hersh. Dr. Hersh is internationally recognized as an informatics educator. He is the
leader of OHSU’s informatics education activities which include not only the NLM-
funded informatics training program, but he also led the university-based training
program funded by ONC as part of the ONC workforce development program. He
was a leader in other ONC-funded workforce programs including the Curriculum
Development Centers program and the National Training and Dissemination Center.
In addition to his work with the ONC workforce programs, Dr. Hersh was the impe-
tus behind the AMIA 10 × 10 program and was director of the first 10 × 10 program.
He was also a contributor to the NIH BD2K program of online educational materials.
In addition to the outstanding contributions of the chapter authors, I want to
express my appreciation for the support of Grant Weston, Anand Shanmugam, and
the Springer editorial team.
Birmingham, AL Eta S. Berner

Contents
Part I Introduction to Lessons Learned

1 Introduction and Overview �� 3
Eta S. Berner and Jacqueline A. Moss
Part II Training Informatics Specialists in the US

2 Training for Research Careers in Biomedical
Informatics and Data Science Supported by the
National Library of Medicine �� 13
Valerie Florance
3 Education in Nursing Informatics�� 23
Marisa L. Wilson, Beth L. Elias, and Jacqueline A. Moss
4 Applied Informatics for Health IT Managers �� 45
Amanda D. Dorsey, Meg N. Bruck, and Sue S. Feldman
5 Translational Bioinformatics Curricula in Graduate
Biomedical Informatics Programs�� 59
Susan H. Fenton, Assaf Gottlieb, and Meredith Nahm Zozus
6 Undergraduate Health Informatics Education �� 75
Saif Khairat and Sue S. Feldman
Part III Informatics Education for Other Health Professionals

7 Educating the Informatics-Enabled Physician�� 87
H. Dominic J. Covvey
8 Informatics Education for Health Administrators�� 101
Margaret Schulte
xi
xii Contents
9 Clinical and Translational Research Informatics

Education and Training�� 113
Peter J. Embi and Philip R. O. Payne
10 NIH Training and Education for Biomedical Data Science �� 125
Valerie Florance
Part IV Informatics Education Worldwide

11 Translating U.S. Informatics Educational
Programs for Non-U.S. Audiences�� 137
John H. Holmes and Jeffrey J. Williamson
12 Nursing Informatics Education: A Global Perspective�� 153
Elizabeth Cummings, Jen Bichel-Findlay, Paula Procter,
Ursula Hübner, Michelle Honey, and Karen Day
13 Informatics Education in Latin America �� 167
Paula Otero, Mariela Leikam, Zulma Gonzalez,
Heimar de Fatima Marin, Ignacio Pérez Aravena,
and Saadia Zawadzki
14 Informatics Education in the Asia-Pacific Region�� 183
Ngai Tseung Cheung, Juanita Fernando, Oommen John,
Alvin Marcelo, Iris Thiele Isip-Tan, Cheng Ooi Low,
Daniel Li, and Vajira H. W. Dissanayake
15 Informatics Education in Sub-Saharan Africa�� 197
Caroline Perrin, Cheick-Oumar Bagayoko, and Antoine Geissbuhler
Part V Assessment of Individuals and Programs in Informatics

16 Clinical Informatics Subspecialty Certification and Training�� 213
Christoph U. Lehmann, Howard D. Silverman,
Reed M. Gardner, Charles Safran, and Cynthia Gadd
17 Accreditation of Health Informatics Programs�� 237
Sue S. Feldman, Suzanne Austin Boren, Linde H. Tesch,
and Annette L. Valenta
Part VI Use of Distance Learning for Informatics Education

18 Online Continuing Education in Informatics:
The AMIA 10 × 10 Experience�� 251
William Hersh
Contents xiii
19 Managing Unspoken Assumptions in Online Education�� 263

Lorrinda Khan, Michael G. Dieter, Eta S. Berner,
and Annette L. Valenta
20 Open Educational Resources (OERs) in Health Informatics�� 277
William Hersh
Part VII Summary of Lessons Learned

21 Informatics Education in Healthcare: Lessons Learned�� 289
Eta S. Berner
Index�� 301
Contributors
Ignacio Pérez Aravena Department of Biomedical Informatics, DUOC UC

Institute, Las Condes, Chile
Cheick-Oumar Bagayoko, MD, PhD Centre d’Innovation et Santé Digitale
(Digi-Santé-Mali), Bamako, Mali
Centre d’Expertise et de Recherche en Télémédecine et E-santé (CERTES),
Bamako, Mali
Eta S. Berner, EdD, FACMI, FHIMSS, FIAHSI Department of Health Services
Administration, School of Health Professions, University of Alabama at
Birmingham, Birmingham, AL, USA
Department of Medical Education, School of Medicine, University of Alabama at
Jen Bichel-Findlay, HScD, MN, MPH, RN, FACN, CHIA Australasian Institute
of Digital Health Nursing and Midwifery Community of Practice, Sydney, NSW,
Australia
Suzanne Austin Boren, MHA, PhD University of Missouri, Columbia, MO, USA
Meg N. Bruck, MSHI Department of Health Services Administration, University
of Alabama at Birmingham, Birmingham, AL, USA
Ngai Tseung Cheung, MBBS, BSc (Med), MSc, DIC Head of Information
Technology and Health Informatics/CMIO, Hong Kong Hospital Authority,
Hong Kong, Hong Kong
H. Dominic J. Covvey, BA, MSc, FACMI (Retired) Faculty of Science, University
of Waterloo, Waterloo, ON, Canada
Elizabeth Cummings, RN, BA, BIS (Hons), PhD, FAIDH School of Health
Sciences, University of Tasmania and Deputy Chair, Nursing Informatics, Sydney,
NSW, Australia
xv
xvi Contributors
Karen Day, RN, RM, MA, PhD, FACHI Faculty of Medical and Health Sciences,
The University of Auckland, Auckland, New Zealand
Michael G. Dieter, PhD, MLIS, MBA Department of Biomedical and Health
Information Sciences, University of Illinois at Chicago, Chicago, IL, USA
Vajira H. W. Dissanayake, MBBS, PhD, FNASSL Specialty Board in Biomedical
Informatics, Postgraduate Institute of Medicine, University of Colombo, Colombo,
Sri Lanka
Amanda D. Dorsey, MSHI, FHIMSS Department of Health Services
Administration, University of Alabama at Birmingham, Birmingham, AL, USA
Beth L. Elias, PhD, MS, FHIMSS University of Scranton, Scranton, PA, USA
Peter J. Embi, MD, MS, FACMI Regenstrief Institute and Indiana University,
Indianapolis, IN, USA
Sue S. Feldman, RN, MEd, PhD Department of Health Services Administration,
University of Alabama at Birmingham, Birmingham, AL, USA
Susan H. Fenton, PhD, RHIA, FAHIMA PI, Gulf Coast Regional Extension
Center, UTHealth School of Biomedical Informatics, Houston, TX, USA
Juanita Fernando, PhD, FACHI MERQ, Public Health and Preventive Medicine,
Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
Valerie Florance, PhD, FACMI National Library of Medicine, NIH, DHHS,
Bethesda, MD, USA
Extramural Programs, National Library of Medicine, National Institutes of Health,
Department of Health and Human Services, Bethesda, MD, USA
Cynthia Gadd, PhD, MBA, MS, FACMI Department of Biomedical Informatics,
Vanderbilt University, Nashville, TN, USA
Reed M. Gardner, PhD, FACMI, FIAHSI Department of Biomedical Informatics,
University of Utah, Salt Lake City, UT, USA
Antoine Geissbuhler, MD, FACMI, FIAHSI HI5lab, Department of Radiology
and Medical Informatics, Geneva University, Geneva, Switzerland
Division of eHealth and Telemedicine, Geneva University Hospitals, Geneva,
Switzerland
Zulma Gonzalez, RN Department of Health Informatics, Hospital Italiano de
Buenos Aires, Buenos Aires, Argentina
Assaf Gottlieb, PhD Center for Precision Health, UTHealth School of Biomedical
Informatics (SBMI), Houston, TX, USA
William Hersh, MD, FACMI, FACP, FIAHSI Department of Medical Informatics
and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
Contributors xvii
John H. Holmes, PhD, FACE, FACMI, FIAHSI Department of Biostatistics,

