Building a future for limb reconstruction in Gaza

Presently about two million people are in need of humanitarian aid in the occupied Palestinian territory.  Lifesaving treatments are hard to come by and the supply of medical amenities is always delayed, so is the training of medics.  According to the WHO’s latest report[3], ‘at least 30 hospitals, 70 primary health care centres and a blood blank are at risk of full or partial closure due to continued power outages’ yet fuel for generators is inadequate.

Movement is highly restricted for both people and essential medical supplies.  For two physiotherapists from AL-Shifa hospital in Gaza, after applying for visas to come to London and getting them, it took them two years to finally head for London.  At the Rafah border in Egypt, which opens once every 40 days, only one, Qasim[4] was allowed to proceed to London.

The THET funded partnership[5] between King’s College Hospital, London and Shifa Hospital, Gaza has for the last two years supported the development of trauma care services in Gaza, with a particular focus on the newly established limb reconstruction service. Qasim spent two months in the UK developing her skills and knowledge of limb reconstruction. In this piece she gives us an insight into her travel, love for physiotherapy, and the skills and knowledge she gained.

I am a limb reconstruction physiotherapist. Our team in Gaza were visited by a physiotherapist from King’s College Hospital which piqued my interest. We discussed [with them] patients’ cases and how best to treat them. This gave me new experiences and I became better able to support limb reconstruction patients.  Prior to this I was practicing general orthopaedics.

In Gaza we are always at war and we receive many injuries. The people are very depressed and frustrated and life continues to be very difficult. We do not have electricity, and all borders are closed around us. While elsewhere people can afford the luxury to get treatment from abroad, this is impossible in Gaza. Despite having funds, patients are grounded and it is upon us to treat them. These patients need qualified physiotherapists with specialist skills, as limb reconstruction is a long and complex process with many stages, right from the patient’s admission until they are discharged.

Unforgettable Patients

On a weekly basis we receive up to ten patients in the unit. In the King’s College team mission for Gaza sometimes we see forty patients a day.  From these, we have to choose the most complicated cases to work with.  All patients touch my heart but there are some outstanding, unforgettable cases. I vividly remember a lady who was injured during the last war. She lost her husband, two brothers and all of her children. The first time I saw her in the wheelchair, she appeared to be dejected and was also partially blinded. This tore at my heart. Her leg injury was complicated and when she went to Israel, the prognosis was to amputate the leg.  Fortunately our colleague after the limb reconstruction project, worked with her and she can now walk.  Seeing her walk was amazing.

When I do anything for these patients and do it well, I am always proud of myself.

Back home, the team is amazing although we are very few.  Unfortunately one of my colleagues with whom we were to travel was denied entry to the UK at Rafah.  He missed out on the opportunity I received from King’s.

Being a first time traveler to Europe, I wanted to return to Gaza with him but he insisted that I come. “No. Go”, he said.  I am glad I came.  I am now tasked with sharing my skills with colleagues when I return.

A shortage of equipment

In Gaza we work in a similar manner to King’s but there really is a huge difference in working conditions. For example, we have a shortage of rooms. As a physiotherapist I need a gym in the inpatient clinic for patient exercises but we don’t have one.  Additionally, the hospital’s environmental hygiene is wanting so we are at a higher risk of acquiring hospital infections, health workers and patients alike.

Also here [in the UK] you can find everything; crutches and all assistive devices are available. But in Gaza sometimes there are shortages in assistive devices, like splints for patients with lower limb injuries. Sometimes without these, our job is difficult. I will try, when I go back, to get another room and redesign it as a gym for inpatients. This would be very helpful for the patient, helping them to build up their muscles, range of movement and get back to their normal life. When I return to Gaza I will definitely share the skills I have learnt with my colleagues.

During my time at King’s we have had weekly skype meetings with the team in Gaza, who have been sharing patient cases with the King’s team.   We have no specialists in physiotherapy in Gaza, and we could be the first with my other colleague, to be limb reconstruction physios at Shifa.  Moreover, I didn’t know anything about nursing skills and removal of the frame.  This was the first time for me to touch the frame and to work with the patient in adjustment and mobilisation including talking to the patient about modifying their home environment. Watching all this interaction and work by King’s physiotherapists felt like a dream come true.

Looking forward

I made time for fun as well.  I went to Big Ben, to the London Eye and I enjoyed a boat ride to Greenwich which I only ever read about while in school.  I went to Hyde Park too and I am amazed by the green spaces here and freedom of movement.  I hope all people in Gaza can know the meaning of freedom one day.  More importantly, is that when I go back to Gaza I can contact people from Kings College when I am met with any hurdles.

As a limb reconstruction specialist now, I want to be an agent of change in medical care.  Firstly, I want to mitigate the dependency on machines, shortwave and ultrasound at the hospital which I now understand to be passive treatment for the patients.  With my colleagues, we must redesign our department as a gym and work with the patients using our manual skills.  Of importance too, to the physiotherapists, is the patient’s education which I will initiate as it can save us time when patients make less frequent trips to the hospital.

I also continuously cheer on my team by reminding them that we are now qualified as physiotherapists and in a position to help our patients amidst this very complicated situation in Gaza.  Now more than ever, I am grateful for my newly acquired skills and knowledge in limb reconstruction.

(Heading) https://search.proquest.com/openview/3ac1e2db7e3d86292172fe642edd7446/1?pq-origsite=gscholar&cbl=27835 and https://www.unrwa.org/activity/health-gaza-strip

[3] http://www.who.int/hac/crises/international/wbgs/en/

[4] Not real name for security purposes

[5] http://www.ideals.org.uk/_files/WEBSITE-LIMBRECONSTRUCTION.pdf