Looking for Trouble

(Gerri Haynes, former president of Washington Physicians for Social Responsibility, returned to Gaza with a delegation of doctors, nurses and others interested in helping the people there. Gerri has been sending back reports and this is her last one, at least until the next delegation.)

Karin Huster writes:

“Where are you from?” “Am’rika”, I reply.“Welcome, welcome”. Time and time again, the same warm, hospitable message.

My stay in Gaza started with the surreal witnessing at the Hamas border of the Islamic jihad and Mujahideens welcoming a prisoner back home to Gaza after having spent 27 years in an Israeli jail. Men in full balaclavas with Kalashnikovs, shots fired in the air in signs of happiness, family, journalists. We hadn’t asked for such a fervent welcoming committee…

In the countryside, the peace sign is constantly flashed when we drive by. Yet Gaza is anything but peaceful. Torn to its core by continuous wars, the latest in November of 2012, Gaza is a place on edge, where people talk about their frustration with the government as well as with their neighbor Israel. The ever-present dust and destruction permeate my daily life, it exhausts me. Everywhere my eyes track, I see iron rods sticking out of concrete rubble, dirt and garbage everywhere, plastic bags flying, chaos—it’s inescapable, pervasive. Nothing is green. Graffiti covers almost every wall at every corner of the streets –it’s truly an art form intrinsic to Gaza—their unique message a plea for peace and the right to their land. It is exhausting and depressing. To my eyes, unused to war and destruction, the bombings could have happened yesterday – so intense is the devastation –yet to the ones who know, Gaza is purportedly doing some rebuilding. But many things have sadly just stayed the same here, or even gotten worse, paralyzed by systemic inefficiencies, political rifts and economic blockade.

With its 1.7 million inhabitants (most of them refugees)squeezed in less than 360km), Gaza is one of the most overcrowded places on earth. Blockaded since 2007 when Hamas gained power and controlled by the Israeli Defense Forces by air, sea and land, Gazans experience hardships very few can imagine: unable to leave, they remain in an open-air prison that boasts over 34% unemployment and 80% of its population on some form of aid. Compounding this situation are a fledgling infrastructure, severe electricity shortages, massive water issues, a struggling municipal service and a state of constant economic squeeze. You may understand a little better why peace is a difficult concept here.

Yet, against this backdrop of people exhausted in the struggle to survive, their resilience and kindness take over. “We are so sorry for what happened in Boston”. How many times did I hear this message?

The cacophony of horns, generators or street vendors selling their goods to the passers-by signal that life still goes on in Gaza. Driving is mayhem, with cars weaving in whichever direction, honking their horn incessantly, asking whether you need a ride. I am the rare foreigner here—one of the only women in this sea of humanity who does not wear a scarf over my head. Walking in the streets in the old souk, I am undoubtedly noticed; the young men want a picture with me. “Welcome, welcome.”

I am their window to the outside. Every day, I have been touched by their gestures of generosity: the pita baker at the street corner invites me to make pita in his oven, and then gives me bread; my falafel hangout feeds me more falafels than I can digest – and wants to marry me; our staff at the hospital brought plates of fresh humus and olives for breakfast. They have kindly taught me Arabic words, enough that I can get my “café aulait” in the afternoon. I have been served more coffees and teas than I could dream of. At work in the hospital, they have taught me how much they can do with so little. They always readily share everything they have – and with a smile.

Even if deprived of their dignity, Gazans cannot stop having hope. It is their only option. And they know it all too well.

Today was my last day at El Shifa hospital – today was a day of optimism. I witnessed two babies being born – two human beings who know nothing about war and conflict. As a new generation is born, each and every one of us, no matter our beliefs, owes it to them to have the right to a future as bright as ours. It is their right as human beings.

Kit Kittredge writes:

I found Palestinian resilience, resourcefulness and resistance alive in the streets and health facilities I worked in during this visit to Gaza.

The physiotherapy clinics are staffed with friendly, competent, committed staff doing great work and willing to share their knowledge and skills as well as learn some of ours. Additionally in the women’s and children’s clinics I found a very weary, stressed and anxious population. I saw many cases of children severely burned from gasoline and candle fires due to electricity shortages from Israel. I worked on children with missing limbs from explosives and phosphorous gas, and unwarranted amputations due to limited emergency care during Israeli attacks.

