Thursday, November 13, 2014

P.S. on Issawiya

All did not end well at Issawiya despite what I said in my last posting, where it looked hopeful when we left.  Apparently, at some point police fired tear gas, "sponge" bullets (plastic coated bullets).  One young boy was taken to the hospital after being hit between the eyes with a projectile.  Tensions seem high in Jerusalem.

Issawiya East Jerusalem

Yesterday we participated in a protest in Issawiya, a neighborhood of East Jerusalem.  They are experiencing what all the East Jerusalem neighborhoods are going through--strangulation and land expropriation. Issawiya is located just adjacent to Hebrew University on Mt Scopus.  A number of years ago, the village submitted a zoning plan to develop according to their needs on a portion of their land.  That plan was not accepted by the Israeli authorities.  Over time, the village blueprint has been made smaller and smaller through land confiscation, lost court battles, etc. The only way they are allowed to build is upward with additional stories on their existing homes--despite having undeveloped land that belongs to the village.  Like so many East Jerusalem neighborhoods, they have been stuck in court battles as settlements, highways, "archeological parks" and all other forms of infrastructure develop around them.

Some time ago (when exactly is not clear) the police blockaded 2 of the 3 roads that lead in and out of the village.  It has created great hardship for the residents as they now must take circuitous routes to get to work, school, clinics, etc.  All public transportation in and out of the neighborhood has had to be re-routed.  One bus stops at one end of the neighborhood, then the person must walk through Issawiya, up the road to the next stone blockade and catch the bus to continue on their route.  We asked why the closure was done.  The only thing we kept hearing was "collective punishment"--the people have been resisting and going to court over the land confiscation.

Yesterday's "event" was meant to be a tour of the village by the local residents to help Israelis (especially Hebrew U. students) see what is happening.   However, when we arrived, there were lines of heavily armed police at the entrance to the village.  At first they prohibited the group of Israelis and local Palestinian residents,  from marching.  We did walk through a part of the village and were again met at the next exit road, by another line of police.  There was a stand-off where we heard speeches telling what was happening (they nicely had someone translating to English for the small group of us exclusive English speakers!!), then we left.  It felt a bit tense as we watched the police with shields, guns, tear gas shooters, etc. all lined up.  Fortunately, I don't see news this morning of any violent confrontations.

Here are some photos--scenes of a very militarized city:

PartOne of Gaza Reflections

Sitting in the tranquil beautiful stone patio garden of St George's Guesthouse in East Jerusalem now.  This is the first moment to stop and write some thoughts.  We've had quite a full schedule.

Just to catch up--we left Gaza on Monday.   Since then we have been on the West Bank and in East Jerusalem.  So many highlights, so I'll just start in no particular order--just whatever comes up first. I think this will come in several installments.

