Tony Waterston returns to Ramallah

Tony Waterston To Ramallah for the twice yearly contact with the Royal College of Paediatrics and Child Health teaching programme in the West Bank, the first time I have visited since the Gaza war. How would this have affected our programme? What are the prospects for expansion and can we start up in Gaza? How did the nurses on the course cope with the recent paediatric life support teaching (1)?

Coming from a heatwave in England, the hot weather was not so different but the blue sky was still a delight, and the fountains were playing in the park opposite our hotel, the bouncy castle was in action and families were out in numbers enjoying the swings and the café.

The word from our paediatrician colleagues was that Ramallah is doing well but outside the city economic malaise continues and the road  blocks still obstruct easy passage from town to town. The contrasts were obvious in Nablus, an ancient city to the North of the West Bank, where a new medical school is being constructed but the hospital is poorly equipped and overcrowded, and has a contrast X-ray machine not used since its donation five years ago owing to lack of key parts.

A child being transferred weekly to Jerusalem for dialysis now has to have this on the adult ward after the parents were refused a permit. Doctors are poorly paid and in short supply in the hospital and the first year residents may up and off to Jordan. Seventy doctors leave the territories every year and the new output from Nablus medical school could barely keep up with the loss, even if its graduates can be encouraged to stay.

Perhaps our programme can assist this. We now have 10 students who are first year paediatric trainees in Makassed, the main teaching hospital in East Jerusalem, and 11 GPs and primary care nurses in nearby Ramallah. All are making good progress in the 18 month RCPCH Palestinian child health diploma programme, and all succeeded in the life support course, including the nurses, who generally excel both in discussion and in written work.

I watched a role play in Ramallah when a doctor explained the prognosis to the parents of a child in intensive care; the remainder of the group critiqued the doctor for his comment to the mother on the late admission of the child, and the father for his lack of support for the mum in the ward.

All the students are now keeping a portfolio, and I see one in the Makassed group that is truly superb, and includes an information booklet written for parents of a child who won’t eat. Set out in perfect English, I ask if it can be translated into Arabic for use by local mothers as it beats anything I have seen in the UK.

The programme is ready for expansion and together with our partner Juzoor, a highly efficient local NGO which coordinates the programme in the OPT, we meet the Minister of Health to seek accreditation with the Medical Council. He is enthusiastic and supports its extension to GPs and nurses across the country, and hopes for its integration into the paediatric residency programme, once the medical council has approved the detailed programme.

With the support of Medical Aid to the Palestinians, the remarkable British NGO which kept its service going into Gaza throughout the dreadful war in January, we expect to offer a training of trainers in Gaza and then a neonatal life support course and perhaps child mental health and disability training. That is if the Foreign and Commonwealth Office moderates its guidance that it would be “reckless” to visit Gaza – anomalous advice at a time when the Department for International Development (DFID) is funding MAP to expand their work there! Does one hand know what the other is doing?

Once again, I leave exhilarated and saddened – by the innovation, inspiration and kindness of our Palestinian partners, and by the injustice, economic hardship and harassment which are a daily part of their lives.

(1) Waterston T, Halileh S, Odeh J, Rudolf M, Hamilton P. Teaching child health in the occupied Palestinian territory. Lancet 2009;373(9667):878-80.

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.