Dr Jane Bates, Dr Mhoira Leng and Dr Tony Jefferis describe their palliative care teaching visit at the Islamic University of Gaza.
A group of 130 boisterous medical students greeted us in a slightly cramped classroom: girls on the left, boys on the right. I was part of a small team headed by Mhoira Leng and Tony Jefferis on a Cairdeas International/Global Health Academy, Edinburgh University visit to the Islamic University of Gaza (IUG), which took place in October 2018. Mhoira and Tony have visited several times over the past five years to support undergraduate teaching and see how palliative care can be developed locally. In recent years, entry to Gaza has been very restricted, necessitating considerable preparation of documents and processing of border permits prior to travel. This visit was facilitated for us by the Palestinian Children’s Relief Fund (PCRF).
On arrival we met the Dean and the lead for palliative care, Dr Khamis Ellesi, and set to work with classroom teaching, which took place each morning on the campus at IUG. Topics included: introduction to palliative care, communication skills, breaking bad news, pain assessment and management, symptom management and self-care. The classroom context was very familiar, though the rapid expansion of medical student numbers at IUG meant that we had to think on our feet to keep control, especially during some of the more interactive sessions. Afterwards, we transferred for small-group bedside teaching at European Gaza and Al Rantisi hospitals in Gaza City.
A specially arranged ‘scientific evening’ attended by local faculty, students and officials from the Ministry of Health provided a focus for the commemoration of World Hospice and Palliative Care day with presentations by students on pain audits they had completed. Mhoira and I spoke about our own palliative care research.
Impact of current situation on patients and families
The broader impact of the current situation in Gaza became more apparent as we listened to the stories of patients and families on the wards. An emaciated 30-year-old man with a massive bony tumour had been using intravenous boluses of morphine as the only available option to get some relief from his pain – that was, until it had run out. His mother expressed her distress saying,
“Now I am the morphine my son needs. I go to the pharmacy every day to see if it is available, but I come back without it.”
Many patients were waiting in hospital during the long delays for radiotherapy and other treatments, despite these being available less than two hours’ drive away in Jerusalem. The Gaza-led steering group for palliative care, which includes Mhoira, is working to develop improved programmes and engaging with hospital management, Ministry of Health officials and the World Health Organization to help move this situation forward.
Despite huge challenges, hospitality in Gaza is warmly expressed and courteous – involving the drinking of frequent small cups of strong Arabic coffee (made with cardamom). It was my first experience of being served coffee whilst delivering a teaching session! As we left, we encouraged our colleagues at the medical school to develop a palliative care interest group amongst the students to support sustainability and interest amongst future medical graduates. Though our time at IUG seemed short, our hosts were grateful for the support we gave by visiting and teaching together. We hope and pray that access to quality palliative care (including appropriate pain medication) will soon be the norm for all who need it in Gaza.
More about the authors
Dr Jane Bates is a palliative care doctor based in Malawi. Contact Jane by email.
Dr Mhoira Leng is medical director of Cairdeas International Palliative Care Trust and senior advisor for palliative care to Makerere University in Uganda. Contact Mhoira by email.
Dr Tony Jefferis is a retired ENT (ear, nose and throat) surgeon and a member of PRIME International.
Coming soon on the EAPC Blog – Dr Mhoira Leng will be writing more about palliative care in Palestine …