Gaza is immense.  Strange to say that for a place which is smaller in size than the Metro Portland area.  But immense in the sense of the palpable layers of poverty, built-up energy, tension, stress, garbage, traffic, people, chaotic sense of the suspension of daring to think future or hope or plan, or to know what/when/if another war or more strangulation or greater suffering will come.  It is like trying to hold onto sand in your hand.  You can hold it only to a certain amount--hold your family who you love, hold sending your children off to school  daily in perfectly pressed striped UNRWA uniforms and combed hair (I wondered how families managed that perfectly washed and ironed uniform until I was told that UNRWA provides that for each child--another example of how a perfectly capable and able society has been forced into "aid dependence") , hold onto that part that is so infinitely gracious and generous and warm to us--the strangers-- hold onto a sense of justice--that this place is "our land, it is our ancestors of generations, we will not be defeated."   And yet, after the slow breaking down by the years of occupation, ramped up by the siege of now 8 years AND 3 devastating wars over the past 7 years, the sand slips through the cracks between the fingers--there is not really a convincing sense of hope.  How could there possibly be--especially now?   Dr. Sammy said that there is a difference between losing hope and losing determination.  It may seem that they are one in the same, but it is clear they are not.  Hope--hard to come by.  This summer really took out the bottom.   How could it be otherwise?  They ask, "Where is the international outcry?' "Where are the leaders--why are they not coming to see what is happening to us?"  And yet, when you marvel at some part of life that is going on--like nursing education, or the questions about best technique for intramuscular medication administration, or therapy for autistic children, or treatment for scabies (widespread from the crowded conditions of the displaced families)--you fall into the conversations that solidify that the people of Gaza, despite all the tons of bombs and all the constriction/strangulation of the siege are NOT GIVING UP.  They are trying to the absolute lengths and stretching of all ability to at least keep it going, and even to learn, grow and improve-- that human quality where we all want to do our best.  They all ask, "Why will the world just not let us live in peace?  That is all we want."    It is a paradox beyond comprehension at times.  And we can talk about both aspects of it.  See the shear destruction and poverty and despair that everyone has after this past summer then you seamlessly move into a classroom in a clinic or hospital or specialty treatment center and the conversation moves to "evidence based practices" and how can we improve how we do this or that.  You are with colleagues.  You talk about their work, you share, you hear of their trauma, their stress (immense and pervasive)-- you put your hand to your heart and TRY to convey from the depths of that heart that you are there as a friend of Gaza.  That you take so seriously your role as an emissary who will take this message out to TRY and tell it to the deaf ears of the US Congress and anyone else who you might light a fire under to listen.  You cannot make promises anymore.  The people of Gaza know of US complicity.  You hug, declare in all our hearts of our deep friendship.   How many times were we told , "You are our family--once you come to our home, you are family!" You take a deep breath, hold back that crushing feeling inside and then you leave.  It is both figurative and real--a piece of the heart stays behind in Gaza.  With every family with saw living in some make-shift lean-to structure next to their bombed out house, with every nursing student who, despite knowing that their chances of a job post-graduation in the stagnant economy of Gaza are pretty much 0%, with every working nurse who is doing so without earning a salary (the nurses work and often do not get paid for 6-8, or even more,  months due to no money coming in).  A piece of your heart stays with the staff and children at the Rantisi Pediatric Specialty Hospital in Gaza City.  (Named for Dr. Rantisi, who we learn about as a "Hamas terrorist"  and when you dig in you learn he was the Dr. Spock of Gaza--a gentle pediatrician, fierce for liberation--you think of Che, you think of his dedication to the children of Gaza.  He said once, "We will all die.  It can be from a heart attack or an Apache attack.  I will take the Apache attack."   That's what happened). 

A piece of your heart stays with all the friends we met and laughed/talked with over many meals.  The families who so graciously invited us over for meals and tea and just to meet us.  One such person, Emad, a wonderful nursing supervisor at Al Rantisi Hospital invited Ned and me over to his home.  We spent a lovely time with his family.  They had never had such visitors--Americans, foreigners--ever before.  His children showed us their school work, their needlepoint, their Facebook pages.  We were so grateful for this little human glimpse of one another.  Emad told us his children cried when we left.  Me too.

It is really hard to capture the multiple levels of destruction and disintegration that one sees in Gaza.  The immediate and most striking thing is, of course the outright and totally horrific destruction from the recent war.  Truly beyond all description--neighborhoods leveled, piles of cement and rebar rubble that look like (these are the analogies I've heard used) Hiroshima, Dresden, a massive earthquake.  You see the occasional glimpses of personal belongings that still remain--a torn blanket, the head of a doll, some plastic kitchenware, a shoe, a broken piece of a toy.  Enough to remind that these piles of rubble that, in Sheyaiya and Kuza'a and several other communities we visited and that go on for blocks and blocks so you are immersed in it, were once the foundation and substance of peoples' lives.  I think the most harsh to see are the houses that collapsed with a total layer still intact.  Now, what was once the floor of one of the upper layers of the house is propped, very precariously at an angle--maybe supported by some cement pillars.  Precarious or not, often we saw people rummaging through the rubble beneath the suspended upper level, or children playing in the "debris" (I have a hard time using the term debris--it was once a home--representing all the hard work, love, family dynamics, births, deaths--all that make up the hive of life).

My writing in Gaza kind of stopped in mid-stream because I was just so busy and in the evenings lacked writing energy--kind of got to the room and crashed.  Except for Friday evening when I stayed up late to work on my Saturday lecture for a community health nursing class at Islamic University.

 Islamic University School of Nursing.  I have lectured there on each of my Gaza visits.  As I said  at past visits, it is such an honor and an amazement to be at the Islamic Univ of Gaza School of Nursing.  Yet another paradox of Gaza. The faculty I have met are amazing academics.  Dr. Yousef is the Chair of the Dept of Community Health Nursing.  Seeing him again was like greeting an old friend.  He asked me to lecture on Primary Health Care--contrast between the US and Gaza.  I told him I could do the lecture about primary health care, but was not familiar enough by any means with the structure in Gaza, so could not really compare and contrast.  He said, "Do the lecture on the theory and the US system, and let the students make the comparison to Gaza."  What a great idea and it added the interactive part.  So, once again, equipped with Powerpoint in hand, I proceeded and was totally amazed at the capability and understanding of the students.  The lecture structure is fairly formal, the esteemed professors sitting in the front.  But the students interacted with me with ease and with a self confidence that showed they know their material. The nursing education and the practice of nursing I saw in the hospitals and clinics was once again amazing with regard to quality and commitment.  Lacking are the resources to update, keep supplies stocked, get their salaries and compensation for work.  This is a photo of the nursing students. Usually classes at Islamic U are not co-ed, but it was done specially for our lectures on that day (mine on Primary Care and then tow doctors of our group lectured and led a workshop on Advanced Cardiac Life Support for nursing and medical students).