The illegal, immoral, barbaric siege of Gaza permeates every aspect of the medical community. The destruction of facilities, blockade of supplies, restricted access to definitive care, and the constant threat of an Israeli attack are horrific enough, but the psychological warfare is as destructive and intentional as the bombs.

Amidst the oppression and terror , the Palestinian spirit continues and the medical community works tirelessly and strives to meet the needs of the people. As always I am continually amazed, humbled and inspired by the people of Gaza. They are more than capable and willing to create a sustainable, peaceful, vibrant country if only we allow them to by helping end the U.S. supported Israeli blockade.

Keith Meyer writes:

I worked with the physical therapy departments of El Waffa , Shiffa, and Public Aid hospitals and a private acupuncture clinic and found their staff and facilities well run. The staff was plentiful and well qualified but sadly there are not enough supplies or equipment to service the people’s needs due to the Israeli blockade, which is supported by Egypt and the U.S. The people I worked with and met on the street love life, family and friends.

After the Boston Marathon bombing all the therapists and doctors expressed their deepest sympathy and stated that they, of all people, understood our loss. As anticipated the people of Gaza were gracious, kind and generous. This was my first time in Gaza so there was some anxiety about what I would see versus what I have heard and read in the media.

The people of Gaza that I met and worked with hold education as very important. One Gazan said he was told by his grandparents, “You can lose your home, your land and all your possessions, but they can not take what you carry in your mind. You can take your education with you and use it anywhere.” This sentiment was echoed by all Gazans I spoke with. It saddened me to see the conditions in which they are forced to live, but I was inspired and moved by their resolve to work and live with integrity and love in their hearts.

And Bill Dienst writes:

My first visit to Gaza was in 1985 and this is my seventh trip to the region. In the 80’s,there were no substantial physical barriers between Gaza and Israel. Many Gazans worked as day laborers in Israel and many spoke Hebrew. Group taxis traveled freely between East Jerusalem and the West Bank, and directly into Gaza City. The society here in Gaza was much moreWesternized and secularized than it is today. Women wore blue jeans and ponytails, and the hijab and the naqab were not nearly as ubiquitous as they are now. But it was hardly a perfect relationship between Israelis and Palestinians; more of a privileged class and servant class based on the birthright of whether or not one was born Jewish. But there was abundant interaction between the two societies then.

Then came the First Intifada (shaking off or uprising) and then the Oslo “Peace Process” which was really a “Piece Process.” This culminated in the division of the two societies and the isolation of Gaza from the rest of the world. There was false hope then and a second intifada. Gaza was locked down as a consequence and became the world’s largest prison.

When I re-entered Gaza some 18 years later in 2003, it was a much different world. Dr.Haidar Abdul Shafi, a respected physician and civic leader in Gaza, explained to me why he had walked out of the Madrid Peace negotiations in 1991. “I concluded that the Israelis we renegotiating in bad faith,” he said. It took me a while to fully understand what he was talking about, but slowly it became clearer. Gaza was now surrounded by a hideous “Berlin Wall”. Rachel Corrie had just been mowed down by a giant bulldozer. Houses and apartment blocks were being systematically destroyed under the orders of Ariel Sharon “to look for tunnels”. Many tunnels were found and destroyed, but even more tunnels were built in their place and remain today. More than2000 people in Rafah were made homeless as a direct result of Israel’s pursuit of the tunnels.

In 2006 I entered Gaza during a time of assault. The streets of Beit Hanoun were ripped apart after a Qassam missile had killed an Israeli woman in Sderot. More than 85 Palestinians were killed in Beit Hanoun and nineteen members of the Al Athamna family were massacred as they slept in their beds. Iinterviewed some of the grief stricken survivors a few days after the onslaught. Apache attack helicopters reigned death and destruction from the skies directly above us; we rushed to the Kamal Adwa Hospital to assist local doctors as 5 young men in their 20s died right in front of us. It was a time of palpable fear for me, as I shared for the first time, the fear that local Gazans feel routinely.