Epidemiology, and Informatics, University of Pennsylvania Perelman School of
Medicine, Philadelphia, PA, USA
Michelle Honey, RN, BA, MPhil, PhD, FIMIA-NI Faculty of Medical and Health
Sciences, The University of Auckland, Auckland, New Zealand
Ursula Hübner, PhD, FIAHSI University of Applied Sciences Osnabrück,
Osnabrück, Germany
Iris Thiele Isip-Tan, MD, MSc Medical Informatics Unit, College of Medicine,
University of the Philippines, Manila, Philippines
Oommen John, MBBS, MD, MBA The George Institute for Global Health,
New Delhi, India
University of New South Wales, Sydney, NSW, Australia
Asia Pacific Association for Medical Informatics, New Delhi, India
Saif Khairat, PhD, MPH Carolina Health Informatics Program, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Lorrinda Khan, MFA University of Maryland University College, University of
Maryland Global Campus, Adelphi, MD, USA
Christoph U. Lehmann, MD, FACMI, FAAP, FIAHSI Departments of Pediatrics,
Population & Data Sciences, and Bioinformatics; Clinical Informatics Center, UT
Southwestern, 5323 Harry Hines Blvd, Dallas, TX, USA
Mariela Leikam Department of Health Informatics, Hospital Italiano de Buenos
Aires, Buenos Aires, Argentina
Daniel Li, MD, MBI Integrated Health Information Systems, Singapore, Singapore
Cheng Ooi Low, MBBS, MRCP Singapore Health Services, Singapore, Singapore
Alvin Marcelo, MD, FIAHSI Professor of Surgery and Health Informatics,
University of the Philippines, Manila, Philippines
Heimar de Fatima Marin, RN, MS, PhD, FACMI, FIAHSI Department of
Nursing Informatics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
Jacqueline A. Moss, PhD, RN, FAAN Department of Family, Community, and
Health Systems, School of Nursing, University of Alabama at Birmingham,
Birmingham, AL, USA
University of Alabama at Birmingham, Birmingham, AL, USA
Paula Otero, MD, MSc, FIAHSI Department of Health Informatics, Hospital
Italiano de Buenos Aires, Buenos Aires, Argentina
Philip R. O. Payne, PhD, FACMI Washington University in St. Louis,
St. Louis, MO, USA
xviii Contributors
Caroline Perrin, PhD HI5lab, Department of Radiology and Medical Informatics,

Geneva University, Geneva, Switzerland
Division of eHealth and Telemedicine, Geneva University Hospitals, Geneva,
Switzerland
Paula Procter, RN, MSc, SFHEA, FBCS, CITP Sheffield Hallam University,
Sheffield, UK
Charles Safran, MD, MS, FACMI, FIAHSI Division of Clinical Informatics,
Department of Medicine, Beth Israel Deaconess Medical Center and Harvard
Medical School, Boston, MA, USA
Margaret Schulte, DBA, FACHE, CPHIMS Commission on Accreditation of
Healthcare Management Education, Philadelphia, PA, USA
Howard D. Silverman, MD Department of Biomedical Informatics, The
University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
Linde H. Tesch, MS Commission on Accreditation for Health Informatics and
Information Management, Chicago, IL, USA
Annette L. Valenta, DrPH, FACMI Department of Biomedical and Health
Information Sciences, University of Illinois at Chicago, Chicago, IL, USA
Jeffrey J. Williamson, MEd Department of Education, AMIA, Bethesda, MD, USA
Marisa L. Wilson, DNSc, RN-BC, FAMIA, FIAHSI, FAAN University of
Alabama at Birmingham, Birmingham, AL, USA
Saadia Zawadzki Department of Medical Technology, School of Medicine,
Universidad de la República (UdelaR), Montevideo, Uruguay
Meredith Nahm Zozus, PhD UT Health Sciences Center San Antonio, San
Antonio, TX, USA
Acronyms and Abbreviations
AACN American Association of Colleges of Nursing

AAMSI American Association for Medical Systems and Informatics
ABMS American Board of Medical Specialties
ABP American Board of Pathology
ABPM American Board of Preventive Medicine
ACGME Accreditation Council for Graduate Medical Education
ACMI American College of Medical Informatics
AHI Applied Health Informatics
AHIMA American Health Information Management Association
AMIA American Medical Informatics Association
ANA American Nurses Association
ANCC American Nurses Credentialing Center
APAMI Asia-Pacific Association for Medical Informatics
ARRA American Recovery and Reinvestment Act
ASL Asynchronous learning
AUPHA Association of University Programs in Health Administration
BIOTEC National Center for Genetic Engineering and Biotechnology
(Thailand)
BISTI Biomedical Information Science and Technology Initiative
BSN Bachelor of Science in Nursing
CAHIIME Commission on Accreditation for Health Informatics and
Information Management Education
CAHIMS Certified Associate in Health Information and
Management Systems
CAHME Commission on Accreditation of Healthcare Management
Education
CBMI Regenstrief Institute Center for Biomedical Informatics
CCNE Commission on Collegiate Nursing Education
CDC Curriculum Development Center
CE Continuing education
CEO Chief executive officer
xix
xx Acronyms and Abbreviations
CERTES Center for Research Expertise in Telemedicine and eHealth

(Centre d’Expertise et de Recherche en Télémédecine et
E-santé)
CHCF California Health Care Foundation
CHI Center for Health Informatics (Singapore)
CHIRAD Centre for Health Informatics Research and Development
(South Africa)
CIN Computers, Informatics, Nursing (Journal)
CIO Chief information officer
CMIO Chief medical information officer
CMS Centers for Medicare & Medicaid Services
CMS Clinical Management System (Hong Kong)
COSTAR Computer Stored Ambulatory Record
CPHIMS Certified Professional in Health Information and
Management Systems
CPOE Computerized physician (or provider) order entry
CRI Clinical Research Informatics
CTRI Clinical and Translational Research Informatics
CTSA Clinical and Translational Science Awards
DHHS Department of Health and Human Services (USA)
DNP Doctor of Nursing Practice
EBM Evidence-based medicine
EBP Evidence-based practice
EDUCTRA Education and Training in Health Informatics
EFMI European Federation for Medical Informatics
EHR Electronic health record
EMR Electronic medical record
EMRAM Electronic Medical Record Adoption Model (HIMSS)
ENRICH Enhancing Research Informatics Capacity for Health
Information in Colombia
EU European Union
EXPASY Expert Protein Analysis System
FEMI Federación Médica del Interior (Uruguay)
FOA Funding Opportunity Announcement
G2HI Gateway to Health Informatics (Singapore)
GBS Graduate Biomedical Sciences
GHIP Global Health Informatics Partnership
GMDS German Medical Informatics Association
GNU Refers to a free software license
GPRS General Packet Radio Service
GWAS Genome-wide association studies
HELINA Health Informatics in Africa
HELP Health Evaluation through Logical Processing
HIBA Hospital Italiano of Buenos Aires
HIBBS Health Informatics Building Blocks
Acronyms and Abbreviations xxi
HIM Health information management

HIMSS Healthcare Information and Management Systems Society
HIMSTA Health Information Management Systems Technology and
Analysis
HIPAA Health Insurance Portability and Accountability Act
HIT Health Information Technology
HITECH Health Information Technology for Economic and
Clinical Health
HITPRO™ Health Information Technology Competency Exams
HSP Hybrid Skills Development Program (Singapore)
ICT Information and communications technologies
IDA Infocomm Development Authority (Singapore)
IMIA International Medical Informatics Association
INFOMED Telematic Network for Health (Cuba)
INS Informatics nursing specialist
IOM Institute of Medicine
IR Information retrieval
IS Information systems
ISD Information Services Department
ISfTeH International Society for Telemedicine and eHealth
IT Information technology
ITU International Telecommunication Union
JAMA Journal of the American Medical Association
JAMIA Journal of the American Medical Informatics Association
KHI Kigali Health Institute
LDS Latter-Day Saints
LMS Learning Management System
MIT Massachusetts Institute of Technology
MLAA Medical Library Assistance Act
MOC Maintenance of Certification
MOOC Massive Open Online Course
MRI Magnetic resonance imaging
MRS Medical Record System (OpenMRS)
MSHIM Master of Science in Health Information Management
MSN Master of Science in Nursing
MU Meaningful use
MUMPS Massachusetts General Hospital Utility Multi-
Programming System
NCBI National Center for Biotechnology Information
NCHS National Center for Health Statistics
NCSBN National Council of State Boards of Nursing
NEHR National Electronic Health Record (Singapore)
NHIP National Healthcare Information Project (Taiwan)
NIH National Institutes of Health
NIHI National Institutes of Health Informatics (Canada)
xxii Acronyms and Abbreviations
NLM National Library of Medicine

