The Palestinian Day of Return: from a short day of commemoration to a long day of mourning

On Friday, March 30, 2018, marking the 42nd anniversary of Land Day—when Israeli forces killed six Palestinians during protests against land confiscation in 1976—Palestinians in the Gaza Strip marched to the eastern border with Israel beginning a six-week protest—what they termed the Great March of Return. It was the bloodiest day in Gaza since the 2014 Israel-Gaza conflict. 1 Thousands of Palestinian civilians including women and children participated in the protest, mostly staying 500–700 m from the perimeter fence between Israel and the Gaza Strip in five places—eastern Jabalia, eastern Gaza, eastern Bureij, eastern Khanyounis, and eastern Rafah. 2 The precise conduct of some participants in the march is disputed, but it is indisputable that the Israeli army responded with live ammunition from snipers, tank fire, plastic coated steel bullets, rubber bullets, and tear gas grenades launched from armoured military vehicles. 3 I have reviewed the latest official statistics and reports from the Ministry of Health in Gaza, 4 official reports from the WHO office in Gaza, 5 the Palestinian Center for Human Rights (PCHR), 6 and the UN Office for the Coordination of Humanitarian Affairs (OCHA) 7 to collate this report on the number and type of injuries sustained by marchers. I have also followed up the patients who were admitted to hospitals by contacting hospital directors and the official spokesman for the Palestinian Ministry of Health (MOH) and comparing the numbers with official reports released by the Palestinian Health Information center at the MOH Gaza office. During our followup, we checked on the numbers of those patients who subsequently

Can the use of “WHO Surgical safety checklist” Save lives? Gathering the evidence.

Background: World health Organization (WHO) has published in 2009, the first edition of the surgery safety checklist (A 20-items tool) that focus on teamwork, communication, adherence to good practice, and anticipation of adverse events. The checklist aims to ensure that teams consistently follow a few critical safety steps and thereby minimize the most common and avoidable risks endangering the lives and well-being of surgical patients worldwide (WHO, 2015)

Antibiotic prophylaxis in caesarean section at Al-Helal Al-Emirati Hospital (Al-HEH), Gaza Strip, Palestine: A clinical audit

Background Nowadays, there is a general consensus among the current best guidelines about the procedural aspects of antibiotic prophylaxis in Caesarean Section (CS). Clinical audit, which has never been done before in the Gaza strip, is a tool of quality control used worldwide for healthcare improvement and is aimed at assessing clinicians’ and other clinical staffs’ adherence to the applicable guidelines. Objective This study was undertaken to audit the use of antibiotic prophylaxis in CS at Al-HEH, Gaza Strip, Palestine. Methods A sample of 38 cases was selected randomly among all the women who underwent CS during the period from 22 March 2015 to 16 April 2015. Using SPSS program, data were analysed for age, type of CS, whether they received antibiotics or not, type of antibiotics, and timing of its administration. Results Of the total 38 patients, urgent CS was carried out in 31.57% of cases while the procedure was elective in 68.42%. Antibiotic prophylaxis was given in 60.53% of cases before the surgery while no prophylaxis was received by the rest. Using Chi-Square Statistic, it was found that the correlation between the type of CS and the decision of prescribing antibiotics before the surgery to be statistically significant (P= 0.02). Moreover, 81.58% of cases were found to have received antibiotics after the surgery and a lack of uniformity of the antibiotics given to this group was also noted. Conclusion This study indicates that clinicians at Al-HEH do not follow evidence-based practice regarding antibiotic prophylaxis when managing CS patients. Moreover, the non-justified use of antibiotics again in many of those who received

The Social and Spiritual Factors Affecting Chronic Renal Dialysis Patients in Gaza Strip