In 2008, I entered Gaza by boat. I was part of the maiden voyage of the Free Gaza Movement; we were the first boats to arrive from international waters in 41 years. Gaza had been under a tightening siege. There were40,000 people on the shores of the Gaza Marina waiting to greet us. It was a time of euphoria as we demonstrated to the people of Gaza that many of us around the world have not forgotten them; many around the world who do care about them. There were several more boat trips and then flotillas. Then there was the massacre on the Mavi Marmara. My Italian friend Vittorio Arrigoni was martyred two years, and he is still remembered by the people of Gaza.

Then came the horror of Cast Lead. I last entered Gaza again in October2009 in its aftermath. The streets were filled with entire blocks of rubble; neighborhoods had been leveled; the siege had been tightened and there were no materials for rebuilding. Dr. Marwan Assalya, the general surgeon at Al Awda Hospital where we were assigned, shared horrific photographs of people he had cared for during the previous winter. There were pictures or victims of white phosphorus attacks with second, third and fourth degree burns all over their bodies. There were recipients of DIME weaponry whose arms were sheared off by vaporized micro-shrapnel. Patients who survived lingered, only to succumb later to sepsis; or if they survived in the short term, succumbed later to cancer – probably a direct result of the tungsten heavy metal vapor supplied by the U.S. arms industry. There were pictures of drone victims who had had both legs blown off; these were the survivors; there were no pictures of those who died immediately in the attacks.

So now we are in Gaza. Our medical team disperses to various assignments. Dr. Bob Haynes and I are teaching elements of Advanced Cardiac Life Support at Shifa and Public Aid hospitals. We are giving lectures to very bright young medical and nursing students at Al Azhar and Islamic Universities.
We are being greeted by smiling and attentive students who still show hope and amazing resiliency for their future. In Gaza, hope springs eternal – Phoenix keeps rising miraculously from the ashes, especially among the youth.

But we will keep coming back as long as we can.

(Gerri Haynes, former president of Washington Physicians for Social Responsibility, has returned to Gaza with a delegation of doctors, nurses and others interested in helping the people there. Gerri will be sending back reports.)

Last day in Gaza for this visit

Following a good meeting with the Minister of Health and the Coordinator for International Activities this morning, Rich Grady returned to the hospital to work for another long day – each night, he has returned to the hotel near midnight having operated and instructed throughout the day. Bob Haynes and Bill Dienst spent this last day teaching Advanced Life Support to classes in two hospitals, completing a week of instruction for dozens of students.

This afternoon, Nikki Nichols and I met with a group of women in an impoverished area of

Gaza. I had met with these women in April 2012 and they assembled in a room just off the street – a room where their children roamed in and out – curious about the meeting their mothers were having. While I talked with the women, Nikki gave a chair massage to each of them. All of the women have experienced the death of a family member in one of the attacks on Gaza. Today, they talked about the effects of the siege on their lives. Here are their words:

“The situation is getting worse. Food is too expensive – we cannot afford chicken. We cannot afford medicine. Unemployment is increasing. UNRWA (the United Nations Relief and Works Agency – organized to provide assistance, protection and advocacy for families in the Near East) is restricting services and we do not get enough food aid or money to be able to live. (Funding to UNRWA has decreased and there have been recent threatening protests at the UNRWA site in Gaza City.) If they cannot help us, they need to let us go back to our land (farmland in the NO GO zone which comprises one third of the arable land in the Gaza Strip). We need our government to come to peace with the Ramallah government so that they can work together to free us.”

“I work as a cleaner for 100 dollars/month. UNRWA told me that this is enough and quit giving aid to my family. I cannot feed my family of eight, pay school expenses (see below) and taxes for this much money. I don’t know about meat for my family – I only hear about meat. We were invited for a family nutrition workshop at ANERA – they told us to feed our children protein … we would like to do this, but we have no money for such things.”

Another woman said, “Even those who work in the government have had their salaries cut in half. We have become overwhelmed with loans and now suffer from debt we cannot pay. More people are committing suicide (strictly forbidden by Islam). The stress is too much.

