Friday, January 8, 2010

Nablus - Alan, 7 January

We’ve just finished our three-day visit to the Farah Center, the Palestinian Medical Relief Society’s outpatient rehabilitation facility in Nablus. Nablus is the home of Dr. Allam Jarrar, PMRS’ director of rehabilitation for the northern West Bank, and our good friend. He briefed us on our arrival and coordinated our itinerary. Alice, Ellen, and Peter headed off to Tulkarm to work in the PMRS polyclinic there; Jon, Marc, Sonia and I worked at the Farah Center.

This is the only such resource for disabled children in the northern West Bank, and an example of how civil society organizations are working to change Palestinian society. They not only care for the disabled, they advocate for their rights and for their acceptance into the wider society. They are very clear about their mission; they recognize the tendency for Palestinians to isolate the disabled, to ignore their basic human needs, let alone their special needs, and they work to change it. Across town, PMRS operates a training center for Community-Based Rehabilitation (CBR) workers, young women who come from villages around the West Bank for training, then return to their communities where they identify and outreach to the disabled, connect them to services, and advocate for them. The eagerness of the CBR workers and the Farah Center staff to learn is striking. On Tuesday, Jon led a discussion of PTSD at the CBR center with about 20 staff and CBR workers – participation was lively.

Today I presented an overview of child development to the group – this was really fun, as all these women had lots of experience with small children, and some of the concepts were new to them, and with Allam and Haya translating for me, it lasted over three hours.

The Farah Center staff includes physical, occupational, and speech therapists, a psychologist, and a pediatric neurologist. As always, they were warm, welcoming, and appreciative. They had arranged for us to see particularly problematic patients: for me, developmentally disabled children with nutritional problems, and for our mental health group (Jon, Marc, and Sonia) individuals and families with psychosocial issues. I saw a series of children with devastating conditions: severe brain damage from birth anoxia (lack of oxygen); genetic disorders; a four-year-old girl who at 18 months had choked on food while in the care of a babysitter and was left blind, spastic, unresponsive.

There were some unifying themes here: the families I saw were devoted to these children and were spending enormous amounts of time and energy trying to adequately feed and care for them. But all of them were seriously malnourished, and none

of the families knew how much their children needed to support normal growth. Most of them would benefit from a feeding tube placed directly into the stomach; it would allow for adequate nutrition, which would maximize their developmental potential, and would make life much easier for their families. I raised this with each of the families and their responses were varied: some could not bring themselves to consider it, some thought it was a good idea but felt that other family members would reject it; and some welcomed it. A seven-year-old boy, devastated by birth anoxia, had had a gastrostomy tube placed, and his father was quite comfortable with it. He told me that many Palestinian families would be ashamed of such a disabled child and hide them away, but he loved his son and kissed and hugged him throughout the visit. Most of them had serious sleep disturbances and severe constipation. All were seeing doctors outside the Farah Center, but it appeared that they weren’t getting the kind of care they needed, care that could make their lives a little easier. This presents a problem, since the Farah Center is not a primary care facility. I asked each of the parents if they’d like to meet other parents with children who had similar kinds of conditions, and all were positive. One mother told me she already did talk with other mothers while in the waiting room at the Farah Center, and it was very helpful. We discussed this with Allam and the staff; they were planning to begin such groups this year, they all agreed this was an important means of providing psychosocial support, and they were going to include this in their plan for the new year.

En route from Nablus to Tel Aviv, we passed through a checkpoint that in the U.S. would be taken for a toll plaza. Our van was pulled aside and we had our passports examined and our baggage scanned; it might have been an airport but of course there were no planes around. Security men and women in plainclothes were everywhere, toting automatic weapons and shades. This is an example of how Israel is attempting to normalize a very abnormal situation: privatizing their security operation, making it appear like other civilian institutions – toll booths, airport security – tempting the casual observer to overlook the underlying dynamic of repression and control.


Dinah said...

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Susan said...

hi al, very interesting. great photos...i see you were at balata camp? if you get back there mention sheik hassan will you?

take good care