Looking for Trouble

As she did last year, Gerri Haynes has organized a Washington Physicians for Social Responsibility delegation of doctors and other health care providers to work in hospitals and clinics in Gaza in an effort to directly help the people there and to bring attention to the ongoing humanitarian crisis that the Israeli blockade has created. She will be sending back reports from inside the Israeli blockade.

Today’s Blog was written by Bob Haynes who is seeing cardiac patients in Gaza

Cardiac Care rounds at Al Shifa Hospital, the largest (500 beds) Palestinian hospital in the West Bank and Gaza, are similar to those at any U.S. teaching hospital. Sleep-deprived interns present a patient’s history to an entourage of medical students and quizzing professors. The interns respond correctly with answers directly from the Mayo Handbook of Cardiology.

I can participate in this part of rounds because all medical presentations are in English. When a point of contention arises, the discussions are held in Arabic. A poignant part of this exercise is that some of the treatments suggested by the “correct” answers are not available in Gaza.

There is a concrete wall 10 meters high around the land border between Gaza and Israel and a sea embargo enforced by the Israeli navy. Goods not allowed into Gaza by Israel an Egypt include a list of essential medical items.

One decade ago in the U.S., care for an individual experiencing a heart attack changed from dissolving heart vessel clots with medicines to opening clogged arteries with tiny balloons on catheters. Balloon technology for heart attacks is not available in Gaza. These interns are very well versed in the use of the clot-dissolving technique. Their knowledge of this methodology is elegant and complete. These interns are sharp – their knowledge is 2010, but due to available technology, their practice is limited to 1990s.

Today, as I exited the front gate of the hospital, the Call to Prayer issued forth from a speaker mounted on a large tent across a busy street. The tent is a temporary mosque, erected on the site of the Al Shifa Mosque – which was destroyed by bombs from Israeli planes during Operation Cast Lead – 17 months ago. As we listened to the Call, the intern who accompanied me commented that a male nurse had died in the bombing on the exact spot where we stood listening.

Heroes and Families

Many physicians from Gaza leave to train abroad and are not allowed to re-enter Gaza for the six or more years of their training. Some remain abroad. Some heroes choose to return to Gaza to serve the population at home. Family membership provides a sense of meaning and purpose and belonging.

Families are identified with specific areas of Gaza. There are virtually no street names or addresses in this densely populated region. Seeking to find a specific home, the seeker questions local people about a “family” and is directed – or taken – to the correct home. Trust between a doctor and patient is established by identification of family.

Family relationships are deeply respected. A nephew assists his uncle through the clinic bureaucracy. Sons help their mother from her wheelchair to the exam table. Beyond the concern and responsibility all of us might have for our family members, there is an intimate caring and great honoring for the privilege of serving a family member – sandals are removed for the relative, canes are held, dressing and undressing for an examination are completed with quiet tenderness. Nursing homes for adults with living relatives do not exist here. Nearly everyone belongs somewhere to a family.

Despite layers of politics and the suffocating siege, the people of Gaza persevere and even thrive in their own ways on their land in their families.

As she did last year, Gerri has organized a Washington Physicians for Social Responsibility delegation of doctors and other health care providers to work in hospitals and clinics in Gaza in an effort to directly help the people there and to bring attention to the ongoing humanitarian crisis that the Israeli blockade has created. She will be sending back reports from inside the Israeli blockade.



Over and over again, we hear stories from women who are moving Gaza to strength and healing.

Today, several of our group met with the women of the Al Majd Women’s Center – a Palestinian NGO dedicated to “enhancing women’s role in society development and political participation through capacity building, awareness raising and formation of neighborhood committees.”

We heard the story of Nawal Al Gussen, the Center’s strong and capable director. Nawal is the mother of six and grandmother of eight. Four of her children were born prior to the ten-year imprisonment of her husband. Two children were born to them following his release from prison – these children are still in school.

Prior to imprisonment, her husband was a teacher at the UNWRA school. Since imprisonment, he is in conflict with the government and works at home – taking care of grandchildren, gardening and cooking. Nawal says they support each other – “he completes me and I complete him.”