During the last war on Gaza, her cousin was cooking in her home when a man from Hamas (being targeted by Israel) came in – a bomb destroyed their home, killing the whole family. Everyone has had a family experience with violent death during the attacks by Israel. They live daily with the fear of another attack – there is nowhere for them to go. Hundreds of civilians were killed or wounded in the November 2012 attacks and they and their children live every moment with the anxiety about another attack.

Because of the economic situation, the level of domestic violence is up – all of the women agreed with this observation. “Our children come to us for money (to be able to pay the fees for school) and because there isn’t enough money, my husband hits them. He is very, very frustrated.”

Medical problems in their children are not being resolved. “Two of my children stutter since the last war. They know about the Israelis targeting cell phones and that people are killed when the Israelis track a phone. The 13-year-old friend of a neighbor borrowed the phone of someone being targeted and the child was killed.

“My problem is no medicine. My seven-year-old daughter has epilepsy and there is no medicine to treat her.” Another woman said that since the war, her nine-year-old daughter has started wetting the bed and no one has been able to help her. “Our children cannot concentrate in school. They are hungry and there are nervous. Their academic achievement has become zero. As adults and parents we cannot help them. The curriculum is very difficult. The school day is short (double shifting) and we cannot afford to pay for the extra classes that are offered after school. Each of these classes costs ten dollars/month/child. We do not have that money. Our children go to school in Beach Camp – it is a very long walk, but we cannot afford to send them on a bus, so they walk through the rain in the winter and become very cold. We have to pay for uniforms for the school – we cannot afford to pay for these uniforms. We cannot afford food for them for school. At school, the water is polluted and we cannot afford to buy clean water for them. Because the electricity is off much of the time, our children have to study by candlelight – this is not enough light and it is dangerous. Many children have died in fires caused by candles.”

I asked about generators. “Generators – don’t remind us! We get mad (crazy) from the noise of the generators. Many people stopped using them because you have to buy fuel to run them and we cannot afford the fuel. When they are running, you can’t concentrate on anything – the noise is so loud. On the other hand, the dark is very scary. Our children stay in one room, afraid of the dark (and what it has brought in the wars.) My husband is working, but it is a very small salary and they take the fees for electricity from him. If he doesn’t pay the fees, we don’t have electricity, even when it is running. Today is a “free” day – we will have electricity all day long, but this is very rare.”

The women were clearly friends; their children played together as family; the air of frustration was strong. They wanted us to tell our government to help end the siege – to let the people of Gaza be free to find jobs and to work in their farms and to fish in the sea.

(Gerri Haynes, former president of Washington Physicians for Social Responsibility, has returned to Gaza with a delegation of doctors, nurses and others interested in helping the people there. Gerri will be sending back reports.)

Day Six in Gaza

Hospital Clinics and surgeries are closed on Fridays in observance of faith. We traveled by bus with friends from Gaza for a tour of this imprisoned land. Bordered by Israel, Egypt and the sea, Gaza has great beauty. Hamada Bayieri of UNOCHA (United Nations Office for the Coordination of Humanitarian Affairs) joined us for two hours to tell us about the challenges of living here. He welcomed us by saying that the people of Gaza have a feeling of isolation and that we are a contact to let people know they are not alone.

Everything we witnessed demonstrated effects on the physical and mental health of the people of Gaza. Hamada reviewed the current statics of

living under siege, noting that 38 percent of the population lives in abject poverty. Fishing used to supply a primary source of protein – now most of the 3,500 fishermen do not fish. The Oslo Accords guaranteed a ten nautical mile border for Gaza, but Israel imposes a border at three nautical miles – making access to clean water and large fish impossible. Hamada noted that this lack of access is not only a matter of loss of “right,” it is a matter of loss of human dignity,

Hamada commented that the people here continue to be resilient, but noted that crowding, poverty, lack of access to building materials and rising population density (increased demand in

the face of shrinking resources) create an atmosphere where gender-based violence is increasing and people consume most of their day trying to cope with the lack of life’s survival essentials. Eighty percent of the people in Gaza are aid-dependent.

We stopped by the Sea to observe a large pipe carrying part of the 80 million liters of partially and fully untreated sewage into the Mediterranean each day. Walking on the shore, the smell was not pleasant, but the possibilities for the Gaza shoreline were obvious. The Mediterranean is a magnificent sea – the shoreline here is easily accessible. If the water could be cleaned and the sea could be freely

used, both the access for the people to the sea and the development opportunities are great. As it is now, the Mediterranean is polluted and not safe for swimming or fishing (as noted previously).

