Cherie's Jordan: The Palestinian Refugee Story

UNRWA Photo Exhibition: What You Don't Know About My Life

Sun, 24 Jul 2011 17:12:19 +0400

Last week, two other UNRWA workers and I were able to go see the UNRWA Photo Exhibition that finally made its way to Jordan Field. The photos told a story of their own and I wanted to share them with you all.

Many of the pictures refer to the Gaza Blockade placed by Israel in 2007. The siege, which was supposed to weaken Hamas, has actually devastated Gazans’ everyday lives and strengthened Hamas. Gaza’s unemployment rate is at a staggering 45.2%.

To learn more about the Gaza Blockade, read through the BBC’s breakdown of what’s allowed in (and what’s not) under the blockade. For example, since 2008, the power plant has received enough fuel to operate at only 2/3 capacity.

Life in the camps as shot by the people who know them the most. The last post showed the top 3 and here are the Honorable Mentions:

This photo essay shows some images from the street corners and the alleyways of the Gaza Strip, capturing the suffering of its people under the siege imposed on them. Most of Gaza’s residents live below the poverty line. These are only five pictures out of the millions of untold stories.

Bilal al Talawi, 19 years old. Khan Younis, Gaza-Palestine.

I carry a lot inside me. The lens of my camera is full of love for Gaza and its people. There is a story to each photograph. Wandering with camera through Gaza’s alleyways, I document the suffering of the Palestinian people, and the suffering of the refugees, especially as I am a refugee myself. With my pictures, I try to show this suffering to the world.

Wisam Salameh, 20 years old. Gaza-Palestine.

Some other snapshots:

First Place: Hadeel Al Ramli, 23 years old. Gaza, Palestine This...

Sun, 24 Jul 2011 16:27:00 +0400

UNRWA Photo Exhibit

First Place: Women in Gaza Prison

Second Place: From My Window, Bethlehem

Third Place: Syrian Refugee Camp

First Place: Hadeel Al Ramli, 23 years old. Gaza, Palestine

This photo work documents the daily life of female prisoners in Gaza Central Prison. It aims to show the relationship between them and the police officers. Most of them were accused of robbery and prostitution, caused by extreme poverty and the deteriorating social situation resulting from the Gaza Blockade.

Second Place: Kholoud Al Jarma, 24 years old. Aida Camp, Bethlehem, Palestine.

Three generations or more of refugees live in Aida refugee camp today on the same space rented by UNRWA over a half century ago. From the windows of our small houses we see overcrowding, walls, dark, narrow alleys and children playing in the streets.

Third Place: Abdul Rahman Abu Lahan, 25 years old. Damascus, Syria.

