Tuesday, June 16, 2020

Surgical Ethics Education Resources #5


[Sent – 11 August 2018 to the 170+ surgeons et al of our Surgical Ethics (Education) Consortium]

Greetings.  I am in between flights on my way home after a week in Gaza on a global health project.  For the ‘Surgical Ethics Education Resources’ #5 communication, I am deviating a bit from the format for sharing surgical ethics education resources by inserting below the final Facebook posting my colleague David McRay, MD, and I wrote last night after the week in Gaza.  (Yes, I am one the few not on Facebook!)  David was the advisory faculty for Advanced Life Support in Obstetrics courses conducted through the week.  I led ethics training sessions for physicians staffing the six neonatal ICUs in Gaza and for general surgeons in the main teaching hospital in Gaza City.  Each previous night before last night, David posted detailed descriptions of our activities and experiences that day.  This final Facebook posting is more reflective.  The reasons to send you these reflections are transparency and context as you assess the possible usefulness of the surgical ethics education resources I am sending to you every few weeks.  The surgical ethics education resources I am sharing with you have been tested/revised/refined during numerous interactions with physicians, surgeons, residents, nurses, and medical students in Palestine.  I would be pleased to answer any questions you may have about (1) the global health elective for 4th-year students David and I lead (@60 medical students – 4-6 each Spring – from medical schools across the US have now completed this elective) and/or (2) the ways David and I are supporting medical/surgical educators in the West Bank and in Gaza.  Doug
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[10 August 2018 Facebook posting]
“So, how was Gaza?”

In the past 24 hours, Doug and I have been asked this question by many of our friends and family – in person here in Ramallah and Old Jerusalem as well as by phone, text, and email.  We anticipate hearing the question again and again after we return home tomorrow.  It is an appropriate question; one I have asked in the past when colleagues have returned from a visit to “the Strip” – the small stretch of land trapped between hostile neighbors, Egypt and Israel, and covering only 141 square miles (25 miles long and 7.5 miles across at its widest point). However, although it is an appropriate question we have hesitatingly tried to answer, the question carries a complexity too challenging to grasp, at least for us.  We really have no firm idea how Gaza is.  During my previous three visits, I had only seen Gaza City (the largest city in Palestine, with a population over 500,000). We had arranged to drive the length of Gaza on our last day, visit the refugee camps, see the Rafah crossing, and tour the area where the Great March of Return happens each Friday. The bombing of Gaza this week forced us to cancel this attempt to have a more comprehensive introduction.  And so, we do not yet know much about Gaza and life there.  We only know what we saw and what we were told during our workshops, at meals, while walking in Gaza City among the people each afternoon and evening. 
Gaza (a derivation of a word I understand means ‘strong’) is vibrant; passionate; educated and informed; tragic; beautiful; polluted; defiant; in rubble; enduring; exhausted; courageous; economically diverse; hot and dusty; littered with trash; choking and gasping; delicious; resilient; welcoming; confused; hopeful; generous and gracious; hungry and thirsty for food and water, for freedom, for electricity, for self-determination, for life; forgotten; strong. 
“So, how was Gaza?” can have several meanings.  Some are asking, “What was Gaza like – the city, the land, the culture, the ‘situation’?” Some are asking, “How are the people in Gaza? How do they feel? How do they survive? How did they receive you?” And, some may be asking, “How did you experience Gaza? What was it like to be in Gaza? Were you afraid?” Each variation of the question has many possible answers, even after only a brief and narrow five-day visit. 
I am just learning about Gaza, after a lifetime of visiting and studying Palestine and Israel. I recently finished one book (Gaza in Crisis) and have started a second (Gaza: Preparing for Dawn).  We are trying to keep our eyes open and our assumptions and presuppositions in check.  We are trying to listen more than we speak, asking questions of anyone who will inform us, while recognizing that our sample size is very small and quite far from random.   
We can comment with more certainty about what Gaza is not, rather than what Gaza is.
Gaza is not Hamas. Hamas controls Gaza inside the heavily guarded and completely sealed territory. Everything that enters and exits Gaza is controlled by Israel (along with most of Gaza’s territorial waters, its airspace, and its land borders). We did not meet a single person who professed support for Hamas (again, our sample size was small and far from random). The hope that many Palestinians placed in Hamas as a political movement in the 2006 election and as an answer to the corruption of the Palestinian Authority has not been realized (and the reasons are complex and subject to much debate). 
Gaza is not a “hotbed for terrorism”. This observation is challenging and controversial for many, but the word ‘terrorist’ has been so misused and abused as to almost have no clear meaning.  The intentional killing of civilians and the targeting of non-military locations for political purposes and for the creation of conditions of terror is simply wrong, whether done by an organized or disorganized militant group or by the army of a nation-state.  But Gaza is not defined by the actions of Hamas or Islamic Jihad or any other militant group.  Gaza is home for two million people struggling to experience the life we all want – to work, to receive an education, to have a family, to enjoy the beauties of nature, to share a meal with friends. 
Gaza is not a sad and miserable place.  Gaza is filled with music, and laughter, and delicious ice cream, and the beauty of wedding caravans, and the joy of birth, and the grief of death, and all the various shades of life present everywhere else.  But it is a place with much sadness and misery, where everyone can distinguish the sound of a primitive ‘rocket’, a missile from an Apache helicopter, a bomb from an F16, the humming of a drone, and the air raid sirens from across the border in Israel – all sounds civilians should not know. Gaza is a place where children cannot sleep at night for fear that death will come from the sky, and where parents tell their children that the explosions they are hearing are just the fireworks from a wedding celebration. 
Gaza is not – or should not be – forgotten. As we listened to the bombs fall nearby during the night on Wednesday and followed the frequent updates from the local news sources, we were saddened, but not entirely surprised, to note how many hours passed before we could find any mention of the escalation in the US media. Gaza may be uninhabitable in the next few years (as the UN predicts), but two million people live there now and they must not be forgotten. 
Doug and I are deeply grateful to the Palestine Children’s Relief Fund, to Juzoor for Health and Social Development, to the physicians and surgeons at Al Shifa Hospital, and to everyone who coordinated our work with them this past week and welcomed us with the remarkable Palestinian hospitality. The feedback we received indicated that the Advanced Life Support in Obstetrics and Helping Babies Breathe courses and the ethics workshops for pediatricians caring for critically ill newborns and for general surgeons were appreciated and helpful. We have been invited to return and eagerly anticipate doing so in the coming months. 
We leave for home in a few hours, with full and heavy hearts.
David 
PS: We invite you to learn more about Palestine and to commit to not forgetting the people of Gaza.  If you want to stay informed, here are two places to find information not often provided by US media sources:
https://jewishvoiceforpeace.org/
https://www.haaretz.com/