Doctors Without Borders
The baby with the enlarged heart, the woman who cannot open her mouth, the toddler whose muscles are degenerating - None of them will get appropriate medical treatment. An imprisoned Palestinian village goes to the doctor
Friday, January 17, 2003
Four-month-old Hedaya Hijazi has been steadily losing weight. She needs to have tests, but where?
(Photo: Miki Kratsman)
Your child has a high fever. Soon you're at the doctor. A few more minutes, and maybe you're at the emergency room. If you live far away, you have to drive a little more. Near or far, for Palestinian parents, such trips take hours. They can't always get to the hospital in the closest town. There are checkpoints that one can't even approach at night. Now imagine that a Palestinian child has a serious ailment, like a heart defect, cerebral palsy, a severe developmental disorder, a malignant tumor or acute anxiety attacks. There is virtually no chance that this child will receive the appropriate medical treatment.
After 36 years of Israeli occupation, in the territories there isn't a single medical center worthy of the name, and the road to medical treatment in Israel is now almost completely closed. A visit to a medical clinic in Israel? You need an entry permit. Complicated surgery? Lengthy treatment? There's no one to pay for it.
Take Rim Rajab, for example. The 10-year-old girl has a cleft palate, which affects her speech. It's not a matter of life and death, but it is a defect that, left uncorrected, will continue to affect her quality of life. Other children will tease her, adults will keep their distance and the girl will grow up with feelings of inferiority and behavioral problems. She was operated on three times in the territories - twice in Nablus and once in Ramallah - but all of the operations failed. There are no mouth and jaw specialists with sufficient training.
Recently, her parents managed to bring her to Ichilov Hospital in Tel Aviv for an examination. The surgery that was proposed there is complicated and expensive, and there is no one who can pay for it. Last Saturday, her father brought her to the makeshift clinic set up in their village, Kafr al-Lubad, that day by Doctors for Human Rights. The volunteer physician, Dr. Yigal Shochat, an ear, nose and throat specialist, examined the girl and sadly clasped his hands together. What could he tell the desperate father? That less than an hour away, in Israel, an operation could be done that would change his daughter's life, and that there was no chance she could have it? That because she was born Palestinian, she was doomed to live with a cleft palate her whole life? That Israel still has a legal and moral obligation to see about the girl's health and that it is being derelict in this duty?
And what can one say to the mother of the baby with an enlarged heart and blue lips? And to the mother of the baby with cerebral palsy whose muscles are withering because she can't bring her to physical therapy? Or to the woman who can hardly open her mouth? Or to the boy who has been mute since the age of seven? Or about the baby who keeps losing weight? Or the girl who is going deaf and needs a complicated implant? Or to the teenage girl whose brain fluid is leaking? What to tell them and their parents? That it's because of the terror? Because of security? Or that they should seek help from the Palestinian Authority that Israel has destroyed?
There is one ray of light in the darkness: Nearly every Saturday, when most Israelis are sitting down to their Shabbat meal or watching soccer games on television, a group of Israeli doctors and nurses - Jewish and Arab volunteers with Doctors for Human Rights - travels across the Green Line to offer medical treatment. Each week they go someplace else. In the past year, they have seen approximately 15,000 Palestinian patients. They were able to help most of them a little. A few patients were subsequently able to receive treatment in Israel. This enterprise is managed by Salah Hajj Yihya from Taibe, the foundation's man in the field, who has earned renown in the territories. "Ad-Duktur" they call the man who never completed any medical training. Last Saturday, they were in Kafr al-Lubad near Anabta, between Tul Karm and Nablus.
The clear blue sky and bright winter sun last Saturday did nothing to soften the sights of desolation and ruin in the territories. The main streets of Tul Karm are full of people, but not like they used to be. Some of the stores are shuttered; maybe their owners are stuck in their villages, or maybe they don't see the point of opening their businesses anymore. Almost all the roads are rutted with tank tracks. Garbage is strewn everywhere and everything is covered with dust. There's a fire at the entrance to the Nur a-Shams refugee camp: A youth is standing by a small bonfire of tires.
A mud monster protrudes from one of the narrow alleyways of nearby Dir a-Rusun. It's a jeep that's covered in mud up to its roof. A menacing-looking armored personnel carrier is parked at the end of another alleyway. It seems as if the IDF is everywhere these days. The last visible remnants of the PA are the blue public telephone booths it built - that is, the few that haven't been destroyed by the tanks.
