Projects Promoting the Health of the Community

Due to the high rates of poverty (82%) and unemployment (70%), the majority of Gazans cannot afford health insurance and rely on charities to provide medical services.

NECCCRW continued to operate the two Family Health Care Centres serving the Shija'ia and Darraj/Tuffah areas in addition to the third one newly opened in Kherbet El Adas in Rafah.  These areas of Gaza and Rafah Cities are amongst the most over-crowded and under-served areas.  Preventive and curative services vary slightly between the three centres.

Aims:

To provide adequate primary health services in operational areas, to poor and overcrowded localities at an affordable level.

To enhance and extend MCH (Maternal and Child Health) services.  To strengthen the provision of preventative health measures and health education and to decrease running expenses of secondary and tertiary health facilities.

To conduct awareness campaigns on public health and environmental issues, in collaboration with the communities and in co-operation with governmental and NGO health institutions.

To attend to the increasing levels of malnutrition among both children and adults, including women through nutritional and health education.

To introduce a computerized system for data storage at each clinic and to develop a reporting system.  This system will develop monitoring and planning processes of the NECC's health programmes and will be made available to governmental and NGO health organizations.

Activities:

NECC’s two existing family health care centres in Shija’ia and Darraj/Tuffah in addition to the third one which was inaugurated in Rafah in middle of August 2002 operated broadly as planned in three of the most over-crowded and poorly served areas of Gaza City and the southern city of Rafah.  The three clinics currently have 20086 registered families.  Preventive and curative services varied slightly between the three clinics, but included the following:

 A well-baby clinic serving children from birth to 6 years old with an increase of 12% in the number of visits.

A laboratory conducting basic medical tests.  The number of tests was increased by 35% which was due mainly to the campaign being conducted on children below 5 years of age in order to identify the children who suffer from malnutrition, anemia, and provided them with necessary supplementation.

A pharmacy providing free and basic medication.  Although the plan was to charge cost-price for all medicines for adults, the deteriorating political, military and harsh economic situation resulted in the decision of the Gaza Area Committee to provide free medicines with nominal contribution from the beneficiaries.

Pre and post-natal care.  This was extended to include, where possible, the examination of pregnant women from the first month, as opposed to the fourth month.  Ultrasound scanners were purchased for both clinics in Shija’ia and Darraj districts and a third one will be provided for Rafah clinic when a specialist is found.  The staff were able to cover 100% home visitations to follow women at their homes.  All the women delivered in the hospital.

The services of full-time female gynecologist who was recruited to head the Health Productive activities in Darraj/Tuffah centre were extended to Shija'ia centre by the end of 2001.  In collaboration with the Ministry of Health (MOH), our midwives and nurses were provided with in-service training.

Health education for neighbourhood women.  This included afternoon activities for women at both centers in Gaza.  The centres provided a place for mothers to meet, to learn and attend courses organized at their request on topics such as literacy, first-aid, various handicrafts, women’s rights and responsibilities.

A Community workers’ training course for 20 women held in the Darraj/Tuffah district.   19 completed the programme in October 2002.  The course included training in health, environmental and social issues such as reproductive health, public health, women’s rights and public awareness raising.  Some of these women began work voluntarily at the health centers, until they find paid employment.  Some of the graduates have already organized collective community activities which aim to protect the environment and clean up communities. 

Their training indicated that women in Darraj/Tuffah district had benefited from their presence and awareness in various topics showed improvement as follows:

Health                                     45%

Environment                           55%

Social                                     36%

An open community meeting held at each centre in order to exchange views on clinic activities and community needs.   Other, smaller group meetings have also been held.  These meetings assisted the centres in reinforcing their goal of continuing to provide low-cost, effective medical care to their communities.

Continuing collaboration with Ahli Arab hospital which allowed the two centres in Gaza to provide a referral service for X-rays and consultants.  Take-up on this was limited due to the harsh economic situation.

Various training days held for the community and staff in various topics mainly first-aid, utilizing experts from NECC and other organizations, such as UNRWA, the University  and Ministry of Health.

In addition to above, and supported by DCA and Church of Wales, we continued to operate the mobile dental clinic.  This provided dental services to patients at both centres in Gaza and visited each of the vocational training centers.  Services included basic dental care and dental hygiene education which was increased by 61% due to the programme applied by the Dentist and two volunteers in screening pregnant women.

In light of the signs of war on Iraq, the three Family Health Cares in Shija'ia, Darraj/Tuffah and Rafah have been provided with medicines, supplies and equipment to meet the needs of the emergency situation thanks to Pontifical Mission in Palestine.  This arrangement was made in collaboration with the Ministry of Health and NGOs.

Arrangements were made with a specialized local NGO (The Palestinian Centre for Solving Crises) to address women at Darraj/Tuffah and Shija'ia centres on topics related to trauma i.e. violence, bed wetting, distress, early marriage etc.

Both centres in Shijai'a and Darraj/Tuffah hosted teams from the Palestinian Hypertension Society and examined women in productive age as part of a joint venture of preventive measure to create awareness and spot any irregular cases.

