A researcher's note from the December 2011 mission

I am a 4th year medical student at the University of North Carolina at Chapel Hill interested in public health and Palestine. I have been developing a congenital anomalies database for the past several months in order to meet three primary goals: (1) to determine the incidence and prevalence of congenital anomalies in the West Bank and Gaza; (2) to help understand the causes of such anomalies in the Palestinian population; and (3) to lay the foundation for a nation-wide health care registry.

During the December 2011 Palestinian Cleft Society mission, I administered this congenital anomalies database for the first time. This pilot involved interviewing the parents of patients undergoing surgeries by the team. The patients were primarily children with congenital anomalies, such as cleft lip and palate, as well as microtia. Many of the children had speech difficulties and some were syndromic, having an array of other major health issues. My pilot will hopefully help me assess whether or not I am collecting quality data. I intend to maximize the quality of the data I collect in order draw accurate conclusions regarding congenital anomalies in the West Bank and Gaza.

During my time in the West Bank, I interviewed the parents of patients using a 500-question survey. I conducted these interviews in Jenin and Hebron Governmental Hospitals. I asked questions regarding the health status of the patient and his or her family, and learned a great deal about the socio-cultural elements that affect health and health care access. In the setting of military occupation, I learned that many of the patients struggle to receive care for the treatment of complex conditions such as cleft lip and palate. For example, prior to the founding of the Palestinian Cleft Society (PCS), no Palestinian providers were trained to treat clefts. As a result, patients had to travel to surrounding countries in order to receive essential care or wait for foreign surgical teams to provide this care. Those patients who were unable to afford the expense of traveling for care often lived with their disfiguring conditions. PCS is helping close a gap in health care in the West Bank, but there are still many vast gaps that need attention. Yet many of these gaps are a consequence of the occupation, which limits resources available to Palestinians and restricts patient ability to travel.

My interviews illuminated many environmental factors that may play a role in the development of congenital anomalies. When querying parents about toxin exposure during pregnancy, several mothers admitted to major gas inhalation during pregnancy as a result of political conflict. Additionally, many of the parents live in villages or refugee camps, which largely rely on rain as their primary water source. I also found that amenities such as heating and air conditioning, which are present everywhere in the United States, were infrequent within the sample of parents I interviewed. While a lot of these environmental concerns are not surprising, I believe that it is important to document them in order to study whether or not they affect the health status of a pregnant Mother’s unborn child.

While I was able to conduct 47 interviews and to train local staff to conduct interviews, I found that my time in Palestine flew by too fast. I was overwhelmed by the warmth and kindness of the people I encountered. I was repeatedly humbled by the commitment shown by the Palestinians working with children with congenital anomalies. The health care providers worked long-days and showed tremendous compassion towards their patients. The team worked together to perform over fifty surgeries in two and a half weeks. This meant that the surgeons were in the operating room for about twelve hours a day and the speech pathologists were working with patients throughout that time. All of the providers worked hard with the shared goal of providing essential care for Palestinian children in need.

During my time in Palestine I learned most from the people around me and I look forward to my return in May.