It's officially been two months in Amman and now it's time to say my goodbyes

Sun, 17 Jul 2011 14:54:05 +0400

I’m going to be cliche for two seconds: looking back, my internship experience was nothing of what I expected, and yet everything I needed it to be. Okay, had to get that out of my system. I officially finished up at UNRWA last Sunday (turned in my computer access and desk space, though managed to keep my badge as memorabilia). Two months ago, I had passed by that office several times in earnest when I thought my project was going to fall apart before it even began. You see, I had been talking to a doctor in UNRWA’s health department for a couple of months about working on a project to quantify the levels of diabetes and hypertension in the camps. However, instead of preparing at least a basis for my project ahead of time, the doctor thought it would just be best to put forth a verbal agreement and figure out what I could do when I got over here. Let’s just say that wasn’t the best idea. I arrived to find the head of the department telling the doctor (my adviser) that there was already an ongoing project on diabetes and hypertension…awesome. So what could I do? My family convinced me to show up to work despite not having a project (btw UNRWA work days start at 7:30 AM) and there were several days that I went home empty-handed and incredibly upset. However, it was their persistence that eventually pushed the doctor to link me up with the adviser and project I have (had?) now. Working on the Health Reform project showed me an entirely different side of medicine—health care’s role in bettering an entire community, and not just an individual’s heath. Working at the health clinics proved the importance of focusing on primary health care and ensuring that the people served are informed participants. If there were anything I wish I could stay longer to work on it would be UNRWA’s health education initiatives. I can only imagine how strong their impact will be when patients are more aware of how to prevent certain illnesses and better manage non-communicable diseases. Working at UNRWA on a whole has also made my views of the UN system more realistic—it’s an incredibly bureaucratic system and yet its services are incredibly essential to the population it serves. While the management structure of UNRWA surely doesn’t lend itself to a lean and efficient managing system, its actual managers stand as the most important factor to the efficiency and success of the organization. My adviser can make things happen regardless of the excess “red tape” and formalities that exist in the UNRWA system—good leaders can still make things happen. However, resistant leaders can make change incredibly difficult, especially those leaders that see any change as a criticism of their leadership. I think both types of leaders exist at UNRWA and at times they balance each other out. I think the biggest challenges UNRWA faces is opting for cosmetic change over real change, because it has to both satisfy donors and complete the job it was mandated to do. (http://www.friendsunrwa.org/about-unrwa/mandate) Ultimately, my time at UNRWA has confirmed why I want to go into medicine. Beyond the scientific aspect of medicine, there’s an incredibly crucial social aspect. While I was interning at UNRWA, I realized that knowing how medicine works and how doctors view their patients and their services are important factors to supporting community health development. On the other hand, just understanding medicine doesn’t equate to the success of community health, one must understand how patients view their health and also have a strong understanding of health service administration. I’m not entirely sure how this translates career-wise, but I’m sure that my future path has been affected (positively) by my time at UNRWA. Now, two more weeks in Amman and I’m heading back home :)

Camp Youth Asked to Create Art for Health Education

Sun, 03 Jul 2011 21:54:00 +0400

This past Wednesday I went on one of my most memorable meetings at the refugee camps. Instead of meeting with the usual senior medical officers or medical staff, I had the opportunity to meet some of the most talented Palestinian youth.

After traveling about an hour and a half (much thanks to the constant rush hour in Jordan), we arrived at Zarqa Camp, the oldest camp in Jordan built to accommodate refugees who left Palestine in 1948. The camp houses over 20,000 registered refugees and is facing some major problems that include:

* Shelters need upgrading

* High unemployment rate

* Lack of sanitation labourers

* Sewage network needs upgrading

* Accumulation of refuse from construction

* Relocated refugees living in rented houses

(http://www.unrwa.org/etemplate.php?id=130)

We drove through a packed road that was filled with a mini-souq (marketplace) that some refugees had put together in front of the health clinic. I’ve seen mini-souqs set up in front of all of the health clinics I’ve gone to, which may be because the health clinic is so frequently visited by so many people that it’s seen as a hub of activity.

Eventually, we pulled into Zarqa Elementary School built in 2009 thanks to a donation by the US government.

Inside, Lama (16 years old), Shorouq (14), Ayah (16), and Ahmed (15) were waiting inside the school’s library with their parents and the director of the camps’ art program. What was so awesome about our meeting was that it was completely bilateral. We wanted their input on how to best convey messages about healthy living through art as much as they wanted to hear from us.

Basically, here’s the plan: UNRWA wants to improve its health education outreach efforts to the refugees. Currently, the health clinics see many people falling sick from the same illnesses (sore throats, the flu, and other communicable diseases) that can be prevented through improved health literacy. We also see a huge problem with chronic illnesses such as diabetes, hypertension, and the million side effects from smoking.

My supervisor and a Project Officer in the Relief and Social Services Department (Jeff, an Australian who along with his wife left the comfort of their home to volunteerwith the UN) thought it would be great to tap into some of the camp’s natural talent and insight…and I totally agree.

