Volume 24, Number 4: April 2023
Master's students at Bethlehem University gathered for a group photo. Photo used with permission.
Palliative Care Inroads in Palestine: Continued efforts are needed
By Hanan Saca-Hazboun, RN, PhD
IAHPC Board Member; and Assistant Professor specializing in nursing education, Tarek Juffali Faculty of Nursing and Health Sciences, Bethlehem University, Bethlehem, Palestine
Palliative care is urgently required in Palestine due to the fact that most cancer patients are diagnosed at advanced stages of the disease, rendering curative treatments ineffective or futile.1
Novelty an impediment to growth
In 2008, a group of health professionals and academics established the Al-Sadeel Society, a nonprofit, and civil organization that provides palliative care. Their mission is to enhance the quality of life for those suffering from cancer and other chronic illnesses by offering hospice care services to patients and their families. Furthermore, in 2010 a program was established in Palestine's nongovernmental hospitals with the aid of foreign groups, which sponsored multiple training events and promoted palliative care. Despite this, it remains unavailable in government hospitals, leaving the needs of oncology patients unmet. The novelty of palliative care as a specialization in Palestine has been the most significant impediment to its growth.
Demand & NGOs propelled program
In 2016, the Faculty of Nursing and Health Sciences at Bethlehem University responded to the demand for oncology and palliative care by establishing a nurse training program. To achieve this, Bethlehem University collaborated with other institutions to advance palliative care and expand opportunities for cancer patients to improve their quality of life and physical and mental health. The long-term success of this initiative relied on the support of various nongovernmental organizations, including Medical Aid for Palestinians (MAP), International Medical Education Trust (IMET) 2000, and members of the European Oncology Nursing Society (EONS). King's College London provided assistance in nurse training, with the program following the curriculum of the EONS Cancer Nursing Education Framework. After the program was taught to three cohorts, the course progressed to become a master's degree program.
Hospital gives comprehensive care…
Augusta Victoria Hospital serves the Palestinian population in the West Bank, Gaza, and Jerusalem, and is supported by the Lutheran Church in America. The hospital introduced cancer care, chemotherapy, and radiation therapy to aid West Bank and Gaza patients.
The Power of One
Tamer Al-Jafaari, a nurse who earned a postgraduate diploma in oncology and palliative care from Bethlehem University, currently works at Augusta Victoria Hospital in Jerusalem. To improve palliative care services and to expand his role, the hospital established a new position and title: advanced nurse practitioner.
He has played a significant role in the field, becoming the first non-physician prescriber in Palestine. His role has evolved from basic nursing care and patient education to advanced nursing practice, including managing pain holistically.
Tamer has contributed to efforts by the multidisciplinary team to improve patient and family care while enhancing patients’ quality of life.
There is no comprehensive, national palliative care program in Palestine. As a result, several organizations, including nongovernmental organizations such as Catholic Relief Services, the US Agency for International Development, Bethlehem University, and Medical Aid for Palestinians are collaborating to improve palliative care services at Augusta Victoria Hospital. This significant milestone would not have been possible without the support and education provided by Jordan’s King Hussein Cancer Center, Israel’s Hadassah Hospital, and Norway’s VID Specialized University.
…but care close to home is lacking
The program is a critical resource for cancer patients and their families, as it is the first facility of its kind to offer patients comprehensive care. However, hospital personnel observed that most cancer patients are neglected before they come to the hospital; they receive only the bare minimum of care and lack access to palliative care where they live.
New services introduced
Furthermore, Augusta Victoria Hospital introduced palliative care services for cancer patients in 2019, supporting a holistic program. Patients will receive appropriate holistic care after training hospital staff members and enabling access to local resources in Gaza. In addition, the hospital established a home service department to care for patients in Ramallah and Bethlehem, as well as in Jerusalem and its environs. A team of employees will also work in Gaza to address the evident need. The hospital provides support to bereaved families for up to a year.
Sustained efforts needed
In conclusion, although the Palestinian Ministry of Health is taking steps to improve oncology care, there is still much work to be done. It is critical to ensure that all citizens have access to adequate pain medication, palliative care initiatives are funded, and more nurses are trained to work in palliative care settings. Therefore, the Palestinian Ministry of Health, nursing leaders, and academics must prioritize palliative care. Continuing to train nurses with advanced degrees in palliative care is vital to enhancing patient care.
Reference
Abu-Odah H, Molassiotis A, Yat Wa Liu J. Analysis of the Unmet Needs of Palestinian Advanced Cancer Patients and Their Relationship to Emotional Distress: Results from a cross-sectional study. BMC Palliative Care 2022; 21(1): 72. DOI: 10.1186/s12904-022-00959-8
Read Hanan Saca-Hazboun's bio.
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