Caring & Compassion in the Middle East

Recently, I returned from Aqaba, Jordan where 75 nurses from 10 Middle Eastern countries gathered to share conversations to be better informed about health in the whole region. While It seems that the Middle East has been one intractable conflict for as long as I can remember, there was no conflict at this event. I have experienced the Middle East in real time, as a place where humanity and compassion can be found deeply among its nurses

Since its inception, the annual Conference of Middle Eastern Nurses and Partners in Human Caring has been a forum for discussing the major concerns of Middle Eastern nurses who are providing care while enduring ongoing political and social conflicts. Nurses from Palestine, Israel, East Jerusalem, United States, United Arab Emirates, Jordan, Lebanon, Saudi Arabia, Switzerland, and Gaza attended.

The relationships between nurses in these countries are critical to make sure that patients are well cared for and the handoff of information is seamless. That was the original inspiration for the conference. Now, concerns have broadened to issues outside of immediate nursing practice, like the social and cultural factors that influence health.

Keynote Speaker Dr. Mahmoud Dahar, a former Palestinian critical care nurse who now works for the World Health Organization, shared that there is price being paid for restrictions that do not allow Palestinian nurses to travel have limited their access to new technologies and up-to-date practices. He told of a nurse in Gaza who had not been able to travel outside of the Territory for 15 years. This meant that her understanding of treatment modalities and her bedside tools were 15 years old.

Dr. Dahar said that the nurse had never seen a closed-suction system (CSST), which is used to keep inter-tracheal tubes clear of phlegm and biofilm without taking a patient off the ventilator. This is an automatic system, as opposed to a manual system in which the nurse has to pump the tube clean. It was only after she traveled to Turkey and saw the CSST that this nurse was able to bring it back to her hospital.

The openness about the family structures in Arabic and Jewish families was a real time demonstration of the trust the comes from the shared mission of nursing. Differences were points of interest, not conflicts. Conflicts in the region were talked about with compassion and concern.

Other Issues

The restlessness of idle, unemployed youth is universal.

However, In the Middle East, two-thirds of the population is under 18. Lack of opportunity, low incomes, discrimination, and educational deficits result in social conflict, violence, and general upheaval. According to the World Health Organization “in 2016, unemployment rates reached 27% despite the efforts to increase the number of work permits for Palestinians. Unemployment rates are higher in Gaza, at 42%, and youth unemployment is at 58%. Although nearly 80% of Gaza’s residents receive some form of aid, poverty is very high.”

From The Carnegie Endowment for International Peace, “The long-term social frustration and disillusionment resulting from unemployment can lead to a sense of marginalization and exclusion, both at the individual and the collective levels…” This is certainly true in the Occupied Territories.

Israeli nurses care for patients from every corner of Israel, the West Bank, and Gaza. All patients are treated equally, a policy of Hadassah Hospitals across Israel. Other Middle East Countries, especially in the United Arab Emirates, have world-class satellite hospitals from the US, such as Cleveland Clinic, Mayo Clinic, and University of Pittsburgh Medical Center. However, the citizens of Gaza and the West Bank remain underserved.

The lack of drugs and supplies is a constant problem. Many of the antibiotics prescribed in Israel for Palestinian patients cannot be found in the Territories. An Israeli nurse told me she had a Palestinian patient who had a temporary colostomy and she couldn’t find stoma* bags and had to clean and reuse the old ones, or not have a bag at all. These are not expensive, but apparently the companies that supply them will not sell them within Palestine.

And while this was news to me, it was not news to these nurses from the Middle East.

Given the highly politicized state of women’s health in the United States, it was profound to hear the issues going on with women and children in the Middle East discussed openly among nurses from different cultures, countries, and beliefs. I was also gratified that they were discussing them through the lens of cultural sensitivity, with obvious caring, compassion, and respect for the existing dilemmas.

The majority of the last day of the conference was spent on women’s health concerns. Jordanian male nursing students gave their perspective on breast cancer screening. Another speaker talked about pre-birthing education for women who are planning on giving up their infants for adoption.

What’s Next

The work of this small group of courageous, determined nurses who are spread out over 10 countries is growing. Regardless of where they come from -- Israel, Gaza, or the West Bank, the political risk is high. I was astonished to learn that the governing Palestinian leadership has declared a policy of “non-normalization” with Israel. This means that all communication among the people of these two countries is discouraged, even citizen-to-citizen, with the exception being nurse-to-nurse.

Perhaps the most powerful steps being taken by this group, now formed as Nurses in the Middle East, are the position papers published in the International Journal of Human Caring following each of the conferences. This year, the Position Papers topics looked at political and social activism as a professional responsibility of nurses, gender violence, and the needs of nurses to ensure their resilience. These will be published in the International Journal of Human Caring.

I am moved and inspired to be involved with this conference and these nurses -- many of whom I met in 2006 when I spoke at the International Nursing Conference in Jerusalem.

Since then, the Gaza War happened. There has been more violence and deaths on both sides.

The Barrier Wall separating Israelis from Palestinian has effectively cut off over 100,000 Palestinians from access to healthcare in Israel and reaching their own hospitals. This is also challenging for pregnant women of whom 18% may have complications. A report from one of the previous conferences stated that to reach an Israeli hospital, one may have to go through 600 checkpoints.

Political upheaval since the Arab Spring has added pressure in the whole region. The result has been more uncertainty and less trust within and among each individual country, let alone the mistrust across boundaries.

In spite of all that has happened, these Middle Eastern nurses are steadfast in their determination to write a different story and create a better future.

From the Nurses in the Middle East website:

As nurses, we are vessels to provide human caring to our patients and our communities. Through joint nursing projects, health promotion, and professional development opportunities, we aim to improve patient care in the Middle East. While we cannot control political barriers, we are responsible for ensuring the best quality of life for all human beings. 

Infused by love and respect for each other coupled with hope and determination, all of us at the conference left Aqaba looking forward to next year when we will meet again.

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