A volleyball net has been stretched across the yard of the girls' elementary school in the village. The school is well-tended. The walls are painted white and festooned with colorful inscriptions. The school system is perhaps the PA's only success. The principal says that the girls are suffering emotionally, and from the economic situation. Their academic achievements have declined. The tanks in the streets and the late-night house searches are affecting them. Only a fifth of the students have paid the token school fee. A number of the girls are getting psychological therapy. "Let's hope that it ends and that we get what we deserve as a people," says the principal.
Two village residents have been killed, nine have been arrested and one house has been demolished; in plain sight of the elementary school, the rubble could be a stark illustration for a social studies lesson. The first floor of the school has been temporarily converted into a clinic; classes continue as usual on the second floor. The yard is crowded with people. It seems as if the whole village has come to be examined or at least to catch a glimpse of the unusual sight. A long line has formed outside the door of the classroom in which Dr. Meir Liron, the retired director of the internal medicine department at Ichilov, is seeing patients.
Throughout the day, the dozen or so Israeli doctors will see about 350 patients. In a village of 5,000, that's a significant number. The opportunity to see a doctor - even for no specific reason - or to receive free medicines, appears to have ignited the residents' imagination. Or maybe it's the possibility of seeing an unarmed Israeli. In the bathroom, a pupil at the school remarks to her friend: "I wish these Jews would get out of here already."
For three months now, Rada Umriya has been unable to open her mouth. Every time Shochat attempts to open it, she screams in pain. It's locked shut. It's hard to imagine how this young and attractive woman has been managing to eat in this condition. The 26-year-old mother of four left her home in the village of Aja this morning with her husband Azzam and traveled for over two hours to get here.
Azzam translates for Shochat; he worked for years at the Habima Cafe and at a restaurant in Jaffa, and speaks fluent Hebrew. They brought with them an X-ray of her jaw; in Nablus, they wanted NIS 1,000 for a CT scan and they didn't have the money. Azzam has been out of work for the past two and a half years. "I sold everything I had. I had a piece of land - I sold it. I had a car - I sold it. I went to Nazareth to work and they wouldn't give me a place to sleep. The police used to come after us. We live from a little bit here and there."
Shochat says that Rada should be referred to a mouth and jaw specialist. But how are they to find a specialist like that in Aja or even Nablus? Azzam says that the children are depressed. They see their mother in agony from the pain. Sometimes, she doesn't get out of bed. There isn't much that Shochat can do. He suggests a stopgap measure: To try to open the mouth a little each day with a tongue depressor to keep the jaw muscles from atrophying completely. He gives the couple a bunch of tongue depressors to take with them. But what will become of Rada? Will she ever be able to open her mouth? The couple glumly leave the classroom-clinic, clutching the tongue depressors, and prepare to make the rough, two and a half-hour journey back home. Hajj Yihya will try to arrange an entry permit for Rada so she can be seen by a doctor in Israel. But who knows when or how that will be accomplished?
In the next classroom, Dr. Hassan Mataneh, a family physician from Kalansua, is examining Hedaya Hijazi, a four-month-old baby girl who has been steadily losing weight. She weighed 3.8 kilos at birth and now weighs only 3.1 kilos. She looks dreadful; her tiny legs are matchstick-thin. Mataneh prescribes a series of tests. It's hard to know where they might be carried out, and by whom. The doctor says that she could be suffering from malnutrition or from a disease. She should be hospitalized. But where?
The next baby who is brought into the room has an enlarged heart. Two-and-a-half-year-old Mohammed Talatin, from the same village, also apparently has an enlarged heart. Mataneh recommends an echocardiogram. But where? Surely not in their village. Perhaps on the other side of the checkpoints? Hajj Yihya will check with the IDF. And if the test indicates that heart surgery is necessary? What then?
Mohammed's mother wants to bring his twin sister Taleh here as well, so the doctor can see the toddler who, at age two and a half, does not stand or speak or see. She has been told before that her daughter's problems stem from a lack of oxygen during birth. The mother leaves and soon comes back with the child. Mataneh examines her and says that it's evidently cerebral palsy. No one had ever diagnosed her before. She needs physical therapy. Mataneh says that, from a medical standpoint, the toddler has been completely neglected; she has received practically no physical or developmental therapy.