The bombing of Islamic University Administration Building just a short walk across campus from the School of Nursing.  This was a beautiful building that was brand new on my first trip--housed the univ administrative offices.  Fortunately, nobody was in the building when it was bombed this summer-- so no casualties.  The building was so severely destroyed that it is not at all useable now.  A large Palestinian flag is hanging over the side of the building that was completed blown out.  The other part of the building has much structural damage that is not so apparent in the photo.  Several nearby university buildings sustained significant damage from the magnitude of the blast. 

I am going to stop for this posting or it will never get online.  There is much more to come.  Like I said, I will do installations.

To those in the States reading this--please know of the importance of the solidarity work we are all doing.  It is Gaza's life-line and we cannot stop.  To friends in Gaza reading this, I hope I am telling your stories well enough and with the dignity and intensity with which you told us.  We can only hope to be your friends and do all we can to walk with you and to represent you "on the outside" as prisoners often refer to the outside world.  You know it well that they can build a prison, but they cannot make you prisoners.  Your determination shows us that.

With love to all.

Thursday, November 6, 2014

Some photos from the past few days.  I am not too good at how to place the photos on the page here, so I'll try to label them.  The contrasts to the devastation we are seeing.  This is a totally amazing culture--you would not believe it.
1.  Meeting w/ the Palestine Autism Society--incredible work with children.So thoughtful and interested in really doing great treatment--so many needs.
2. Young child at the Center for Autism--he is an AMAZING photographer--we saw a display of his photographs.  Six years old!!!!
3.  Mohammed's father and good friend, Omar.
4. The nursing students at my lecture.

love to all here and there.  Maxine

Upstream public health--end the occupation

[For those of you not in public health, here's the story to illustrate prevention.  Two people are fishing from the side of the river.  Every once in a while a dead fish floats by.  Over a short while they notice that the number of dead fish increasing and one by one,  they start pulling the dead fish out of the river with their net. Soon the dead fish are coming in such great numbers that they cannot keep up with pulling them out of the river.  One of the fisher-people insists this is the best thing to do as the river is now covered with dead fish floating by.  Meanwhile the other one decides to walk up the bank of the river to see what's happening upstream.  And there discovers a turbine engine that is on and is killing the fish as they swim through.  The fisher turns off the engine and, low and behold, no more dead fish!!  That's the parable of "going upstream"--getting to the source or the root of the problem rather than trying in vain to treat the symptoms.]

So, today I spoke with a group of nursing supervisors from various hospitals throughout Gaza gathered for a meeting at Shifa Hospital.  I listened as they spoke of the realities of nursing in Gaza.  Everyone goes immediately to the summer--there is a need to tell about it.  There is a desperation to tell about it.  Only one or two sentences in and you can see the tension in the speaker's body and the tightness of the muscles and the voice increases.  Explanations are interlaced with the phrase, "Can you imagine?" A rhetorical question--to underscore the pain and anguish.

 "We worked for more than 20 hours at a time, then rested for a few hours in the hospital, then back to work --sometimes for days without going home.  Can you imagine?"...

 A nurse talked about being on duty in the ER and patients pouring in--over 100 per hour.  All of a sudden she looked up and saw that it was her cousin on the incoming stretcher--critically wounded (he later died).
"To be working and everything is covered in blood, and there are children and parents screaming, and no way to relieve their pain, and then it is your family member who is the next stretcher to come in the door.  Can you imagine?"....
"You work without pay--there is no money for salaries, but you cannot stop.  You cannot even go home because any moving around is not safe.  And you cannot reach your family when the phones don't work so you don't know if they are even safe.  Can you imagine?"...
"This child only 4 years old, bleeding screaming.  The father holding his wounded son--'WHY WHY'--what did he do, he doesn't launch a rocket.' Can you imagine?"...