NRSA National Research Service Award
NTDC National Training and Dissemination Center
NUR National University of Rwanda
NUS National University of Singapore
OER Open Educational Resources (OER Africa)
OHSU Oregon Health & Science University
ONC Office of the National Coordinator (for Health Information
Technology)
PAHO Pan American Health Organization
PDB Protein Data Bank
PHR Personal health record
proTICS Professionalization Program in Information Technology &
Communication in Health
PURE-HIT Professional University Resources and Education for Health
Information Technology
QUIPU Andean Global Health Informatics Research and
Training Center
RAFT Reseau en Afrique Francophone pour la Télémédecine
(Research in Africa for Telemedicine)
RCR Responsible Conduct of Research
RDHI Research and Development Health Informatics
REACH-Informatics Regional East African Center for Health Informatics
REC Regional Extension Center
REHCE Regional e-Health Center of Excellence (Kigali)
REIMICOM Malian Medical Information and Communication Network
RHIT Registered Health Information Technician
RN-BC Registered Nurse – Board Certified
SCAMC Symposium on Computer Applications in Medical Care
SWOT Strengths, Weaknesses, Opportunities, Threats (Analysis)
TBI Translational bioinformatics
TIGER Technology Informatics Guiding Education Reform
TMI Thai Medical Informatics Association
TMT Taiwan Electronic Medical Record Template
UAB University of Alabama at Birmingham
UBT University-based Training
UCSF University of California—San Francisco
UIC University of Illinois at Chicago
UP-HI University Partnership for Health Informatics (University
of Minnesota)
VistA Veterans Health Information Systems and Technology
Architecture
WEB Workshop on Education in Bioinformatics
WHO World Health Organization
Part I
Introduction to Lessons Learned
Chapter 1
Introduction and Overview
Eta S. Berner and Jacqueline A. Moss
In the last 25 years, there has been a proliferation in the number and types of infor-
matics education programs. Interest in health and biomedical informatics education
has increased dramatically in response to the increase in use of healthcare informa-
tion technology (HIT) in both clinical and research settings. Accompanying the
growth in these programs is the concurrent interest in the development of informat-
ics certification processes and program accreditation standards. Some of the impe-
tus for informatics education in the U.S. comes from the growing use of HIT in
clinical settings as a result of the HITECH Act [1], a part of the American Recovery
and Reinvestment Act, which tied adoption of Health IT to incentives from the
Centers for Medicare and Medicaid Services (CMS). In research settings, drivers
for the increased use of health IT include the growing interest in personalized and
precision medicine, the growth of the bioinformatics field, and the emphasis on
biomedical informatics to support research as a part of the Clinical and Translational
Science Awards (CTSA). Internationally, as technology infrastructures have grown,
there is increasing use of HIT and the concomitant need for education not only for
informatics professionals, but for the clinicians and others who use these systems.
While there have been many definitions of informatics in the literature over the
years [2–7], it is more productive to examine the scope of the field, rather than a
specific definition, when we talk about education in informatics in healthcare. The
E. S. Berner (*)
Department of Health Services Administration, School of Health Professions, University of
Department of Medical Education, School of Medicine, University of Alabama at
e-mail: eberner@uab.edu
J. A. Moss
Department of Family, Community, and Health Systems, School of Nursing, University of
e-mail: mossja@uab.edus
© Springer Nature Switzerland AG 2020 3

E. S. Berner (ed.), Informatics Education in Healthcare, Health Informatics,
https://doi.org/10.1007/978-3-030-53813-2_1
4 E. S. Berner and J. A. Moss
following description of the scope of the field was developed by the first author
(ESB) over 20 years ago, with recent adaptation. This definition was developed as a
result of conversations with students, to help clarify their understanding of the pur-
pose and scope of their informatics education.
Informatics involves developing and utilizing a broad range of information technology to
facilitate the collection, management, exchange, analysis, use (and re-use) and storage of
patient (including clinical and genomic), fiscal, and administrative information to sup-
port and improve (1) the quality of patient care and health outcomes, (2) secure access to
information, (3) professional and organizational efficiency, and (4) the decision making
capabilities of health professionals, administrators and others within the healthcare
organization.
The highlighted areas above indicate that information technology supports the
field, but the focus of informatics is on the information, rather than the technology
per se. This book describes the major initiatives in informatics education interna-
tionally. It includes educational initiatives to produce informatics researchers,
applied informatics practitioners, and informatics education programs for other
healthcare practitioners as well. The focus is on the lessons learned from the variety
of health and biomedical informatics programs, some of which are fairly young,
while others have been established for decades. Although we will describe a variety
of types of programs for different audiences, some common themes run through
these programs.
Interdisciplinary Basis
The practice of informatics, and therefore the education necessary for this practice,
draws on knowledge from a wide variety of disciplines. Informatics practice, and
the research of phenomena central to this practice, involves knowledge that informs
the optimal design of information systems for the optimization of data collection,
delivery, and analysis, as well as usefulness and usability for end-users. All of the
relevant knowledge and skills related to aspects of organizational science, informa-
tion science, human factors, computer science, and cognitive science must also be
nested within the associated healthcare context. This context may be primarily
driven by end users, such as in consumer health informatics, nursing informatics or
pharmacy informatics, or public health informatics.
Informatics education programs, regardless of their healthcare focus, include
content from other related supporting disciplines and apply this content to either
the design of research for the generation of knowledge in informatics or the appli-
cation of this knowledge to the practice environment. Each professional domain
applies this interdisciplinary content in relation to their healthcare focus; however
all informatics specialties are based on the same or very similar theoretical under-
pinnings. Several of the chapters in this book explicitly describe curricular content
in some detail and the interdisciplinary nature of the content is obvious. In addition,
as the chapters in the section on Assessment of Individuals and Programs in
1 Introduction and Overview 5
Informatics illustrate, the standards for certification of individuals and accredita-

tion of programs implicitly or explicitly include these supportive interdisciplinary
underpinnings.
Informatics Competencies
Another consistent theme echoed by multiple contributors to this edition, is the

assertion that all healthcare professionals require basic competencies in the use of
information technology to work in today’s technology rich environment. A compe-
tency is “an expected level of performance that integrates knowledge, skills, abili-
ties, and judgment” [8]. First, all healthcare professionals need to acquire basic
computer and information science competencies to be able to interact, not only with
electronic medical records, but also with a variety of patient information and com-
munication technologies that are increasingly a part of every aspect of healthcare.
Second, every healthcare professional needs to be information literate. Finding,
evaluating, and synthesizing the best evidence helps ensure that patients receive the
highest level of care available from their providers. Those managing the organiza-
tion and delivery of this care require current and accurate information to effectively
and efficiently manage care access and organizational resources. Finally, all health-
care professionals require basic competencies related to the management and analy-
sis of data. Development of data management competencies enables individuals and
organizations to understand the need for ensuring the privacy and confidentiality of
data, standardized data collection, and patient and organizational outcomes analy-
sis. Chapters 3, 7, 8, 16 and 17 in particular list competencies that reflect these
emphases and provide references that include the recommended competencies in
more detail.
Standards for Certification and Accreditation
As the field of informatics education has matured there has been increased interest
in certification of individuals’ competencies and accreditation of informatics educa-
tion and training programs that produced these individuals. Different organizations
are often involved in certification of individuals than are involved in the accredita-
tion of the programs preparing these students. The International Medical Informatics
Association has focused on informatics education program accreditation on a
worldwide basis [9]. In this book we include other examples of accreditation efforts.
For instance, as described in Chap. 8, the Commission on Accreditation of Healthcare
Management Education (CAHME) is responsible for accrediting programs in
healthcare management. Within their accreditation guidelines are the information
management competencies that are expected to be taught by educational programs.
None of these accreditation programs oversees a certification program for
individuals. On the other hand, there are certification programs for individuals that
are not specifically tied to program accreditation. The HITPRO examination that
was initially designed for students graduating from the ONC-funded workforce pro-
gram (see Chap. 20) did not require specific educational preparation for the creden-
tial. The CPHIMS credential, administered by the Health Information and
Management Systems Society (HIMSS), that is designed to certify healthcare IT
managers like those described in Chap. 4, also does not prescribe specific educa-
tional preparation. The American Nurses Credentialing Center (ANCC) in associa-
tion with the American Nurses Association offers a credential for nurse informatics
specialists (Chap. 3), but a different organization, the American Association of
Colleges of Nursing (AACN), is involved in accrediting nursing education pro-
grams. However, graduating from an accredited informatics program is currently
not required for eligibility for the certification examination.
On the other hand, the clinical informatics subspecialty examination for physi-
cians described in Chap. 16 is closely tied to preparation in an accredited training
program, especially after the initial years of the examination. Although the
Informatics Fellowship program accreditation is done by the Accreditation Council
for Graduate Medical Education (ACGME), there is close collaboration between
the organizations that certify individuals and accredit programs.
The Commission on Accreditation for Health Informatics and Information
Management Education (CAHIIM) [10], which began as a Health Information
Management (HIM) accrediting body, has now added health informatics to its name
and mission and some informatics programs are starting to seek accreditation from
them, as described in Chap. 17. There is a new Health Informatics Certification
Commission that is in the process of determining eligibility criteria for granting
certification (see Chap. 16).
As informatics education programs proliferate and more individuals are trained,
we can expect to see that both individual certification and informatics education
accreditation will become more important. For this reason, we have devoted a spe-
cific section of this book to the issues of accreditation and certification.
Adaptation to Current and Future Needs
One of the challenges of developing informatics education programs in today’s

