Healthcare in Palestine

1
Healthcare in Palestine

• Nader Hebela, MD
• The Palestine Childrens Relief FundFebruary 2004

2
Overview

• Children in the context of world health
• Organizations delivering medical care abroad
• Healthcare in Palestine
• Palestine Childrens Relief Fund
• Pediatric orthopaedic surgery in Palestine

3
About me

• Parents emigrated from Alexandria, Egypt to
  Jersey City, NJ
• Born in Bayonne, NJ
• Dartmouth College
• Resident, Dept. Orthopaedic Surgery, Hospital of
  the University of Pennsylvania
• Interested in international medicine
• Orthopaedic healthcare in Palestine
• Currently live in Philadelphia, PA

4
World Wealth

• Poverty living on less than 1 per day
• 1.1 billion people live on less than 1 per day
• 2.7 billion people live on less than 2 per day

Source http//www.worldbank.org/research/povmonit
or
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World HealthUnder-five deaths 2000 United States
Source http//www.cdc.gov/nchs/data/nnvsr/nvsr51/
nvsr51_05.pdf
6
World HealthUnder-five deaths 1993 developing
world
Source http//www.childinfo.org/cmr/Kh98/kh8chap1
.pdf
7
World HealthUnder-five deaths 1993 developing
world
A large majority of these lives being lost could
be saved.? Kenneth Hill, Rohini Pande (Johns
Hopkins University), Gareth Jones (UNICEF),
Trends in Child Mortality in the Developing
World 1960 to 1995
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Overview

• Children in the context of world health
• Organizations delivering medical care abroad
• Healthcare in Palestine
• Palestine Childrens Relief Fund
• Pediatric orthopaedic surgery in Palestine

9
Foreign Medical Relief Organizations

• Doctors Without Borders
• Operation Smile
• Palestine Childrens Relief Fund (PCRF)
• Gaza the West Bank

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Foreign Medical Relief Organizations

• Treat patients
• Find care for patients abroad
• Educate healthcare providers

11
Give a man a fish, and you feed him for a day.
Teach a man to fish, and you feed him for a
lifetime. ? Chinese proverb
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Palestine IsraelGeography Demographics

• Israel
• Area 20,770 sq km
• Comparative slightly smaller than NJ
• Population 6,116,533 (including settlers)
• Growth rate 1.39
• Gaza, Palestine
• Area 360 sq km
• Comparative 2x Washington, DC
• Population 1,275,868 5000 settlers
• Growth rate 3.89
• West Bank, Palestine
• Area 5,860 sq km
• Comparative slightly smaller than Delaware
• Population 2,237,194 364,000 settlers
• Growth rate 3.30

Source http//www.odci.gov
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Palestine IsraelThe Occupation the Intifada

• Intifada the abrupt sudden waking up from
  sleep or unconcerned status
• Came to symbolize the Palestinian uprising
  against the Israeli occupation
• Kids throwing stones
• September 2000

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Palestine IsraelThe Intifada Healthcare

• The Intifada has had a detrimental effect on the
  overall delivery quality of healthcare to the
  average Palestinian man, woman, child
• As of May 10, 2004
• 2,886 Palestinians dead
• 25,755 Palestinians injured
• 977 Israelis dead
• 6,314 Israelis injured

Source Palestinian Red Crescent,
http//www.palestinercs.org/ Source Israeli
Ministry of Foreign Affairs, http//www.israel.org
/mfa/go.asp?MFAH0ia50
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Overview

• Children in the context of world health
• Organizations delivering medical care abroad
• Healthcare in Palestine
• Palestine Childrens Relief Fund
• Pediatric orthopaedic surgery in Palestine

16
Checkpoints
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Healthcare in PalestineCheckpoints Sept. 2000
Dec. 2002

• Access
• 47 deliveries at checkpoints
• 28 newborn deaths at checkpoints

Source http//www.moh3.com/annual/2002/Intifada.p
df
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Healthcare in PalestineEmergent Medical Issues

• The Occupying Power shall afford civilian
  medical personnel in occupied territories every
  assistance to enable them to perform, to the best
  of their ability, their humanitarian functions.
  ...