On and on........
The nurses.  They talked about their dedication to health care.  How well they are educated and how hard they work.  Now due to lack of funds for health, they work without pay.  Maybe a paycheck every 3-5 months.  They cannot stop working because, well, they are nurses and so dedicated to their patients.  There have been protests for salaries by the nurses, doctors and other health workers for salaries. But the infrastructure is so stretched and in many ways chaotic that the system is one step away from broken.The nursing supervisors spoke of the difficulties--working short staffed, times they must fill in and do patient care for several shifts in a row just to be sure there is a minimal level of staffing. Today all the dietary services at Shifa Hospital went on strike due to not receiving salaries for months.  All the patients had to get food brought in by their families.  The nurses often clean the floors of the hospital because there is no money to pay for custodial staff.

I have never seen higher dedication.  When I walked around the hospital units--from the Neonatal ward to the Pediatric Neurology and Cardiology units, to the ERs, and on and on, you see such caring and highly skilled nursing care.  The desire to learn in acute.  We had one discussion outside of a the newborn nursery--at what weight to start vaccines for premature low birth weight babies.  Technical discussions that one would have with colleagues.  And here we are talking and the thought comes into my mind--"These are the people we are told are terrorists."  It is just sometimes too much of a paradox to even hold onto. 

Each time I leave a visit, I get the warmest thanks--"Your caring and the caring you tell us about from others makes our day."  In the past visits, I heard it a little differently.  "Your caring and your visits give us hope."  The word "HOPE" is not in the lexicon now.  The beautiful child psychiatrist from Gaza Community Mental Health Program, Dr. Sami, last night talked about the difference between not having hope (the loss of hope)  and still having resolve. 

The hope part is hard to come by now.  The resolve is strong. 
People say, "Where can we go?  What can we do?" And then the person looks up and says, we have our faith.

Nobody answers the question--"What do you tell your children?"  Everyone talks about the pain that question gave them over the 51 days.
Q:  "What do you tell your children?"
A:  "That you will keep them safe?  That they are safe?  Nowhere in Gaza was safe this summer."
..."That this won't happen again?  After how many wars do you keep telling them that?"

I have stopped asking that question.  It's too painful.  

There is so much to tell--
  • The visit to the orphanage where only a fraction of the 1700 new orphans can be accommodated.  There several doctors and nurses from the Palestine Medical Relief Society (who we had met the day before at one of their mobile clinics) recently set up a health room to deal with the common illnesses that the children are facing.  They were so grateful for the vitamins, Acetaminophen, hats, gloves, crayons, books, etc that we brought.  
  • Inspiring work of two totally underfunded centers --one for children with autism, another for children with hearing loss 
The nursing schools in Gaza graduate about 500 nurses per year.  About 50% graduate with a Bachelor's Degree in Nursing, the other 50% with a diploma degree.  About 100 nurses in Gaza have Master's Degrees and 5 have PhD's.  Over 95% -98% of graduating nurses cannot find work despite the critical nursing shortage in all the hospitals.  There are just no funds to hire them.  Many work as volunteers.  Many join the 50% or more of the rank of the unemployed here. 

So, getting back to the upstream dead fish story.
Obviously, in public health going upstream refers to the idea that the best and most sustaining work requires us to "go upstream" to work on prevention--eliminating the root cause of the problem, rather than pulling dead fish out of the water when it is too late.

Explaining that parable to the nurses at Shifa today and it was not at all lost.  "What do you think is upstream?"  I asked.
Didn't take a minute for them to answer, "The occupation!"  "End that and we are on the starting line and ready to be the good nurses we know how to be."

Keep up the solidarity work, you all.  "What else can we do?"  That is the best  and most effective public health aid we can offer to Gaza.  The rest is just pulling the dead fish out of the water.

Love to all.


Tuesday, November 4, 2014

Day 3 in Gaza--Life in Shejaiya "These are our homes and our country and we won't leave"

Day 3 in Gaza
Just as Gaza is crowded with people and cement, it is also crowded with complexity and contrasts.
The days are full from seeing the most amazing, resilient people--full of warmth and hospitality, to a tour through such destruction that you cannot believe it even to see it with your own eyes.  Today that tour was through the neighborhood of Shejaiya--one of the areas that was devastated by Israeli bombs and tank fire this August.

We started the day at a school and center for hearing impaired children--a center for children with Cochlear Implants.  The philosophy is to have classes blended with children who have hearing impairments and children with normal hearing.  Together they get lots of great instruction and learn together.  They build bonds of friendship and camaraderie.  Though the school furnishings and materials are older and a bit worn out looking, the atmosphere was very inspirational and the teachers seemed so loving and committed.  The children were beautiful.  The director talked about the added hardship of being through the trauma of the war and siege and having a special health care need. The children have needed a lot of psychosocial support since the start of school yet staffing to support this need is limited due to lack of funds.  In addition, their equipment needs are huge.  But it was one more example of the sheer humanity and determination that one sees in all aspects of life here.

