Jerrycans of water in Madama
The drive to Nablus is uneventful, unlike the experience of two of our delegates who got stuck in a massive four hour happening at a checkpoint that involved many IDF and tanks and lots of waiting and cigarette smoking and no clear explanations. The Al Yasmeen Hotel, on the edge of the old city, seems to have perked up since our last visit, with many more guests and meetings, although, despite an attentive and friendly staff of attractive young men, and five separate attempts to book our rooms, they managed to screw it up anyway. Small potatoes in the occupied territories.
I have been looking forward to my day with Dr Khadejeh Jarrar, the head of women’s health care from Palestinian Medical Relief Society (PMRS). We are going to three villages with a team from Medical Relief, UNDP (United Nations Development Program), a representative of the Palestinian Authority, and members from the local community councils to discuss how to create a more organized system of health care between three towns that are trying to collaborate. Since I am always stunned by the disorganization of health care delivery in these parts, the NGO-ization of different compartments of care, and the consequences to patients living in this disjointed and confusing world, this should be interesting to see in action.
Nablus is a gorgeous old city built on the palm and up the fingers of mountains that hold it like a giant cupping of hands. The traffic is of the chest pain variety, there are billboards for all sorts of international companies (two happy, handsome guys drink Coca Cola, blonde women with hair flying sell all sorts of products including sexy wedding dresses to the covered women in the streets), and Israeli military bases dot the hilltops. There are mountains of pita bread and watermelons on every corner and a clear feeling of being watched by the guys above us.
We head to the town of Burin, population 10,000, where part of the mosque is in area B and part in area C so there is a threat that it will be demolished, (this kind of humiliation and downright meanness takes real creativity). We enter the local community health center where the hallway is lined with mostly women who represent the community or work professionally in the clinic, plus the representatives of the previously named organizations. The Director of the Burin Charitable Association seems to be chairing. The clinic is trying to provide services to the towns of Burin, Madama, and Asira al Qiblia. It seems that there is a lot of physical community support for the center, (painting, curtains, etc) but there are many complaints and conversations of the following types:
1. The doctor comes to the clinic two times per week, which is an inadequate number of days and which results in a stressed out doctor, crowded clinic, short visits, and inadequate care, patients get angry, urgent patients cannot be seen quickly and there is a high level of frustration. The UNDP representative explains that their role is to support marginal communities to get access to care and given the occupation, perhaps they can build on the capacities of PMRS and the Ministry of Health working together. The nurse suggests that many services do not need a physician and that, for instance, the clinic had figured out how to provide vaccinations. If fact much of primary care that involves monitoring, height, weight, etc can be done by a nurse or midwife.
2. For pregnant women, there is no female doctor, no reliable ultrasound; Burin currently is seeing 35 pregnant patients, but they predict that number should be 75, so women are going elsewhere.
3. There is a lack of available medications (I think back to my trip last October, when I was told there was no digoxin, a basic cardiac medication, available in the West Bank). A patient who is on the council tells the story of her epileptic son who was unable to get his (not sure if free or inexpensive) medications from the Ministry of Health, she was told to drive to Nablus, so she just paid for it herself in a local pharmacy. Another person discusses the lack of insulin to be found in the Ministry of Health pharmacies. Once a medication arrives, it is distributed to all the Ministry of Health clinics but how does it get to the patients? The clinic uses a computerized data base and can easily organize home visits and screening. Another person talks about how time consuming it is to make a referral to the Ministry of Health and wonders if they could have direct computer access to their appointment system. (I have certainly had many conversations back in the US non-health care system that remind me of this one.)
4. Several complain that there is no ambulance, no public transportation, and private transportation is expensive. If someone fractures a bone or goes into labor, it is difficult to get all the way to the Ministry of Health hospital in Nablus. One diabetic, hypertensive man called an ambulance which never came. He was taken in a private car and died on the way to the hospital. It seems there is little coordination between the Red Crescent and the Ministry of Health. One elderly lady was hit by a settler and injured; the IDF told them she was stable, but the Red Crescent ambulance took her anyway. Yesterday, a motor vehicle killed two people and injured four on the main road of Nablus.