world is that the world keeps changing and the change is in the direction of requir-
ing more and more varied informatics competencies, even if one is not an “informa-
tician” and especially if one is. ‘Big data’ and ‘data science’ have become buzzwords
[11], but being able to use those data that, with the help of electronic health records,
we are now able to collect, will require some traditional and some new informatics
competencies. Chapters 10 and 20 discuss new educational programs in data sci-
ence. Similarly, the focus on Meaningful Use in the U.S. [12] has led to more inter-
est in informatics-trained professionals. New developments in genomic research
have spurred the development of programs in bioinformatics education (Chap. 5), as
well as programs for translational scientists [13] that integrate both clinical and
bioinformatics (Chaps. 5 and 9). Existing programs for health professionals have
also seen the need to incorporate informatics into the basic educational preparation
of clinicians (Chaps. 3, 7 and 12) and other health professionals (Chap. 8). Chapter
4 focuses directly on the need to adapt curricula to a changing external environment,
but virtually all of the chapters recognize that informatics competencies will change
and evolve as the environment in which they apply changes.
Online Education
One of the major changes that has been occurring in education generally is a trend
toward more and more education being delivered online via distance learning tech-
nology. Several informatics programs described in this book are either primarily or
entirely delivered online. Examples of online curriculum content, strategies for cre-
ating online content, and feasible methods of content delivery are included in these
chapters, but there is now an entire section (Chaps. 18, 19 and 20) that focuses
specifically on online educational programs. Chapter 19, in particular, is focused
specifically on the different assumptions and expectations of students and teachers
in online education as compared to face-to-face programs. While the focus of this
book is on informatics education, and not distance learning per se, there is a great
deal of information for those who want to start a distance-accessible informatics
education program.
Arrangement and Focus of Book
This book is arranged in five major sections with additional introductory and con-
cluding chapters. This overview is the introductory chapter. The last chapter, Chap.
21, synthesizes and integrates the key points from the other chapters for a compre-
hensive view of the lessons learned from the variety of informatics education pro-
grams described.
The other major sections include chapters on:
1. Training Informatics Specialists in the U.S. (Chaps. 2, 3, 4, 5 and 6)
2. Informatics Education for Other Health Professionals (Chaps. 7, 8, 9 and 10)
3. Informatics Education Worldwide (Chaps. 11, 12, 13, 14 and 15)
4. Assessment of Individuals and Programs in Informatics (Chaps. 16 and 17)
5. Use of Distance Learning for Informatics Education (Chaps. 18, 19 and 20)
The section on training informatics specialists in the U.S. includes chapters on
the National Library of Medicine (NLM) training programs (Chap. 2), as well as
programs to train IT managers and other IT and informatics workforce profession-
als (Chap. 4). Chapter 3 on Nursing Informatics focuses on both educating nurse
informaticians as well as integrating informatics into general nursing curricula. In
addition to programs that train applied informatics in clinical settings, this section
also includes chapters on training specialists in bioinformatics (Chap. 5) as well as