Lama, Shorouq, Ayah, and Ahmed are all extremely talented young artists who use their art to convey strong messages (from gender discrimination to patriotic messages, and now, to the importance of healthy living). The project would be a year-long one and one that Mr. Jeff would like to see reach into the art classes at schools where students would tackle the health issues that most plague their camps. The one issue the students we met with wanted to face first: smoking.

Earlier this summer, I posted a statistic that showed that 93% of kids had smoked a cigarette before the age of 14. Smoking is a HUGE problem, not just in the camps, but in Jordan in general. Everyone and their mother smokes (literally).

Now, I don’t want to get too off-topic, but sometimes (when I have nothing else to do) I turn on the TV to watch “The Doctors,” a “medical” talk show that basically makes you say, “I can’t believe they convinced me to wait until the commercial break just to hear that.”

Well, on one episode (that was actually worth watching) the main doctor (the one dressed in scrubs to convince us that right after the show he’ll be back performing surgery in the ER…oh and he’s also a Vandy Med grad) makes a surprise home visit to a family with a grandmother who smokes and a child who suffers from cystic fibrosis. Long story short, the doctor convinces the grandmother to quit smoking in order to prolong the life of her grandchild. I hope it sticks, but beyond that their story really made me realize how effective America’s war on cigarettes has been—just comparing the prevalence and social stigma of cigarettes now to the 90’s is remarkable. (note: it wasn’t really the doctor’s actions that convinced me how effective the campaign has been more than it was just realizing how unconventional such stories are becoming in the US)

Well (back on track), those students had the insight to know one of the most potent targets used against cigarettes: making cigarettes lose their glamor. Their goal is to create a series of drawings that will be used by UNRWA and its health centers as posters, in brochures, newsletters, and even online to get the word out against smoking.

UNRWA wants to start displaying their work in a “Ramadan Special” (which starts in August) and hopefully continue throughout the year with different topics. The students may even create special characters for their series! Meet UNRWA’s new superstars!

Sensing Progress

Sat, 25 Jun 2011 14:24:05 +0400

I love the days that I’m at Marka camp. Honestly, I’d choose a day in the camp over a day in the field office anytime (this may be biased by the fact that I have to work on my report when I’m at the office). It’s true that the ideas and a lot of the planning happens at the field office, but it’s at the camps where you see those ideas come alive. Even just thinking about when we we’re merely talking about the appointment system versus seeing it in place at Marka, it’s a completely different experience. Whether the days at the camp go really well or really badly, the experience still always reinvigorates and re-inspires us.

One of the reasons that I’m so lucky to be working under my supervisor, the Head of Health Reform, is her strong belief in staying close to her project. True, the department of transportation to the camps always pleads with her to give them more notice in advance (my boss is known for requesting a driver less than 24 hours beforehand), but I think our visits to the camp have made the difference in the progress I’ve witnessed. I’ve met some staff who rarely go out to the camps they have projects in and it risks making their work almost too theoretical…too disconnected from the realities of the camps, which can hinder their impact. Meanwhile, my boss’ visits force her to constantly adapt and refine her plans to fit the context or emerging problems at the camps.

That being said, you can imagine my excitement when we visited Marka last week and things just seemed to…work! The appointment system is nearing upon a month since it was first implemented, so still very new, but its effects already seems present. Walking into the clinic, huge crowds of people were replaced with a trickle of people at the front desk and a modest number of people sitting in the waiting room waiting for their numbers to flash on the screen above the doctor’s room. Kids seemed way more interested with watching the cartoon on healthy living than turning the health clinic into a playground.

We met with the doctors to introduce the new checklist that would gauge how thoroughly doctors were examining their patients. Doctors seemed more receptive than ever and their questions only tried to make the checklist better, versus questioning its value.