5. Then there is the special issue of the nearby Jewish settlements that frequently block access between the villages, burn farms and olive trees, grow wild pigs that get released into the Palestinian farms and cause massive destruction and no one knows how to get rid of them. The biggest complaint is the frequent Israeli settler attacks; the lack of available ambulances, the PA police are paralyzed and afraid to do anything, safe transport is desperately needed. I discover that the clinic does not even have a phone line.
Everyone agrees that the health committees should empower the local people to demand their rights for quality services and PMRS supports this idea. On the positive side, the Director of the Charitable society proudly shows off his computerized records for all the activities in the center: the monthly visits monitoring patients with chronic diseases, the educational consults for the kindergarten teachers, the cooking and breakfast programs, the theater that is being built, safety awareness programs, summer camps, the machine that is available for villagers to make honey. The PA representative is from the fire department and talks about the civil protection, safety courses, first aid and CPR courses, the volunteer teams that support the villagers during settler attacks, the training for evacuating the entire village in case of emergency. We visit a room filled with handmade soap, handicrafts and pickled fruits. This is a pretty impressive and well organized village.
Madama, on the other hand, is in crisis. Their main source of water has been taken over by settlers and they are reduced to carrying water of questionable quality from a well in the town in large plastic buckets by hand or on donkeys. We meet with the village council and besides the water disaster, contamination from the sewer system, and the prevalent infectious diarrheal diseases, all the complaints are worse. Although PMRS and the Angelican Hospital both have clinics two days per week, they are on the same two days, there is little coordination between all the players, the Ministry of Health is hopelessly bureaucratic, there is little available medicine, and no capacity for supports such as fire departments and ambulances. The stakeholders at the meeting agree to set up a committee, create an action plan, and learn from the more successful experience in Burin.
Asira al Qiblia is the poorest and most marginalized of the three villages, a small, dusty, crumbling town. It seems that there are no health councils, paved roads, or water. They suffer from daily settler attacks and attacks on their water system and infrastructure, so the villagers have lots of injuries and a generation of traumatized children. Of the 3,500 villagers, (350 households) approximately 100 families have health insurance. They buy water at exorbitant prices, (a tank of 3,000 liters for 30 shekels which lasts 5 days.) The monthly cost of water per family is more than their total monthly incomes and many have sold their cattle because of the lack of water. In addition there are three nearby stone quarries so there is the issue of dust related respiratory diseases and allergies as well as large trucks loaded with stone.
This is where I tend to shake my head in utter despair, but instead we are all invited to one of the women’s homes for a feast. Palestinian resilience is always a source of inspiration for me. The living room is filled with stuffed couches and chairs, and decorated with intricately embroidered pillow cases, lamp shades, and scenes of traditional weddings. We are soon sitting around a long table facing enormous platters of mujadara (some kind of fabulous grain and lentil combo) and thin cigar shaped yalanji (grape leaves) along with the usual labneh (yogurt) flavorful salads, pita, pickled vegetables, water, Sprite, aromatic tea flavored with mint, and small cups of Turkish coffee and a crowd of women all encouraging us to eat more, (sounds of my grandmother).
These village women are warm and tough. One speaks good English, went to college, and tells us that women in the countryside want to improve their lives and have projects like making honey, growing herbs, and raising sheep. Many of the women attended university and many of their men are unemployed. In Asira on January 14 this year, 70 women formerly registered an organization called The Palestinian Foundation for Women; they are fixing up a donated house that has no water, electricity, or plumbing facilities, and they are creating a women’s center for training in crafts such as embroidery and knitting as well as how to use more modern methods to make olive oil soap. She tells me most married women are working, particularly as teachers, and they all giggle and kvell about the new Arab Idol from Gaza. The older woman who cooked the vast quantity of food will not let us leave without doggie bags for the road and will not take no for an answer (like I do not have a refrigerator). I give her a thank you gift of an olive oil hand cream made in Davis, California by a friend of my daughter’s and she gets out her local version in a plain white bottle but smelling fragrantly of almond and apricot oil which is pretty divine. Despite the challenges this village is facing, it seems that the self esteem and integrity of the women is solid. They are not looking for charity; they just want the opportunity to raise their families and live productive, creative lives which seems utterly reasonable.