undergraduate informatics majors (Chap. 6).
The other chapters that involve integrating informatics education into other edu-
cational programs are covered in the next section, Informatics Education for Other
Health Professionals. These professionals include physicians (Chap. 7), health
administrators (Chap. 8), and clinical and translational researchers (Chap. 9).
Chapter 10, the last chapter in this section, focuses on informatics and data science
training for students in basic science training programs.
The third major section of this book includes chapters on informatics education
in non-U.S. settings. This section is significantly expanded from the previous edi-
tion. Chapter 11 includes a description of the efforts and challenges of translating
some of the U.S. programs into educational programs in other countries. Conversely,
Chaps. 13, 14 and 15 provide the perspectives of the recipients of some of those
programs, as well as a description of informatics education programs developed in
the local settings. The focus of these chapters is on the many countries with limited
resources for healthcare in general, and for informatics education in particular.
While Chaps. 13, 14 and 15 focus primarily on medical and health informatics,
Chap. 12 describes nursing education in a variety of countries outside the U.S.
Although competencies are described throughout many of the chapters, the sec-
tion on assessment of programs and individuals describes the activities of certifica-
tion programs for medical subspecialists and others (Chap. 16) and accreditation of
informatics programs (Chap. 17).
Within the section on distance learning, Chap. 18 describes the AMIA 10 × 10
programs which have been used for continuing education not just in the U.S., but in
other countries as well. Chapters 19 and 20 address some of the challenges of online
education. Chapter 19 focuses on the various assumptions that both students and
teachers bring to online education and describes strategies for managing these
assumptions. Chapter 20 discusses the benefits and challenges involved in using
freely available online educational materials. Each chapter of the book ends with
lessons learned and/or key take-away points.
While the lessons learned provide ‘words of wisdom’ from internationally rec-
ognized informaticians and educators, the references in this book provide a compre-
hensive compilation of the scholarly literature on the history and current status of
informatics education in the U.S. and globally. Both the lessons and the references
will be useful for informatics educators who are embarking on developing the new
informatics education programs that are sorely needed as we navigate the expanding
digital healthcare age.
References
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2. Greenes RA, Shortliffe EH. Medical informatics. An emerging academic discipline and insti-
tutional priority. JAMA. 1990;263(8):1114–20.
3. Friedman CP, Altman RB, Kohane IS, McCormick KA, Miller PL, Ozbolt JG, Shortliffe EH,
Stormo GD, Szczepaniak MC, Tuck D, Williamson J. Training the next generation of infor-
maticians: the impact of “BISTI” and bioinformatics—a report from the American College of
Medical Informatics. J Am Med Inform Assoc. 2004;11(3):167–72. https://doi.org/10.1197/
jamia.M1520.
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what physicians need to know and how they learn. Acad Med. 2011;86(4):429–34. https://doi.
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LA, Musen MA, Ozbolt JG, Smith JW, Tarczy-Hornoch PZ, Williamson JJ. AMIA board
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org/10.1136/amiajnl-2012-001053.
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7. Valenta AL, Berner ES, Boren SA, Deckard GJ, Eldredge C, et al. AMIA Board White Paper:
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Another random document with
no related content on Scribd:
The dough was then handed to a third woman, who baked it in the
form of cakes on a chafing-dish, with charcoal and straw. These
cakes she distributed to the division of warriors, whose food she was
charged to provide, and who came every minute to demand their
portion.
Other women walked beside the camels to milk them into cahahs,—
wooden pails, containing four litres: these were passed from hand to
hand to slake the thirst of the troops. The camels ate as they
marched, from bags hung round their necks; and when their riders
wished to sleep, they lay at their length on the camels, their feet
secured in the sacks to protect them from falling. The slow and
measured step of the camels invites to sleep, and I have never slept
better than on this march. The wife of the Emir Faress was delivered
in her howdah of a son, who received the name of Harma, from the
place we were passing when he came into the world: it is at the
confluence of the Tigris and Euphrates. We were soon after joined
by three tribes: El Harba, El Suallema, and El Abdalla. We reckoned
seven thousand tents when Dehass joined us. This imposing
succour reassured him; we gave him a magnificent supper, after
which he affixed his seal to our treaty.
The enemy was still at the distance of a day’s journey. Our men and
horses being in great need of repose, the Drayhy commanded a two
days’ rest; but the assailants did not allow us the desired truce. As
soon as the report of our approach reached them, they began their
march, and the next day thirty thousand men were encamped an
hour from us. The Drayhy immediately advanced his army to the
banks of the river, fearing that our supply of water might be
intercepted; and we took up a position near the village of El Hutta.
The next day, the Drayhy sent a letter to the chiefs of the five tribes
who were come to attack us: Douockhry, chief of El Fedhay; Saker
Ebn Hamed, chief of El Modianu; Mohdi Ebn Hud, of El Sabha;
Bargiass, of Mouayega; and Amer Ebn Noggies, chief of Mehayeda.
This attempt was wholly unsuccessful: the answer was a declaration
of war, the style of which clearly proved that our intentions had been
misrepresented, and that the chiefs acted under foreign influence.
Sheik Ibrahim proposed to send me to them with presents, to
endeavour to come to an explanation. My embassies had hitherto
succeeded so well, that I accepted this with pleasure, and set out
with a single guide: but scarcely had we reached the tent of Mohdi,
who lay nearest to us, when their advanced guard came upon us like
wild beasts, robbed us of our presents and our clothes, put irons on
our feet, and left us naked on the burning sands. In vain I entreated
permission to explain; I was threatened with instant death if I
persisted in remonstrating. Some moments afterwards, I saw the
perfidious Absi advancing to me: I then understood the cause of the
inconceivable treatment of which I had been the victim; he had been
travelling from tribe to tribe to raise enemies against us. I was so
enraged at the sight of him, that my fallen courage revived, and I
determined to die bravely if I could not live to take vengeance. He
approached, and, spitting in my face, cried, “Dog of an infidel! in
what manner do you choose that I should separate your soul from
your body?”—“My soul,” I replied, “is not in your power; my days are
numbered by the great God: if they are to end now, it signifies little in
what manner; but if I am still to live, you have no power to kill me.”
He then withdrew to excite the Bedouins against me afresh, and
men, women, and children came to overwhelm me with outrages:
some spit in my face, others threw sand in my eyes; several pricked
me with their djerids. I was kept twenty-four hours without eating or
drinking, and suffering a martyrdom it is impossible to describe.
Towards the evening of the second day, a young man, named labour,
came to me, and drove away the children who were tormenting me. I
had already remarked him; for, of all those I had seen during this
day, he alone had not insulted me. He offered to bring me bread and
water at nightfall. “Hunger and thirst,” I replied, thanking him, “are of
little consequence; but if you could assist me to escape hence, I
would reward you generously.” He promised to attempt it, and in the
middle of the night brought me the key of my fetters, which he had
had the address to procure while the chiefs were at supper. He
opened them without noise; and without taking time to throw on my
clothes, we ran back to my tribe. All were asleep in the camp, except
the four negroes who kept guard at the entrance of Drayhy’s tent:
they uttered a cry on seeing me, and in great haste woke their
master, who came with Sheik Ibrahim: they embraced me with tears,
and handsomely rewarded my liberator. The Drayhy expressed the
most lively grief at the treatment I had experienced, and the greatest
indignation at this violation of the rights of nations. He immediately
gave orders for battle, and at sunrise we perceived that the enemy
had done the same. On the first day, there was no marked
advantage on either side. Auad, chief of the tribe Suallema, lost his
mare, for which he had refused twenty-five thousand piastres. All the
Bedouins participated in his affliction, and the Drayhy gave him one
of his best horses, very inferior however to the superb animal he had
lost. The next day the battle was renewed with increased fury, and
our loss was more considerable than that of the enemy. We were
obliged to act with extreme caution, having only fifteen thousand
troops to oppose to him. Forty of our men fell into their hands, while
we made only fifteen prisoners; but amongst these was Hamed, son
of the chief Saker. The captives on both sides were put in irons.
To these two days of fighting succeeded a tacit truce of three, during
which the two armies continued to face each other without any
demonstration of hostility. On the third day, the chief Saker, with a
single attendant, came to our camp. He was uneasy for his son, a
valiant young man, adored by his father and by all the Bedouins of
his tribe; and he came to ransom him. Hamed had been very well
treated by us; I had myself bound up his wounds. The Drayhy
received Saker with great distinction. The latter, after the customary
civilities, spoke of the war—expressed his astonishment at the
Drayhy’s ardour against the Wahabees, and said that he could not
credit so much disinterestedness, under which some secret motives
or personal views must needs be couched. “You cannot take it ill,”
added he, “that I do not engage with you without knowing your
object. Take me into your confidence, and I will second you to the
utmost of my power.” We replied, that we were not in the habit of
admitting to our secrets those of whose friendship we had no
assurance; but that if he chose to sign our treaty, we should have no
concealments from him. He then asked to be made acquainted with
this engagement, and after having listened to a lecture of the
different articles, with which he seemed to be very well content, he
assured us that things had been very differently represented to him,
and repeated the calumnies that Absi had spread concerning us. He
ended by affixing his seal to the treaty, and afterwards pressed us to
explain the object we were aiming at. Sheik Ibrahim told him that our
intention was to open a passage from the coasts of Syria to the
frontiers of India, to an army of a hundred thousand men, under a
powerful conqueror, who would relieve the Bedouins from the yoke
of the Turks, restore to them the sovereignty of the country, and
enable them to obtain possession of the treasures of India. He
affirmed that there was nothing to be lost, but every thing to gain, in
the execution of this project, the success of which depended upon
the union of forces and the harmony of inclinations. He promised that
their camels should be paid at a high price for the transport of the
provisions for this great army, and made him look to the commerce
of these vast countries as likely to become a source of inexhaustible
riches to them.
Saker entered fully into our views; but it was still necessary to
explain to him that the Wahabee[J] might counteract our plans; that
his religious fanaticism would naturally be opposed to the passage of
a Christian army; that his spirit of domination, which had already
made him master of Yemen, Mecca and Medina, would extend his
pretentions to Syria, where the Turks could not offer him any serious
resistance: that, on the other hand, a great maritime power, enemy
to the one we favoured, would infallibly make an alliance with him,
and would send forces by sea to cut us off from the road of the
desert. After much debate, in which Saker showed both judgment
and sagacity, he entirely acquiesced in our arguments, and promised
to use all his influence with the other tribes. It was agreed that he
should be chief of the Bedouins of the country we were then in, as
the Drayhy was of those of Syria and Mesopotamia: he engaged
between this time and the same period in the next year to unite the
different tribes under his orders, while we should pursue our route;
and promised that at our return all should be made easy to us. We
separated, enchanted with each other, after loading his son with
presents, and liberating all the other prisoners. Saker, on his part,
sent back our forty men; and the next day wrote us word that Mohdi
and Douackhry no longer opposed our projects, and that they were
about to remove to hold a conference with Bargiass, at three hours’
distance. In fact, they broke up their camp, and we did the same; for
the assemblage of so large a number of men and cattle had covered
the earth with filth, and rendered our continuance in the place quite
intolerable.
We encamped at six hours’ distance, at Maytal el Ebbed, where we
rested eight days. Saker came there to us, and it was agreed that he
alone should undertake to raise the Bedouins of these districts, while
we should return into Syria, lest by too long abandoning our first
conquest, our enemies should take advantage of our absence to
embroil our affairs and detach the tribes from our alliance.
Besides, the spring was already advanced, and it behooved us to
hasten thither, lest the pasturages of Syria and Mesopotamia should
be occupied by others. We deferred then, till the year following, the
project of pushing our recognizance as far as the frontiers of India.
By that period, Saker would have had time to prepare the tribes of
his neighbourhood to second us; “for,” said he, “the tree is uprooted
by one of its branches.”
Some days’ march brought us back to Mesopotamia. In two more we
crossed the Euphrates near Mansour and the desert called El
Hamad. We encamped in a place where water is only to be had by
digging deep holes, and is at last only fit for the beasts. Man cannot
drink of it. The place is called Halib El Dow, because milk is here the
only beverage.
We went from thence to El Sarha, a district abundantly supplied with
water and herbage, and here expected to be indemnified for our
privations; but a particular circumstance speedily dashed our hopes.
The soil is covered with an herb called Kraffour, which the camels
eat with avidity, and which has the property of inebriating them to the
point of madness. They run to the right and left, breaking every thing
they encounter, overthrowing the tents, and pursuing the men.
During four-and-twenty hours no one could get any rest; the
Bedouins were constantly employed in mastering the camels and in
calming their fury. I should have preferred actual war to this continual
struggle with animals whose prodigious strength, and delirious
exaltation presented incalculable dangers. But it appears that the
triumphs of skill over force has great charms for these children of
nature; for, when I went to the Drayhy to deplore the state of fever in
which this novel revolution held us, he only laughed, and assured me
it was one of the greatest amusements of the Bedouins. While we
were talking, a camel of the largest size made straight towards us,
with his head erect, and kicking up the dust with his great feet. The
Drayhy, seizing one of the stakes of his tent, waited for the furious
animal, and struck him a violent blow on the head. The weapon
broke, and the camel turned away to exercise his ravages
elsewhere. A dispute then arose as to which was the strongest, the
camel or the sheik. The latter averred, that if his club had resisted,
he should have cleft the skull of his adversary; the attendants
maintained the superiority of the animal, who had broken the
obstacle opposed to him; and my decision, that their strength was
equal, because it was a drawn battle, excited the mirth of the whole
audience.
The next day we broke up our camp, and were overtaken on the
road by a messenger from Saker, who sent us an account of the ill-
