Building a Paediatric Health System in Occupied Palestinian Territory

More is necessary than just curing sick children

Von Issa Bandak, Livia Leykauf, Sybille Oetliker

Since more than 60 years, Caritas Baby Hospital offers to the Palestinian children and their families access to comprehensive health care service. The only exclusively paediatric hospital in Westbank, which is run by “Children’s Relief Bethlehem”, guarantees best medical and nursing services for all children – independently of their origin and religion. Since its beginning the hospital has implemented a holistic approach and it includes mothers into the treatment of their sick children. This makes Caritas Baby Hospital a pioneer in the health care system in Palestine.

More is necessary than just curing sick children

In the holistic approach, the parents are narrowly included in the treatment. Photo: Children’s Relief Bethlehem

 

In 1952, a Swiss priest, Father Ernst Schnydrig, travelled to Bethlehem. He wanted to see the living circumstances of the people in the Holy Land just a few years after the Nakba respectively the creation of the state of Israel (followed by the Independence War). He was shocked of what he saw: poverty, huge numbers of Palestinian refugees living under miserable conditions, a terrible lack of medical services. However, the most heart breaking for him was the suffering of innocent children. Boys and girls died because of malnutrition and dehydration. A simple diarrhoea or coughing might have led to the death of a child.

There were no paediatricians to treat children and there was no hospital, where children could stay overnight to have an infusion or any other simple therapy. Many parents did not have the basic knowledge about health issues and used traditional practices, often even causing harm to their children. Father Schnydrig did not want to tolerate this. For him, as a person and as a priest, this was unacceptable, especially in Bethlehem, where in his beliefs the baby in the truest sense of the word, is “holy”.

With the support of the Palestinian doctor Antoine Dabdoub and the Swiss nurse Hedwig Vetter, who had been working in Bethlehem since 1946, Father Schnydrig decided to start a small paediatric health centre to treat children in need in and around Bethlehem. This was in 1952/53 and it was the beginning of Caritas Baby Hospital. From the very first moment the medical staff underlined, that it is not enough to cure sick children. The involvement of the parents was an important element to cure the children. They needed to understand why their kids got sick and what they could do to help them.

In 2017 close to 50000 children were treated in the hospital as in- and out patients. Photo: Children’s Relief Bethlehem


From a small health station to an important paediatric hospital

What decades ago started as a small purely charity based health station called Caritas Baby Hospital, is today a pillar within the Palestinian Health system. It is the only exclusively paediatric hospital in the West Bank. The hospital today is an important partner of the Ministry of Health, certified by World Health Organisation with the “Patient Safety Friendly Hospital Initiative” and a training hospital for paediatricians and nurses.

An extended Social Service and social workers regularly visiting patients' families at home, a unique offer of physiotherapy for babies and children up to four years as well as a Mothers' Department where mothers of hospitalized children can stay and get support, complete the offer of the hospital. Finally, Caritas Baby Hospital has an excellent laboratory and publishes articles on its scientific research.

In 2017 close to 50’000 children were treated in the hospital - 44 584 in the Out Patient Clinic and 4 642 in the wards of the hospital as in- and out patients. The hospital has 82 beds in four wards: two paediatric wards, one for neonatals and premature and one Intensive Care unit and an Out Patient Clinic.

The medical needs for children today are very different to those, when the hospital started. Malnourishment is nearly eliminated in Palestine. Parents know more about food, hygiene and the overall medical context. But the Declaration of Alma-Ata did not get less important in the last 40 years. Still Palestine faces “gross inequality in the health status of the people” and other challenges mentioned in the document. The hospitals’ mission and vision aim to abolish those deplorable situations by its daily work.


Involving parents to the treatment of sick children

Working together with the mothers and the whole family of the sick child is crucial for the long-term success of any treatment. The better parents know about the disease their child suffers, the better they can support the treatment at home. Reading and interpreting correctly the signals of a child, the faster the parents can react, when a problem occurs. That’s why in the holistic approach of the treatment, the parents are narrowly included. The mother can stay in the Mother’s residency department, during her child is hospitalized. Every day there is a lecture about a relevant topic, from medical basics to parenting tips.

