Last month I was fortunate to be able to spend 2 weeks working with the Faculty of Medicine and Health Sciences in An-Najah National University, Nablus in the Palestinian Territory on the West Bank. It had been a long standing ambition of mine to do some international developmental work outside of Western Europe, and so when I was offered the opportunity by Dr Samar Musmar, Vice Dean for Post Graduate Studies at An Najah University and a trained family physician, I was delighted to accept. I was particularly pleased about the prospect of working in Palestine, because of the combination of professional and political insights which it seemed likely to offer.
Following our initial discussion at the SAPC meeting in Bristol last July, Dr Musmar and myself had an intermittent correspondence in the months leading up to my visit scheduled from 19 May to 1 June of this year. We discussed the possibility of my providing input to the Family Medicine Training Programme which she had initiated last year, and of my potential to support to the University’s clinical research programme in whatever way seemed most appropriate. My offer to her was to make whatever use she thought best of my presence over the two weeks of my visit, and to maintain links as appropriate following my visit via email and teleconferences, with the potential for future return visits depending on circumstances and funding.
I was not disappointed; an appointment with Dr Musmar was fixed for 08.00 the Sunday morning after I arrived (Friday and Saturday constitute the weekend days in Palestine) and we immediately set to work on planning a detailed programme of meetings. I was to work with the clinical research leads of the Faculty in Nablus over the first fours days of my visit, to go to the ancient city of Jericho by the Dead Sea on the fifth day to attend a high level primary care conference chaired by the newly appointed Minister of Health, and to spend the following week in Hebron in the south of the territory working with the Family Medicine residents and visiting their primary care facilities.
The work with the clinical research leads proved both fascinating and fruitful. Most of them had undertaken postgraduate training outside of Palestine, many in the US and Europe, and it was clear that there was a considerable pool of research talent but perhaps unsurprisingly the structures and resource needed to promote a co-ordinated and effective research programme were lacking. As a result of several discussion sessions and workshops during the first week, we decided to produce a draft research strategy document for the Faculty of Medicine and Health Sciences and this was presented to the Dean of the Faculty for discussion and approval two days before the end of my visit.
The primary care conference in Jericho was equally interesting, and I was particularly struck both by the Minister’s clear commitment to prioritising Primary Care within the Palestinian Health Service and by the evident need to develop a properly trained primary care workforce including a cadre of properly trained family medicine doctors .Elements of the UK model appeared to be relevant to the emerging programme, but it was clear that these would be need to be modified to take proper account of the very different social, cultural and economic realities in Palestine.
My time in Hebron with the first wave of Family Medicine residents (I called them “The Mothers and Fathers of Family Medicine in Palestine”) was both fascinating and enjoyable, They are a diverse group of trained doctors with widely varying levels of training and experience. Some of the primary care facilities which they showed me were of excellent quality but many left much to be desired. We discussed the potential to develop their training programme further and to build international links both within the Middle East Region and in Europe.
Of course it was impossible to spend time in Palestine without being involved in the political situation and in any case that had been one of my principal personal objectives. I spent a great deal of time talking to colleagues and acquaintances whom I had met during my stay as well as to others in Palestine and Israel whom I had known before I went out. I was struck by the significant gaps in the international media coverage of the situation inside the West Bank and at my own lack of understanding of the realities of every day life. Seen through the eyes of the Palestinians, the situation is challenging to say the least, and there is no escaping the overwhelming sense that the ability of ordinary people to lead the working and family lives to which most of them aspire is overwhelmingly determined by decisions made out-with their control by the Israeli state.
I count myself enormously fortunate to have had this experience and am determined to continue to develop my links with my Palestinian colleagues. At the moment we are in dialogue about the future development of the family medicine training programme and are sounding out the possibilities of involving international colleagues at various stages on the course. My personal ambition would be to engage some of my Israeli colleagues in this venture but only time will tell whether the politics of the region will allow this to happen.
Paul Wallace
Clinical Director, Primary Care Research Network
June 2012