The First Additional Protocol of the Geneva
Conventions, Article 15
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Healthcare in Palestine Checkpoints Sept. 2000
Dec. 2002

• 2. Access
• 81 patients died at checkpoints
• 720 ambulances prevented from reaching patients
  or hospitals

Source http//www.moh3.com/annual/2002/Intifada.p
df
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Healthcare in PalestineEmergent Medical Issues

• The Occupying Power has the duty to ensure that
  the medical needs of the civilian population in
  occupied territory continue to be satisfied.
• The First Additional Protocol of the Geneva
  Conventions, Article 14

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Healthcare in Palestine Checkpoints Sept. 2000
Dec. 2002

• 3. Access
• 22 ambulance drivers killed
• 35 ambulances destroyed

Source http//www.moh3.com/annual/2002/Intifada.p
df
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Healthcare in PalestineEmergent Medical Issues

• If the whole or part of an occupied territory is
  inadequately supplied, the Occupying Power shall
  agree to relief schemes on behalf of the said
  population, and shall facilitate them by all
  means possible. Such schemes ... shall consist,
  in particular, of the provision of consignments
  of foodstuffs, medical supplies and clothing. All
  Contracting Parties shall permit the free passage
  of these consignments and shall
• guarantee their protection. ...
• The Fourth Geneva Convention, Article 59

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Healthcare in PalestineEmergent Medical Issues

• Emergent medical issues
• 1. Access, access, access
• 2. MVI, supplements, equipment
• 3. Pediatric surgical specialists
• Urgent medical issues
• Supplies to hospitals
• Training to physicians

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and we do not expect people to be moved by what
is not unusual. That element of tragedy which
lies in the very fact of frequency, has not yet
wrought itself into the coarse emotion of
mankind and perhaps our frames could hardly bear
much of it. If we had a keen vision and feeling
for all ordinary human life, it would be like
hearing the grass grow and the squirrels heart
beat, and we should die of that roar which lies
on the other side of silence. ? George
Elliot, Middlemarch
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Guest House, Gaza
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Overview

• Children in the context of world health
• Organizations delivering medical care abroad
• Healthcare in Palestine
• Palestine Childrens Relief Fund
• Pediatric orthopaedic surgery in Palestine

27
Palestine Childrens Relief FundAbout the PCRF

• American-registered non-political, non-profit
  organization established in 1991
• Address the medical crisis facing Palestinian
  children

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Palestine Childrens Relief FundAbout the PCRF

• Provide free medical care in the U.S Europe for
  children who cannot adequately be treated in
  their homeland
• Send volunteer medical missions to the occupied
  territories from the U.S. Europe to treat
  children train Palestinian healthcare workers
• Donate urgently needed medical equipment
  supplies

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Palestine Childrens Relief FundMissions to
Palestine 2001 2002

• 2001 Plastic (63), cardiac (40), ophthalmic,
  orthopaedic surgery, NICU, EMT training
• 2002 Ophthalmic (79), cardiac (18),
  orthopaedic surgery, ER, NICU, EMT, OT training

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Palestine Childrens Relief FundOverseas Program
2001 2002

• 2001
• North America (29)
• Europe (20)
• Middle East (35)
• 2002
• North America (40)
• Europe (40)
• Middle East (12)

Nour at Shriners Hospital of Philadelphia, March
2003
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Palestine Childrens Relief FundHumanitarian
Projects 2001 2002

• Summer camps for handicapped children
• Women empowerment project
• Medical supply donations

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Palestine Childrens Relief Fund Information for
Potential Donors

• The PCRF is a registered 501(c)(3) non-political,
  non-profit organization
• Tax Exempt Identification no. 93-1057665
• The PCRF complies with Voluntary Best Practices
  for U.S.-Based Charities, issued by the U.S.
  Department of the Treasury following the tragic
  events of 9/11

Source http//www.treasury.gov/press/releases/do
c/tocc.pdf
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Overview

• Children in the context of world health
• Organizations delivering medical care abroad
• Healthcare in Palestine
• Palestine Childrens Relief Fund
• Pediatric orthopaedic surgery in Palestine