Along the long land border with Israel, Israeli guard towers and the Wall were obvious. The area known as the “NO GO” zone is comprised of one third of all the good crop land in the Strip – this is 17 percent of Gaza’s 360 square kilometers. Israel guards this area with guns and even though the border was to be narrowed after the November 2012 attacks on Gaza, this narrowing has not happened. Farmers venturing into the restricted zone are shot. Since

November, four people have been killed and more than 100 wounded in this border zone.

We observed some of the areas where goods used to enter Gaza from Israel. Now, there is only one crossing for materials and Hamada reported that since the 23rd of March this year, even this crossing has been closed more than 70 percent of the working days. This heightens the need and use of the tunnels between Egypt and Gaza. After Hamada left us, we ventured into the tunnel area at the Rafah border. The tunnels employ about 7,000 workers – many of them 15- 17 years old. Since the beginning of this year, ten people have been killed in tunnel collapses. We were able to enter the mouth of one tunnel, but access is strictly guarded.

Following a tour through the Rafah border (where passage to Egypt is severely monitored and not freely given), we returned to Gaza City.

A visit highlighted our evening! After receiving medical and surgical care in Jerusalem, our dear friend, Eyad Sarraj, has returned to his home in Gaza. We enjoyed a visit with him and knew again the wisdom of this founder of the Gaza Community Mental Health Programme.

(Gerri Haynes, former president of Washington Physicians for Social Responsibility, has returned to Gaza with a delegation of doctors, nurses and others interested in helping the people there. Gerri will be sending back reports.)

Day five in Gaza

In the Al-amal Institute for Orphans and in the Atfaluna Society for Deaf Children the dedication of the people of Gaza to their families is clearly evident. The orphanage serves children from five years to eighteen years of age. Most children of Gaza whose parents have died are taken care of by their families – even when the families are extremely poor. Some of the 100 children in the orphanage are not fully orphaned – they may be without a mother or a father but come from a situation where the remaining parent is unable to provide a home. The parent may visit the child but the orphanage assumes 24-hour care for the child and mainstreams them into the neighborhood for school.

The facility is impeccably clean and each child is

taught to be responsible for his or her living area. We met with the Director of the orphanage and gave him some of the school supplies donated in Seattle. With war a constant threat and too-frequent reality, the Director told us there are 5,000 – 7,000 orphans in Gaza, served by two facilities and many families.

Alfaluna, the institute for the care of deaf children is another inspirational organization in Gaza.

David Helfand writes:

“As adults we learn to hide our fear. We use bravado, humor, silence, and any number of other mechanisms to mask the psychological and emotional scars left by the struggles and traumas in our lives. Children are not such good liars. As a stranger stepping into a kindergarten class at the Atfaluna Society for Deaf Children, one might expect to be greeted with apprehension or fear. However, what I found was the opposite. The boys and girls stepped forward with wide smiles, eager to shake hands with us, some of them repeatedly. They posed for photographs, and then crowded around, jostling and pushing up against us to see the results. These children live in a place where life is a constant struggle and terror can and has ruled the day. With hearing impairments they face further challenges beyond those of their peers. Some might argue that they do not show fear simply because they are too young to know better or to understand the world around them. There may certainly be some truth to this idea. There is no way that siege, bombardment, poverty, and repression could possibly leave these children unaffected. But the fact that even in such circumstances the most vulnerable members of society can show such enthusiasm and appetite for life speaks volumes about the resiliency of the people of Gaza and the human race as a whole.”

We also visited the Water Authority to learn how Gaza is addressing critical issues regarding their water. The 1.7 million people of Gaza presently live with a diminishing supply of water – water that is 90 – 95% polluted. Plans for desalination and sewage treatment plants are complicated by the siege. Essential building materials are not available.

There is now only one crossing from Israel to Gaza and importation of building materials is strictly controlled. See the UNRWA report “Gaza 2020: A Livable Place?” for a picture of the environmental and humanitarian crisis facing Gaza.