One of their sons is now in an Israeli prison and her husband cares so much for the children of this son that the children refer to him as Baba (father).

Nawal wants women to be politically independent and strong and her work in the center reflects this desire.

We attended an advocacy training at the Center. One woman after another related the ongoing trauma of their children from their experiences in last year’s war from Israel. Fear remains in these children – fear from bombs destroying their homes, from the death of relatives, from the sound of airplanes.

The women discussed ways they have attempted to help their children cope – some now accompany their children even to the bathroom as the children fear being alone and feel exposed to the dangers of war.

David Hall talked with them about the strength they have in each other – in the group therapy that is present in their work with each other. The women expressed dismay that the world allows Israel’s blatant disregard for the Geneva Accords – and expressed their sadness that the Goldstone report has been disregarded by the international community. We promised to bring their stories back with us to the United States.

This afternoon, the majority of our delegation visited in the home of physician, Suma Baroud, sister of Bothell resident and author, Ramzy Baroud. We took copies of Ramzy’s new book, “My Father Was a Freedom Fighter” to Suma – who has not seen Ramzy for 16 years.

Suma and her husband and five children served a delicious traditional Palestinian lunch, followed by tea in their beautiful garden.

One of the daughters was part of a delegation of Palestinian children to visit the White House in January. Their delegation met Jimmy Carter and Ban Ki Moon in New York. We were delighted to have the opportunity to meet Suma and her family.

Laura Hart, adult urologist, worked in Gaza last fall with the WPSR delegation. She spent two weeks here then and realized that a pediatric urologist could be very helpful – and she was right! Rich Grady, Laura’s husband, is a pediatric urologist.

They have been warmly welcomed and are very busy doing surgical procedures in two Gaza City hospitals. They are spending mornings in Al Shifa Hospital and afternoons and into the late evening, operating in the Public Aid Hospital.

Rich is an international expert in the surgical treatment of bladder exstrophy and, by fortunate coincidence, will be here to care for a new infant with a need for surgical repair of the birth defect – bladder exstrophy. Laura reports that, as in every area of Gaza, new tools are needed but that Gaza’s surgeons are working valiantly and resourcefully with the equipment available and are eager to exchange ideas.

As she did last year, Gerri has organized a Washington Physicians for Social Responsibility delegation of doctors and other health care providers to work in hospitals and clinics in Gaza in an effort to directly help the people there and to bring attention to the ongoing humanitarian crisis that the Israeli blockade has created. She will be sending back reports from inside the Israeli blockade.

And so to the tunnels.

This is Friday, day of worship in the Muslim world. For our group, a day of rest and a time to take a wider look at the country we are visiting.

We traveled in a large bus with our hosts and friends from the northern border with Israel to the southern border with Egypt.

As we traveled, we talked with these wonderful residents of Gaza and listened as they sang the spirited songs of their country. Buildings damaged or destroyed in Operation Cast Lead were visible in abundance in the north.

Along the way, we noted the areas where Israeli settlers once lived. In 2005, approximately 5,000 Israelis were evacuated from Gaza – moved by Israel to different homes in the Occupied Territories and Israel.

We learned that, while all of the settler homes were destroyed by Israel when Israel left Gaza to become an external occupier, several lovely schools and most of their greenhouses were left standing. Rubble from the destroyed houses has been cleared from the settler home sites – in part, at least, to use one day in the construction of a port.

In the south, we drove near the border with Egypt through the area of the tunnels. Today, the tunnels were silent, but we saw many tunnel structures and talked with a man who was doing his shift at a tunnel that brings gasoline from Egypt to Gaza. His tunnel is 15 meters deep – some are much deeper, and some are built over one another (with the occasional result that the tunnels collapse into each other). This man told us that there are hundreds of tunnels – perhaps 500 – but only 50 are now moving material back and forth. Each tunnel costs about $200,000 to construct.