Before I get too ahead of myself, there’s still a lot of work left to be done at the clinic. My supervisor wants to see a higher number of patients request appointments for a later date and to see a drop in the rate of antibiotics prescribed to patients. Health education initiatives that we want to see at the clinic include recruiting and training “health ambassadors” from the community that can speak about topics ranging from smoking to diabetes to obesity. Regardless, just watching the clinic function that day with much greater ease than I had seen before made me feel incredibly lucky to witness this reform process. Can’t wait to see what this next month brings!

Today is World Refugee Day

Tue, 21 Jun 2011 00:49:00 +0400

Today is World Refugee Day:

Palestinian refugees are the world’s oldest and largest displaced community, but they’re not the only ones. Here’s a great link to learn more about the world’s refugees.

Dear World, Today I'm Mad.

Mon, 20 Jun 2011 00:58:25 +0400

Today I’m mad. I’m mad because the President of the World Chess Federation (Kirsan Ilyumzhinov) somehow justified to himself that playing chess with a mass-murderer (Muammar Gadaffi, Libyan dictator) who couldn’t care less about the blood of his own people is okay.

I’m mad because Bashar Al-Assad (Syrian dictator) has created a rapidly-growing refugee population made up of his own people, despite the fact that his country is already responsible for the welfare of over 467,000 refugees from Palestine who are spread out over 12 camps. (For the record, his displaced countrymen are now housed in tents provided by Turkey).

I’m mad because politics-of-old in Egypt have resurfaced and has censured voices that critique the military government, thereby turning a blossoming Arab Spring into what looks like a winter of suppression.

I’m mad because for some reason we still live in a world where the voices of the majority can still be brutally challenged by an oppressive and out-of-touch minority. It’s upsetting to think that the actions of Al-Assad or Gadaffi can be interpreted as the mindset of Arabs or Muslims. Hey, the ripple effect is going so far that even Herman Cain (Republican candidate for President just said that he’d be “uncomfortable” with having a Muslim in his cabinet unless they went through a loyalty test). And that’s just for American Muslims! What would he think of an Arab/Muslim who grew up in the Middle East?

Finally, I’m mad because these dictators are putting the daily lives and growth of their countries and their people at a standstill for their own callous agenda. This even relates to UNRWA, instead of focusing its resources on the social and economic growth of the refugees, it now must reallocate its energy to ensure that even basic aid reaches refugees in Syria.

And for youth/young adults who dare to dream of a better future for their country, what message are they receiving when they have to expend more/if not all their energy fighting against their government rather than receiving support from it?

I wish I had a more positive message to convey, but today I’m mad. Today, I’m realizing how important it is that the foundation we often neglect to see or take for granted stands as high-principled and evenhanded. Otherwise, any change we try to promote for a problem can easily be stopped in its tracked, put at risk for sustainability, or raise high hopes while only delivering pocket change. In my case, foundation=a government and change=bettering the lives of refugees. What about the issues that you care about? How complicated is the foundation of that problem and how can that affect the work you want to do?

Becoming an Assistant Director Before the Age of 22...Checked off the bucket-list ;)

Wed, 15 Jun 2011 20:38:07 +0400

Okay, it’s not really as glamorous as it sounds, I just needed an eye-catching title.

As part of our reform’s latest effort to increase health education initiatives in Jordan’s 24 health centers, the group is creating a health promotional video that highlights the changes occurring under the new block appointment system.

We held our first “casting call” yesterday (read: asking various staff at the medical center if they were interested in being cast into main roles and recording short bits as they speak to remember their voices/mannerisms).

Shooting will start just as soon as the rest of the new queue system apparatuses are installed. (the Q-systems are the main part of the new appointment system which will assign people discrete times to meet with the doctors and are used by doctors to call in patients to come to their specific room).

Most importantly, the video will help put a face (literally!) to the new system at the health centers. Patients will see the new role of the clerk, how they can set up an appointment, and hear about the improved doctor-patient contact times.

The clinic, as it currently stands, offers very little educational material in the waiting rooms (despite the 2-3 hour waits). UNRWA has tried to address this by creating brochures explaining the new changes and providing educational videos (in cartoon form too!!) that explain more about healthy lifestyle habits (everything from family planning, to diabetes, to general health).

