Healing Across the Divides: American Engagement with a “small p”

1. Healing Across the Divides: American Engagement with a “small p” Norbert Goldfield, M.D. Executive Director Healing Across the Divides, Inc www.healingdivides.org

2. Our Mission • Healing Across the Divide (an American not for profit organization) assists Israeli/ Palestinian health care organizations to • improve the health of Israelis and Palestinians, • document that health has, in fact, improved and/or the barriers to improvement from a health and human rights perspective have been removed • bring the barriers to improvement to the attention of policymakers in the US and Europe

3. Why bother trying to improve the health of Israelis and Palestinians? Why not just pursue an explicitly political strategy?

4. Diabetic stories of Palestinians are useful • For the patients themselves as health professionals repeat the stories back to the patients • For the organization from a planning and evaluation perspective • From a political/ policy point of view to influence an understanding of the impact of societal forces on diabetes control.

5. Board of Directors as of November 2005 • Heidar Abu Kteish, MPH, Director of Prevention Programs, Union of Palestinian Medical Relief Committee, Ramallah, Palestine • Ziad Asali, M.D., Executive Director, American Task Force on Palestine, Washington DC • Paul Hassoun, M.D. Johns Hopkins University School of Medicine, Baltimore, MD • Peter Gubser, President ANERA, replaced Alfred Khoury, M.D.

6. Board of Directors (cont) • Larry Lowenthal, PhD, Executive Director, American Jewish Committee, Boston Chapter, Boston, MA • Margaret O Kane, MPH, President, National Committee for Quality Assurance, Washington, DC • Leonard Rubenstein, J.D. Executive Director, Physicians for Human Rights – USA, Washington, DC • Hadas Ziv, Executive Director, Physicians for Human Rights – Israel, Tel Aviv Israel

7. PMRS is a grassroots, community-based Palestinian health organization. PMRS was founded in 1979 by a group of Palestinian doctors and health professionals seeking to supplement the decayed and inadequate health infrastructure caused by years of Israeli military occupation. It is non-profit, voluntary, and one of the largest health NGOs in Palestine. PMRS's national health programs emphasize prevention, education, community participation, and the empowerment of people.

8. PHR-Israel has worked since its inception to promote peace and human rights through health, and to promote health through safeguarding human rights and ethics. Not only should the right to health be safeguarded in times of conflicts, it is a dam in the face of further deterioration and violence and a basis for future reconciliation.

9. International Committee of Expert Scientific Advisors

10. It is important for Israeli and Palestinian health professionals with the assistance of outside professionals from outside the Middle East to identify: • ·concrete health and ethical problems, • ·research questions that are significant, need resolution, and are resolvable

11. Empowerment: Definition • increasing the capacity of individuals and groups to make choices and to transform these choices into desired actions and outcomes

12. Historical analysis of the development of health care facilities in Kerala State, India • Though poor by standards of per capita income, industrialization or agricultural production, the Indian state of Kerala has shown that these constraints need not hinder the development of social sectors. The state has achieved near universal literacy for both males and females and the health care indices are comparable to countries with more advanced economies

13. Illustration If a team were trying to assess the degree of political empowerment of women as it pertains to health, information would first need to be gathered on the existence of women’s access to health services. Then the question would be asked, do women choose to access these services and why/why not? Finally, the team would assess the health outcome of these choices; that is, does the health of women actually improve?

14. Our Currently Funded Projects • Galilee Society: 25,000: Diabetes Improvement in Tamra • UPMRC: 25,000: Diabetes Improvement in Abboud, Idna, Singil. • PHR-Israel: Women’s Health: 25,000 – funded but not implemented.

15. What has been accomplished • Improved Outcomes: Documented Changes in HgbA1C for the UPMRC diabetes project. Several hundred diabetics enrolled • Process Improvement: Well-Validated Study Design for Tamra together with beginnings of intervention • Structural Improvement: Beginning of ongoing one month training sabbaticals of Palestinian and eventually Israeli health professionals.

16. Healing Across the Divides is ready to move the diabetes project from the test phase onto a large scale application – we’ve committed to increasing our support to 50,000 per year for 3 years

17. Next Planned Projects • UPMRC/PHR-Israel: Women’s Health/ Breast Cancer • Expansion of existing projects: UPMRC from 3 to 33 villages. General proposal done. In process of developing quality of care audit instrument • Women’s Health Project – PHR-Israel. • Expansion of Galilee Diabetes Project to other Israeli Arab communities. • Smoking Cessation Intervention among health professionals and diabetics

18. The Health of Palestinian Women • As a Palestinian woman with breast cancer, your chances of survival are poor. Breast cancer is the second most common cause of death among Palestinian women, even though breast cancer occurrence is generally much lower among Arab women than Western women. • The number of Palestinian women stricken with breast cancer is dramatically on the rise. Conservative estimates suggest that seven out of ten Palestinian women with breast cancer will die

19. Policy/Political Question • How should project results/ obstacles to improvement be brought to the attention of different constituencies – health care professionals, policymakers (health, foreign relations)

20. Clinical stories are used in many ways: to inform, to share, to inspire, to educate, and to persuade.

21. Khalil Ibrahim Awwad • In the PMRS clinic, Dr. Abdul-Rahim and Dr. Suheil educate us about food and sport. I feel psychologically comfortable, because the clinic staff show a lot of respect and care for the patients. Based on advice from the workers in the clinic, I changed almost completely my life style: • I reduced consumption of tea, potatoes, rice and sweets. I provide special care to my feet as per the advise and according to the instructions provided by the clinic staff. And after discovering diabetes, I stopped smoking.

22. Palestinian in Abboud, West Bank • Why can’t I control my sugar? Well its obvious. It is the stress of Israeli occupation. You (speaking to me) should go do something about it • Healing Across the Divides response: How can HATD work with you/PMRS so that you will live to see the day that you will be in a country of your own.

23. Why bother trying to improve the health of Israelis and Palestinians?Answer: Without health one cannot be an empowered citizen Why not just pursue an explicitly political strategy?Answer: Today, there is no political strategy that is worth presenting – unless you like talking to yourself.

24. I have pessimism of the intellect, optimism of the will – Gramsci, 1920’s I try to be cynical but I can't keep up- Lilly Tomlin

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