I arrived in the West Bank in February of this year. I thought I had at least some idea of what I’d face: after all, I grew up watching the intifadas and the endless cycle of failed peace negotiations on television. But the reality of the situation hit me hard.
You see signs of the occupation everywhere here. There are massive walls, checkpoints, Jeeps and soldiers, Israeli settlements and Palestinian villages separated by electronic fences, and the less visible but grinding system of permits and restrictions. I saw the separate number plates and roads for Israelis and Palestinians, the different laws, and the fact that Palestinians have no control over 60 per cent of the West Bank, and limited control over the rest. It is clear how the situation might cause depression, anxiety and trauma-related disorders.
My morning starts with a meeting with our clinical staff. We have a multidisciplinary team made up of psychologists, social workers and doctors, working in Nablus, Qalqilya, Hebron and the Gaza Strip. We sit down each morning and talk about what happened yesterday and what we’ll be doing today. This is important because we share patients to help with different aspects of their lives. We coordinate our tasks for the day and off we go.
You can’t help but wonder; Am I patching someone up to face this again tomorrow night?
We typically see patients in the field; more than half the time we do home visits. There are people in smaller villages and those who can’t leave their homes for different reasons, such as worrying they might be demolished when they go out.
My first patient in the West Bank was a nine-year-old boy who struggled with bedwetting and nightmares. His mother described the search operations by Israeli soldiers into their house late at night, how the family was woken at 1am by banging on the door. Imagine: all these soldiers with helmets, guns, dogs, bursting into your bedroom. It’s shocking. Who wouldn’t have nightmares after experiencing that?
You can’t help but wonder sometimes; ‘Am I doing this, patching someone up, so they can go back and face this again, tomorrow night?’ It’s an ethical dilemma, but in the end, our patients are just like everyone else, everywhere else. They want to go to school and learn, to work, and share meals with their families. People want to live normal lives. We can help them reach some of those goals.
A lot of our patients are mothers. We know that women are usually the emotional support for their families; they do the practical caring, and carry the burden of worrying. There’s no doubt that men suffer too, although they have different expectations placed on them by their culture and their community.
The great thing about working with children is how resilient they can be. To experience a traumatic event like those we see here, then after six or 12 sessions of therapy show this huge improvement – it makes you see the value in therapy.
It’s also satisfying to see a family with our doctor, a therapist and social worker. The whole team works together to support their needs – therapy for mental health symptoms, treatment for any medical conditions, then possibly support in finding training opportunities, or thinking about a way to earn money from home. Everybody can make a difference in their own way.
Even though I’ve worked as a doctor for 15 years, working with children who have been through traumatic situations can be quite difficult, especially when you know the trauma can reoccur. It’s emotionally heavy for all of us. On average, we would do five to seven sessions per therapist per day. There are four of us and we’re adding another therapist. It’s critical to stay focused and do the best job we can while looking out for each other as a team, so we can go home at the end of the day, be functional and live our lives.
This is one of my key responsibilities as a clinical manager, in supervising all of our clinical staff. Some cases can be quite traumatic, sad, sometimes scary, and can trigger different emotions. I have to make sure the team is OK, so I check in with them at the beginning and end of each day. Once a week, we discuss their cases and the things they found hard to deal with or want to celebrate.
My mission here is for nine months, and saying goodbye is not going to be easy. When you leave somewhere, you take a part of the people you’ve worked with, and hopefully you can leave something of yourself too. The team here is awesome. They live the occupation but keep working day after day to build something with the lives they patch up. One person goes back to work; a child gets up in the morning, awake and energetic for school; a mother supported in her grief can start parenting her other children again: there’s a fire in a lot of the people you meet here, a refusal to give up. You have to be humble about the changes you attempt to make.
As a psychiatrist who has come to help people with mental health disorders I find the concept of resilience here fascinating. What makes people strong? What pushes them to get up each day? Some people have faced enormous loss; their family, a loved one, their home, their job or their whole country, yet they can be joyful, they can contribute and live fulfilling lives. For me, watching that is fascinating. It’s something to which I can only aspire.
Credit: Medecins Sans Frontieres