Life goes on despite the horror of the siege and the veil of the summer's trauma ("The war of aggression" as it is called).  These aspects of life are never farther than a millimeter away in every conversation.  Everyone reports that they truly thought they would die as no place in Gaza was safe.  People talk of how they held their children close for weeks and never let go.  The nurses talked of how they had to be at work due to the huge #s of trauma patients, yet all the time--often for days on end staying at their jobs in the hospitals, they worried and stressed about the safety of their families at home.  People talk about the summer in words laden with hopelessness and immense isolation--("How could the world have watched and let this happen?") to just a strong faith in Allah--what ever was meant to happen will happen--not just about last summer, but onward for things to get better.

After the Cochlear Implant Program we spent much of the rest of the day touring neighborhoods and medical sites with a wonderful young man from the Palestine Medical Relief Society (PMRS).  The mission of PMRS is to be a sort of "safety-net" system--to find people in remote and very under-served areas of Gaza (the hardest of the hardest).   We toured a "mobile clinic".  This is a great public health setting.  In really difficult to reach and highly (HIGHLY) impoverished neighborhoods,  a family volunteers their home for the medical team to hold a clinic in for a day.  So right there in the neighborhood, in one of the homes, they set up the clinic.  The site moves around the neighborhood, so all the neighbors are familiar with where the clinic is and, if today was any example, they line up in large #s to get care.  Today there was a dermatologist, a nurse, a pharmacist and a psychologist--all seeing patients in one room that was jammed with people. I am guessing they can see 100 patients or more in a day.  The doctor told me about how the crowded living conditions, warm weather and lack of hygiene facilities for bathing or clothes washing led to a dramatic outbreak of scabies that often gets infected. 

We also accompanied the Palestine Medical Relief dressing change team on a home visit.  They are monitoring wounds and dressings of 27 patients throughout Gaza who are still recovering from wounds sustained in the summer from bombings.  The woman we saw with the team today was wounded on August 4.  She and her 8 year old daughter went out to the market to grab some food for the family when they were hit by a bomb.  The 8 yr old little girl was killed.  The mom sustained fractured tibias in both legs, burns and bad wounds over her legs and thighs.  She was taken to a hospital in Jerusalem for pinning of her legs, and skin grafting of the wounds and burns.  She is now home with huge "cages" around her legs supporting the externally placed pins that go through the skin to hold the bones until she must return to the hospital in 2 months more for the external pins to be made into internal pins.  Her wounds on her legs and her emotional pain were enormous.  Just totally beyond all words...

The quote in the title of this blog is from one of a group of men who spend their daytime hours in a small make-shift shed atop the rubble that was their homes just a few months ago.  Their entire neighborhood, Shejaiya, was bombed into stone.  It is now blocks and blocks of heaps of rubble, slabs and rebar with some partially (precariously) standing, but very damaged houses.    These few men have set up a little encampment.--perhaps a vigil of sorts.  In the night they go back to where their families are staying--some of the ~100,000 Gazans who are still internally displaced. They have a little fire over which they were toasting pitas, a few battered mattresses and broken chairs.  They spend part of the day looking through the rubble for belongings and beginning to figure out how they will ever do the absolutely enormous painful and seemingly impossible job of removing mountains of cement that used to be walls and floors and ceilings and belongs--their homes.  One man showed us the few things he had salvaged--some torn and dirty blankets and fabric (possibly curtains), one blanket that was folded in a plastic blanket bag--probably it had been stored away clean and neatly folded for summer.  Now the plastic bag was torn and the blanket was covered in dirt.

Next to another badly damaged home was a very small garden (see the picture).  The owner of that home came over to us and showed us several photographs of the before (a beautiful house, yard and community garden plot).  Now all dirt, mud puddles and a badly broken house.  The people of this once close-knit neighborhood are scattered all over--staying in UN School-shelters, renting flats elsewhere if they can afford it, or staying with friends or family.  Scattered in the destroyed houses one sees little make-shift shelters of corrugated metal, blankets or plastic sheeting tied up over broken walls, or whatever people have rigged up to try to protect themselves.  There were very heavy rains during parts of the last 2 days, so I have no idea how they are even surviving. 

I think I will let some photos tell the day's story--they will do it better than my words.  It is absolutely a humanitarian crisis and there should be no question--war crimes WERE committed here.

Sunday, November 2, 2014

P.S. Link to Gerri Haynes' blog:
She is a great blogger!! Photos tell a million words.

 Love her.  Hope you can read her blog, too!!