success of his negotiation with Bargiass. Our enemy Absi, who was
high in favour with the latter chief, had exasperated him against us;
had persuaded him to join Mehanna, and then to form an alliance
with the Wahabees, who were to send an army for our destruction.
The Drayhy answered, that this was no cause for uneasiness—that
God was stronger than they were, and could with ease give the
victory to the good cause. After this incident we continued our
journey.
We next learned that the tribe El Calfa was encamped at Zualma.
The Drayhy considered it important to secure the co-operation of this
powerful and courageous tribe. Its sheik, Giassem, was an old friend
of the Drayhy; but he could neither read nor write, and it therefore
became dangerous to address a letter to him, which would be read
by a Turk, and might be essentially injurious to our affairs, as
experience had taught us in the instance of the scribe Absi. Again,
then, the negotiation was committed to me; and I was sent to him,
with an escort of six men mounted on dromedaries. We arrived, after
a journey of three days, at the spot indicated, and were greatly
disconcerted to find that the tribe had removed their camp, leaving
no trace of the road they had taken. We passed the night without
eating or drinking, and deliberated the following day on what we
were to do. The affair of most immediate necessity was to find water;
for it is well known that thirst is more insupportable than hunger, and
we might also reasonably expect at the same time to meet both with
the springs and the tribe. We wandered three entire days without
finding either water or food. My palate was so perfectly dry, that I
could neither move my tongue nor articulate a sound; I had
exhausted all the artificial means of mitigating thirst, as keeping
pebbles and balls of lead in my mouth; my face was become black,
and my strength was forsaking me, when suddenly my companions
cried out, “Gioub el Ghamin!” (the name of a well in the desert,) and
darted forward. These men, inured to fatigue, sustained privations in
a manner inconceivable to me, and were far from imagining to what
a deplorable condition I was reduced. On seeing them run from me,
the irritation of my nerves, excited by fatigue, made me despair of
reaching the well, where I fancied they would not leave a single drop
of water for me; and I threw myself on the ground weeping. Seeing
me thus overcome, they returned, and encouraged me to make an
effort to follow them. We arrived at length at the well, and one of
them leaning over the parapet, drew his sabre, declaring he would
cut off the head of the first man who dared approach. “Be governed
by my experience,” said he, “or you will all perish.” The authoritative
tone he assumed had its effect upon us, and we all obeyed in
silence. He called us one by one, beginning with me, and made us
first lean over the margin of the well to inhale some of its moisture.
Then drawing a small quantity of water, he wetted our lips with his
fingers; by degrees he allowed us to drink a few drops, then a small
cup full; and having pursued this rational treatment for three hours,
he said, “You may now drink without risk; but if you had not listened
to me, you would have been all dead men; for drinking without
precaution, after long privation, is certain destruction.” We passed
the night on this spot, drinking continually, as much for nourishment
as to slake our thirst, which, notwithstanding this indulgence,
seemed insatiable. In the morning we climbed an eminence that we
might see farther round us; alas! nothing but the boundless desert
met our view. At length, however, one of the Bedouins thought he
descried an object in the distance, and soon asserted that it was an
howdah covered with scarlet cloth, and borne by a camel of great
size. His companions saw nothing, but having no better guide to
follow, we turned our steps in the direction indicated; and, in fact,
soon afterwards we found ourselves approaching a great tribe, and
distinctly saw the howdah which had served us for a pharos: happily
it proved to be the tribe we were in quest of.
Giassem received us kindly, and did his best to remedy our fatigue. I
satisfactorily accomplished the object of my mission to him, and he
dictated a letter to the Drayhy, in which he undertook to place his
men and goods under his orders, saying that the alliance between
them ought to be of the closest kind, on account of their long-
standing friendship. I set out on my return, provided with this
important document, but, on the other hand, much interested in the
news he had imparted to me of the arrival of a princess, daughter of
the King of England, in Syria, where she was displaying the luxuries
of royalty, and had been received with all sorts of honours by the
Turks. She had made magnificent presents to Mehanna el Fadel,
and had been escorted by him to Palmyra, where she had profusely
distributed her largesses, and had made a formidable party among
the Bedouins, who had proclaimed her queen.[K] Sheik Ibrahim, to
whom I carried this intelligence, was greatly disturbed by it, believing
it to be an intrigue to ruin our plans.
The Drayhy, perceiving our misgivings, reassured us by declaring
that if they sowed sacks of gold from Hama to the gates of India,
they would be unable to detach a single tribe from the solemn
engagement which had been contracted.
“The word of a Bedouin is sacred,” he added; “follow up your
projects without uneasiness. For my part, my campaign is planned. I
am going to the Horan to watch the proceedings of Ebn Sihoud,
whom alone we have cause to fear. I shall then return, and encamp
in the environs of Homs.”
Sheik Ibrahim, having no longer either money or merchandise,
determined to send me immediately to Corietain, whence I should
despatch a messenger to Aleppo to procure a supply of cash. I went
joyfully, as the expedition gave me a prospect of visiting my friends
and reposing some time amongst them. My first day’s journey was
performed without accident; but on the following day, about four
o’clock, at a spot named Cankoum, I fell into the midst of what I
believed to be a friendly tribe, but which proved to be that of
Bargiass. It was now too late to recede; I therefore made for the tent
of the sheik, preceded by my negro Fodda: but scarcely had I set
foot on the ground, when he was massacred before my eyes, and I
saw the same weapons which had despatched him raised upon me.
The shock was so great, that I have no recollection of what followed,
except that I cried out, “Stop! I claim the protection of the daughter of
Hedal!” and fainted. When I re-opened my eyes, I found myself lying
on a couch in a tent, surrounded by a score of females, who were
endeavouring to recall me to life: some were holding burnt hair,
vinegar, and onions to my nostrils; while others bathed me in water,
and introduced melted butter between my dry and contracted lips. As
soon as I had perfectly recovered my consciousness, the wife of
Bargiass took me by the hand, saying:
“Fear nothing, Abdallah: you are in the tent of the daughter of Hedal,
and no one has a right to injure you.”
Bargiass presenting himself shortly afterwards at the entrance of the
tent, to make his peace, as he said, with me,—“By the head of my
father,” cried she, “you shall not cross my threshold till Abdallah is
entirely cured!”
I remained three days under Bargiass’s tent, tended in the most
affectionate manner by his wife, who was negotiating meanwhile a
reconciliation between her husband and me; but I felt so rancorous a
resentment at his brutality that I found it difficult to pardon him: at
length, however, I consented to bury the past in oblivion, on
condition of his signing the treaty with the Drayhy. We then
embraced and entered into an oath of fraternity. Bargiass presented
me with a negro, saying, “I have sacrificed your silver, but in return I
give you a jewel;” a play of words upon the names of the two
negroes, Fodda, silver, and Gianhar, jewel. He afterwards gave an
entertainment in honour of our reconciliation. In the midst of the feast
a courier arrived at full speed from the Drayhy, bringing to Bargiass a
declaration of exterminating war, and full of the most opprobrious
epithets. “Oh! thou traitor,” he wrote, “who violatest the sacred law of
the Bedouins! thou wretch for ever infamous, who massacrest thy
guests! thou Ottoman under a black skin! know that all the blood of
thy tribe would not suffice to compensate for that of my dear
Abdallah! Prepare thyself for battle, for my courser will rest no more
till I have destroyed the last of thy race!” I hastened my departure, to
prevent any collision, and to comfort Sheik Ibrahim and the Drayhy. I
cannot describe the joy and astonishment which my presence
caused; and so miraculous did my return appear, that they could
scarcely credit the evidence of their eyes, till I had related all my
adventures.
The next morning I again took the road to Corietain, where I waited
for twenty days the return of the messenger I had sent to Aleppo,—a
respite which I found very seasonable both for repose and for the
repair of my tattered wardrobe; but necessity protracted my stay
beyond my inclination, for news was spread that the Wahabees had
invaded the desert of Damascus and ravaged several villages,
massacreing men and children without exception, and pillaging the
women, whom alone they spared. The Sheik of Corietain, too weak
to offer the smallest resistance, caused the gates of the town to be
closed, forbade any egress from it, and tremblingly awaited the
issue. We soon learned that the enemy having attacked Palmyra, the
inhabitants had retired within the precincts of the temple, and there
successfully defended themselves; and that the Wahabees, unable
to force their position, had contented themselves with killing the
camel drivers and carrying off their camels. From thence they
proceeded to ransack the village of Arack, and had dispersed
themselves throughout the environs. This sinister intelligence
alarmed me for the fate of my messenger, who however arrived safe
and sound with Sheik Ibrahim’s money. He had taken refuge for a
short time at Saddad, the inhabitants of which having paid a pretty
heavy contribution, had for the moment nothing more to fear.
Profiting by this circumstance, I laid aside my Bedouin habiliments,
and dressing myself as a Christian of Saddad, made my way to that
village, where I obtained news of the Drayhy, who was encamped
with the tribe of Bargiass at Ghandah el Cham. I rejoined him the
first possible opportunity, and learned with chagrin that a formidable
coalition had been effected between Mehanna el Fadel and the tribe
established at Samarcand; and that by their intrigues with the
governors of Hems and Hama, some Turks and Bedouins had been
drawn into the alliance against us. In this critical conjuncture I
bethought myself of our friend the Pacha Soliman, and persuaded
Sheik Ibrahim to visit Damascus for the purpose of consulting with
him. We set out at once, and alighted at the house of his prime
minister, Hagim, from whom we learned the name of the supposed
English princess: he informed us that it was through the influence of
Lady Stanhope’s presents that Mehanna had acquired so powerful a
party amongst the Turks. These details confirmed our suspicions that
England, aware of our projects, was subsidizing the Wahabees on
one hand, while on the other she endeavoured, through the
intervention of Lady Stanhope, to unite the Bedouins of Syria with
the Turks. An Englishman, whom we met at the house of M.
Chabassan, assuming the name of Sheik Ibrahim, added strength to
these conjectures: he endeavoured to extract something from us, but
we were too much upon our guard. Having obtained what we wished
from Soliman Pacha, we hastened to rejoin our tribe.
The Drayhy’s courage was not diminished; he assured us he could
make head against a much stronger array. The firman granted us by
Soliman Pacha required the governors of Hems and Hama to hold in
respect his faithful friend and well-beloved son, the Drayhy Ebn
Challan, who ought to be obeyed, being supreme chief of the Desert
of Damascus; and that any alliance in opposition to him was contrary
to the will of the Porte. Furnished with this document, we advanced
towards Hama; and some days afterwards Sheik Ibrahim received
an invitation from Lady Hester Stanhope to pay her a visit in
company with his wife, Madame Lascaris, who was still at Acre; an
invitation that annoyed him the more, as he had for three years
avoided sending any intelligence to his wife, in order to conceal from
the world the place of his residence and his intimacy with the
Bedouins. It was necessary, however, to send an answer to Lady
Stanhope; he therefore wrote that he would do himself the honour of
visiting her as early as circumstances would permit, and despatched
at the same time a courier to his wife, desiring her to decline the
invitation. But it was too late; Madame Lascaris, anxious to ascertain
the existence of her husband, had instantly obeyed Lady Stanhope’s
summons to Hama, in hopes of gaining some traces of him from that
lady: M. Lascaris thus found himself under the necessity of rejoining
her.
Meanwhile Mehanna advanced nearer and nearer, fancying himself
certain of co-operation from the Osmanlis; but the Drayhy, judging
the time arrived for producing the pacha’s firman, sent it to Hems
and Hama by the hands of his son Saher, who was received with the
greatest honours. After inspecting the order of which he was the
bearer, the two governors placed their troops at his disposal,
declaring Mehanna a traitor for calling in the Wahabees, the most
inexorable enemies of the Turks.
Lady Hester Stanhope sent an invitation to Saher, and overwhelmed
him with presents for himself, his wife, and mother; gave a saddle
and boots to every horseman of his suite, and announced her
intention of shortly visiting his tribe. M. Lascaris’ visit ended less
agreeably: Lady Stanhope having vainly endeavoured, by questions
ingeniously contrived, to draw from him some explanation of his
connexion with the Bedouins, finally assumed a tone of authority
which afforded M. Lascaris a pretext for a rupture. He sent his wife
back to Acre, and quitted Lady Stanhope at open variance with her.
Mehanna made his dispositions for commencing the struggle: but
finding the Drayhy by no means intimidated by his approach, he
judged it prudent to secure a reinforcement of Osmanlis, and sent
his son Fares to Hems, to claim the governor’s promised assistance;
who, however, instead of investing him with the command of a body
of troops, had him loaded with irons and thrown into prison; and the
dismayed Mehanna, at this afflicting intelligence, beheld himself
precipitated in a moment from the supreme command, to the sad
and humiliating necessity, not only of submission to the Drayhy, but
of even soliciting his protection against the Turks. The unfortunate
old man, overwhelmed by so unexpected a reverse, was obliged to
implore the mediation of Assaf Sheik of Saddad, who promised him
to negotiate a peace; and actually accompanied him with a hundred
horsemen within a short distance of our camp. There leaving
Mehanna with his escort, he advanced alone to the tent of the
Drayhy, who received him very cordially, but refused at first to accept
the submission of Mehanna, till we interposed in his behalf. Sheik
Ibrahim represented the hospitality with which he had received us on
our arrival in the desert, and Saher, twice kissing his father’s hand,
united his solicitations to ours. The Drayhy yielding at last, the
principal men of the tribe marched forward to meet Mehanna,—an
attention due to his years and rank. As soon as he alighted, the
Drayhy assigned him the seat of honour in the corner of the tent, and
ordered coffee to be brought. Mehanna hereupon rose: “I will drink
none of thy coffee,” said he, “till we shall be completely reconciled,
and have buried the seven stones.” At these words the Drayhy also
rose; they drew and mutually presented their sabres to be kissed;
after which they embraced, and the example was followed by their
attendants. Mehanna with his lance made an opening in the ground,
in the centre of the tent, about a foot in depth; and choosing seven
small stones, he said to the Drayhy, “In the name of the God of
peace, for your guarantee and mine, we thus for ever bury our
discord.” As the stones were cast into the hole, the two sheiks threw
earth over them, and trod it down with their feet; the women
signalizing the ceremony with deafening shouts of joy: at its
termination the chiefs resumed their seats, and coffee was served.[L]
From that moment it was no longer allowable to revert to the past, or
to mention war. I was assured that a reconciliation, to be according
