Finding creative uses with limited resources in Palestine

AFOPA members Dr Francis Nathan (Ophthalmologist) and Merlin Nathan (Occupational Therapist) report back on their recent visit to Palestine, 28 Oct.-3 Nov. 2017, with the Palestine Children's Relief Fund (PCRF).

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Dr Francis Nathan, Opthalmologist
Rafidia Hospital, Nablus (West Bank)

As usual, it was a pleasure to go back to Rafidia Hospital in Nablus on a PCRF (Palestine Children’s Relief Fund) eye surgery mission.

Dr Francis Nathan in surgery, Rafidia Hospital, Nablus (West Bank, Palestine)

Dr Francis Nathan in surgery, Rafidia Hospital, Nablus (West Bank, Palestine)

Fifty (50) patients were operated on for cataracts (clouding of the natural lens in the eye), all receiving lens implants. One patient developed a complication with an infection and was referred for urgent investigation and treatment to the University Eye Department, which fortunately resulted in a good outcome.

I was pleased to have met with Dr Khalid Abughazaleh, the chair of the PCRF Medical Board, who was leading a maxillo-facial surgical mission to Nablus, and Dr Hamdi Nabulsi, the Director General of Hospitals in Palestine.

We discussed, in more detail, the procurement of a phaco machine for cataract surgery, which would enable the surgery to be done through a much smaller wound and facilitate earlier recovery. I hope to be able to use the machine on my next visit, as the understanding was that the purchase of the machine has finally been approved. It would also require planning for teaching and instruction of surgical and nursing staff before and during the next visit.

I was also able to use the new operating microscope that was donated from Australia with the help of the previous Australian Representative for Palestine, the Hon Tom Wilson. Although the machine was donated some years ago, the microscope had been loaned to another department to fill an urgent need. The microscope was still functioning well and was used for the whole project.

A donation of a set of microsurgical instruments was facilitated by private donors from Adelaide who have opted to remain anonymous. This was handed over to the Director of Nursing at Rafidia Hospital in Nablus.

We are most grateful to AFOPA (Australian Friends of Palestine Association) for their financial contributions to assist this mission by myself and my wife, Merlin (read Merlin's report below). We were pleased that we were able to send a video message from Nablus on 4th November to the AFOPA Annual Dinner.

The mission was successful due to the usual high standard of preparation by Dr Anan Matar, head of the eye department in Rafidia Hospital, and the diligent help from the nursing staff viz. Shifa, Ayeshah and Rouba.

Dr Francis Nathan
Ophthalmic Advisor, PCRF

> Read PCRF article on Francis's working visit to Palestine.



Merlin Nathan, Occupational Therapist

Occupational Therapy Service Development

Rafidia is an outstanding public hospital which I've had the privilege of working with for the last four years. This hospital, with its wide regional reach and responsibility, will surely be striving to meet or achieve accreditation. As PCRF seeks to provide state-of-the-art equipment for the development of Ophthalmology Services, I am seeking PCRF assistance in working to establish, hopefully with the support of the Palestinian Ministry of Health, a Multi-Disciplinary Allied Health Service within Rafidia Hospital’s confines.

Our favourite foundation, the PCRF, is not only a service delivery organisation, but also one that encourages developing a recognised, accredited and prestigious institution for the population it serves.

In this report I hope to strongly support in the relocation of the Occupational Therapy services (as the physiotherapy department has to expand), to establish the beginnings of a Speech Therapy/Social Work service together with Occupational Therapy.

These Hospital services need to develop a trans-disciplinary model. This will be the first to be established in the Palestinian public health system and possibly in the region. This model requires shared spaces, rather then separate, isolated departments, to promote close teamwork and interrelated treatment plans to achieve optimal client goals.

I would like to propose we work with PCRF through Mr Steve Sosebee, Dr Khaled Abughazaleh and Palestinian Ministry of Health representative Dr Ahmed Hamdi, to support this recommendation. If this is within the purview of PCRF mandate, I would like to assist in any way I can.

Private children’s therapy/rehabilitation centres in Tulkarem, Nablus and Salfit.

The Palestine Children Relief Fund (PCRF)  coordinators, Hana Abdeen and Sawsan Soufan, had arranged a visit to a number of centres in the north of the West Bank.

I had the enviable opportunity of meeting a number of motivated Allied Health staff, Physiotherapists, Social Workers and Speech Therapists, very keen on interchange of ideas, learning and interaction.

We had the opportunity to discuss a whole range of rehabilitation paradigms, specific treatment options and outcomes. Short individual reports were provided for some 15 patients.

Patient Case File: Child, 9 years old

Diagnosis: non-verbal due to total hearing loss, has hearing aids but non-compliant

Concerning Behaviours reported by Social Worker and Occupational Therapist:

  1. Excellent social skills, able to attend and participate.
  2. Able to hold a pen though grasp is very weak and poor quality; able to copy name.
  3. Lacking in hand dexterity and strength.
  4. Poor posture and upper trunk/upper extremities weakness.

Possible Occupational Therapy/Language related goals:

  1. Develop a written communication strategy program with Speech Therapist.
  2. Bilateral eye-hand coordination skills training as demonstrated.
  3. Demonstrated upper body posture alignment and strengthening exercises for correct seating/sitting tolerance.

Visit to the Occupational Therapy School, Arab American University, Jenin

I had the opportunity to be involved in three classroom presentations run by Adel Nader H Abuhammad. The very keen and enthusiastic students were provided a clinical perspective to the subjects covered. These were Rheumatoid Arthritis and Burns, Pain and Behaviour Management as a strategy. 

Merlin teaching a class at the Arab American University, Jenin (West Bank, Palestine)

Merlin teaching a class at the Arab American University, Jenin (West Bank, Palestine)

As the students had little or no clinical placement we had to draw on their personal experiences and the opportunity to practice ‘reflection’, an important skill in continuing professional development.

We discussed the importance of Burns Prevention, post-surgical infection prevention and developing resources for public education.

We also discussed the wide variety of current pain management strategies from pharmaceutical dependencies to alternative practices of relaxation and mindfulness.

Mentoring third-year Occupational Therapy students on placement at Rafidia Hospital Occupational Therapy Department