Gaza day 5

 First off, I want to send a link to the blog of my colleague/our trip organizer, Gerri Haynes.  She does a great job of summarizing our experiences and her husband, Bob is taking such fabulous and expressive photos.  I'm a novice at this, so look at their blog for photos!!
http://www.larryjohnsononline.com/category/gerri-haynes/

We just came from a presentation given by someone at the Ministry of Environmental Quality.  I think hearing about the environmental issues gives a good idea of the magnitude of the problems here from an ecological perspective.  Ecological not just in the sense of the natural environment, but also in terms of the issues where the human condition in Gaza intersects with nature-- population density, scarcity of resources, loss of infrastructure through internal conflict and (most importantly)the siege and ongoing aggression by Israel,  Israel's control over water, storm water overflow, sea use, and huge disparity in living conditions.   Just one example--the siege totally affects pretty much every aspect of everyone's lives.  However, if you have some money, you can make it a bit easier to live. For example, 50% of the day, on most days, there is no electricity, so those who can afford it own a generator.  If you are poor, you are in the dark.  Everyone in Gaza has to drink bottled water as the tap water is not potable--for those with money, bottled water is a hassle, but available.  Only 5 to 10% of the water is safe.  Sea water and sewage have infiltrated into the aquifer. Water salinity is increasing as is the nitrate concentration in the ground water.  Nitrate content in water is a marker for sewage contamination.  The WHO nitrate limit for drinking water is 45 parts per ml.  In the norther part of Gaza, the concentration is >150 pp ml.

There is about 1300-1400 metric tons/day of municipal solid waste generated in Gaza.  They have 3 solid waste landfills that are all located along the eastern border of the Gaza Strip.  They are there for the best soil conditions.  However, they are located in the "high risk zone"--an area that Israel has declared off limits for their "security" reasons.  Thus, the disposal of solid waste is a public health crisis.    

Unemployment in Gaza is now at 45%.  You just see huge numbers of men sitting around outside and walking in the street in the mid-day.  There are shortages of all kinds of things.  Many of the shortages are being compensated for by goods coming in through the tunnels.  What all the health workers tell us is that sometimes they have certain needed medications and sometimes they don't --depends on how much gets through the borders.  It is intermittent and not dependable.  The Gazans have no control over the situation, it's all in Israel's hands.

Yesterday my colleague, Kara (a Psychiatric Mental health Nurse Practitioner) and I did a discussion group with a group of nurses at one of the hospitals, Public Aid Hospital.  Their backgrounds were varied--practical nurses, several nurses with Bachelor's degrees, a nurse midwife.  There is no such thing as a nurse practitioner in Palestine (or in most of the world, for that matter).  I think it was a bit hard for them to comprehend what we do.  I have found that at all the places I've visited--the notion of nurses being the primary care provider, or prescribing meds is not at all familiar.  I think there was a lot of interest from the nurses in advancing the profession and all were so curious and eager for ongoing education.  I really see the focus on education here.  It was a relaxed and friendly discussion group and so interesting to learn about one another.

Three of us then visited one of the UNRWA schools in the southern part of Gaza.  If you look at Gerri's blog, you'll see a photo of the school with its bare dirt courtyard.  About 1.1 million out of the population of 1.7 million Gazans are classified as refugees.  If you have that classification, you can be served by UNRWA for health care, education and other essential services.  If you imagine refugee camps, you might think of temporary shelters in tents.  These refugees have been here for a very long time--many since being forced out of their homes in 1948, when Israeli statehood was declared.  Others were refugeed during the 1967 war, again under forced exodus by Israel.  So, now families are into their third generation of being refugees, living in the camps.

The refugee camps are pretty much awful to see and describe.  Broken down homes, one on top of another, many in a state of incomplete construction--no glass in the windows, rebar sticking up from unfinished upper levels, dirt streets that are way too narrow for cars, trash in empty lots. Definitely no places to play and no green areas.  They are totally depressing places.

