UK Paramedic in Gaza: What I’ve been up to so far

April 19, 2014

Originally posted at Paramedics in Gaza

I’ve been in Gaza for nearly six weeks now, and I’ve largely found my feet. I plan my days around when there will be electricity, know when I’m being overcharged in a taxi and can drink 3 cups of sugary tea without getting the shakes. Countless meetings are finally paying off, and possibilities for work beyond observing are beginning to appear. This week I taught a First Aid session in the remote Bedouin community in the north, which I hope to repeat. Next week I’m teaching a basic trauma First Aid course for the Palestine Trauma Centre who sponsored us to come to Gaza. I’m particularly looking forward to it as the folks at the PTC have been so welcoming and do amazing work.

Beyond that, I’m working with the Ministry of Health to develop a training around ambulance pre-alerts to the Emergency Department, and making a presentation on the use of communications equipment in the UK ambulance service for their managers. They’re looking to develop in this area, despite the blockade on GPS and most communications equipment. The time I’ve spent here and conversations I’ve had increasingly point to equipment and economic limitations as the biggest issue for the health service here, rather than any lack of knowledge or ambition. Even when the present situation makes maintaining any service at all very difficult, there is an awareness of service improvement and a desire to plan for the future. I certainly don’t envy the managers here their jobs – it makes the UK’s National Health Service (NHS) look relaxed and over-resourced. Which is saying something.

I’m also meeting with the Red Crescent ambulance service to plan some work with them. Read the rest of this entry »

Israeli forces injure 5 medics after ‘targeting’ Gaza ambulance

April 12, 2014

Published yesterday (updated) 12/04/2014 10:05

 

(MaanImages/file)
GAZA CITY (Ma’an) — Five Palestinian medics suffered from excessive tear gas inhalation after Israeli forces fired a tear gas canister at their ambulance in the northern Gaza Strip, a medical official said.Spokesman for the Gaza Strip ministry of health Ashraf al-Qidra said that Israeli forces had “targeted” three military ambulances near the Eastern Cemetery east of Jabaliya.

The five medics were treated on the scene, he added.

The circumstances of the reported attack were not immediately clear.

An Israeli military spokeswoman had no information regarding the incident.

“We leave without expecting to return”: meeting the firefighters of Gaza

April 10, 2014

trucks

Originally posted at Paramedics in Gaza

Yesterday I visited the Civil Defence Directorate, which provides the fire and rescue service in Gaza, as well as some emergency ambulances and marine rescue. These guys have a reputation as being fearless, as well as being the most vulnerable to attack during times of war. In the 2008-9 war, 13 Civil Defence workers were killed in the line of duty, with 31 injured. This includes medics killed in their ambulances by snipers and firefighters injured by secondary drone attacks while rescuing victims of the initial strikes. These risks are additional to jobs which are considered dangerous even in peaceful countries like the UK and USA.

I found out plenty about the Civil Defence’s ambulance service, including interviewing staff and looking around muralthe ambulances and equipment stores, but I’m going to save that for a later post and just write about the firefighters. In the UK, the ambulance service and fire service are separate so please forgive any ignorance about the equipment and vehicles I saw. I knew they were fire engines because they were big and red, and I knew it was a fire station because there were some weights in the corner and a ping pong table. Beyond that, it was all new to find out. Read the rest of this entry »

How we spent your donations! Thank you!

April 9, 2014

Originally posted at Paramedics in Gaza

Before we travelled to Gaza we decided to ask friends and colleagues for donations so we could take some medical kit with us. We were hoping for a few hundred pounds, so we were really surprised and excited to raise about £2000! Thank you so much to everyone that donated, including friends of friends who don’t know us but read our call out. It was amazing to be able to revise our planned donations to include more kit, better quality equipment and more expensive models that are designed to be reused (which we know they will be).

Here is everything we bought!

Complete kit

Everything we bought

We decided to take four complete first response kits to donate to the ambulance services here. As paramedics we had a fairly informed idea of what would make a decent kit, and we tried to tailor it to the needs and skill levels of crews here. We left out paramedic specific equipment and added extra trauma supplies. We also put in extra shears, stethoscopes, torches and pentorches for the crews. Read the rest of this entry »

Al Shifa Emergency Department – largest in Gaza (part 2)

April 9, 2014

See Paramedics in Gaza for original post

In part one  I gave a brief introduction to the Emergency Department (ED) at Al-Shifa hospital, Gaza’s largest healthcare facility. I spent a few hours there last week meeting staff and seeing for myself the current situation in the ED and Intensive Care Unit. In this post I’d like to focus on the shortages affecting health care provision in the ED and ICU, which are the same shortages affecting every part of the health service here.

Image

Shortages here come in a few different forms. Firstly, many drugs are scarce or completely unavailable. Secondly, many disposables (single use bits of medical equipment, such as suction tubing or syringes) are expired or unavailable. Thirdly, parts and servicing for medical equipment are often unavailable. This includes ambulances themselves, as we heard from the Ministry of Health.

