One man’s struggle to undergo heart surgery shows how difficult it is to find care in Gaza: NPR



ARI SHAPIRO, HOST:

You may know what it’s like to have your life suddenly cut short by a health problem in the family: finding the right doctor, the right hospital for specialized surgery. Now imagine doing that in a place that is largely isolated from the rest of the world, the Gaza Strip. This week, we are going to follow the story of a man in Gaza who needs heart surgery. To that end, we have a special series from our co-host, Daniel Estrin.

Hello Daniel.

DANIEL ESTRIN, HOST:

Hi Ari.

SHAPIRO: I know you’ll be telling us a man’s story for several days. And I want to start with the place where the story takes place, in the Gaza Strip. What makes this place special, distinctive, unique?

ESTRIN: It is a small strip of land along the Mediterranean Sea. There are 2 million Palestinians who live there and they have been virtually confined there for the last 15 years. Gaza was taken over by the militant group Hamas. It frequently launches attacks against Israel, for which Israel has imposed a blockade and Egypt has also restricted its border. And there has been conflict and war there every few years. It has been that way for the last 15 years. And all that time, I’ve seen conditions in Gaza deteriorate, and especially medical care.

Now, it wasn’t always like that. Gaza used to be this portal to the rest of the Mediterranean, especially during ancient times. There is even a theory that the word chiffon comes from the word Gaza because it was made there centuries ago. But today, the modern health system in Gaza is in shambles.

And you have well-equipped hospitals just a few hours’ drive away. In Jerusalem, in the West Bank, in Israel, everyone is willing to accept patients from Gaza. But every time I’m in Gaza, I hear stories about people whose medical problems are getting worse. They lose their sight. They even die while waiting for permission to go to those hospitals.

SHAPIRO: And as you watched this gap grow, as you watched the healthcare system in Gaza deteriorate, what drew you to the story you’re about to share with us?

ESTRIN: I think what attracted me is that when I report from Gaza, I go there every few months or so, even during quiet times when there is no war and Gaza is not in the headlines. I’m based on the region for NPR. And every time I’m there, I hear these stories, people struggling to get medical care for themselves or someone in their family. They are caught in this web of conflict, suspicion and geopolitics. And it has been getting worse over the course of 15 years. If you’re really sick, you’re bound to get caught up in it.

So I wanted to understand what it takes for someone in Gaza to get care. My colleague Anas Baba and I went to the main hospital in Gaza, Shifa Hospital, at the end of last year. We went looking for a patient we could follow, and found one in the chaos of the waiting room.

Wow. Everyone is crowding here.

ANAS BABA, BYLINE: They’re going to close the doors.

ESTRIN: The security guards are trying to control the crowd clamoring to see a doctor.

Can we ask someone what they’re doing here?

And in a sea of ​​patients, we approach a man with a trimmed beard and gaunt face.

YOUSEF AL KURD: (Speaking Arabic).

ESTRIN: “I haven’t slept since yesterday,” he says. His name is Yousef al Kurd. He is 70 years old and is with his son, Ibrahim.

Why did you come here?

IBRAHIM AL KURD: (Speaking Arabic).

BABA: “He needs open heart surgery.”

I AL KURD: (Speaking Arabic).

BABA: “Three months, we are totally suffering for three months. We just want to have him operated on. That’s all.”

ESTRIN: Should we take your number in case of…

And this is how we know Yousef al Kurd. So let me tell you a little more about him.

You can listen to the evening prayers.

Throughout Gaza you can hear the loudspeakers of the mosques, which Yousef al-Kurd himself repaired. His son tells me that his father studied electrical engineering in Germany and returned home to become a professional repairer of sound systems in Gaza.

I AL KURD: (Speaking Arabic).

BABA: “And he is the most famous technician in Gaza. He fixes the mixers, the microphones of street vendors, the microphones of mosques, the microphones of schools.”

ESTRIN: He did it for 30 years. He retired a few years ago, but taught his children to do the same work. And it was in his workshop where his father had his first heart attack.

I AL KURD: (Speaking Arabic).

BABA: “Suddenly, one day out of the blue, he started feeling the heart attack.”

ESTRIN: He is a heavy smoker with diabetes. The doctor said he needed heart bypass surgery. This was in the spring of 2020. But with the COVID pandemic, his cardiologist was reassigned to a COVID ward, and Kurd himself was hesitant to have surgery.

I AL KURD: (Speaking Arabic).

BABA: “At the same time, he was afraid that there would be COVID in hospitals and at the same time an open heart, so he just put it off.”

ESTRIN: A year later, he developed another condition: leg ulcers. His children took him back to the hospital.

I AL KURD: (Speaking Arabic).

BABA: “We went back to Dr. Mohammad Nassar and we were totally shocked and surprised that Dr. Mohammad Nassar left Gaza forever.”

ESTRIN: The head of cardiac surgery had gone to Spain, following the path of many doctors fleeing harsh conditions in Gaza in recent years. A new doctor was put in charge.

SAHER ABU GHALI: Hello. My name is Dr. Saher Abu Ghali. I am 40 years old.

