Tony Waterston: Making the connection between education and practice … and a pipe band in Bethlehem

Tony WaterstonAttending the graduation ceremony for the Royal College of Paediatrics and Child Health Child Health Diploma programme in Ramallah I fantasised over the effect of the course on children’s health. We want to see the following: thriving, well nourished infants, lively and independent minded children, healthy teenagers with high self esteem, disabled youngsters who are well rehabilitated and integrated in society … all topics being covered in our teaching. What in fact we see at present are high levels of malnutrition, increasing poverty, notable anxiety and stress levels in young people and a scarcity of disability services. So our evaluation which is currently about to start, will need to be focused and realistic in its objectives, recognising that our impact on health will be limited or nil (since, as the recent Lancet series on Palestinian health showed, the main determinant of health is the occupation).

But even so, the impact of the course could be considerable, if we relate the teaching to the real world of the clinic and the ward. Our students are primary care doctors and nurses as well as trainee paediatricians, and following the graduation of the 20 students on the course, there were presentations which included swine flu (from the President of the RCPCH Prof Terence Stephenson), educational methodology including assessment, and cases from the students. These demonstrated the potential benefits of the teaching and covered child protection, growth faltering (presented by a nurse) and emotional difficulties. The latter is a completely new area for the students and the cases presented showed an excellent grasp of how to help parents of children with sleeping difficulties, behaviour problems and bed wetting.

So, how to evaluate? The standard approach is structure, process and outcome and the latter is most important. We don’t have a base line so will have to obtain this now. The students will be interviewed together with their line managers and the tutors; data on attendance and results will be collated. Important issues include the involvement of the nurses in the teaching, the use of English, and how easy it will be to change the clinic system to improve patient care. All students are writing an action plan on what they hope to change in their clinical practice and this will be reviewed at 3 and 6 months.

Visiting a refugee  camp in Bethlehem and the UNRWA clinic where one of our students works, it became apparent how huge the tasks are in trying to improve children and young people’s health. Bethlehem itself is now a walled city and getting out is like getting out of a prison. We admire and respect our partner paediatricians who continue to give the highest level of service under such difficult and emotionally draining circumstances. Amazingly, the day we visited Bethlehem was Palestinian Independence day (of course this is an aspiration rather than a reality) and among the troops on parade in Manger Square was a Palestinian pipe band.. I can’t wait to hear them at the real Independence celebrations.

Tony Waterston is a paediatrician in Newcastle-upon-Tyne, working mainly mainly in the community with long term conditions, disability, child abuse and social and mental health concerns. His interests are in child public health, children’s rights and global child health and he leads the RCPCH teaching programme in the occupied Palestinian territories.

  • jan coebergh

    approximately two weeks ago my wife and i visited Bethlehem as Western tourists, took the local bus from Jerusalem via Beit Jala, which took 45 minutes and on the way back, with 14 palestianians, got out of the bus, showed our passport, and went off again, at a checkpoint looking just like a toll road barrier, which lasted 1 minute. Hardly a prison i would say. I am aware that the other Bethlehem checkpoint is more prisonlike, so that is why many locals with a Jerusalem travel ID (many in bethlehem) take the beit jala one (which is a detour). The checkpoint coming from Ramallah to Jerusalem did feel like that (camera’s, turnstiles, x-ray, biometric analysis, queues etc, taking at least 30 minutes-1 hour extra, walls/watchtowers). All i am pleading for is accurate reporting, since much of it in this conflict comes with an agenda.

  • Thank you Tony for posting this- and for your efforts.

    For the majority of Bethlehem residents, the town is indeed a prison- I met numerous well-educated young people there forced to do unskilled jobs as there is no way they with their green West Bank IDs can make it to Jerusalem where most employment is.

    The ugly Wall weaves in and out of neighbourhoods, defacing the once-beautiful landscape and separating people from their livelihoods. The idea that it is a ‘security barrier’ is laughable as it does not follow any internationally recognized border or ceasefire line.

    Whether it takes 5 minutes or 5 hours to get through a checkpoint is entirely at the whim of the soldier. When visiting, I noticed that the presence of internationals did speed things up, even for the Palestinians sometimes.

    Whether it’s a ‘terminal’ with x-ray facilities or a rock in the road is immaterial- the 600+ restrictions on movement are illegal, imposed as they are by an occupying power on an entire population- and again, built not between Israel and the Palestinian territories but overwhelmingly between Palestinian population centres.