The reasons for these shortages is a little complicated. The largest factor is the Israeli blockade of Gaza, which includes control of goods crossing into the country at the Kerem Shalom and Erez Crossings. This means that all imports of medical equipment must be approved and coordinated by Israel, making shipments vulnerable to delays, refusal or seizure. In the past these controls were circumvented by the smuggling of medications and equipment through tunnels under the Egypt-Gaza border. In the past the Ministry of Health, for example, have received 30% of their medicines through the tunnels. In 2013, the vast majority of these tunnels were destroyed by Egypt, cutting off a vital lifeline for Gaza and the health service in particular. As a result, shortages have been exacerbated with little hope for improvement. Read the rest of this entry »

Al Shifa Emergency Department – largest in Gaza (part 1)

April 2, 2014

See Paramedics in Gaza for original post

Last Thursday I visited Al-Shifa hospital, the largest medical complex in Gaza, to get a look at the Emergency Department (ED). I was hoping to get a better grasp on the structure of the ED, to meet some of the staff and to see for myself the situation they’re working in. I saw and learned so much that I’m going to split this into a couple of posts to make it manageable. In this post I’ll describe my visit, the structure of the hospital and touch on the role of the hospital in the recent history of Israeli military assaults on Gaza. Then in another post I’ll look at the day-to-day challenges of working in this environment with particular reference to equipment and drug shortages.

"What could have been a modern university-like hospital is, however, reduced to a completely worn-out, almost makeshift, field hospital after years of siege, as well as a lack of maintenance and upgrading." - Norwegian doctors Mads Gilbert and Erik Fosse, 2009

 

First off I met Dr Nser Al Tater, a cardiologist and the general director of the hospital who welcomed me and gave me a bit of an overview of the situation. We talked most about the impact of the electricity crisis on the hospital – I’d read details recently but to hear stories along with the statistics was eye-opening. The hospital is currently reliant on generators for 16 hours/day, requiring a huge amount of expensive and increasingly unavailable fuel. The generators aren’t designed to be used so much and have previously cut out completely – Dr Al Tater told me about a cardiac surgery where the electricity cut out ten times over the course of the operation. All life support had to be continued manually while each blackout lasted. In between, surgery resumed. Similarly, a recent powercut in the neonatal ICU resulted in staff manually ventilating 12 babies until the power returned to their ventilators. Read the rest of this entry »

International Medics visit Ministry of Health Ambulance Depot

March 24, 2014

See Paramedics in Gaza for original post

Yesterday we visited the Ministry of Health’s ambulance depot in Gaza City. The government’s ambulance service runs alongside that of the Red Crescent, the Civil Defence, Military Medical services and some some small NGOs. The day-to-day emergency calls are predominantly responded to by the Red Crescent, but the Ministry of Health vehicles have the capacity to assist at busy periods and especially during conflicts.

They also run many community first aid trainings, health professional refresher trainings and have recently participated in some Majax (major incident) drills with other services. During quieter periods the MoH ambulances mainly run patient transfers, including taking dialysis patients to appointments, transferring between hospitals and taking patients to the Rafah and Erez border crossings for treatment abroad. They have about 30 intensive care ambulances and 67 first response vehicles, with 23 EMT-Is/nurses and 142 first responder (EMT-B) drivers. At present they are short of some nurses who have been recalled to hospital Emergency Departments due to staff shortages.

We had a long talk (and coffee) with a few different managers, who were all formerly on the road and will still get back into uniform in times of crisis. Then we had a look round some of the ambulances in the depot, talked to some of the crews and tried to get our heads round the huge issues facing the ambulance service here. In many ways, the ambulance service is a microcosm of Gaza in general. The complex problems facing it as a service are also the problems facing the wider population. There’s the huge issue of the Israeli blockade, now compounded by the political situation in Egypt. Then there’s the border closures, which leaves intubated patients waiting at the Erez crossing into Israel for hours while the medical team keeping them alive watch the oxygen and equipment batteries run down.

There’s the resulting scarcity of resources that means that the MoH ambulance have no non-rebreather masks (something that we use routinely and offhandedly back home) among many, many other items.  There’s the crippled economy, a government that can’t pay its workers on time and the resulting poverty and 50% unemployment rate. Then there’s the dependence on international aid, the lack of training opportunities and inadequate infrastructure. And of course there is constant tension and violence, with occasional vast and devastating military aggression.  In short, these broader issues combine in the health service to make the provision of even a basic standard of care exceptionally difficult.

Image ImageImage

Read the rest of this entry »

UK and NZ Paramedics arrive in Gaza

March 16, 2014

before our surprise call out

Kathleen and Gillian are paramedics who work on emergency ambulances in England and New Zealand respectively. Both have previously been involved in human rights work at home and abroad, including the West Bank. In true Defend The Rescuers spirit they have arranged sabbaticals, covered their own expenses, then fundraised to bring medical kit in person to their fellow rescuers in Gaza, arriving March 9th.

