It began as a mission to heal the congenital heart defects of Arab children and ended as a quest against poverty and despair. This past September Dr. Aubyn Marath, director, cardiac surgery at Saad Specialist Hospital (SSH), led a team representing CardioStart International (www.cardiostart.com) to Palestine to provide help in reducing the long waiting list of children needing corrective heart surgery. SSH is shortly to open the most prestigious and comprehensive program for the care of patients with heart disease in the Eastern Province, and the visit to Palestine emphasized the objective SSH holds dear — “compassionate care for all.” The medical mission was made possible by financial and logistical support from the Palestinian Children’s Relief Foundation (PCRF), CardioStart International, and donations from supporters both within the Kingdom and abroad. Not only did the medical mission perform and teach cardiothoracic surgical procedures at two Palestinian hospitals but team members also lent assistance to an orphanage, rural clinic and special needs program.
The two main regions of Palestine, the West Bank and Gaza, are isolated by checkpoints and the requirement of passes. Most Palestinians are not allowed to travel between the two regions. Therefore, they are almost completely isolated from each other. Families with children who have medical conditions are virtually unable to seek and obtain medical consultation outside their region. For this reason, CardioStart split its two-week assistance program to allow for one week at a hospital in Ramallah and the other in Gaza.
The medical volunteers on the team gave their time and their skills to provide specific pediatric expertise in intensive care, surgical procedures and general supportive care. In addition to the representation from Saudi Arabia by SSH, the CardioStart team was made up of experts from some of the world’s top medical centers including Rush Presbyterian, Chicago; Brigham & Women’s, Boston; Central Hospital, Portland, Maine; Adventist Hospital, Portland, Oregon; Largo Medical Center, Florida; Sick Children’s Hospital, Toronto; Green Lane Hospital, Auckland.
Each volunteer was asked to bring part of a wish list of medications and other specialist equipment needed by the two Palestinian hospitals to be visited. The restrictions to the delivery of sea freight imposed by the Israeli security forces prevented CardioStart from donating a container shipment so only vital medications and disposable equipment for the performance of pediatric heart surgery were possible. These had to be confined to suitcases or carry-on luggage.
With no direct connections by air to Palestine, the team members arrived in Tel Aviv at different times on Aug. 31, 2001. In pre-trip briefing notes, each volunteer had been advised to truthfully declare the purpose of the mission — “a humanitarian medical visit to two locations in Palestine.” The Israeli security forces were less than impressed. They interrogated the group members, searched their luggage and confiscated all of the medical equipment and medications they could find. Although the officials were provided a written invitation from the Palestinian Health Authority’s minister and given an explanation “that the equipment was to help children in need of heart surgery,” the team was shown no mercy.
The Israeli Customs Department gained about $28,000 worth of medical equipment that day. Frantic efforts on all fronts, both local and international, during the team’s visit to get the medications and equipment released were useless. One week into the medical mission a young girl died in Ramallah Hospital on her fifth day post-operatively largely because a medication she desperately needed had not been released by the Israelis.
Once they had all emerged from the airport, the team gathered for the drive to Ramallah. The journey required passage through several checkpoints, with inspection and harassment at each one. Upon passing the last checkpoint, the visible contrast between Israeli-claimed and Palestinian-controlled territory was substantial.
“There was a sense of desperation in the area that worsened as the housing density increased,” explained Marath. “The center of Ramallah was dirty, stark, clearly deprived, and covered with graffiti. Passers-by had a depressed, blank expression, similar to that seen in the poorest countries, with very few standing around or chatting.”
Ramallah Hospital perched on top of a hill. It was run down and surrounded by partially damaged buildings. Inside, the hospital was dowdy, grossly under-equipped and neglected. Despite the hospital’s serious deficiencies the medical team soon saw that every day patients suffering from a variable number of gunshot wounds were admitted. Each night during the first week, the rat-tat-tat sounds of sporadic machine gun fire could be heard in the adjacent hills.