(Gerri Haynes, former president of Washington Physicians for Social Responsibility, has returned to Gaza with a delegation of doctors, nurses and others interested in helping the people there. Gerri will be sending back reports.)

Day Four in Gaza

The complexities of politics are reflected in nearly all of life here. Living under Israeli siege and having extremely limited ability to move outside this 25-mile-long strip of guarded land and sea presents challenges to every citizen.

We see more building and newer cars than one year ago, but are told by many that this reflects that a few are profiting, while climbing prices are making life even more difficult for the vast majority of people. The tunnel economy, regulated by the government, seems to be thriving, but the tunnels remain dangerous and we hear regularly about people being crushed in tunnel collapses.

There are two primary political parties here (Fatah and Hamas – with Hamas maintaining the government) and many small parties – not all of them working congenially or with basic agreements. Life is difficult. One agency director told us today that the siege is not only external but, because of the constant and continuous threat to life, the siege has also become internal.

This afternoon, planes flew overhead (always an ominous sound here) and the shudder of a bomb filled the air – this is such a common occurrence that when I asked several locals about it, they shrugged and said, “It is normal.” In the meantime, there is a folk festival tonight in Jabalyia Refugee Camp and four members of our group are headed there with local friends.

My great Kirkland neighbor, Susan, made forty boxes of delicious candy for me to bring to Gaza. Everyone who tastes this candy has a big smile – “thank you” to Susan for this yummy gift!

Dr. Bob Haynes and Dr. Bill Dienst are continuing with classes in advanced life support. Today, they offered a class in the Islamic University School of Nursing (men and women students are segregated in this school, in classes as well as in the elevators).

The Islamic University has 800 nursing students (four year baccalaureate program) and 200 in the two-year midwifery program. Bob was told that all of the nurses will have employment when they graduate, but medical students look forward to 70 – 80 percent employment as physicians (after their internship year) and many will go abroad for specialty training.

Nikki Nichols writes:

“I came to Gaza to serve. Tuesday gave me that opportunity when we (two massage therapists and a chiropractor) worked together on a war-wounded man with low back pain. During the last war, Nov 2012, a rocket exploded near this man and shrapnel and debris invaded his body, destroying his intestines. Surgery left him without a spleen, only part of his intestines and a long scar from his neck to his abdomen.

“I did cross fiber friction on his scar and recommended that he do this regularly using Vitamin E oil (if it is available). Back surgery for his injuries left him with back pain that radiated down his leg to his feet. Our team massaged him while getting his feedback. At one point the patient was surrounded by about 10 people- our team of three, physiotherapists who work at the hospital (and with whom we enjoyed sharing knowledge), hospital administrators (including an interpreter), and representatives from the government‘s Ministry of Health. Lots of attention and healing energy was focused on the patient. I was glad to be part of the team!

“Basman, the grant coordinator for the El Wafa Rehabilitation Hospital where we were working, was an excellent interpreter during our work. Basman lived in the USA for 45 years and said he is very happy to be home in Gaza. Looking out his office window, Israeli guard towers and the wasted fertile farmland that lies between the hospital and the Israeli Wall are visible. This land could produce food for hundreds of Gazans, people who are extremely short of food supplies, but it is in the “no go” zone – an area deemed too close to the Israeli Wall (for security reasons).

“El Wafa Medical Rehabilitation Hospital has lots of impressive equipment but some sits idle because of inability to obtain parts and maintain service due to the blockade. This hospital gets donations from many countries, not including the USA. It serves a population that is served by no other place in Gaza.

“We had an extensive tour of the hospital, seeing patients who demonstrated various effects of the blockade and wars. Some lay in contorted positions as they had been electrocuted while trying to obtain electricity from power poles for their families. Some had wounds from land mines and some had horrible wounds from road traffic accidents. I am thankful that El Wafa is present to serve this needy population.”

(Gerri Haynes, former president of Washington Physicians for Social Responsibility, has returned to Gaza with a delegation of doctors, nurses and others interested in helping the people there. Gerri will be sending back reports.)

Day Three in Gaza

Nearly every person I met today expressed sorrow over the bombing in the U.S. This kindness and concern over the tragedy at the Boston marathon was particularly tender from people whose land has been bombed so frequently and so recently.

