Gaza: Reflections of a student
In the second part of our series of articles exploring medical students' perspectives around the world, Alexander Cowan-Sanluis reports on the developing nature of healthcare in Gaza.
When the opportunity to visit the Gaza Strip arose I jumped at it immediately. This is a region which dominates our news channels and never ceases to incite heated and controversial debate. Now I had the chance to see it through my own eyes instead of the edited lens. As with any conflict, be it racially, religiously or politically instigated, those hit hardest are the people. More often than not those who have never actually participated in it or even supported it. Yet they take the brunt of all knock on effects especially with regards to health. Health is an honest reflection of society and the state in which it exists. As a medical student I was in a privileged position in which I could interact with the people of Gaza at a level that most other foreigners do not reach. In this article I merely want to relate my experiences of the region, the people and the healthcare away from any personal preconceptions.
Entering Gaza is a lengthy, unfriendly and imposing process. Never before have I entered a country through turnstiles, dark corridors, steel doors and 750m caged walkways exposed to the relentlessly hot sun. For a border where walking is the only transit option a young man like myself encounters no problems. But what about the old, the ill, the disabled and those with children? Unfortunately due to lack of medical facilities many patients must leave Gaza to seek out better availability of treatment in Tel Aviv or elsewhere. Their only route there is via this frontier. Fortunately I crossed swiftly but I could not help feel for the ordeal that others undergo. Once in Gaza it is soon apparent that you have entered a different world: fields laden with rocks, abandoned cars, rubbish strewn on the streets and half constructed buildings. A far cry from what existed on the other side of the wall just a few hundred metres behind.
With such a dim initial view of Gaza and certainly with media instilled notions of a war torn region, I was pleasantly surprised to find the city more vibrant than anticipated. There are hospitals, universities, shops, hotels, fireworks at night and even people enjoying the beach. There are people everywhere but with a population of near 1.5 million in an area of 366km2 the density is not surprising. The city was alive, even with the deadly and chaotic traffic. Although littered with the memories of war, bullet marks and the like, perhaps Gaza had more to it than I thought.
On my first visit to a hospital, it soon became apparent that trauma care consumed a large part of a doctors day. Within ten minutes of participating in a ward round I met a man who had suffered a serious spinal injury caused by a dangerous type of work that is unique to Gaza and its situation. This small strip on the Mediterranean coast is guarded by Israel via land, sea and air, bar one small border with Egypt, the Rafah crossing. Due to very tightly controlled exports and imports with Israel it is here that the Palestinians take advantage of their less attentive neighbours. Tunnels have been dug virtually by hand under the frontier in order to smuggle in goods from Egypt; petrol, food, construction materials and even cars. However, this is no easy feat and for those men who choose to build these, there is the risk of ending up with permanently damaging injuries like the man in the hospital. The dreadful disability that this young man will spend the rest of his life with made me realise to what lengths the people will go to ensure the development of their society.
A large and extremely important aspect of this is medical development. One of the main issues surrounding this particular patient was the delay in adequate treatment, which turned a curable injury into a disabling one. I saw this again first hand in another man who required ever shortening leg amputations, and with it considerable distress, due to improper excision of the infected bone. The doctors in Gaza are extremely skilled and knowledgeable and do the utmost to look after their patients, but, like any doctor in any country, training and education is needed to ensure up to date care. This is a big issue in Gaza. Many surgeons and other healthcare staff are not granted visas to leave the region at all, never mind for training purposes. This is a real barrier to medical education. Despite this, much like the men in the tunnels, doctors and nurses go to great lengths to improve themselves and receive additional teaching in Cairo and other cities, paving the way for healthcare development.
Yet more of the man’s leg could have been saved if better diagnostic and other medical facilities were available. The lack of facilities was even more apparent when I was invited into theatre by a plastic surgeon. There was inadequate equipment and supplies, but the most pressing concern was the intermittent electricity supply during the operations. Every ten minutes the power would suddenly shut down, meaning theatre lights, equipment and even the life support and monitoring machine would turn off. It would take thirty seconds or so before a generator would provide back up. It is only due to the surgeon’s great competence and patience that the majority of his cases are successful.
Many of the cases seen by the surgeon involve severe burns due to domestic accidents involving oil cookers, gas stoves and hot water. To cater for this there is a small burns unit. It was here that I met a nursing assistant without whom it would not function. The unit is basic, lacking in kit, and with an open sewage drain in the centre. Yet it is maintained extraordinarily clean by this one man, keeping infection rates to a minimum. Whilst I was there, a discussion was held by the doctors concerning fund allocations i.e. what was needed? It was at this point that an important feature of medicine, that was missing here, came to light. One of the men most informed and aware as to what was needed for the unit was the nursing assistant, but the doctors were unwilling to listen to his thoughts. Why? He was not a doctor. In Gaza, the traditional patriarchal view of the doctor still needs to be broken down. Focus on involvement of all members of the team should be encouraged. This is part of holistic and professional patient management, and it needs to be addressed.
Fortunately outside the hospital, within a community setting, this is already beginning to happen. On one day I managed to leave the city and explore the region further south beside Egypt. I went to visit an organisation, Al-Astika, which works to improve an often forgotten subject, rehabilitation of the disabled. Projects focusing on acute illness and trauma, especially in developing countries, are popular to fund and manage. The long term effects and rehabilitation are too easily neglected as they are not so glamorous. People in the community and professionals collaborate to better the lives of the congenitally disabled and those who are so due to trauma. They provide not only assistance equipment but also train families and friends how to cope with, and care for someone with a disability, be it mental or physical. A particularly impressive component of their work is the training of locals in the maintenance of disability equipment, thereby creating jobs and also ensuring the longevity of the project. Whilst I was there a young man, of no more than 20, proudly showed me photographs on his mobile phone of the prostheses he had learnt to make in one of the organisation’s workshops. Involving the youth of Gaza forms a significant ingredient of Al-Astika’s objectives.
The greatest hurdle however, is combating the taboos of society with regards to disability. In many countries disability is seen as embarrassing or shameful, and those afflicted are hidden away from the world. Changing the attitudes of adults is difficult, but those of children are much easier to break down. Children are born without prejudice and it is this openness which can be used to eliminate discrimination all together. Summer camps have been created, where for two weeks at a time, both mentally disabled and normal children play together, learning to live in and enjoy each other’s company. Seeing these camps was one of the most enjoyable experiences for me during my time in Gaza. The children painted, sang and danced together, setting an example to older generations that disability is nothing to conceal. That is real medicine, at its core.
Luckily Gaza is full of optimistic and hard working people. One such man is the Dean of the medical school at the Islamic University of Gaza. He invited me to have a tour of the university and it was this that truly displayed to me how different this place is to what I had seen in the media back home. They had facilities equal to ours and they provide scholarships to the brightest students, one of whom eagerly showed me around, bursting with energy and enthusiasm. One night I went to the graduation ceremony of a cohort of science students. One could feel the pride that both the country felt and that the young men and women receiving their degrees. These students, like the one I met, are the future of Gaza.
It is the people that have left the greatest impression on me. I have never visited a place with such a welcoming and hospitable community. Perhaps it is their situation that makes them even more positive, but what is certain, is that despite the difficulties they are presented with, together they strive without rest to develop Gaza and make it their own nation.
Unfortunately on my last day two bombs were dropped. Blame and politics aside, I will be left with memories of a friendly people with never ending optimism. The symbol of Gaza City is the Phoenix, a bird that grows for years, builds its nest and then ignites itself. A young one then arises from its ashes. This is a fitting symbol for Gaza. Always arising from the ashes to which it is constantly reduced.
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