Blog Saturday 6/22/13 Symbolism meets solidarity: the Saturday
mobile clinic
I
have to interrupt this message: Last
night around midnight, the streets all over Palestine erupted with joyous
crowds, cars honking in a delirious cacophony. A young man from Gaza, Mohammed
Assaf, was voted the winner of Arab idol and either Abu Mazen or UNESCO (not
clear) named him an Ambassador of Good Will. A victory for Palestine, and I
might add, a victory for the entertainment industry and adoring women
everywhere.
Bright
and early, three of us take a service (a van that takes multiple passengers) to
Khalil (Hebron) through open checkpoints and ominous but quiet guard
towers. We meet up with Dr Othman, a
dentist and Dr Hassan Abu Amro, an optometrist trained in Saudi Arabia, in
preparation for traveling to the village of Idha, eight kilometers from Hebron,
just along the Green Line. We are traveling to the Saturday Mobile Clinic with
Physicians for Human Rights Israel and Palestinian Medical Relief Society. We
start with familiar stories.
Idha
is surrounded by three Jewish settlements including Adora and Telem. Because of
permits and checkpoints, travel in and out has become extremely difficult. The
quantity and quality of their water is problematic due to the large allotments
going to the neighboring settlements, and the village is plagued by rats which
can be seen jumping amongst the vegetable stands. Poverty is on the increase
and the separation wall has wreaked havoc with the economy and people’s
personal lives for the past five to six years.
In
desperation, the villagers started collecting garbage, metal, car parts, and
burning tires to get the metal and sell the metal to the Israelis. The burning garbage and tires created a
massive, toxic smog and predictable health problems. Combined with the polluted
water, PMRS is seeing more diarrhea, asthma, miscarriages, diabetes,
hypertension, and smoking. “That’s stress.”
PMRS and Red Crescent clinics, the private sector and Ministry of Health
Hospitals cannot handle the community’s medical needs. Hassan also notes that
no one wants to talk about cancer but the Dimona nuclear reactor is near
Hebron. Israelis nearby receive some
kind of prophylactic pills (?thyroid) to reduce their risks, but nothing is
offered to the local Palestinians.
More
fragments of conversation: Yesterday 15 settlers with guns blocked a nearby
road, threw stones and were protected by the IDF for two hours. This also
happened in Beit Ommar.
The
IDF is becoming more aggressive (how can this be possible?) and are training
dogs to attack when they hear certain words like Allahu Akbar (Did you pray
today?)
There
is a proposed law in the Knesset to make it legal for settlers to fire on
Palestinians (which of course they are already quite adept at doing), a sort of
legal white washing stand your ground.
Both
men are thoroughly disgusted with the Palestinian leadership and elite power
holders. They are “thieves;” they have stolen international aid money and will
steal more if Kerry reinvigorates the (useless) negotiations and aid programs.
Nabil
Shath, a Palestinian negotiator, recently explained to his Israeli associates
that the PA is spending more money on Israeli security than on Palestinian
health and security combined.
Hassan
is warm, obviously intelligent and insightful. He worked in Saudi Arabia for 17
years, and lived in a special compound so his wife and four children had more
personal freedoms than those outside the compound. If they left, he had to drive his wife; she
had to cover herself, etc. They came back in 2000 because he felt there was
going to be a state and he wanted to serve his people, but now he worries, “For
my kids and their lives, their futures.
What should I tell them? Sometimes I stand stunned. Am I going to create
more hate? But still they can see what is on the ground.” His 23 year old son,
trained as an electrical engineer in Egypt and now unemployed, feels totally
frustrated and wants to leave.
We
drive into the village and see large bales of hay and huge mountains of charred
metal fragments. For reasons that are
not entirely clear to me, the mobile clinic is being “honored” by a large
number of fully armed Palestine National Security forces who line the streets,
direct the vehicles, and line up for photos with clinic staff. We crowd into a
large room and on the stage there are municipal and PA dignitaries, Saleh who
directs the mobile clinic from PHR Israel, and Alan, one of our doctors, sitting
in front of a large photo of a smiling Arafat. We hear a history of the town
and a thousand thank yous in Arabic and Hebrew as a large crowd of patients
gathers outside.
And
then we start seeing patients. How can I
describe this? A local family doctor who will be my interpreter and see
obstetric patients, a nurse from the US, and I set up our “office” in a
classroom. We have a real exam table, an
ancient ultrasound machine, and I have brought a flashlight, large bottle of
Purell, various surgical instruments (to remove IUDs, sutures, etc), and a
measuring tape. I suddenly realize there
are no drapes (not unusual) but even more striking, no gloves and no speculums
and no basic lab work. A challenging moment for a gynecologist. (The gloves are finally located.)
And
then the work begins, a veritable flood of women in hijabs, blue, black, plaid,
sparkling decorations, and long jilbabs,
buttoned up to the neck and long sleeves, one naqap totally covering a lovely
woman’s face. She flips it back when she
enters the room. I try guessing ages and
realize that everyone ages prematurely under the stress of poverty and
occupation. The heat is oppressive, and
we are dripping with sweat. I feel for
the women who are covered. The women
present alone, in twos and threes, some with small children, some
argumentative, some focused, and everyone has an earnest story and a long list
of medical issues that frequently include back pain, abdominal pain, vaginal discharge, symptoms of urinary tract
infections and hot flashes. There are
questions about irregular bleeding, pain on intercourse, infertility. Everyone who is not trying to get pregnant
has an IUD. I try to reach across the
language and cultural barriers; instead of, “Are you sexually active?” I ask,
“Are you married?” I already know that many women take hormones to delay menses
when they travel to Mecca. I am
listening carefully, empathically, woman to woman. There is no medical charting, no vital
signs, no prevention, but soon we are in a rhythm of brief history taking,
strategic exams, lots of education and empathy, and then a wild search through
the available donated medications and decision making for referrals for a
variety of testing. I am sure many
symptoms are stress related and there is no simple treatment for that. My basic
strategy is: Is this very serious? What is the most likely diagnosis given an
utter lack of adequate information? What is the most we can do quickly
here? The hardest part for me is the
women with menopausal symptoms. I have
always wondered how women covered in multiple layers deal with hot flashes and
it is a challenge to give culturally appropriate advice. And of course we have
lots of antibiotics and antifungals, and steroid ointment, but no free hormone
therapy and I have no idea what is available in local gynecology offices. I have heard there is a rich herbal tradition
in Palestine, but that is way beyond my US first world experience.
Hours
later, the clinic is over and the women still waiting are angry and disappointed,
but turned away by PA soldiers with guns.
I have seen 24 patients and the entire staff has seen over 700. I feel a bit run over and my pregnant
colleague is looking more than tired. The organizers are pleased and we are
hosted by the village with chicken, rice and Turkish coffee with more officials
and more men with guns.
The
power of working in this Saturday clinic for me, year after year, is hard to
explain. Symbolism meets solidarity.
There were women who actually received appropriate care and I found one
woman with a breast mass and one with a pelvic mass who definitely need further
care. But more importantly, the women understand that a doctor from some
faraway place came to their forgotten village to provide care and see them as
deserving human beings. They are not invisible.
I am also working in solidarity with the Israelis (Jewish and
Palestinian) and the West Bank clinicians who are swimming against the cultural
and political tides of their own societies and I want to stand with them as well. It is really the most concrete thing I can
do.
No comments:
Post a Comment