I’ll keep you updated!

Also...Home Demolitions displaced 67 children in East Jerusalem and Area C of the West Bank last month.

Tue, 14 Jun 2011 00:52:24 +0400

Also...Home Demolitions displaced 67 children in East Jerusalem and Area C of the West Bank last month.:

“Children often watch with their parents as their homes are demolished. A house is a place of safety and comfort for most children around the world. A home demolished is a future destroyed.”

When Your Local Clinic Becomes Your Biggest Social Outing

Tue, 14 Jun 2011 00:18:35 +0400

Despite the huge crowd of women sitting in the waiting room, the nurses still seem to recognize most women by face if not by name. I was surprised by their level of familiarity and thought I’d ask how they knew their patients so well (they could even predict exactly what complaint some of their patients would have). ”It’s incredibly easy to remember these people when they show up at our clinic so often!” It turns out that a significant number of women at Marka visit the clinic at least once, if not more, a week. Many come with many similar complaints (explaining how the nurses could predict so well)! According to Marka’s nurses, many factors contribute to the high visit rate:
1. It’s Free: UNRWA’s clinics are free of charge for all Palestine refugees. It’s a necessary undertaking given the grave financial situation of most refugees—add a charge and you add the risk of people only coming for life/death situations (not the goal of a preventive primary health care center). The flipside is patients who may show up for any and all complaints (which might also be due to a lack of comprehensive health care education). This could also explain why doctors are seeing so many patients in such little time (they’re seeing very similar cases over and over again). However, such a high number of minor complaints risks limiting the amount of time a doctor has to see a serious case (or cause him/her to overlook it altogether). *UNRWA is using the appointment system to avoid this problem.
2. No Open Spaces: Drive up and down the streets of Marka and you’ll almost never see two things: 1) open spaces and 2) meeting places. This is a major problem for youth, but it has also spilled over to the adult population. As untraditional as it sounds, the clinic boasts a (relatively) large waiting room for patients and their guests to catch up on each other’s news and escape otherwise cramped refines (most refugees live in 1-2 room houses with their entire family).
3. Health Clinic = Acceptable Outing: If your thought process is any bit similar to mine, you maybe be wondering if UNRWA has any initiatives to address the lack of gathering space. I asked the nurses why the women didn’t find another community setting to frequent. We pass the Women’s Training Center every day on our way to the clinic, why weren’t women meeting up there? Or, as a Muslim who grew up seeing her masjid as a central community center, I wondered if women would consider holding dinners or halaqas (informal religious education events). Well, it turns out for various legal reasons the masjids can oftentimes be closed between prayer hours and isn’t exactly seen as a community center. Moreover, the nurses reminded me that a halaqa isn’t necessarily as enticing as just catching up with friends. As for the women’s center, a more tender issue (for me) surfaced. Early marriage ages in the camps make education/training a less viable option for some women in the camps. Moreover, some husbands and fathers (and mother-in-laws) don’t like their wives/daughters spending much time outside the house (much to the chagrin of the nurses I was speaking with who were quick to say that their fathers/husbands didn’t hold this same mentality). “Others will talk” is the big worry, “that’s the culture in the camps.”
As a Muslim and a woman, it was difficult to see the same religious views that I use to justify my education path (college was a must, post-grad is an increasingly necessary next-step) could also be seen on completely different terms. However, my views on education weren’t built from just my generation. In fact, this debate is nothing new (nor is it restricted to the Muslim world). Looking back at my only family, my grandmother had just completed middle school before getting married. Her kids, however (especially her daughters), had to at least finish college before considering marriage. Something must have stuck because her son (my father) strongly believes that women should pursue as much higher education as possible. Stories like this exist both inside and out of the refugee camps (just look at the nurses I spoke with!). It’s important to realize that these women stand as the changemakers—they’re the permanent examples of how education can elevate a family’s status and still allow a woman to maintain a good reputation in her community. They can affect the cultural connotations of faith better than any outsider can. Some of the women I spoke to juggled several jobs to pursue a college degree. My conversations with them really made me realize that I would support investing in education over and over again.

