Palestinian doctors train in Canada to help sick kids back home

TORONTO, Canada – When Amir Atawna returns to Hebron in July, he will be one of only four Palestinian physicians specially trained to care for premature babies.

Atawna has spent almost two years as a fellow at the Hospital for Sick Children in Toronto, training with the best in neonatal health care. It is an area of paediatrics that the doctor says is lacking in Palestine – and one he hopes to improve upon his return.

“The main mortality rates among children [are] in the newborn period, due to prematurity itself,” he told Middle East Eye at the cafeteria at Sick Kids, as the hospital is commonly known. “We need this specialty to improve.”

Atawna, 33, came to Canada in July 2014 to participate in the Palestinian Healthy Child Fellowship, which seeks to provide Palestinian doctors with specialised paediatric training, and in turn, raise the level of care in the West Bank, Gaza Strip and East Jerusalem.

Atawna, who did his residency in paediatrics at al-Makassed hospital in East Jerusalem, said that while about five in 1,000 babies die when born prematurely in Israel, that number is four times higher in Palestine, at 20 deaths per 1,000 births.

He said he was drawn to neonatal care after meeting a mother at a hospital in Bethlehem in 2008 who had given birth to twins only 28 weeks (seven months) into her pregnancy. The newborns weighed around one kilogramme each.

“I liked the way [the doctors] managed to care for those babies. They got bigger and older and they became very healthy. It was something that pushed me towards [this specialty],” Atawna said.

“A lot of those premature babies who are born [at] less than one kilo die early on because of a lack of specialists, because of a lack of technical support [like] ventilators and incubators. When I go back, I hope that I can help.”

Making a ‘fundamental’ change

Dr Rand Askalan, a Palestinian doctor who came to Canada in 1995, launched the fellowship program for Palestinian paediatric doctors six years ago after noticing a gap in services in the West Bank.

Both Askalan’s parents fled Nablus, in the West Bank, during the war of 1967.

She returned to the West Bank in 2002, during the height of the Second Intifada, with a group of volunteer doctors. At the time, she had just finished medical school at the University of Toronto and was in her first year of paediatric neurology at Sick Kids Hospital.

Askalan navigated Israeli checkpoints and closures to provide primary health care to Palestinians in the West Bank, many of whom were living under strict, Israeli army-imposed curfews and had no access to medical care.

“We went to villages where they hadn’t seen doctors for months … It was terrible,” she said.

“All the villages were under curfew. We had every day to negotiate our way with the Israeli army to enter the villages, despite the fact that our cars were very well-designated as [being from] a Canadian medical mission.”

That experience stayed with her, and when she returned to Canada, she began fundraising to bring Palestinian children to Toronto for treatment. When she finished her studies, she returned to Palestine more often to hold clinics and teach students.

“I realised how bad the situation was when it comes to sub-specialties in paediatrics. We have general paediatricians, but then when children need a specialised [treatment] … then things fall apart,” she said.

She told MEE that when children need specialised treatment, they either succumb to their disease because Palestinian paediatricians do not have the needed expertise, or are forced to travel to neighbouring countries at a high cost to their family.

If Palestinian children secure permits to enter Israel for treatment, then they worry about having their treatment interrupted as a result of checkpoint closures or permit problems.

“I started thinking, ‘OK, we have to address this in a more fundamental way, which is basically invest in people,’ and train the Palestinian paediatricians so that they won’t depend on help from the outside,” she said.

‘A domino effect’

The first Palestinian doctor to come to Toronto on a Palestinian Healthy Child Fellowship arrived in March 2011. “He was from Nablus,” Askalan said, laughing, “honestly by chance.”

The first two doctors to be trained were from the West Bank, but Palestinian physicians from Gaza have also taken part.

Generally, two doctors begin the two-year fellowship each year and it costs about $350,000 to support four fellows annually. That money is collected through donations from individuals, Askalan said.

Three new fellows will arrive this July. “They really work hard. They are very dedicated. They know this is a chance of a lifetime and they really take it seriously,” she said.

“You’re not just affecting the life of one individual. The impact is like a domino effect.”

Askalan said a past fellow from Hebron who returned to the West Bank has since expanded the intensive-care unit at the local Red Crescent Hospital. He also introduced a cooling system to aid infants that are born without oxygen to their brains.

“This was never done in Palestine,” she said about the cooling system. “When we see this, we say, ‘Yes!’ That is exactly what the program is aiming to do. You have invested in people and … they are making an impact when they go back.”

Askalan stressed, though, that the fellowship’s goal is to improve the lives of children in Palestine.

“If [the doctors] don’t go back, what’s the point? It’s great that you’re training Palestinians, that’s fabulous, but [if] then they go and work elsewhere, the Palestinian child living in Palestine didn’t benefit from this,” she said.

“The program is for the Palestinian child living in Palestine. These kids need their doctors to be there, to be with them in the community, and have access to them when needed.”

Bringing innovation home

Mahmoud Shbair is from Khan Younis in the southern Gaza Strip. The 37-year-old father of two is finishing his Palestinian Healthy Child Fellowship at Sick Kids Hospital in paediatric haematology and oncology, the study of blood-based diseases and cancers.

He told MEE that the sector is severely under-developed in Gaza. As a result, Palestinian children diagnosed with these types of cancers are often forced to seek treatment in Egypt, Jordan or Israel, if they can leave the territory at all.

“Kids may need to wait for three or four weeks with leukemia, for example, without receiving any treatment,” he said.

Shbair said he wants to establish the first specialised unit for cancer treatments in the Gaza Strip when he returns home. But securing the necessary equipment to treat these diseases, including machines that diagnose blood cancer types and conduct genetic analyses, is crucial.

Despite the challenge, he said he is hopeful about being able to provide better care for Palestinian children, and helping build a self-sufficient health-care system in Gaza.

“Here [in Canada], a child diagnosed with leukemia will start treatment the next day … It’s difficult for any [Palestinian] family to look at their kids having leukemia for three weeks, waiting for security approval to go wherever he can be treated,” Shbair said.

“It’s a great [amount of] suffering on the families and on the kids and everybody.”