Transcript United Nations Plan of Action on Peace

Healing Across the Divides:
American Engagement with a
“small p”
Norbert Goldfield, M.D.
Executive Director
Healing Across the Divides, Inc
www.healingdivides.org
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
Why bother trying to improve the
health of Israelis and Palestinians?
Why not just pursue an explicitly
political strategy?
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.
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.
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
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.
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.
International Committee of
Expert Scientific Advisors
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
Empowerment: Definition
• increasing the capacity of individuals and
groups to make choices and to transform
these choices into desired actions and
outcomes
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
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?
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.
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.
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
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
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
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)
Clinical stories are used in many ways: to
inform, to share, to inspire, to educate, and
to persuade.
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.
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.
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.
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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