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My time in Bethlehem: a personal view of a placement in the Palestinian territories

Working in a physio team can offer particular challenges in some countries. Here, Frontline looks at the special issues for physio staff in the Palestinian territories

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Alexandra Hejazi (left) in a paediatric physio session

The CSP is keen to support physiotherapists in the Palestinian Territories of the West Bank and in Gaza, which has been sealed off and under blockade since 2006, writes CSP fellow Dr Lesley Dawson.

Following a debate at last year’s annual representative conference, the CSP requested that members send donations of books and training materials that could be forwarded to physios in the two areas.

Our original intention was to link up with physiotherapists in Gaza but, so far, only Ahmed Younis, deputy head of the school of rehabilitation sciences at St George’s, University of London, who is from Gaza originally, has been able to gain permission to enter Gaza.

During his visit this summer he met the new secretary and communication officer of the Palestinian Physiotherapy Association Gaza Governorate.

The new board seems enthusiastic to promote high-quality patient care through contact with the most recent and evidence-based practice via continuing professional personal development for physiotherapy graduates. The new board appreciated the support from the CSP.

Because of our inability to access Gaza, we have turned our attention to the West Bank, donating books, CDs and other materials which have been received gratefully by physiotherapists there. I would like to express a big thank you to CSP members for these.

Alexandra Hejazi is the first student from the UK to go to the West Bank on placement at a Palestinian rehabilitation centre. I was delighted to read about Alex’s experiences on a five-week placement at the Bethlehem Arab Society for Rehabilitation (BASR).

I imagined what it would have been like to be a fly on the wall when she met up with our Bethlehem University graduates.

It made me smile to read her delightful account of coming to terms with different professional practices, a different working environment and culture while being able to actively participate in team working with disabled children and their families. It brought back happy memories of working at BASR.

More information

You can email Dr Dawson (lesleyd70@gmail.com) or Lu Cass Darweish (MariaCass@bhamcommunity.nhs.uk) if you are interested in more information. They are collecting electronic CPD material for Gaza.

To find out how to get involved with BASR, email: alexandra.hejazi@gmail.com  For more information see: World Health Organization Occupied Palestinian Territory: Medical Aid for Palestinians

Alexandra's experience

With the morning greeting ringing in my ears, I started my first day as a volunteer at the Bethlehem Arab Society for Rehabilitation (BASR) in the paediatrics department.

Filled with nerves and excitement at the prospect of working with children (a specialism I lacked experience in), I finally began working after months of planning.

Last year I read an article in Frontline (3 October 2012) about Lesley Dawson’s efforts to forge links between CSP members and physiotherapists in Gaza and the West Bank.

Dr Dawson used to teach physiotherapy in Bethlehem University and I ended up working with some of her former students.

With her help the arrangements over my visit fell into place, and, before I knew it, I had written an email and pressed ‘send’ to the head of the physiotherapy department at BASR confirming that I would be going there in July this year.

During the first week, I mainly observed and assisted the other physiotherapist and prepared to take charge of her patients when she went on holiday – a scary but exciting challenge.

Most of the children had cerebral palsy and were aged from one to four years. During the first week, we assessed each child and agreed on individualised treatment plans.

Though there were some toys, cushions and a few walkers, resources were limited.

However, challenges can bring out your creative side; plastic gloves became balloons which encouraged grasping, my house keys on a string encouraged the children to reach and improve dynamic balance and playing music from my mobile phone turned out to be a great ‘tool’ to improve head movement.

Changing old habits

Although I hadn’t worked in paediatrics before, I knew that parent involvement was a vital part of children’s development and this was missing at BASR. Most mothers left their child with us and returned when the session was over.

I discussed this with the other physiotherapist who said this was, in part, a cultural phenomenon.

Many patients assumed a passive role in their treatment, but the mothers also needed a break from the travails of daily life, which I fully appreciated. Being a parent is a 24-hour job and can be even more demanding when your child has a disability.

However, I also felt that the mothers needed to take a more active role in the sessions as they would take over once we finished. While we worked a great deal to help the child to become more independent during the sessions, the mothers would do everything for him or her during the rest of the day, which was counter-productive.

With this in mind, I organised a session for a group of children at the same developmental level with their mothers. We went over basic massage techniques and gentle range of motion exercises explaining the importance of slow rhythm for children with spasticity.

We also went over ideas and techniques to encourage independent sitting and balance exercises. At the end we distributed hand-outs to encourage the mothers (and family members) to continue working with their children.

One physiotherapist helped to interpret everything into Arabic during the session while another one translated the handout. A third colleague brought in famous Arabic children’s songs. Talk about teamwork!

Creative thinking

I became good friends with a woman whose mother was an inpatient after having from a stroke.

Most patients returned home during the weekend and on one occasion I was invited to my friend’s house.

Between being fed the most delicious food, my friend’s mother and I went over bed mobility exercises and practised using the stairs again with her.

She struggled to lift her leg on to the bed by herself, something that bothered her as she wanted to maintain independence.

In her late 60s, she had worked every day in the family shop until she had her stroke. Her daughter and I went through her wardrobe and an hour later, with the help of some old belts and strings, we had made our own leg-lifter.

All those years watching the MacGyver TV series (about a secret agent who solves complex problems with everyday materials) had paid off! fl

Reflections on the experience

People in Palestine have been living under occupation for more than 65 years, writes Alexandra.

The grave constraints this poses is plain every day in, for example, the lack of resources and the difficulties face in accessing essential health services.

As I spent time with the children, whose innocence and love for play was the same as children all over the world, I couldn’t help wondering what kind of future these children would have.

The separation wall that was visible from the window acted as a constant reminder of the conflict. That the wall does not just separate land, but also separates these children (and their families) from services that people on the other side of the wall can access.

Another consequence of the conflict is that there are severe restrictions on movement for Palestinians which have a detrimental impact on healthcare professionals who face extreme difficulties in travelling and therefore have limited access to continuing professional development.

It was overwhelming at times, and some evenings lying in bed it felt hopeless. There were many times I doubted myself and I wondered if what I was doing was beneficial.

Then a mother would tell you that their child managed to sit unaided for the first time or that their siblings were now playing with the child in a way to encourage independence, similar to your physiotherapy sessions, and you are reminded of why you chose this profession to start with.

You see the smile of the children when you walk in to the room and you know that giving up is simply not an option.

Before I left the West Bank, I asked the physiotherapists at BASR what I could do to help when returning to the UK.

All their answers were the same: tell them to come to Palestine! Come and share your knowledge and skills.

Whether you want to go and spend some time there or share material or hold an online-conference, there are hundreds of ways you can help.

Our profession develops through sharing, and that is not just among ourselves. Let’s show others that as physiotherapists, we are part of one big community without any borders.

Alexandra Hejazi is a third-year physiotherapy student at St George’s, University of London. She is a CSP rep and a member of the student executive committee.


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