Thursday, November 6, 2014

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.


1 comment:

  1. Keep up the great blogging. We get perspectives not shown in the mainstream media.