This afternoon, several of us visited Ard El Insan Child Nutrition Center. I’d read that the level of chronic malnutrition in Gaza is over 10 percent. The Center sees hundreds of children each day and has ongoing research regarding their nutritional status. The director told us they are noting that about 3.2 percent of children in Gaza have acute malnutrition and over 13 percent are chronically malnourished. Chronic malnutrition carries many ominous characteristics – growth stunting, diminished ability to learn, lessened immunity among them. The benefits of breastfeeding are emphasized and milk supplementation for infants is strongly discouraged. Dr. Adnan came to Gaza on a temporary job assignment in 1987 and has remained – the work and the people being too compelling to allow him to leave. His work is internationally known.

This afternoon, the cousin of a young man who is working with us brought his four-month-old baby to be examined by members of our delegation. The baby is growing slowly and the parents are concerned about his neurologic status. We do not have a pediatric neurology member in our group, but we helped the mother with breastfeeding and normal childcare and will refer them to Ard El Insan’s pediatricians.

Karin Huster, R.N., writes of her experience in Gaza:

“It took a few minutes of observation in the Al Shefa emergency department to shred my plans and revisit how I can be of most use here. Aside from teaching by giving a few nursing-focused lectures at the university or at the hospital (for the future, on topics that they can really use), I know that what I can do is learn as much as I can from them and bring back their stories to share — raising more awareness about Gaza – and as far as health is concerned, knowing a little better what it is that we can share with them given their situation. Teaching them the “American way” is not useful – things do not change in a few weeks, particularly in this situation.

“My days are spent in the ED, observing what they do and how they do it. The chaos is incessant, yet the staff goes about their business; they see close to 700 individual patients per day (family members not included). While at home we strive for documenting data and making data-based decisions, here data documentation is not a focus – too many patients to care for quickly. How can you worry about data when you have so many patients to care for?

“Overcrowding, sorely lacking resources, and a seemingly chaotic system make care as we know it very different. Drug shortage seems to be an issue. Pain medicine is limited to intramuscular Tramadol or Diclofen. Patients do not get pain relief as they do in America. Vital signs in the ED are seldom taken and are not recorded. Gloves are used as tourniquets. Hand washing is not part of the nursing care. Where I am at Gaza’s main ED, the CT scanner has been broken for 6 months (parts are not available due to the siege). Patients needing a CT scan are transferred to another hospital. I’ve ridden with a patient in the ambulance through town – the traffic is extreme and we had “near misses” at every corner. Probably the one and only public good I’ve done so far was to convince the ambulance driver to wear his seatbelt – and I held the hand of a very scared and brave 9-year-old badly injured patient.

“Otherwise, the falafels are out of this world, and I could eat them every day. Their sweets are also out of this world, and I make it a habit of trying a few everyday. The Gaza people are very welcoming and very kind. Today, several mentioned the Boston marathon bombings and expressed their sorrow to us. What a resilient and truly generous people.
I already feel at home here — I know I will be back.”

(Gerri Haynes, former president of Washington Physicians for Social Responsibility, has returned to Gaza with a delegation of doctors, nurses and others interested in helping the people there. Gerri will be sending back reports.)

Day Two Gaza

Going to Work

Following a morning orientation, all of the delegates turned to work this morning. From clinic work to meeting with Gazans traumatized by war, we again experience the courage of the people here.

It’s 11:30 PM now, and Dr. Richard Grady is still operating. His work to help children with urologic conditions has brought him back to Gaza for the fifth time. Children born with ambiguous genitalia and those who develop other complex problems are the focus of Dr. Grady’s work. As he works, he teaches procedures – helping other surgeons prepare to do this delicate surgery.

Today was the second anniversary of the death of Italian journalist/activist, Vittorio Arrigoni. Vittorio lived most of the last three years of his life in Gaza, supporting the fishermen, writing articles about the plight of Gaza under siege, and authoring books – the most famous titled “Stay Human.” He was critical of extremist Islamic groups and one of those groups is commonly blamed for his kidnap and murder in Gaza.