Health Care’s Role in the Arab World’s Push for Democracy

Sun, 05 Jun 2011 23:46:29 +0400

When the “Arab Spring” bloomed across the Middle East, people responded that it had been a long time coming. The Arab world was plagued by a culture of privilege that overrode meritocracy and created a general sense of apathy from its ruling elites. Any pressure for change either from outside or inside was usually palliated by rulers paying lip-service to reform, often implementing things more for “show” than for real change. So when the Arab world rose up, it rose for sustainable and accountable change. The path to its fruition has been a rocky one and even Egypt, what many wished would be the beacon of the revolution movement, has suffered from a military regime playing the same politics of old.

Some people have actually asked whether or not the Middle East is “ready” for democracy (I’m tempted to believe that the only people not ready for it are its leaders). Anyone who shares such prejudice only needs to listen into the conversations that happen daily in the Middle East. Long before the revolutionary fervor, “ordinary” Arabs spoke of the need for increased accountability in their governments and a forum that would allow them to share their grievances with the people they elect to represent them. Sounds a lot like democracy to me. However, the realization of these dreams has been far from what democracy ostensibly looks like. Banned protests, continuous unrest and embroiled battles are quickly replacing the inspirational images we held of the quest for democracy in the Middle East. Before we give up hope, we should remember that most successful democracies suffered some major setbacks before becoming what they are today (even America underwent a civil war that divided its people in its formative years).

So what can “ordinary” people do to push for democracy outside of Tahrir Square? Or, to get more to the point of my post, what can health care do to promote democracy? UNRWA’s health care reform efforts represent what health care can do best: stand as a model of good governance. Buzz phrases include ensuring patient’s right to affordable health care access and holding doctors and their management accountable for health care services with high standards. Its reform efforts are pursuing the ultimate goal of a patient-centered approach versus merely service-delivery: meaning the doctors/health care centers work towards the specific needs of the patient and not just as medicine-dispensary centers. As the heads of the Jordan Field Office speak of creating guidelines to gauge whether they are working to the standards their people deserve and the Head of Health Reform (a woman) holds steady in her goal of seeing these posts transition from permanent positions to ones that are aquired and kept only through performance, I can see the parallels between their outlined goals and the aspirations of the people around them. When people see a model of good governance will they feel a desire to replicate it? If the UNRWA health care reforms turn out to be a brilliant success (patients are given adequate contact time with doctors, increased emphasis on health care education for informed patients, and physician contracts that are based on performance) perhaps this efficient model can propel similar smaller organizations to reorganize to follow a client-centered model. Likewise, as patients realize they are entitled to certain rights perhaps they will push to educate themselves in other areas (including their rights in government) and push for similar models from their leaders.

The Arab governments may be unready to embrace the reforms their people welcomed a long time ago, but that doesn’t mean we just have to sit back and wait for them to embrace the inevitable. Those who see the benefits of a democratic model (or even just a model of good governance) should find ways to implement it locally. For the youth of the Arab world who have more access than ever to vast amounts of knowledge, education may hold the key for making informed decisions on their country’s government model. Whatever the solution may be, it’ll be incredibly exciting to see how UNRWA’s reforms will impact the community it serves and give patient’s a central role in their health care system.

20% of Palestinian youth of GSHS have actually attempted suicide

Sat, 28 May 2011 20:20:13 +0400

Global School-based Student Health Survey: Palestine’s Numbers

During my first 3 days at UNRWA (last week), I attended a training seminar for new UNRWA physicians. One lecture really caught my attention. The GSHS is a survey (for children aged 13-15) developed by the World Health Organization (WHO) to provide data on health behaviors and help countries establish programs and advocate for resources for their youth.