Background: End-Stage Renal Disease (ESRD) is a progressive worsening of kidney function over a period of months or years. It is a complex debilitating disease that needs a lifelong treatment. Because patients with ESRD cannot be cured of their underlying conditions and mostly underwent hemodialysis program, it usually leads to many physical and medical consequences and complications, and beside them, there are lots of concealed social and spiritual factors that can affect people who have this disease or are on renal dialysis. Some studies about medical and clinical consequences of ESRD and renal dialysis were conducted but this study will be the first one to determine the factors affecting the social and spiritual wellbeing of patients who are on renal dialysis in Gaza Strip. Objectives: It is important to give a detailed picture about the social and spiritual wellbeing of patients who are on renal dialysis to

Evidence-based health care in the occupied Palestinian territory: findings from a conference-based preparatory workshop

Background The principles of evidence-based health-care (EBHC) are not widely appreciated in the occupied Palestinian territory. During the past 5 years, interest in EBHC in Gaza has been generated through a series of lectures and workshops run by the EBHC Unit in Gaza. To further promulgate the principles of EBHC in the occupied Palestinian territory and to raise awareness of differences between local practice and best evidence, a 2 day conference was organised in October 2013. In this study our objectives were to promote the principles of EBHC and to improve clinical practice in 15 specific areas of clinical practice. Methods Five subcommittees were established 6 months before the conference that addressed general surgery, medicine, paediatrics, obstetrics, and orthopaedics and neurosurgery. Each subcommittee comprised a senior and a junior specialist and was given 5 months to identify the three most

Informed-Consent Taking Procedure for Elective Surgery in Gaza strip: Patient's Satisfaction with Doctor's Communication

BACKGROUND : Widespread dissatisfaction and mistrust exists among patients in the Gaza Strip towards doctors. A sense of a lack of sufficient information regarding diagnosis, risks and benefits of interventions and subsequent management plans is present among patients. All of these areas are considered essential components in the surgical consent process. A gap between patients’ actual understanding and that perceived by doctors has been shown to exist in different settings.1 Unfortunately, no former study has been done on this topic in the Gaza-Strip.   OBECTIVES : This study aims to assess the satisfaction of patients in Gaza with the information provided to them during the consent process prior to an invasive procedure and compare this to the current practice and attitudes of surgeons.   METHODS : A five-section self-designed questionnaire was administered using convenience sampling to the first 60 patients and first 60 surgeons who met the selection criteria in the two hospitals in the Gaza Strip: Al-Shifa Hospital and the European Gaza Hospital.   FINDINGS : Among the surgeons surveyed, 55% answered that informed consent should be obtained by doctors only, 3% thought that it can be obtained by nurses only, while 45% stipulated either doctors or nurses can obtain it. In total only 38% of those healthcare professionals taking the consent from the patient, actually performed the procedure. During consent procedures, 73% of surgeons reported providing written documents 30% drawings explaining the procedure, 3% giving videos or animations and 8% suggesting website links for more information. The survey of patients revealed that only 25% of surveyed surgeons identified themselves to their patients, and 12% asked for the patients’ signature without a complete discussion of the intervention. Around 35% of surgeons depended on verbal communication only. Surgeons identified barriers for best practice as time constraints, as well as lack of hospital policies and informational resources. However, 87% of surgeons believed that informed consent has an impact on patient wellbeing. A total of 90% of surveyed patients thought they received the right treatment and were satisfied. While 43% of patients prefer to travel overseas to get treatment, 77% of these because of a perceived lack of medical equipment and facilities

Inpatient management of community-acquired pneumonia at the European Gaza Hospital: a clinical audit

Background Disease severity scores such as CURB-65 are often used to guide the management of patients with community-acquired pneumonia. Early and adequate empirical antibiotic treatment reduces mortality. The aim of this study was to examine the severity assessment and management of patients presenting with community-acquired pneumonia at the European Gaza Hospital in the Gaza Strip and to compare this to the best available evidence. Methods Medical records of all patients admitted to the European Gaza Hospital with a diagnosis of community-acquired pneumonia between Dec 1, 2015, and March 31, 2016, were reviewed retrospectively. Clinical practice was compared with recommendations for severity assessment and the management of community-acquired pneumonia, as reported in guidelines by the National Institute for Health and Care Excellence and the American Thoracic Society