to rule, ought always to be solemnized in this form. After a plentiful
repast, I read aloud the treaty, to which Mehanna and four other
chiefs of tribes affixed their seals.[M]
Their united forces amounted to seven thousand six hundred tents;
and, what was far more important still, the Drayhy became by this
alliance chief of all the Bedouins of Syria, where he had no longer a
single enemy. Saher went to Hems to solicit the deliverance of
Fares, whom he brought back, attired in a pelisse of honour, to take
part in the general rejoicing; after which the tribes dispersed, and
occupied with their several stations the whole country from the
Horan to Aleppo.
We now only waited the end of the summer to return towards the
east, in order to conclude the negotiations we had commenced the
preceding year with the tribes of Bagdad and Bussora; and this
interval of calm and leisure was filled up with preparations for a
marriage between Giarah, son of Fares, chief of the tribe El Harba,
and Sabha, daughter of Bargiass, the most beautiful maiden of the
desert. I was peculiarly interested in the affair, having known the
bride during my residence with her mother. Fares begged the Drayhy
to accompany him to Bargiass to make his proposals; and the chiefs
of the tribe, in the richest attire, were in attendance. We reached the
tent of Bargiass without any one being sent to meet us; Bargiass did
not even rise to receive us: such is the usual form on such
occasions; the smallest sign of forwardness would be considered
unbecoming.
After a few moments’ silence the Drayhy spoke;—“Why,” said he, “do
you receive us so indifferently? If you are resolved to offer us no
refreshment, we will return home.” During this time Sabha,
withdrawn within that part of the tent reserved for the women,
observed her suitor through the opening of the curtain; for custom
exacts that the lady should signify her satisfaction at the appearance
of her lover, before any negotiation is entered upon; and if, after the
secret survey I have just mentioned, she gives her mother to
understand that the intended bridegroom does not please her, the
matter rests there. On this occasion, however, a young and
handsome man, of a proud and noble presence, presented himself,
and Sabha gave the requisite token of satisfaction to her mother,
who then responded to the Drayhy’s inquiry,—“You are all welcome!
Not only will we heartily afford you refreshment, but we will grant all
that you can desire.”—“We come,” returned the Drayhy, “to demand
your daughter in marriage for the son of our friend: what do you
require for her dowry?”—“A hundred nakas,”[N] replied Bargiass,
“five horses of the race of Nedgde, five hundred sheep, three
negroes, and three negresses to attend upon Sabha; and for the
trousseau, a saddle embroidered with gold, a robe of damask silk,
ten bracelets of amber and coral, and yellow boots.” The Drayhy
made some remonstrances on the exorbitance of the demand,
saying, “Thou art minded to realize the Arab proverb: ‘If thou wouldst
not marry thy daughter, increase her price.’ Be more reasonable if
thou desirest the conclusion of this marriage.”
The dowry was finally settled at fifty nakas, two horses, two hundred
sheep, one negro, and one negress. The trousseau remained as
dictated by Bargiass; saddles and yellow boots for the mother and
some other members of the family were even added above his
demand. Having written these articles, I read them aloud. Then the
assistants at the ceremony recited the prayer Fatiha—the Pater
Noster of the Mussulmans, which confers its sanction on the
contract,—and camel’s milk was handed round, as lemonade had
been at a town in Syria. After this refreshment the young people
mounted their horses and amused themselves with the djerid,[O] and
other games. Giarah, desirous to ingratiate himself with his bride,
was particularly distinguished, and she remarked with pleasure his
agility and grace. We separated at nightfall, and preparations for the
nuptials now employed the thoughts of all.
By the evening of the third day, the dowry, or rather the price of
Sabha, was ready, and a numerous procession moved with it in the
following order:—A horseman led the van, with a white flag pendent
from the point of his lance, and crying, “I bear the spotless honour of
Bargiass.” After him followed the camels, decorated with garlands of
flowers and foliage, attended by their drivers; then the negro on
horseback, richly clothed, and surrounded by men on foot singing
popular airs. Behind them marched a troop of warriors, armed with
muskets, which they frequently discharged. A woman followed,
sprinkling with incense a large vessel of fire which she carried. Then
the milch ewes, under the guidance of their shepherds, who were
singing like Chibouk, the brother of Antar, two thousand years
earlier; for the manners of the Bedouins never change. After these
came the negress, mounted upon a horse and evironed by two
hundred women on foot, constituting not the least noisy of the
groups; for the joyous shouts and nuptial songs of the Arab women
are shrill beyond expression. The procession was closed by the
camel which bore the trousseau, and formed a splendid spectacle.
The embroidered housings were spread out on all sides and covered
the animal; the yellow boots hung from his sides, and the jewels,
arranged in festoons, completed his trappings. A child of one of the
most distinguished families, mounted on this camel, repeated with a
loud voice, “May we be ever victorious! May the fire of our enemies
be extinguished for ever!” Other children accompanied him, crying,
“Amen!” For my part, I ran from one side to the other, to enjoy the
whole spectacle to the utmost.
This time Bargiass came out to meet us, attended by the horsemen
and women of his tribe; the cries and chants then became truly
deafening; and the horses galloping about on all sides, soon
enveloped us in a whirlwind of dust.
When the presents were all displayed and ranged in order around
the tent of Bargiass, coffee was made in a monstrous caldron, and
every one took some, while waiting for the feast.
Ten camels, thirty sheep, and a prodigious quantity of rice formed
the staple of the meal; after which a second caldron of coffee was
emptied. The dowry accepted, the ceremony was concluded by a
repetition of the prayer; and it was agreed that Giarah should come
at the expiration of three days to fetch his bride. Before my
departure, I visited the women in their apartments, to introduce Sheik
Ibrahim to a more intimate acquaintance with Bargiass’s wife, and to
reiterate my thanks for her care of me. She replied by expressing her
readiness to increase my obligations by bestowing her niece on me
in marriage; but Sheik Ibrahim deferred taking advantage of her
favourable intentions towards me till the following year.
On the eve of the day fixed for the wedding, a rumour arose that a
formidable army of Wahabees had appeared in the desert: couriers
flew from tribe to tribe, exhorting them to unite three or four in a
company, that the enemy might find them prepared on all points to
receive them; and the espousals had nearly been consummated by
a mortal combat, instead of the sham fight which is customary on
such occasions.
The Drayhy and the other chiefs set out very early in the morning
with a thousand horsemen and five hundred women to achieve the
conquest of the beautiful Sabha. At a short distance from the camp,
the procession halted: the women and old men alighted and awaited
the issue of a combat between the young people who came to carry
off the betrothed, and those of her tribe who opposed their design.
These contests have sometimes fatal results; but the bridegroom is
not permitted to take part in them, lest his life should be exposed to
hazard from the machinations of his rivals. On this occasion the
combatants came off with about a score of wounds; and victory, as
was reasonable, decided for our party, who carried off the bride in
triumph and consigned her to the women of our tribe. Sabha’s train
was composed of a score of maidens with three well-laden camels;
the first carrying her howdah covered with scarlet cloth, trimmed with
fringes and tufts of various-coloured worsted, and adorned with
ostrich-feathers: the interior was decorated by festoons of shells and
strings of coloured glass, forming a sort of frames to small mirrors,
which, placed at intervals, reflected the scene on all sides; and
furnished with silken cushions for the reception of the bride. The tent
formed the burden of the second camel, and the carpets and kitchen
utensils that of the third. The queen of the festival being placed in
her howdah, surrounded by the wives of the chiefs mounted on their
camels, and by other women on foot, the procession commenced its
retrograde march. Horsemen prancing in the van announced its
progress to the tribes we might meet, who were expected to greet us
by throwing incense and killing sheep under the feet of the bride’s
camels. It is not possible to convey a very exact idea of this scene,
nor of that which lasted during the whole day and night; nor to
describe the dances, the songs, the bonfires, the banquets, the
tumult, and the cries of all sorts, which her arrival occasioned. Eight
tribes were entertained by the hospitality of Fares. Two thousand
pounds of rice, twenty camels, and fifty sheep, furnished out the
feast; and in the middle of the night the cry was still, “Let him who is
hungry come and eat.” So great was my reputation among them, that
Giarah begged a talisman from me to insure the happiness of this
union: I accordingly wrote his cipher and that of his spouse in
European characters; placed the charm solemnly in his hands; and
no one doubted the efficacy of it, when they observed the
satisfaction of the new-married couple.
Some days afterwards, hearing that the Wahabees, ten thousand
strong, were besieging Palmyra, the Drayhy gave orders for
marching against them. We encountered them at El Dauh, and
exchanged some musket-shots till nightfall, but without coming to a
pitched battle. I had here leisure to appreciate the advantage of the
mardouffs, in these wars of the desert, in which it is always
necessary to carry about the commissariat of the army, and often for
a considerable time. These camels, mounted each by two soldiers,
are like moving fortresses, provisioned with everything necessary for
the nourishment and defence of their riders. A budget of water, a
sack of flour and another of dried dates, a jar of sheep’s butter, and
the munitions of war, are formed into a sort of square tower on the
animal’s back. The men, conveniently placed on each side on seats
composed of cordage, thus carry with them everything of which their
temperate habits have need. When they are hungry, they knead a
little of the meal with butter, and eat it in that state without baking; a
few dates and a small quantity of water completing their moderate
repast: nor do they quit their post to sleep, but throw themselves
across the camel in the manner I have already described. The next
day’s engagement was more serious. Our Bedouins fought with
more inveterate obstinacy than their adversaries, because their
women and children were in their rear, while the Wahabees, far from
home, and with no other object than pillage, were little disposed to
risk their lives in the cause. Night separated the combatants, but with
the earliest dawn the battle recommenced: at length, towards
evening, victory declared in our favour; the enemy having lost sixty
men killed, took to flight and left us in possession of the field of
battle, besides twenty-two prisoners, forty beautiful mares, and sixty
camels. This victory still enhanced the reputation of the Drayhy, and
filled Sheik Ibrahim with joy; in the exuberance of which he
exclaimed, “Thanks be to God, our affairs prosper!”
Having no longer any enemies to fear in the Syrian desert, Sheik
Ibrahim parted company for a time from the Drayhy, and went to
Hems to purchase merchandise and write to Europe. During our stay
in that place he left me perfectly at liberty to seek amusement, and to
recover from all my fatigues; and I made daily excursions into the
country in company with some of my young friends, doubly enjoying
this life of pleasure from its contrast with that which I had led
amongst the Bedouins. But, alas! my joy was to be of short duration,
and was soon converted into bitter anguish. A messenger, who had
been to Aleppo to fetch remittances for M. Lascaris, brought me a
letter from my mother, couched in terms of the deepest affliction, and
announcing the death of my elder brother by the plague. Grief made
her writing almost incoherent. She had been ignorant of my destiny
for nearly the last three years, and conjured me, if still in existence,
to go to her.
This dreadful intelligence deprived me of the use of my senses, and
for three days I was unconscious where I was, and refused all
nourishment. Thanks to the attentive care of M. Lascaris, I gradually
recovered my recollection; but all that I could obtain from him was
permission to write to my poor mother. Neither was I allowed to
despatch my letter till the eve of our departure, for fear she should
come herself to seek me. But I pass over the detail of my personal
feelings, in which the reader can have no interest, to return to our
travels.
The Drayhy having advertised us that he would shortly set out for the
east, we hastened to join him, with three camels, two mares, and
four guides, whom he had placed at our disposal. The day of our
departure from Hems, I felt so extraordinary a weight upon my heart
that I was tempted to regard it as a fatal presentiment. It struck me
that I was advancing to a premature death. I made the best use,
however, of my reasoning powers, and at length persuaded myself
that the oppression I experienced resulted from the dejection into
which my mother’s afflicting letter had plunged me. We set out on a
journey of twenty hours, and though wearied by travelling the whole
day, were persuaded by our guides not to halt till we had completed
it. Nothing particular occurred till midnight; when growing drowsy
from fatigue and the monotonous movement of the march, we were
alarmed by a sudden cry from the advanced guide—“Rouse
yourselves, and look well about you, for we are on the brink of a
tremendous precipice!” The road was but a foot in breadth; on the
right was a perpendicular mountain, and on the left the precipice
called Wadi el Hail. I woke in surprise, rubbed my eyes, and reseized
the bridle, which I had allowed to hang loosely over the neck of my
mare. But this precaution, which ought to have saved me, was the
very thing that had nearly caused my death; for the animal having
stumbled against a stone, fear made me draw the reins too hastily.
She reared, and in coming down lost her footing, stepped only on
vacancy, and rolled over with her rider to the bottom of the precipice.
What passed after that moment of agony I know only from Sheik
Ibrahim, who has since told me, that he dismounted in terror, and
endeavoured to distinguish the nature of the gulf in which I had
disappeared; but the night was too dark,—the noise of my fall was
the only notice he had of it, and he could discern nothing but an
abyss beneath his feet. He then betook himself to weeping, and
conjuring the guides to go down the precipice. But this they declared
impossible in the darkness, assuring him moreover, that it would be
useless trouble, since I must not only be certainly dead, but dashed
to pieces against the points of the rocks. Whereupon he announced
his resolution not to stir from the spot till the daylight should enable
him to make his researches, and promised a hundred tallarins to
whoever should recover my body, however mutilated it might be, as
he could not, he said, consent to leave it a prey to wild beasts. He
then sat down on the edge of the gulf, waiting in mournful despair for
the first glimmerings of daylight.
No sooner were they perceptible, than the four men descended the
abyss with much difficulty, and found me, insensible, suspended by
my sash, my head downwards. The mare lay dead a few toises
below, at the extremity of the ravine. I had ten wounds on my head,
the flesh torn from my left arm, my ribs broken, and my legs
scratched to the bone. I was deposited, without any sign of life, at
the feet of Sheik Ibrahim, who threw himself upon me in tears. But
having a little knowledge of medicine, and carrying always some
valuable remedies about with him, he did not long abandon himself
to a useless grief. Having satisfied himself, by the application of
volatiles to the nostrils, that I was not absolutely dead, he placed me
carefully on a camel, and retraced his steps as far as the village of El