They will be regularly blogging while they are there, and are now accepting donations to help cover translation and incidental costs for the training they hope to deliver to local  medics whose access to skills updates is severely limited by the siege. Here is one of their first blog posts below – visit Paramedics in Gaza to become a follower and receive their news as they post…

Paramedics in Gaza: Waiting for something

We went to bed last night unsure as to what the situation would be today and had an uneasy sleep. Fortunately we awoke to news that while there had been airstrike retaliations by Israeli military overnight, no casualties had been reported. The situation has remained calmish throughout the day, although it appears that people are preparing for the worst.

next time we'll remember to write a list

donations get catalogued: next time we’ll remember to write a list

Our day has been busy. We had the total honour of handing over a donation of medical supplies to the director of the Red Crescent in Gaza, Dr Khaleel Abu Alfol. The supplies included two complete ‘response bags’ (/ jump packs) for ambulances and a stack of miscellaneous hospital kit including stethoscopes, sphygmomanometers, ET tubes, airway adjuncts, forceps, bag valve masks, suture kits,  thermometers and suctioning equipment. While it wasn’t a huge amount, we had managed to bring in equipment which is currently unavailable in Gaza; including suction handles and universal suction tubing which appeared to impress Dr Khaleel and his staff. These medical supplies will be shared through multiple departments in Al Quds hospital and will undoubtedly go to good use. At least one of the response bags will be used in an EMT training course which is beginning in a week or so. Massive thanks again to everyone who donated! We still have a stack of gear which will be shared with other organisations.

After drinking our fill of coffee we were sent off by Dr Khaleel for a tour of the nearby Red Crescent central ambulance station. We sat down for tea and an orientation with the station boss, going over their paperwork systems (essentially the same as in our own respective services) and getting to poke our heads in the dispatch room (two phones, one laptop). Then we were sent outside with a crew to have a look at an ambulance and their kit. Or at least we thought that’s what we were doing. Next thing we’re told to hurry up and jump in and we’re off under lights to a job. Read the rest of this entry »

Risking their lives to save lives: Gaza’s Civil Defence First Responders

February 24, 2014

from Joe Catron, The Electronic Intifada, Gaza City, 16th April 2013

Firefighters aim hose at building billowing with smoke

Palestinian firefighters extinguish a blaze after an Israeli air strike in Gaza City, 18 November 2012.(Ashraf Amra / APA images)“When thousands of Palestinians poured into the streets of the Gaza Strip after the announcement of a ceasefire with Israel on the night of 21 November last year, they found many of them flooded.Celebrants in areas hard-hit by eight days of Israeli airstrikes, artillery fire and naval shelling were particularly likely to find themselves wading through rivers of water. Firefighters had sprayed it to extinguish blazes at nearby bomb sites as missiles fell hours earlier.“If we — if anyone — thinks of this as his job, he will not work,” said Yousef Khaled Zahar, general manager of the Civil Defense Directorate in Gaza.“But because we believe in our people and our country, because we belong to this people, we work without ever thinking of the dangers. We are only concerned with serving our people.” Read the rest of this entry »

Interview with two Palestinian paramedics: “They don’t care if we are medics or not. They target everything”

June 17, 2013

16th April 2013 | International Solidarity Movement, Ramallah Team | Nabi Saleh , Occupied Palestine

M. and A. are two independent paramedics who regularly attend different protests against Israeli occupation of the West Bank. Israeli forces usually respond to Palestinian popular resistance with extreme violence, including the shooting of tear gas canisters, rubber coated steel bullets and live ammunition. Considering that injuries are very common and that the nearest hospital is usually far from the village where the protests are taking place, the presence of medical personnel in these demonstrations is essential and highly appreciated by protesters.

Last Friday, we had the opportunity to talk to M. and A. during the weekly demonstration in Nabi Saleh, which they regularly attend.

International Solidarity Movement: How long have you been volunteering as paramedics? Why did you choose to volunteer?

M: Since 2009. In the beginning I was working in a project with the Danish Red Cross Youth and then I joined the Red Crescent.

A: I have been volunteering since 2004. I do it because I like to help people and this is the way I want to do that.

ISM:  You go to a lot of demonstrations as paramedics – why do you think that these protests are important to the community and to Palestine?

Protesters marching at last Friday demonstration in Nabi Saleh (Photo by Tamimi Press)

Protesters marching at last Friday demonstration in Nabi Saleh (Photo by Tamimi Press)

M: Well it is better to do something than to do nothing. Also, when there are medics at demonstrations people have more courage to go to the front because they know that we are there to assist them in case something happens.

A: As you know, we live under occupation so people have to move and do something to end it. We have to protest and attend demonstrations anytime and anywhere…

Click here to read on…


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