We addressed the needs of patients with chronic disease i.e. diabetic and hypertension in the two districts.

Difficulties encountered:

The Israeli government has imposed severe travel restrictions on Palestinians in the Gaza area.  This has had a negative impact on several programmes including the Health sector:

Gaza City has been isolated for parts of the year from other parts of the Gaza Strip.  It has proved logistically impossible to set up a third Family Health Care Centre in the south of the Strip in early 2002 as planned.  But our organization with assistance of the community and the PNA Ministry of Health were able to find a suitable building.  Work on refurbishing the building, preparation of furniture, purchasing of basic equipment, medicines and supplies was possible to begin in early April 2002.

The selection of the doctor and paramedics was made after they have been interviewed by the medical sub-committee.  The Committee took in consideration the restrictions on movement imposed by the Israeli army and therefore had selected the staff from residents of the southern districts.  This action minimized the number of lost days to only 41 days.

Most of the planned exchange visits, field trips and external training for the staff were not possible under the prevailing travel restrictions and the prohibition on travel between Gaza and West Bank / East Jerusalem.

The impact of stress which was already having a marked effect on the population has greatly worsened.  Loss of family income and the sense of the insecurity of the home, widespread troop invasions and destruction of  homes or households possessions, humiliation or violence against parents and the knowledge that parents could offer no protection to their children have all led to an increase in mental distress.

The key problems identified by our doctors were anemia and malnutrition.  Many pregnant women with small children were treated for anemia – a result of a poor and iron-deficient diet.  Advice was given to each of them on how best they can feed their families when all they can afford are the cheapest vegetables.  In light of this situation our doctors dispensed iron supplementation to those children who found to constitute as high a percentage of 40% within the areas were the centres are located. 

Activities to be undertaken next year:

The two family centers in Shija’ia, Darraj/Tuffah and the third one in Rafah will continue to provide medical and educational services as detailed in the above activity report, with an emphasis on preventative medicine and education.

The mobile Dental Clinic will continue to serve both communities in Shija'ia and Darraj/Tuffah districts in addition to the trainees of the various vocational training centres.  A Dental Clinic will be attached to Rafah family health care centre when possible.

A part-time Gynecologist will be searched for in Rafah to address the needs of women productive services and operating the Ultrasound scanner which will be provided thanks to a special earmarked donation made by the Global Ministries, Uniting Protestant Churches in the Netherlands.

We shall continue the search for a qualified staff nurse/midwife in order to develop the pre-natal services as there is shortage in this type of professions.  At the same time we shall investigate the possibility for enrollment for training of one of our staff nurses.

To provide each family health care centre with a generator, multi purpose high all counter and centrifuge.

To organize two community courses for 40 women in Rafah and Gaza which will provide training opportunities for 20 women in each area.

Outputs:

The number of newly registered children had increased by 35% from 1569 to 2125 children compared to the same period in 2001.

The number of children attended well-baby clinic days increased by 12% from 12250 to 13765 children compared to the same period in 2001.

The number of new pregnant women reporting to the center increased by 8% from 956 to 1037 compared to the same period in 2001.

80% of the pregnant women received antenatal care services during the last week before the expected day of delivery.

100% of the deliveries 1569 were institutionalized either at a maternity center or a hospital.

The number of high risk pregnancy decreased by 6% from 142 to 134 compared to the same period in 2001 due to the quality of services and follow up, and the availability of the ultrasound scan.

The number of repeated ante care cases increased by 13% from 5820 to 6609 compared to the same period in 2001.

The laboratory tests increased by 55% from 11713 to 15859 compared to the same period in 2001.

There was an increase of 14% in the number of home visits in spite of the lost days resulted from absence of a number of the para medical staff.

An increase of 29% compared to last year from 676 to 877 in the number of sessions organized to create awareness and provide training on various topics i.e. First Aid, proper food, breast feeding etc. through demonstrations conducted at the centres.

An increase of 24% in the number of women received family planning services compared to the same period in 2001 which is due mainly to the introduction of this service to Shija'ia FHCC by the end of last year.

There was a tremendous drop of approximately 40% in the number of women attending afternoon activities which was due to the trauma occurred during the tense situation resulted from the continuing Israeli army incursions and bombardment of various sites in Gaza.

62% increase in the dental services rendered to patients which indirectly has impact on the general health of the patients.  There was tremendous efforts as well exerted by the volunteer dentist towards education of women and their children.

The inauguration of the new Family Health Care Centre in Rafah.

100% of the medical and para-medical staff had on the job training through organized sessions and workshops either by NECC, NGOs, or Ministry of Health.

Variations:

The net increase of the population continued to drop due to the improvement in the standard of awareness and the need for family planning.

The inauguration of the new centre in Rafah.

The continued harsh economic condition which resulted in the increased numbers of inhabitants who could not afford paying for health insurance or private clinics.

The focus on children with malnutrition and anemia and the follow up conducted by the staff after dispensing them with iron supplementation.

The emphasis on conducting home visits especially to women after deliveries.

The availability of a volunteer dentist.

The quality of services and good care NECCCRW renders.