You can find the questionnaire the kids filled out here. I’ve highlighted some interesting (and pretty grave) results:

10% of children described themselves as going hungry most of the time or always because of lack of food at home.
37% of children usually cleaned/brushed their teeth less than 1x a day
40-50% of children were physically attacked at least once a day
14-16% of students felt lonely most or all the time
17% were so worried about something they couldn’t sleep at night
20% of youth actually attempted suicide
93% of children have smoked a cigarette before the age of 14
67% of those have tried to stop at least once in the past 12 months
37.8% of students have skipped class before without permission
57% of students reported that most of their peers were kind and helpful
40% of students reported that their parents checked their homework
45% of students reported that they did NOT have a source of clean water in schools (Gaza only has salty sources of water)

There were plenty more statistics and I’ll try to find the results and get them to you all when I can! I don’t claim to be a politician, nor do I claim to fully understand the complex set of policies/agreements/history (on both sides) that have created this situation, but I do feel strongly in saying that they have had an effect on the youth of the camps. Instead of creating an environment where we can inspire children to be changemakers, peace-makers, and education-go-getters, we’re fostering a stagnant atmosphere where children can barely trust the stability of their tomorrow, let alone think of their future. It’s so integral that we invest in the future of these children and cultivate an environment where they are inspired to do more for themselves. In the very least, so that when policies/agreements take place that effect their future, they can be involved as informed participants. UNRWA has made children’s relief efforts a priority, but it’s still so difficult to see progress in an environment where there are so many factors that contribute to the poverty and desolation. What’s an education when there are bills unpaid at home and work beckons? What kind of environment does a school promote when its classrooms are worn down, rotten, and its restrooms unusable? Poverty is such a complex entity, a multi-faceted problem, that cannot be solved until all factors are addressed and tackled. I’m interested to see what other organizations and people are doing to address the many dimensions of poverty and what methods could be adapted to the Palestinian refugee setting.

Day 2 @ Marka Camp

Fri, 27 May 2011 15:20:18 +0400

http://www.facebook.com/media/set/?set=a.10150623520165077.686333.731950076&l=32c9c23e2d

I spent my second full day in Marka camp! ps-I OFFICIALLY have a project (minor problems plagued my first couple of days at UNRWA, but I’m now officially part of the health care reform team for the refugee camps!) My first step is designing a study to analyze current problems with visits to the major health care center at Marka. As UNRWA plans to shift from a curative-based health care center to a primary health care-based approach (PHC), visits to the center will need to be more systematized (all visits to the same family doctor, pre-planned & regular appointments, and electronic medical records for easy transfer between the family’s assigned medical team). Patients/clients (UNRWA has begun to use the term client to emphasize the preventive and “healthy lifestyle”-seeking aspect of PHC) mostly complain about terribly long waiting hours and extremely short contact time with doctors. Under the current system, patients are seen on a first-come-first-serve basis, meaning some come as early as 5 AM (clinic opens at 8) to ensure that they are seen by a doctor. FYI: the average time a patient spends with a doctor is ~2-3 minutes (probably barely enough time to catch their named, the short version of their complaint, and fill out a prescription).

The Health Field Department has decided to adopt an appointment/cue system to cut down on waiting time and increase contact time between patients and doctors. The cue system will time how long doctors spend with their patients and how many patients they see per hour slot. I’ve created a survey to collect concrete numbers of how long people are waiting, why they come to the health care center, and indirectly gauge the quality of the doctor’s services. We’ll check in as Marka camp eases into the appointment/cue system and finally conduct another survey after two months to see if we’ve had any improvements in waiting time and quality of services.