“Fortunately the cardiology department had several modern facilities from donations previously given for specific development projects, and the medical staff were very well informed about their patients and standards of investigation,” said Marath. “They would not have been out of place in any Western nation’s facility, except for the gross procedural short cuts they were obliged to take to complete their patient evaluations due to a lack of equipment and disposables. The staff were warm and friendly with us even though they knew that most of the team was from the United States.”
The medical volunteers quickly realized that they were facing an enormous challenge. Lacking equipment, supplies, medications, and sometimes even electricity, the team still decided to find ways to operate and heal as many children as possible. Nutritionally and developmentally, all the children in need of surgery were near the bottom in applied standard percentiles of growth and height. Successful surgery for them was a matter of life or eventual death.
The team members were Muslim, Christian and Jewish and they faced many personal and professional challenges over the two weeks they were in Palestine. One respiratory therapist of Jewish heritage described her participation in CardioStart’s Palestinian assistance program as, “the most important, meaningful and valuable experience of my life, and one which fills me with sadness for the situation I see.” It was during the team’s second week in Palestine at Shifa Hospital in Gaza that they faced their most emotional moments.
“On Sept. 11, after a routine day marked by two successful operative open heart cases, our team retired for the evening to the Ministry of Health’s guest house,” said Marath. “We then watched on CNN the full horror of the destruction of the World Trade Center and Pentagon. For all the Americans on the team, it was an appalling act of savagery on their people, but for one CardioStart ICU nurse, from New York, Nelson Aquino, it was especially cruel. He stared at the television knowing that his uncle was working on the 102nd floor of one of the Twin Towers and after some distressing phone calls back to New York, he confirmed that his uncle was missing. Later, the man was confirmed dead. Astonishingly, Nelson recovered his composure and continued working 16-hour shifts until the end of the week to help the children. It was an incredible act of courage on his part. It had a very positive affect on other members of the team.”
According to Marath, other Americans in the team were also feeling gutted, from sharing a national sense of deep pain and hurting, and also personally.
“It was difficult not to feel uncertain about the usefulness of continuing one’s role in a compassionate mission, when terror appeared to have won the day,” he said. “Some of us wondered if Americans in Palestine would now be a focus for personal attack. What followed was remarkable. These negative thoughts and concerns were quickly dispelled by scores of Palestinians patients, visitors and staff in the hospital coming forward to speak to the team. They emphatically expressed their sorrow and deep sympathy for all the Americans on the team — and for all Americans. Many openly declared that such atrocities were completely ‘un-Islamic’ and would set back the peace process in many ways. It was a deeply moving testimony.”
President Yasser Arafat further emphasized the warm, conciliatory mood by his embracing gesture of donating blood at Shifa Hospital the following day. He exhibited obvious sincerity and genuine personal concern for the CardioStart team and held a reception in their honor. He gave thanks for their contribution, which he described as “the most graciously offered act of kindness possible, in consideration of the state-of-war circumstances present in Palestine.” He also warmly greeted two Jewish members of the team, praising their courage and farsightedness in crossing traditional political boundaries to offer simple non-discriminating, compassionate support.
The days following Sept. 11, became painful for everyone involved, even though they were productive. There were two further Apache helicopter attacks half a mile away from the hospital. Among the many other nightmare issues that the team was facing in caring for the children they had concerns about how they would return home. Despite these pressures, on conclusion of the mission over 50 cases had been fully evaluated and over 20 open-heart cases had been successfully carried out — with great results under very difficult conditions. Most patients achieved a full definitive repair of their heart lesion and satisfactorily left the hospital.
“The CardioStart volunteers who participated in this mission made a generous, simple, focused and highly effective step in affirming dignity and helping to preserve non-discriminating humanitarian interest,” said Marath. “Under the most difficult conditions, Palestinian children were assisted and their medical problems resolved. The Jewish book of law, The Torah teaches, ‘When you save one life, you save a nation.’ That beautiful saying remembered clearly by Jews who endured World War II, equally applies to all oppressed people everywhere. Those who remain silent or inactive condemn themselves.”