Basic necessities and many other items come through the tunnels: water, cloth, cars, motorcycles, building materials, camels, goats – almost any item that can claim a price. Several times in the last few days, we have seen shiny new cars in Gaza – successful navigators of the tunnels. Even brides have arrived in Gaza through the tunnels – carried sleeping through the underground passage.

While we visited the tunnels, we heard an explosion – we were told this came from the Egyptian side and was probably the destruction of a tunnel – its hiding place found. The tunnels are not legal.

As we traveled north to our hotel in Gaza City, we stopped to enjoy the Mediterranean Sea – with waters too polluted for swimming, the sites and sounds of the sea remain lovely. We shared lunch, games and conversation, then drove along the Sea to stop once more for ice cream and then to say farewell to our hosts.

Tomorrow is another day for work.

As she did last year, Gerri has organized a Washington Physicians for Social Responsibility delegation of doctors and other health care providers to work in hospitals and clinics in Gaza in an effort to directly help the people there and to bring attention to the ongoing humanitarian crisis that the Israeli blockade has created. She will be sending back reports from inside the Israeli blockade.



Members of our delegation continue to work in their areas of experience.

Howard Putter has been working with other orthopedic surgeons at Al Shifa Hospital. He has seen traffic trauma (the traffic in Gaza is the stuff of legend – there are no traffic lights for the heavy car and cart traffic and children play in and around the streets) and old war injuries. Attending orthopedists and a resident staff provide care – equipment and supplies are needed, but difficult to get during these years of siege.

David Hall taught an enthusiastically-received class on psychotherapy for psychologists, nurses and social workers this morning at the Gaza Community Mental Health Programme Center http://www.gcmhp.net/. Working through a series of translators, the discussion was spirited.

The level of psychological trauma here makes care giving complicated. Traumatized professionals have to find ways to care for themselves so that they may continue to provide care – this is true in every medical discipline.

We are making some visits with GCMHP staff to private homes.

Today, we visited some members of a family of 16 who live on the fourth floor of a small concrete building – sleeping quarters are under an open tin roof, while the protected living happens in a space about 12×10.

The father of the family – which is composed of brothers and nieces and nephews as well as the wife and children of this father – is a fisherman. He tells us that the only fish in the waters they are permitted to fish (deep water fishing is prohibited by Israel) are very small and the water is sewage-polluted.

He has no income. The family receives food aid in the form of dry staples every three months from UNRWA http://www.unrwa.org/.

Their life is desperate. Still, the children gather and smile their beautiful smiles. Everywhere we go, people express gratitude that people from the United States have not forgotten them.

As she did last year, Gerri has organized a Washington Physicians for Social Responsibility delegation of doctors and other health care providers to work in hospitals and clinics in Gaza in an effort to directly help the people there and to bring attention to the ongoing humanitarian crisis that the Israeli blockade has created. She will be sending back reports from inside the Israeli blockade.



The stories we are hearing as we go about our work are full of great sadness and often, great courage. This week marked the commemoration of The Nakba (Catastrophe) – the time 62 years ago when hundreds of thousands of Palestinians were driven from their homes as the state of Israel came into being.

Now, while the siege continues, these stories most frequently reflect the pain remaining from the thousands of deaths, tens of thousands of injuries and countless destruction resulting from the December 2008/January 2009 attacks by Israel on Gaza.

In the Women Empowerment Clinics we hear of families who narrowly escaped prior to the total destruction of their homes. We listen as stories of the death of mothers, fathers, sisters and brothers are related. In these clinics, the “Post Traumatic Stress” treatment includes group sessions, physical exercise, personal counseling and mind/body care. Across Gaza, there are projects of healing, but the hovering trauma in the population of Gaza is nearly universal.

Today, several members of our delegation were treated to a visit to a very special place: The Qattan Centre for the Child is directed by Reem, a brilliant woman of purpose.

During the summer, this center hosts 1,000 children per day – children using the library, doing art projects, learning about science, learning to use computers, participating in theatre productions.

The facility was funded by one individual – believing that education of children is the most essential need for a successful community.

