Today was the first of our health visits. From what I am understanding, health care is administered in a number of ways here. For those who have refugee status by virtue of having been displaced from their homes and land by Israel in either 1948 or 1967 the UN provides education (until 9th grade) and health care, including all vaccines, until age 3 yrs. I learned today that each of the doctors and nurses at the UNRWA Clinics see 100 patients a day. Tomorrow I will go there and see that system. And I am sure there will be plenty to say about that. One thing that is amazing is that Gaza has an immunization rate of >90% for the basic childhood vaccines. That is so unbelievable.
For Gazans who are not classified as refugees, health care is provided by either government run clinics, private hospitals funded largely by NGOs or a few small private hospitals. I spent the morning at one of the NGO funded hospitals. The hospital is called Al Awdah in Gaza City. Al Awdah in Arabic means, "the return". It sounds religious, but in actuality it means the right to return--the dream and hope of all Palestinians that they will be able to return to the homes they were forced out of in 48 or 67. Many still have the key to the door of that home. Someone said that the Palestinians don't paint their dwellings in Gaza because to do so would make it feel like a permanent home rather than a temporary place. (I am not sure if that is true, or if it is because paint is a luxury that cannot be afforded here.)
So, Al Awdah Hospital. My first task was to do a training for ~15 maternity nurses on postpartum depression. Preparing and thinking about the talk was a bit strange--I had so little information about the group, the health care system and I really had no idea of their needs and how this topic was viewed by them. I have always dreamed about going to another country and working in health care, including doing health education. Here was my first chance at it and I realized how really unprepared I was having not had the time to research the cultural dimension of this. Anyway, I think it went well--aside from some technical glitches. Post-partum depression was something the group was familiar with, they had a few pt stories to share and, hopefully, I was able to leave them with a few tools to use in screening. The pediatrician who took me around the hospital and clinics shared that this hospital makes you feel that you are "not in Gaza"9meaning that all other facilities in Gaza are pretty broken down). It is quite nice, but with about 1950s or 60s technology. They have lost a lot of their funding stream with the downturn of the global economy and so the shelves of the pharmacy are very empty. What meds they do have are in short supply and they are out of a lot of things. They have an 8 bed Neonatal Intensive Care Unit and a 4 bed ICU that they have had to close due to the shortage of funds and supplies. It's kind of like a lot of other structures one sees here--started and unfinished for lack of supplies and money. They have also had to decrease the nursing staff by 30% to manage costs. The hospital sustained severe bombing in Operation Cast Lead, so the part they have been able to re-build is nice--though very simple and obviously they had to use recycled and older things like the doors and windows. The equipment, with a few exceptions, looks older and dated--probably someone's cast-offs donated by some EU NGOs.
I think the most intense thing is the poverty, crowding and unbelievable amount of piles of concrete and rebar--buildings started and not finished, bombed and now still in piles of broken cement. Nothing looks new or tidy or modern.
Again, I am amazed to be "on the ground"--the wide angle lens shows the things I mentioned above--a crowded, dirty, polluted place. Zoom in and you have these images--the warmth and graciousness with which we are received at every moment, the hotel clerk who was teaching me some Arabic words, holding the room key up over his head and jokingly telling me that I couldn't get it back until I remembered the Arabic word for "key"(which he had just taught me 10 minutes before!), the 10 yr old niece of the just released prisoner who showed me her art work, and on and on. Most of all I am so full of respect for the health and mental health professionals we met today who are just doing their day's work trying to heal the people here. The war, occupation, trauma, injustice, and outrage just form the ever-present backdrop for their daily work and lives. This evening we were talking to the child psychiatrist and a psychologist from the Gaza Community Mental health Program. One of them talked about the psychology of the Palestinians--that resistance has become a part of the national identity--a part of oneself that cannot be taken away or diminished. You feel it in everyone you meet.
This is so much bigger than an intellectual political issue to be debated or made deals about. It is a genuine human right catastrophe of enormous magnitude.