UNRWA schools are built by the UN through contributions of outside governments (notably missing are any US contributions).  They provide education for grades 1 through 9. Then students continue to high schools--either public high schools (for the vast majority) or some go to private high school.   There is a huge need for more schools--the existing ones are overcrowded--often > 50 students per classroom, and running two half day shifts, so students go to school only for 1/2 day, either AMs or in the afternoon.  It is estimated that they need > 100 new schools, however,  only 7 new schools have been completed due to shortage of building supplies.  Even the United Nations cannot get adequate supplies across the borders.  One badly needed supply for schools (and all construction) is cement.  This is one of the things the Israelis greatly limit as they say it could be used in some way for weapons manufacturing.

The school we visited only operates 1/2 day as they do not have salaries to pay the teachers for the full day. So, unfortunately, by the time we arrived, the students were gone.  However, we got to see the school and meet the principal and several of the teachers.  As we arrived a group of parents were there.  They thanked us for visiting and requested that we tell the world of the great needs their children have for adequate places to learn. They told us how they have been waiting for a very long time for a permanent school building. 

The school, in its "temporary" state (for the past 2 years)  is housed in a cluster of metal shipping containers with corrugated metal roofs, with a central dirt courtyard.  There was no outside play equipment and the dirt courtyard was very dusty, so not easy to run around in.  Inside the classrooms were very clean and tidy.  Supplies and furnishings were pretty basic.  There is a computer lab with somewhat antiquated looking computers and usually no internet connection.  The Principal explained that the classrooms are exceedingly hot in the spring/summer and very cold in the winter.  This school has 452 students in 15 (small)  class rooms.

In addition to the UNRWA school, I had the opportunity to visit an UNRWA Clinic.  It was a very busy place.  The doctors and nurses are so dedicated and truly are doing such good work under scarcity and stress.  Today I visited another primary care clinic that is funded by many NGOs and some by the government.  The community around the clinic is exceptionally poor, many are Beduoins, who are among the poorest of the Palestinians.  I donated our huge suitcase full of medications to that clinic. They were very grateful as their pharmacy was low in stock of many medications.

  At all the health facilities I have visited, I have had it confirmed that there is no shortage of talent and fortitude.  What is lacking are supplies, up to date technology and equipment and enough of a work force.  All the clinics are old, pretty run down looking, but totally spotless.  Forget the idea of sharps containers or retractable needles.

I am hoping that tomorrow I can visit one of the hospitals that does pediatrics.  All the doctors in the primary care clinics have told me that hospital resources are the most limited of all.  Whenever possible really sick children get sent to Israel for treatment.  They can only go with one parent.   There are stories everywhere of children being denied a visa to cross the border, or having to wait excessively long time and getting sicker or even dieing as a result of lack of care.

Tomorrow I give a lecture to the Nursing students at Islamic Univ. (the topic is infant development).  My colleague Kara is also lecturing (her topic is Cognitive Behavioral Therapy).  The Palestinian Nursing Association gave us a proposal for a collaborative project in community health nursing. It is amazing that life goes on in these many creative and inspiring ways.  So to quote the Dean at the School of Nursing yesterday, "And, this is Gaza under siege!"

The person who has mostly been my interpreter is the most lovely young woman named Lima.  She just graduated from Pharmacy School and is doing her internship.  She took me to her cousin's delicious Shwarma restaurant yesterday and then at the end of our day, we did a quick shopping trip for coffee and nuts from Palestine.  She is so smart, "gets" all the things we ask her to translate, loves everything purple, is the only woman to play tennis in all of Gaza, and dreams of studying more in the US.   I cannot believe just how easy it is to fall in love with her and with the other people we are meeting here. Whether it is the people helping to make our tour, or simply the hotel desk clerk who, when I asked him how he is doing today, he gave me the biggest smile and said that he is "very VERY good!" Since that's not usually the magnitude of response, I asked if there was something special.  He replied that he and his wife just found out that they are expecting their first child.  He looked so happy and said he was going to stop on the way home and buy her flowers.  It's just everyday humans being human.   

So as I prepare to wind up this experience with tomorrow as the last full day in Gaza, I truly hold so many people we have met in my heart.  Each dollar spent on bombs and tanks and bulldozers deprives them of their lives.  You cannot believe how similar we are to these people.  Way more the same than different.  What will it take for them to know health and peace and justice?  Whatever it takes, that's our work.