Many of the mothers staying in the hospital are living in very precarious conditions due to the difficult political, economic and social situation in the region (Southern Westbank, Occupied Palestinian Territory). The stay in the Mother's residency department not only allows the mothers to be close to their sick child and follow lectures but also enforces them as women, wives and mothers. For them the Caritas Baby Hospital also is a place where they can relax from their daily stress in the family, where they can exchange with other women and find time for themselves and thus are supported and strengthened in the role they have in their community.

There are of course also cases where a close individual support for the mothers is indicated and necessary. One such example is the whole topic of early-marriage as well as inter-marriages that are quite common in the region. The Caritas Baby Hospital often sees patients with genetic diseases. Talking about the risks for future pregnancies is a very sensitive matter. Doctors, nurses and social workers closely cooperate in such cases and give individual support to the concerned families. Finally, Caritas Baby Hospital participates in the prevention work done by the Palestinian National Authority and local NGOs. "Although this is a very sensitive matter, we are happy to see changes in the behaviour of the families", says Dr. Hiyam Marzouqa, Chief Medical Doctor of the Caritas Baby Hospital. "But we have to be aware that changing longstanding traditions is a huge challenge and results are only seen in a long-term".


From donor-guided to local ownership approach

The Swiss Non-Profit Organisation “Children’s Relief Bethlehem” is running Caritas Baby Hospital. The operational tasks are trusted to the local Executive Committee and staff. Funding is guaranteed mostly by donations from Europe. Palestinian insurances, the Ministry of Health, UNRWA and contributions by the parents also help to finance the hospital. Needy families are exempted to the hospital charges.

For Children's Relief Bethlehem it is a fundamental commitment that every child gets the same best quality of medical and nursing care - notwithstanding the religious, social, political or financial background of the parents. Running a hospital in Occupied Palestinian Territory on a longterm is a huge challenge for a Swiss NGO. Enforcing the sustainability of the Caritas Baby Hospital is therefore a main task. Having started as a purely charity-based project with a donor-driven somehow paternalistic approach it was important to allow the Caritas Baby Hospital to become an important local player. This is realized basically on three levels:

1.    The operational responsibility for the hospital has been more and more delegated to local staff. The Palestinian leadership of the hospital maintains close contacts with all important local stakeholders: the Palestinian National Authority, other local hospitals and institutions, health-insurances etc. This allowed Caritas Baby Hospital to become an important pillar of the Palestinian health sector.

2.    From its beginning, medical doctors and nurses in Caritas Baby Hospital had a holistic approach for the treatment of the patients. This means: medical doctors, nurses, physiotherapists, social workers, nutritionists etc. are all consulted when looking for the best therapy for a sick child. Mothers and families of the patients are also always closely involved into the whole treatment and are regularly supported. This close cooperation of all involved people is unique in the region and very much appreciated by the local stakeholders and is for sure one of the keys for the success and recognition of the hospital.

3.    The responsibility for the financing of the hospital is shared between Children's Relief Bethlehem und Caritas Baby Hospital. While being up to 90 per cent dependent on foreign donations for a long time, the local income-generation is now strengthened and will become more important in the next years.

Since the hospital was founded more than 65 years ago, many things have changed. But one did not, our motto “We are here”. This is a promise of Children’s Relief Bethlehem and Caritas Baby Hospital to the Palestinian children and their families and the promise to defend the right to access to primary and comprehensive health care services – for all.

Issa Bandak, Livia Leykauf, Sybille Oetliker

Sybille Oetliker Managing Director Children's Relief Bethlehem; Sybille Oetliker studied History and Economics in Berne and Hamburg, then worked as a journalist in Switzerland and correspondent in Israel/Palestine; later she worked in a political lobbying association in Switzerland. In 2014 she was appointed Managing Director of Children's Relief Bethlehem, an NGO which has its head-office in Lucerne, Switzerland.

Livia Leykauf Head of PR and Media Department at Caritas Baby Hospital). She studied Theology and Journalism. Before she moved to the Holy Land, she worked as a freelance journalist and as Press Officer at Caritas Switzerland.

Issa Bandak (CEO Caritas Baby Hospital; Issa Bandak was educated in the United States. Grown up in Bethlehem, he has a Masters' Degree in business administration from Bowling Green State University and has a Masters' Degree in Health Care Management from Georgetown University; he was appointed as the Chief Executive Officer of the Caritas Baby Hospital in 2012.

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