2019 Position Paper: Choice in Childbirth in the West Bank, Gaza Strip, and East Jerusalem

Background: Good maternal care, by modern standards, includes choice. Changing Childbirth, the case was made “The way a woman gives birth can affect the whole of the rest of her life- how can that not matter- unless the woman herself doesn’t matter.”

Perspectives:

This dialogue was conducted between Palestinian midwives and nurses that operate in the West Bank, Jerusalem, and Israel. A key issue for choice in childbirth in the Israel/Palestine region are the vast differences between giving birth in Israel and giving birth in Palestine. When the dialogue facilitator asked the first question about choice in childbirth, midwives practicing under the Palestinian system responded “what choice?”

Palestinian midwives in Israel noted that choice in childbirth was built into the hospital’s birth model. They noted that mothers were aware that they had options, were encouraged to choose whether or not to have birth plans, visit the hospital before giving birth, attend pre-natal classes, and her doctor. These choices are up to pregnant women regardless of their ethnic, national, or religious affiliation. 

Palestinian midwives operating under the Palestinian system noted that in their institutions, pregnant women are not consulted as to their preferences, and choices are made by clinicians and the material situation. In particular, they note that there is no facilitation through the birth process, which is complicated by a large volume of young mothers, patriarchal culture, lack of knowledge that there are different ways to give birth, and poverty. For caregivers, midwives are disempowered by the material situation of their institutions that facilitating choice becomes a low-priority. Midwives name the quick overturn of patients in the maternity ward (sometimes mothers after birth only stay a couple hours under supervision before discharge); the lack of materials, including hot water, gloves, and sheets, as their primary concerns in insuring a safer birth; and the politics of the health system and hospital, including relationships with doctors. 

Recommendations:

We, nurses and midwives in Israel and Palestine, call for institutional and policy interventions in order to improve Palestinian women’s ability to choose how they want to give birth. 

·      Communication between midwife and patient regarding existing options for birth. This communication must coincide with trust-building between midwife and patient. 

·      Education for the public, including pre-natal classes through clinics and hospitals, education in schools, and public media campaigns about options women have in childbirth.

·      Government investment in birth services and general hospital and clinical services, including paying the salaries of medical staff. 

In our context, it is important to recognize the underlying causes of a weak health system in the Palestinian Authority, including the lack of political will to improve health services. As nurses and midwives, we recognize that many factors are beyond our control. Through the listed interventions, we hope to start a bigger dialogue about how to protect women’s human rights in birth in Palestine. 

2019 Position Paper: Healthcare and the Environment

Background: The Lancet published in 2016 a report claiming that environmental sustainability is the 21stcentury’s greatest challenge to human health. A few weeks ago, The WHO named climate change one of the most dangerous health threats in the coming years. 

Healthcare systems have 2 major issues to balance when it comes to sustainability: 1) the duty to the environment, which impacts human health, and 2) prevention of infection measures. In recent decades, we have erred towards the latter, and in the process, increased the amount of disposables used in hospital and clinical care. 

Perspectives:

Knowledge about climate change and it’s causes differed significantly among participants, with an array of beliefs expressed in the course of the dialog. Some of these beliefs are unsupported by scientific literature, but held as truth in the participants’ communities. These different knowledges reflect an even more diverse array of beliefs about climate change in larger society. During this dialog, we spoke about plastic use, the effect of medication disposal on the water system, and how a deteriorating environmental situation affects human health. 

While most participants named the overuse of plastic products as one of the main problems of healthcare’s contribution to climate change, practical and institutional restraints were named as significant barriers to reducing plastic consumption. Particularly, in the West Bank, inconsistent waste services and a lack of recycling facilities limits possibilities for properly managing waste. 

Secondly, many nurses working with patients voiced concerns about alternatives, such as glass, which can be sterilized, citing that nurses are already pressed for time without adding sterilization procedures. 

Recommendations:

We, nurses and health professionals, call for institutional and national policy and interventions to decrease environmental harm caused by healthcare. 

In order to address healthcare’s effect on climate change, hospitals must find sustainable solutions. Our recommendations include:

·      Investing in reusable materials that can be sterilized, in addition to increased staff to conduct and monitor sterilization systems. 

·      Engage the public in campaigns about the environment and how the environment connects to human health. 

·      Encourage handwashing as an acceptable and encouraged method of preventing infections, and discouraging overuse of gloves. 

We call on policy makers across the globe to:

·      Educate the general population about climate change and its causes.

·      Provide incentives, including tax benefits and subsidies, to businesses and consumers to buy products in sustainable packaging. 

·      Provide incentives for hospitals who initiate green initiatives, discussed in the WHO Healthy Cities model. 

In the context of the Middle East, it is important to recognize that the socio-economic causes underlying irresponsible consumption that contributes to climate change must be addressed to create a long term public health solution across the Israel/Palestine region. However, as health workers, we recognize that many factors are beyond our control. Through this list of interventions, we hope to encourage individuals and policy makers to begin implementing policies that protect our collective futures. 

Non-Verbal Communication- Necessary for Patient Healing?

Non-verbal communication has been mentioned in literature, including the Bible, for centuries. The importance of touch in the healthcare extends beyond bandage changes-- the hands, it seems, are the gateways to the soul.

Written by a former-patient-turned-medical-sociologist and a trauma nurse, this article explores patient experience and nurse methodology. 

Read more here:

http://link.springer.com/article/10.1007%2Fs00134-015-3710-8

Hundreds of Syrians have entered Israel-- for healthcare

S. Eisenberg and J. Benbenishty 

Since 2012, Israel has established a system to care for Syrian refugees who make it to the border. Often critically wounded, Israeli hospitals serves as a safe haven for patients to heal. Nurse S. Eisenberg describes how cultural and lingual boundaries can be easily navigated with kindness, communication, and simple meals in this powerful case study published in the International Nursing Review.

Read More!

S. Eisenberg, J. Benbenishty. "Milk and Rice." International Nursing Review 2013.