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INFORMATICS EDUCATION IN

HEALTHCARE lessons learned 2nd

Systems Engineering: Fifty Lessons Learned 1st Edition

Innovations in Community Based Crime Prevention Case

The State of Peacebuilding in Africa: Lessons Learned

Service Learning Essentials Questions Answers and

Divestitures and Spin Offs Lessons Learned in the

Project Management Lessons Learned A Continuous Process

Applied Data Science: Lessons Learned for the Data-

Crisis communication : case studies and lessons learned

Eta S. Berner Editor

More information about this series at http://www.springer.com/series/1114

ISSN 1431-1917 ISSN 2197-3741 (electronic)

© Springer Nature Switzerland AG 2014, 2020

Birmingham, AL Eta S. Berner

Part I Introduction to Lessons Learned

Part II Training Informatics Specialists in the US

Part III Informatics Education for Other Health Professionals

9 Clinical and Translational Research Informatics

Part IV Informatics Education Worldwide

Part V Assessment of Individuals and Programs in Informatics

Part VI Use of Distance Learning for Informatics Education

19 Managing Unspoken Assumptions in Online Education���������������������� 263

Part VII Summary of Lessons Learned

Ignacio Pérez Aravena Department of Biomedical Informatics, DUOC UC

John H. Holmes, PhD, FACE, FACMI, FIAHSI Department of Biostatistics,

Caroline Perrin, PhD HI5lab, Department of Radiology and Medical Informatics,

AACN American Association of Colleges of Nursing

CERTES Center for Research Expertise in Telemedicine and eHealth

HIM Health information management

NLM National Library of Medicine

Eta S. Berner and Jacqueline A. Moss

© Springer Nature Switzerland AG 2020 3

Informatics illustrate, the standards for certification of individuals and accredita-

Another consistent theme echoed by multiple contributors to this edition, is the

Standards for Certification and Accreditation

Adaptation to Current and Future Needs

One of the challenges of developing informatics education programs in today’s

Arrangement and Focus of Book

also includes chapters on training specialists in bioinformatics (Chap. 5) as well as

1. Blumenthal D. Launching HITECH. N Engl J Med. 2010;362(5):382–5. https://doi.

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Birmingham, AL Eta S. Berner

Part I Introduction to Lessons Learned

Part II Training Informatics Specialists in the US

Part III Informatics Education for Other Health Professionals

9 Clinical and Translational Research Informatics

Part IV Informatics Education Worldwide

Part V Assessment of Individuals and Programs in Informatics

Part VI Use of Distance Learning for Informatics Education

19 Managing Unspoken Assumptions in Online Education�� 263

Part VII Summary of Lessons Learned

Standards for Certification and Accreditation

Adaptation to Current and Future Needs

Arrangement and Focus of Book