Just as I am promising myself never to eat again, I discover that tonight’s social activity is a family dinner with one of the main organizers of the Farrar Center in Nablus where many of the delegates are spending their clinical days. A few hours later I am in the arms of another warm and welcoming Palestinian family, four lively children, a stunning view of the sun setting over the Nablus hills as lights start twinkling in the dusk, and of course a tasty dinner of overwhelming proportions. We laugh and joke into the evening playing a (goofy, fast paced) card game called Uno. Another resilient family refusing to be silenced in the midst of occupation.
This is one of a series of posts that Rothchild has been posting at the blog for Pluto Press, where her last book, Broken Promises, Broken Dreams, was published.
Alice– thank you from the bottom of my grateful heart. I felt as though I was at your side! Your authorship is magical, and the resilience of the Palestinian people leaves me in awe.
http://www.guardian.co.uk/global-development/2013/jul/06/food-supply-threat-water-wells-dry-up
“In a major new essay Lester Brown, head of the Earth Policy Institute in Washington, claims that 18 countries, together containing half the world’s people, are now overpumping their underground water tables to the point – known as “peak water” – where they are not replenishing and where harvests are getting smaller each year.
The situation is most serious in the Middle East. According to Brown: “Among the countries whose water supply has peaked and begun to decline are Saudi Arabia, Syria, Iraq and Yemen. By 2016 Saudi Arabia projects it will be importing some 15m tonnes of wheat, rice, corn and barley to feed its population of 30 million people. It is the first country to publicly project how aquifer depletion will shrink its grain harvest.
“The world is seeing the collision between population growth and water supply at the regional level. For the first time in history, grain production is dropping in a geographic region with nothing in sight to arrest the decline. Because of the failure of governments in the region to mesh population and water policies, each day now brings 10,000 more people to feed and less irrigation water with which to feed them.”
Brown warns that Syria’s grain production peaked in 2002 and since then has dropped 30%; Iraq has dropped its grain production 33% since 2004; and production in Iran dropped 10% between 2007 and 2012 as its irrigation wells started to go dry.”
The TEN excuses that all Hasbara trolls and government- inspired pricetag terrorists are required to learn by heart and to spew out at every available opportunity:
1. The 3/4 million Arabs forced to flee their homes in Palestine in 1948 after the massacre of the village of Deir Yassin by Irgun and Lehi terrorists, left ‘voluntarily’.
2. There is no such person as a Palestinian Arab
3. Palestine in 1948 was ‘a land without people for a people without land’
4. The US$6 billion given to Israel every year is not really a gift from the American tax payer because one half is used to purchase US made fighter planes and munitions that places work with American factories
5. All criticism of Israeli violence and violations of international law are merely anti-Semitic rants
6. All those many thousands of Jews around the world who are horrified at the actions of the Israeli state, are ‘self-hating’
7. Without the essential contribution of the Israeli state, the world would collapse as there would be no cell phones, Uzi machine guns, computer software, medicinal drugs, diamond necklaces, hummous, oranges, water, electricity or sex
8. All the land between the river and the sea belongs to Israel by divine right
9. The Israeli army is the finest in the world although it has never yet had to engage a properly trained and equipped fighting force
10. Israelis possess a character trait that makes them innately superior to all other people
I experienced a mild surge of cognitive dissonance after reading that “Israel must become a democratic state where Palestinians have equal rights…..” Expecting this lofty goal to be achieved in this century are remote given the imbedded racist DNA of Israel. And how about all of the U.N. Resolutions condemming Israel’s lawless behavior, U.N. Resolutions, ICJ rulings, Goldstone Reports, right of return, et. al. ?All for naught? Just as the 2state “solution” is highly advantageous to the Zionist cause, I have some reservations about the author’s true allegiance.