Issue No.
150, October 2010 Latest update 8 2011f January 2011, at 3.56 am
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Ramallah Hospital, CT Scan room (the CT Scanner was already there).
New operating theatre at Rafidya Hospital.

Beginning in Gloom, Ending with Hope
By Nadia W. Awad
Worse than every Palestinian’s fear of being involved in a car accident or contracting a disease is the fear of going to a hospital for treatment. It is a very unfortunate fact that Palestinian hospitals across the West Bank and Gaza, especially those in the more marginalised communities, suffer greatly from a severe decline in their infrastructure, which in turn impacts badly on the quality of health care services that they provide. From superficial problems such as peeling paint and water damage to major problems such as obsolete equipment and a shortage of doctors, the problems are widespread. According to the World Health Organization (WHO), standard indicators of the Palestinian health system suggest an overall national shortage in the number of hospitals and hospital beds needed, deteriorating primary health care facilities, not enough hospital personnel, and inconsistent standards for training and equipment. These problems are partly due to restricted mobility, over-burdened and under-financed health care providers, and a weak institutional capacity for monitoring and assessment. Nor are these indicators surprising, given the devastating impact of the Israeli occupation, and poor governance and mismanagement over the years. Indeed, the Palestinian Authority Ministry of Health (MoH) continues to refer patients to Israel, Egypt, and Jordan because they are unable to provide adequately for people’s needs. Part of a vicious cycle, these referrals lead to a substantial drain on already limited health resources.

Yet despite these gloomy indicators, efforts are being expended every day to counteract the problems in the health care system. The MoH has a clearly defined role in organising, improving, and developing the health sector, especially in coordination with the private and non-profit sectors. In fact, its responsibility within the 13th Government’s state-building plan is clear on this front: to ensure that all Palestinian citizens enjoy equitable access to high-quality health care services. This means promoting quality improvements in health care services so that Palestinians can receive treatment in their home country for all ailments.

With these aspirations in mind, the MoH is working with NGOs and international donors to identify key targets for assistance and to coordinate assistance efforts. Specific to this article is the work that the MoH has prioritised in the governmental hospitals of Jericho, Nablus, Beit Jala, and Ramallah, identifying them as being in immediate need of major rehabilitation works.

All four hospitals have several characteristics in common. They are vastly overburdened and do not possess the capacity to respond to the respective needs of their patients; they lack the finances necessary to maintain their hospitals according to standards set forth by the MoH; and all include departments that are in severely deteriorated, often dangerous, conditions. Because these hospitals are run by the PA, they are the only destination for poor Palestinians who cannot afford private treatment. Each hospital was assessed by ANERA in close coordination with the MoH and USAID.

Nablus
Rafidya Hospital in Nablus is the largest referral hospital in the northern West Bank and hence receives patients from all across the Palestinian territory. Major work is ongoing in several different sections of the hospital, including the operation theatres, the recovery rooms, the intensive care unit, the burns unit, the central laboratory and blood bank, and the outpatient clinics. Of particular interest, though, are the newly completed operation and recovery rooms. The construction of two new operating theatres, the rehabilitation of the recovery rooms, and the installation of medical gases and piping systems have already enhanced the capability of the hospital to perform life-saving surgeries on its patients. Even more exciting, however, is the installation of LED surgical lighting systems and six cameras which will enable live transmission of the operations for young medical students to observe and study. This intervention in itself will have a long-term impact on the Palestinian health system by helping to train future doctors and nurses.

Jericho
One of the first things one notices upon entering the Jericho Governmental Hospital is the acrid smell of sewage. Indeed, the major problems at the hospital include sewage leakage, faulty air conditioning (A/C) systems, exposed pipes, mouldy walls and ceilings, a lack of proper drainage (rendering many patient bathrooms unusable), and a shortage of space. Work is ongoing to tackle these problems and others by replacing the sewage and drainage system, installing new ventilation and A/C systems, constructing new sections of the hospital (in particular, a kidney dialysis unit and medical staff lodgings), in addition to basic works such as re-plastering and tiling, painting, and electrical works.

Beit Jala
The Beit Jala Governmental Hospital caters to the needs of 170,000 Palestinians and has the only oncology centre to serve the people of Beit Jala and the Ramallah and Hebron governorates. An assessment of the hospital revealed a long list of needs, including rehabilitation of the emergency unit, the outpatient clinics, the X-ray department, the surgery department, the kidney dialysis unit, the endoscopy department, and the intensive care unit. Much of the ongoing work involves re-plastering and re-tiling, replacing damaged ceilings, covering exposed piping, installing proper water and drainage systems as well as A/C and ventilation systems, and replacing and securing electrical and medical gas works.

Ramallah
The Ramallah Governmental Hospital, now part of the newly christened Palestine Medical Complex, will undergo major works in the near future. Its entire first floor will be remodelled, involving the emergency, neonatal, and obstetrics wards. The “old building” will be completely renovated, while two bridges will be constructed to connect the various buildings of the complex. Currently, the Ramallah Hospital’s radiology department is being completely overhauled, with new partitioning, re-plastering and painting, new piping, mechanical and electrical installations and a new A/C and heating system.

The Impact Is in the Details
Although the list of needs for intervention can be repetitive and monotonous, each detail can significantly influence the ability of doctors and nurses to save lives. For example, consider Rafidya Hospital, where more than a thousand surgeries a month were conducted in its original operation theatres. A faulty A/C and ventilation system, steel windows which were not sealed, and dirty, torn PVC flooring translated into an inability to control room temperatures and also meant that dust and bacteria were able to accumulate as operations were ongoing. Such seemingly simple problems endangered the lives of the patients lying on those operating tables, but fortunately, these problems are being tackled and remedied.

Another example is the addition of medical staff lodgings in the Jericho Hospital. These new accommodations will mean that doctors and medical staff living outside Jericho will have somewhere to stay and therefore be able to be on-call more often and work more graveyard shifts. In addition, the initial lack of accommodation proved a disadvantage for the hospital when it was trying to recruit new staff. Thanks to ongoing work, this will not be an obstacle in future.

Once the interventions are completed, each newly renovated hospital will be ready to receive new equipment, be better prepared to train new staff, and be able to provide a higher quality of health care for its patients. A positive hospital experience can also incentivise young men and women to pursue careers in the health sector. In short, the benefits can be immeasurable.

The future is now brighter for Palestinians. As the government’s state-building plan declares, a belief in hard work, coupled with faith in the ability to create new realities on the ground, will clear the path to freedom. Taking this belief and directing it into any aspect of life will mean that Palestinians are able to take control where they had none before. Through cooperation and communication amongst the PA, the Palestinian people, NGOs, and international donors, needs can be identified, assessed, and treated successfully. In the health sector, the role of the MoH is key to coordinating assistance so that resources are not wasted or misused. What is more essential, however, is that the needs of the Palestinian people be understood and addressed in this process of assistance.

The four hospitals are being renovated under the Emergency Water Sanitation and Other Infrastructure (EWAS II) Program, funded by USAID and implemented by ANERA.
Nadia W. Awad works for ANERA, American Near East Refugee Aid.
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