34
Palestine Childrens Relief FundMission October
2002

• Identify pediatric orthopaedic needs in Gaza
  the West Bank
• Identify children who need orthopaedic care not
  found in Palestine
• Match children with doctors hospitals in the
  U.S. Europe

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Case 1, Gaza

• AM, 16F
• Difficulty with ADL
• Severe scoliosis
• Back pain
• Bilateral UE neuromuscular abnormalities
• Needs plain films, CT, MRI
• Spinal fusion to halt curve progression

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Case 2, Khan Younis

• DS, 13F
• Progressive spinal curvature
• Appearance
• PE suggestive of UMN lesion
• Plain films of entire spine MRI requested
• Likely benefit from spinal fusion

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Guest House, Gaza
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Palestine Childrens Relief FundSummary October
2002

• Lack of specialists
• Lack of access
• Lack of equipment instrumentation (orthopaedic
  hardware)

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Palestine Childrens Relief FundFebruary 2004

• Temperature in Philadelphia 40F
• Temperature in Ramallah 32F

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Palestine Childrens Relief Fund February 2004

• Access assess patients determine level of care
  necessary
• Specialists see patients in need of complex
  orthopaedic care
• Expertise match foreign surgical teams coming to
  Palestine with specific cases requiring treatment

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Jerusalem
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Palestine Childrens Relief FundFebruary 2004

• 7 day mission in Ramallah, Nablus, Hebron,
  Jerusalem
• Children from Jenin, Tulkarem, and neighboring
  refugee camps
• 100 children with complex disorders seen
  examined

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Patient Screening

• Scoliosis
• Congenital deformities (clubfoot, hip
  dislocations)
• Neuromuscular disorders (cerebral palsy)
• Pediatric trauma

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Church of the Nativity, Bethlehem
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Church of the Nativity, Bethlehem
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Gaza
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Trauma

• Routine pediatric trauma
• High velocity gun shot wounds

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Trauma

• Nour, 15 years old
• Stepped on land mine after lunch
• R AKA, L BKA
• Treated at Shriners Hospital in Philadelphia, 2003

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Congenital Abnormalities

• TAR syndrome
• Arthrogryposis
• Club foot
• Hip dislocations

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Al Aqsa Mosque, Jerusalem
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ScoliosisUntreated in Palestine
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ScoliosisLimitations of care in Palestine

• Lack of expertise training
• Instrumentation (expensive hardware)
• Post-operative intensive care units

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ScoliosisThe PCRF role in healthcare delivery

• Hugh Watts former chairman at CHOP, Saudi
  Arabia for 12 years, distinguished career at LA
  Shriners Hospital
• Lifetime of volunteerism in orthopaedic surgical
  relief missions

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ScoliosisThe PCRF role in healthcare delivery

• Training for Palestinian orthopaedic surgeons
  through fellowships in the field
• Dr. Ala Al Sheikh 1 year fellowship in Pediatric
  Orthopaedic Surgery at the L.A.
  Shriners--emphasis on scoliosis surgery

Teach a man to fish
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ScoliosisBefore after
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Nour Revisited

• Philadelphia Shriners Hospital
• Physical therapy for 3 months
• Homestays with 3 generous Palestinian-American
  Philadelphia families

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Shriners Hospital

• The Shriners is an international fraternity of
  approximately 500,000
• Shriners Hospitals for Children a network of 22
  hospitals that provide expert, no-cost
  orthopaedic, spinal cord, and burn care free of
  charge to children under 18.

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Palestine Childrens Relief FundFuture Directions

• Identify areas of interest potential training
  for Palestinian orthopaedic surgeons
• Palestinian orthopaedic contacts to help deliver
  orthopaedic care efficiently

In the end, my desire to go to Gaza stemmed
neither from adventurism nor from insanity, but
from that dread of being a bystander
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Palestine Childrens Relief FundInformation

• The PCRF
• P.O. Box 1926
• Kent, Ohio, 44240
• [phone]
• http//www.pcrf.net
• thepcrf_at_aol.com
• hebela_at_yahoo.com

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Thank you