Shoulder Pain among Rehabilitated Spinal Cord Injured Persons Using Manually Propelled Wheelchairs in the Gaza Strip: A Survey

Shoulder pain among paraplegic persons has negative effects on their lives. The prevalence of shoulder pain among persons with spinal cord injury (SCI) varies from 30% to 70% in different studies and may be related to repetitive use of the shoulder during self-care and wheelchair-related activities. Purpose: This study focused on the prevalence of shoulder pain and examined its effects on activities of daily living and social participation, and on functional, work and recreational or athletic activities. It also aimed to detect the degree of satisfaction with shoulder functioning wheelchair users who were paraplegic due to spinal cord injury, in the Gaza strip. Methods: Cross sectional study design was used to collect data from 80 persons with paraplegia, post rehabilitation, who were still using manual wheelchairs (MWC) for ambulation. After giving informed consent, the selected persons were interviewed directly in their homes, and filled questionnaires which included the demographic data, Wheelchair User’s Shoulder Pain Index (WUSPI) and Shoulder Rating Questionnaire (SRQ). Results: The prevalence rate of shoulder pain among paraplegics who use manual wheelchairs was 62%. Pushing a wheelchair for 10 minutes or more, and propulsion up ramps or inclines outdoors were the most common activities that caused and exacerbated shoulder pain. Sixty four percent from among the study sample mentioned that they had no limitation in shoulder-using ability during daily personal and household activities, while the rest experienced different degrees of limitation. Seventy-four percent reported no limitation during recreational or athletic activities

Intraosseous Lipoma of Calcaneus as a Rare Cause of Heel Pain

Bone lipoma is a rare, primary and benign tumor. In recent years, its detection rate is higher as a result of the increasing use of accurate and more detailed cross-sectional imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) plus the utilization of advanced histological diagnostic facilities. The radiographic appearance on x-ray is not usually characteristic of this lesion and therefore requires differential diagnostics conducted for a long time. However, CT and MRI allow for a tissue-specific diagnosis. The microscopic features are usually those of mature adipose tissue. Sometimes, still, pathological reports may show discordance with radiologic findings. For optimal management, surgical curettage and packing with autogenous bone grafts is usually recommended if the lesion is causing the pain or if the correct diagnosis cannot otherwise be obtained. Our case is a 43-year-old female patient who presented to our clinic with chronic left foot pain. Pain was localized over the left heel with radiation to surrounding areas. The radiological diagnosis of intraosseous lipoma was made based on CT imaging and confirmed later through biopsy. Surgical intervention was needed after failure of conservative management. Curettage of all lesion and packing with autogenous bone grafts was done. Postoperatively, the patient showed remarkable improvement and follow up consultations showed good healing and no signs of recurrence

Attitudes of University Students in Gaza to Organ Donation

Background: This study aimed to explore the attitudes and knowledge of university students in Gaza to organ donation. Methods: A structured questionnaire was used to collect data including socio-demographic characteristics, knowledge level and attitudes of participants toward organ donation and factors that affect personal beliefs of the participants on donation. The questionnaire was distributed using the convenience method to 489 (179 males, 310 females) students at the Islamic University of Gaza. The data were analyzed in a descriptive fashion using SPSS program. Results: The study showed that 97.5% of participants were acquainted with the term “organ donation”. Those participants were eligible and were asked to complete the questionnaire. Less than half of participants chose multimedia as the main source of information regarding organ donation and more than half of respondents (56%) said that,“saving lives” was the most important reason for organ donation. One fifth of participants (22%) reported that they completely reject donating any of their organs during their lifetimes, whereas more than one fourth of them (27%) reported that they refuse organ donation even after death.(54%) of students denied any knowledge about local or international legislation regulating organ donation. Conclusion: The results of the study confirm the presence of good level of knowledge regarding organ donation among participants, which was reflected in their positive attitudes towards organ donation. However, one of the main concerns to promote organ donation was the fear of surgery and its complications. Additionally, legislative, educational and