"It will be an important part of your job to deal with human tragedy with a strong heart." This was the warning from my instructors when I first entered medical school six years ago. I asked myself, “Isn’t everything I have experienced in Gaza already enough for my heart to be strong?” I never thought, however, that a tragedy might be of our own making.
I had known Mahmoud for just two weeks. I first met him during one of the routine, daily rounds with one of the pediatric consultants at the European Gaza Hospital. The 5-year-old boy was sitting on the floor by his bed in Room 3 of the Pediatric Department, eating his breakfast with a smile on his face.
“He doesn’t like to lie on the bed,” his mother explained. “He may be sick, but he doesn’t like to be a patient.”
The next few times I saw him after that, he was either playing contentedly with his toys or talking cheerily to someone else in his room. All of the staff on the floor knew Mahmoud for his simple, sunny spirit. We adored him and hoped fervently that his health would improve.
Mahmoud first became ill years before, suffering multiple asthmatic attacks and chest infections. Then he received a much more serious diagnosis.
“That day when Mahmoud came back from school with a swollen neck and constant cough was the worst day in my life,” his mother recalled. She brought him to the hospital and after several exams and tests, the doctor in charge delivered the devastating news: Mahmoud had a type of cancer called lymphoma, and it already was in an advanced stage–spreading throughout his body.
“There is nothing we can do here to help him,” the doctor told Mahmoud’s mother. “We will have to apply for permission to refer him out.”
Sometimes, due to shortages of medicines, absence of proper technology or lack of specific expertise caused by the Israeli blockade, our health system in Gaza is inadequate to treat certain patients, and they must be sent to the West Bank or Israel—requiring a nerve-wracking delay as the families wait for the Palestinian Authority (PA) to agree to cover their treatment, a hospital to accept them as patients and the Israeli government to give permission for them to pass through the Erez border crossing.
When I saw Mahmoud’s mother after the decision to refer him out, she was greatly relieved. After 45 days of waiting, the PA had finally agreed to pay the cost of Mahmoud’s referral to one of the hospitals in Israel, and the hospital had agreed to admit him. Now, she had to wait again, this time for a call informing the family that Israel had given permission for Mahmoud to leave Gaza through Erez.
A week later, we passed by Mahmoud’s bed again, but he was not there. We asked the doctor in charge about him and he replied simply, “he died.” Mahmoud was exhausted in his last days, and was not able to wait anymore. He had suffered an attack of severe respiratory distress; and was rushed to the intensive care unit. She told me she felt like his eyes were pleading with her not to leave him. Half an hour later, one of the physicians told her, “We couldn’t do anything to save him.” On January 5, 2015, Mahmoud’s file was closed, the final step in the referral process still pending.
Patients too frequently die while they wait for referrals to be approved. I used to believe all of these failures were the responsibility of the Israeli government, since it controls and restricts the opening of our borders. And it certainly played a role in Mahmoud’s tragic death. But it was also our fault. We delayed a decision on financial coverage of his referral for more than six weeks. By then, it was already too late.
I don’t know the reasons that caused the delay in a decision for Mahmoud, but whatever they are, they are not justified. Because of the delay, Mahmoud is gone. And meanwhile, others like him are still waiting.
Mentor: Hatim Kanaaneh, MD
Posted June 22, 2016