In the meantime, I had a chance to travel a bit through the camp today! I even visited a school today as the Associate Programme Officer at UNRWA completed a necessary inspection of the school’s facilities. The school (KG-3^rd grade) has a double shift to be able to accommodate all their students, meaning a set of students come in for day classes and another set come in for classes at night. Both day/night shifts have approximately 750 students each. We visited the first grade classroom that had 42 students to 1 teacher! This school was one of UNRWA’s newest (built just last summer) and offered some of the best facilities for refugee students (complete with a computer lab donated by the Polish government)! Even then, the school could still use some revamping, with many classroom supplies and desks looking like they were quite worn (and possibly from an older set of donated items). Check out some of the pictures from today’s trip! http://www.facebook.com/media/set/?set=a.10150623520165077.686333.731950076&l=32c9c23e2d

Health Care, Opportunities, and what the future holds :)

Tue, 24 May 2011 00:01:00 +0400

It’s funny how you end up in certain places/situations that you’d least expect. About this time last year, I was 100% sure that I would end up in Cairo, Egypt for a second summer crisscrossing the city on a quest to find the most innovative and progressive nonprofits run by Egyptian youth. A sequence of timely and (in effect) game-changing effects changed my aspirations for this summer completely. As the same Egyptian youth I interviewed took to the streets to demand more of their government and more for their people, travel restrictions increased and I quickly realized that Egypt was undergoing a much more important transformation that could only help the same nonprofits I planned to work with this summer. Per the advice of another Ingram Scholar and my professor, I found myself rediscovering a pipe dream that I never thought I could entertain seriously until this year for my Ingram summer project.

I had been researching the social determinants of health, the conditions that people are born into and live in that propagate health inequities. The World Health Organization defines it as a new way of looking at health care whereby it’s impossible to treat someone holistically without changing the conditions that are making them sick. Simple and genius in ideology, but much more difficult to attack in real life! I spent some time trying to see if this idea was manifesting anywhere in the Arab health care system and stumbled upon the UNRWA’s new health field initiatives. UNRWA is the UN-body that provides assistance, protection, and advocacy for the Palestine refugees pending a solution to their plight. I’ve always been extremely interested in learning about and even working with Palestinian refugees, those people who fled or were expelled from their homeland during and after the 1948 Israeli-Arab conflict. Thanks to Dr. Halasa, a professor at Vanderbilt’s Medical School, I was able to set up contact with UNRWA’s health field office and (long story short) here I am six months later working with their health care reform department! I’ll be working on their initiative to use e-health technology to improve health care services to the Palestinian refugees (streamlined appointments, improving doctor-patient relations by finding ways to ensure that doctors are spending enough time with their patients, and increasing both patient and physician satisfaction). It is estimated that doctors right now spend ~2.7 minutes with their patients and with the continuous overflow of overworked and overstressed patients coupled with demotivated and also overworked staff, this task is a huge one and will be incredibly humbling to work on.

President Obama recently gave his second major address regarding the

“Arab Spring” and the importance of supporting democracy where people are striving for its existence. His speech also addressed the long-standing issue of Palestinian statehood. Beyond politics, I find it incredibly important to hear the personal stories of those displaced, those who actually live out the arbitrary rules that distant leaders have placed. How do people live daily both inside and outside of the refugee camps? What stories would they like to share with people who may only know about Palestine from the debates ensuing in Washington that focus more on geographical boundaries than actual people? I consider myself incredibly lucky to have the opportunity to be in Jordan/work with the refugee community/be in the Middle East during this time and I only hope that I can share the stories of the people I work with and also speak to the impact of health care on a community and its efforts towards sustainable community development.

A couple of photos from UNRWA Headquarters and the Jordan Field...

Mon, 23 May 2011 23:41:20 +0400

Jordan Field Office Entrance

Look at the Entrance Parking at HQ

my first (of many) cups of coffee.

A couple of photos from UNRWA Headquarters and the Jordan Field Office. JFO is my main workplace.

Shots from UNRWA HQ

Wed, 18 May 2011 01:26:04 +0400

Shots from UNRWA HQ