At the Port this afternoon, several hundred people gathered to commemorate Vittorio and others whose lives were cut short while working for the end of the siege in Gaza – including Rachel Corrie and Tom Hurndall. Following words of thanks and commemoration, people took boats into the harbor to call for the freedom of Gaza and to throw red carnations of memory and thanks onto the water. There are many internationals living in Gaza or who come here frequently to support the people and to work with the 1.7 million people who live here.

Trauma and emergency medicine have, by necessity, become major areas of focus in Gaza. Family medicine and emergency physician, Bill Dienst and Cardiologist, Bob Haynes, are consulting in these areas and teaching the essential skills of advanced cardiac life support. Look for their report in a coming blog.

Nurses in our group are seeing patients and consulting on the care of patients in their specialty areas – including neurology, intensive and emergency care and end-of-life.

Three practitioners are seeing patients in the physiotherapy. Two are massage therapists and one, a chiropractor, were busy until late evening today, seeing patients in two of the hospitals.

This will be a busy week for the members of our delegation and this is possible only because the staff of the Gaza Community Mental Health Programme have worked many hours to find areas of need for our various skills. As this is the sixth medical delegation supported by Washington Physicians for Social Responsibility, friendships have been made.

One of the joys of returning is seeing those “old” friends again and hearing about their lives. One staff member who is helping us told me today that, in his mid-twenties, he has never been out of the Gaza Strip – an area of about 360 square kilometers.

I’ll write more about the health effects of living under siege, but the trauma of living under the constant threat or reality of aerial, ground and sea attack has affected each person who lives here. The spirit of these loving people continues to inspire us.

(Gerri Haynes, former president of Washington Physicians for Social Responsibility, has returned to Gaza with a delegation of doctors, nurses and others interested in helping the people there. Gerri will be sending back reports.)

Day One: Gaza, April 2013

Another delegation from Washington Physicians for Social Responsibility has come to Gaza to learn and to provide medical service and consultation. This delegation is composed of physicians, nurses, massage therapists and one student. Eight of us entered Gaza through Erez/Israel and four entered through the Rafah Crossing from Egypt. Those who entered through Israel were invited by Israeli security to watch a Power Point presentation regarding the services their organization provides to Gaza. The presentation provided a view of the relationship between Israel and Gaza that was not often consistent with the view from Gaza. However, Israeli security personnel have consistently provided excellent assistance to our delegations.

We passed into Gaza through the Hamas checkpoint quite quickly – a large crowd of family members, friends and armed resistance members had assembled at the checkpoint to eagerly welcome home a young man released after more than 20 years in an Israeli prison.

After two weeks of closure by Israel (we were told the closure was due to rockets being fired into Israel from Gaza), the checkpoint at Erez was opened for only one day. Monday and Tuesday, the checkpoint is closed for Israeli Memorial and Independence days. As Erez is the only passage for pedestrians to enter Israel from Gaza, these closures create a sense of imprisonment. The Rafah checkpoint from Egypt has remained open, but passage there is also severely monitored and restricted, adding to the sense of imprisonment.

In the evening we met with our hosts, the Gaza Community Mental Health Programme, hospital representatives and the coordinator for international cooperation to preview our work for the coming week. We are generously received and this morning, our work was initiated by a reception with hospital medical directors. According to specialty, members of our group will be in medical clinics, on hospital wards, in operating rooms, in women empowerment clinics and teaching in hospitals.

While waiting for Erez Checkpoint to open, those delegates traveling through Israel were hosted in Bethlehem by Zoughbi, Director of Wi’am, the Palestinian Conflict Resolution Center. This group had a lovely opportunity to visit the Golan Heights – in its springtime floral display! We looked across borders to Lebanon and Syria and learned of the ongoing conflicts in this area – with Syria continuing to hold that the Golan should be a part of Syria. The area is heavily mined and mine fields abut residential areas.

We heard from a clinic director of the Druse clinic in the mountain town, Majdal Shams about the work they are doing to serve their community. This clinic provides primary care, some specialty care, and outreach to the community in music, art, drama and health education. We were inspired by the work of this clinic!

Now again in Gaza, the resilience and determination of the people here are palpable. We are greeted with grace and are again grateful to be able to be here.