This summer, UNRWA will again host the Summer Games for approximately 250,000 children of Gaza. Living only miles from the sea, some participating children will be seeing the Mediterranean for the first time. Swimming in the sea, however, is prohibited due to sewage pollution.

Bombing of Gaza’s infrastructure and prohibition of repair of these facilities due to siege restriction of supplies entering this land mandates that no one swim in the coastal waters of Gaza.

As we travel through Gaza City, we see an occasional new car. These cars enter the Gaza Strip through the tunnels from Egypt. We will visit these tunnels on Friday.

As she did last year, Gerri has organized a Washington Physicians for Social Responsibility delegation of doctors and other health care providers to work in hospitals and clinics in Gaza in an effort to directly help the people there and to bring attention to the ongoing humanitarian crisis that the Israeli blockade has created. She will be sending back reports from inside the Israeli blockade.

The universal trauma to the people of Gaza continues to be central to the lessons we are learning.

The medicines we brought with us to the Gaza Community Mental Health Programme were received warmly – so many medicines are in short supply here.

The level of unemployment is very high (39% or much more) and we are learning of small businesses that are in development – attempts to provide family security in an insecure environment.

We are continuing with clinic and hospital work – and expanding our connections with the work going on in this imprisoned land.

Dr. Don Mellman, neurosurgeon and mediator, writes that today he assisted the project director and field directors of the non-governmental organization, Sharak, with their student project between two universities. Students from the Islamic University (Hamas) and Al Azhar University (Fatah) are working together to create dialogue, reconciliation and national unity. The project is funded by UNDP and the Carter Center.

This afternoon, most members of our group visited the Islamic University and were treated to the end-of-the year senior science exhibits. Delightful creativity and hope were built into projects designed to improve automatic irrigation, mobile test-taking, emergency phone dialing, home security systems, jar sealing, home lighting control and dozens of others.

One recent student (now working with the Gaza Community Mental Health Programme) related how, during the Israeli Operation Cast Lead (2009), she survived emotionally by concentrating fully on her studies – preparing successfully for the examinations that were delayed due to the bombing. She described walking around with her book in her hands, studying while the bombs fell – determined to succeed.

Again and again, resilience.

Our group: Physicians: Richard Grady, Pediatric Urology; David Hall, Child and Family Psychiatry; Laura Hart, Urology; Robert Haynes, Cardiology; Donald Mellman, Neurosurgery; Howard Putter, Orthopedics. Minister/counselor: Anne Hall. Nurse consultants: Debra Goff, Gerri Haynes.

For the next 9 days, Gerri Haynes will be sending back reports from inside blockaded Gaza. As she did last year, Gerri has organized a Washington Physicians for Social Responsibility delegation of doctors and other health care providers to work in hospitals and clinics in Gaza in an effort to directly help the people there and to bring attention to the ongoing humanitarian crisis that the Israeli blockade has created.

Working today in Gaza. In clinics and schools and in operating rooms, we are hearing from the people of Gaza about life under siege.

Pictured here: Debra Goff, oncology nurse from Seattle, who is consulting with the oncology team at Al Shifa Hospital in Gaza City and witnessing people who will die early for lack of the supplies deemed essential for current cancer care.

While the work for patients diagnosed with cancer is heroic, the treatment center lacks pain medicines, nutritional supplies, chemotherapeutic agents and radiation treatment facilities.

The presence of a cardiologist, a neurosurgeon, two urologists, a psychiatrist, and an orthopedic surgeon in our delegation was advertised in the local paper. People of Gaza are self-referring to be seen while we are here and the list of surgeries to be done in the next week is growing.

In the classes I taught at the Gaza Community Mental Health Programme today, we talked about the ongoing nature of traumatic stress – calling this “Continuous Traumatic Stress Injury”, rather than “Post Traumatic Stress Disorder.”

Resilience and care for each other from their community are essential parts of a society that is in a daily struggle to survive.

Personnel from the Gaza Community Mental Health Programme are providing ongoing assistance in refining our schedule for this visit – as new opportunities to meet and serve arise.