ESTRIN: He was one of only four heart surgeons left in Gaza. But a doctor in his department died, actually of cardiac arrest. A month after that, another died of COVID.

ABU GHALI: From four, we have become three, and now we have become two.

ESTRIN: There are only two heart surgeons left in Gaza for a population of 2 million. That’s what Dr. Abu Ali told me when we spoke earlier this year. And it is still the case. He thinks Gaza needs 10 surgeons. In the US and Europe, the accepted ratio is about 55.

ABU GHALI: Not only us, the number of surgeons is only two. This is not the only problem. You don’t have all the instrumentation. You don’t have all the resources.

ESTRIN: Israel restricts the import of medical devices, such as some X-ray equipment that it says Hamas could convert for military use. And the Palestinian Authority in the West Bank does not provide enough medical supplies to Gaza. The reason for this could be that his rivals for power with Hamas. So there’s a chronic shortage of supplies, like something called a cannula, the thin tube that’s put into the heart during bypass surgery. Dr. Abu Ghali says you’re only supposed to use them once and throw them away.

ABU GHALI: Here, each cannula is re-sterilized more than 100 times. Yes it’s correct. This is Gaza, because if you want to use it once and throw it away, you won’t operate. You will never have surgery.

ESTRIN: Now, Israel allows doctors into Gaza to help a few days a month, but that’s not enough. And with the blockade, Israel doesn’t let Palestinian doctors out much for training. With health systems so small, it is too risky to perform many complex procedures in Gaza. Yousef al Kurd needs coronary artery bypass surgery and Dr. Abu Ghali can’t do it.

ABU GHALI: No, it is difficult to do it safely in Gaza. We need heart surgeons. We need vascular surgeons. We need the instrumentation. So it was a very high risk surgery for us.

ESTRIN: The doctor recommends that you go to a better-equipped Palestinian hospital in the West Bank, a non-Hamas-controlled and non-blockaded Palestinian territory less than 2 hours away. But when I meet him in the hospital waiting room, he is waiting for Israeli permission to go to the West Bank. He already scheduled the surgery a couple of times, but missed each time. He did not have the Israeli permit that he needed to travel.

(Speaking Arabic).

I AL KURD: (Speaking Arabic).

ESTRIN: “The surgery is very urgent,” says his son.

BABA: “If they just cancel it, I think my father will pass away. He will die.”

ESTRIN: He fears that if his father doesn’t get an Israeli travel permit for the surgery, he won’t live much longer.

SHAPIRO: Daniel, I want to know how this story ends. And I know they will tell us about it in the next few days, but this patient, Yousef al Kurd, is in a really difficult situation right now.

STRYN: Yes. He needs a heart operation which is too complicated to do in Gaza. There are only two heart surgeons left in Gaza. The others have fled or died. There is not enough medical equipment in Gaza to do it. And that is just one example of how Gaza has deteriorated since Hamas took power and since Israel and much of the world have tried to isolate it.

Now, Israel says that this blockade is necessary to contain Hamas. Israel, the US and the EU consider it a terrorist group and launch attacks against Israel. But 2 million Palestinians live there, and rights groups call it collective punishment.

SHAPIRO: Is there any effort to improve conditions, either by getting more medical equipment or surgeons?

ESTRIN: Well, the World Health Organization has been asking for this for years. They want Israel to facilitate the entry of medical equipment, to allow doctors to leave Gaza for training, and also for the Palestinian Authority to pay for more medicine and equipment to Gaza. But Hamas controls Gaza. Israel and Hamas are enemies. The whole conflict is at a standstill, and health care is a victim of that.

SHAPIRO: Who pays for this medical care?

ESTRIN: Well, that’s the thing. The Palestinian Authority pays for it, and since it is a government-provided healthcare system, the Palestinians have it. And they also pay for treatment outside of Gaza. So if someone needs surgery that they can’t get in Gaza, they pay for care outside.

What happens is that there is not much money. It comes from international donors: the US and other countries. There isn’t much, so they have to be very selective about who they send for care.

SHAPIRO: Tell us what we’re going to hear tomorrow.

ESTRIN: Next, we will see how Kurd and his family will try to get him out of Gaza for surgery. It involves many approvals. Palestinian officials must make the first call. And they have to be especially selective because they don’t have a lot of money to send patients out of Gaza and because Israel only lets out the most serious cases and there are thousands. So we’re going to meet a Palestinian doctor who has really tough choices about what constitutes him and what doesn’t constitute an urgent case. And when we were in his office, he got a call about another patient who was on the operating table in Gaza with a complication that they couldn’t treat there. And the question was, should they take him out of Gaza or not? And this is what the doctor said.

So it’s not bleeding.

UNIDENTIFIED DOCTOR: No active bleeding, some drainage on the side of the surgery. So it’s not an active bleed, so it’s not a peak emergency. We can wait. And we…

ESTRIN: It’s just one example of how selective he is and how much is at stake for a man like Yousef al Kurd, who just needs to have heart surgery.

SHAPIRO: Daniel Estrin, looking forward to hearing the next installment of the story. Thank you.

STRETCH: Thank you, Ari.

(SYNCHRONOUS SOUND OF MUSIC)

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