In the course of the day, he saw many children whose conditions had worsened due to a lack of appropriate treatment because of the closure and the economic situation. These children will always have to live with their disabilities and their suffering.
Taleh has had physical therapy only twice, in East Jerusalem - once about two weeks ago and once nine months ago. Each time, her mother snuck into the city, having paid NIS 200 to make the trip, which lasted anywhere from two to nine hours, depending on the situation. The little girl has recently started to experience epileptic seizures, too. Mataneh says that this could be due to the lack of treatment. "What can I tell her?" he asks.
A 12-year-old girl who has nearly lost all the hearing in both ears was brought in by her father. He'd heard about a special kind of implant that could restore her hearing. Again, Shochat feels helpless. It's a rare and complicated procedure. But the girl doesn't even go for speech therapy. Shochat: "Is she a good student? Does she go to a regular school? Then my advice is to stop chasing after doctors and be happy with the hearing aid that she has."
The next patient has a leakage of spinal fluid. The procedure necessary to close the leak is very complicated. She has already contracted meningitis once. She needs a CT scan to indicate precisely where the problem is, and perhaps surgery. Shochat: "What can I tell her?"
Little Lama Rajab has a cataract in her eye. She was previously treated at the eye hospital in the Sheikh Jarrah neighborhood of Jerusalem. Her mother has not taken her there since April of last year. She has not been able to get there.
Ten-year-old Iman Tiltan weighs just 27 kilos. Her parents have not taken her for a checkup in the four years since the family returned from Saudi Arabia. Her father is unemployed and there's no money. She sits across from the doctor who prescribes a series of basic tests which most likely will never be done.
Outside, a young man waits his turn to be examined. He has large, bulging eyes that appear ready to burst from their sockets; he keeps them hidden with dark sunglasses. In another classroom sits Dr. G., an Arab psychiatrist from the Galilee who prefers not to give his full name for fear of the reaction at his hospital should it become known that he volunteers in the territories. The parents of one 12-year-old boy tell him that, for the past several months, their son has become withdrawn and suffered from sleeplessness and now bedwetting as well. They say that it started after the boy witnessed the demolition of the house across from the school. Another boy, a 7-year-old, recently stopped talking. Perhaps he, too, was exposed to trauma, or perhaps it's due to another problem. It's hard for Dr. G. to tell.
Back to the land
The head of the village council is called Ziyad Jibati and everyone in the room laughs at the mention of the name of the IDF brigade with the similar name. The Givati brigade is currently destroying workshops in Khan Yunis. The IDF also shows up in this village almost every day. All of the residents are unemployed; they live off of their olives alone. For over a year, the council head has not been to Nablus, the district center, which is just 19 kilometers away. One can still get to Tul Karm, nine kilometers away, but only sometimes. Eighty percent of the residents worked in Israel and the rest in Nablus and Tul Karm. Now they're stuck at home.
The villagers have gone back to the land: Everyone is growing something in his yard, for personal consumption. Most of the residents no longer pay taxes or water and electricity bills. Once council member says that he owed NIS 5,000. He doesn't have it. The council coffers are empty, just like the building's refrigerator. Trash collection? "We don't have all that Bisli [a packaged snack] kind of stuff like you do, so there's not a lot of mess."
A house in the village, across from the council building: It belongs to Adnan Bakhar, a father of five. From a small distance away, there is no hint of the appalling sight that lies within: the kind of poverty and destitution that I haven't seen in a long time, not even in the refugee camps. Before the intifada, Bakhar worked as a foreman for harvesting jobs on moshavim in Gush Tel Mond. Then he opened a hardware store in the village, but had to close it. Now the windows have no panes in them, the roof is sinking, the children are barefoot and dressed in shabby, threadbare clothes. Bakhar recently started raising some chickens in the yard. Two of them now lie in the old, rusted refrigerator. Aside from the chickens, the refrigerator is totally empty - in a home where there are five children.
An unpleasant odor hangs in the empty rooms. Bakhar says that he sold all of his electric appliances. The house is completely bare. "I hope Sharon and Arafat both read this," he says bitterly. His neighbor, the bereaved father of Hamas activist Nashat Jabbara, is also bitter. On September 26, the soldiers killed his son in the nearby olive grove and then they came to demolish his house. The rubble has not been cleared; 15 family members were left homeless.