Palestinian Physicians Research Articles

Centering Place in Tawfiq Canaan’s Literary Cartography

In the early-twentieth century, Palestinian physician and ethnographer Tawfiq Canaan published roughly forty-five studies on the cultural and narrative traditions of the largest section of Palestinian society, the fellaheen (peasantry). In this article, the author examines how Canaan’s expansive collection of stories related to holy sites across Palestine in Mohammedan Saints and Sanctuaries in Palestine (1927) produces a provocative literary cartography—a narrative that operates much like a map. In so doing, she contends that Canaan both contests orientalist constructions of the Holy Land as frozen in biblical time and, critically, unsettles the very spatiotemporal logic governing dominant colonial narrations of place. This epistemic shift, the author concludes, is the result of Canaan’s recentering of Indigenous Palestinian place-based knowledge as both the subject and method of his study. This approach offers instructive lessons applicable within and beyond the disciplinary, regional, and temporal boundaries that have so far circumscribed the study and reception of Canaan’s work.

Physicians' perceptions of electronic prescribing of controlled medications in the West Bank, Palestine: A pre-implementation assessment

BackgroundIn Palestine, prescribing controlled medications is still done on paper. Despite valuable regulatory efforts, there is a high risk of undetected abuse and “doctor shopping”. These problems can be addressed with electronic prescribing of controlled medicines (EPCM). User adoption is essential to the successful implementation of any technology. Therefore, it is crucial to determine the perception of end users at an early stage. This topic has never been addressed in Palestine. Our study aims to investigate the perception of Palestinian physicians towards the introduction of EPCM. MethodsThis cross-sectional study was conducted among Palestinian physicians in the West Bank who are familiar with controlled medications prescribing. Data were collected using a self-administered questionnaire based on the Unified Theory of User Acceptance and Use of Technology (UTAUT) from a convenience sample of 300 physicians. Data were analyzed using SPSS version 26. Bivariate analysis and binary and multivariate logistic regression were performed to identify factors associated with physicians' perceptions of ECPM. ResultsMost physicians expressed their willingness to use EPCM, with an acceptance rate of 85%. This perception was significantly affected by performance expectancy, effort expectancy and trust. None was moderated by age, gender, or experience with electronic prescribing. Age and specialization level were independent factors significantly influencing the intention to use EPCM. The level of current workflow challenges did not correlate with the intent to use EPCM. ConclusionPalestinian physicians will accept EPCM. Based on the results of this study, it is recommended that the following be considered: ensuring maximum efficiency of the system, selecting user-friendly interfaces and high-security measures to prevent system breaches.

Palestinian physicians' self-reported practice regarding antibiotic use for upper respiratory tract infections in primary healthcare.

The main objective of this study was to evaluate the antimicrobial therapy knowledge, attitudes, and practices of primary care physicians in the West Bank and Gaza. Between January and April 2021, this cross-sectional survey was conducted. A link to the online survey was sent via confidential email lists to 336 primary care physicians who treated patients in Ministry of Health clinics. The survey questions scoring system was devised in order to evaluate the physicians' practice, knowledge, and attitudes. Our scoring system identified favorable (good) and unfavorable (average and poor) antibiotic practices. In addition to independent t-test, the Chi-square test was used to compare the two groups of physicians' knowledge, attitudes, and practices with their background characteristics. A multivariate analysis was performed to identify potential confounding variables having significant relationships. Of the 336 distributed questionnaires, 316 were completed, with a response rate of 94%. More than half (54.7%) were males, half (51.6%) were between 30 and 45 years of age, and most were general practitioners (74.1%). The overall good knowledge and attitude scores were 125 (39.6%) and 194 (61.4%), respectively. More than half (58.2%) had good antibiotic prescription practices. Females reported significantly more favorable practices than males, as did family medicine specialists compared with general practitioners. Finally, knowledge about antibiotic prescriptions had a substantial impact on changing their practices. However, physicians' attitudes toward antibiotic prescriptions did not have a significant role in shaping their practices. Overuse of antibiotics is a significant health issue in Palestine and worldwide. Most physicians know that improper antibiotic usage can cause antimicrobial resistance. More than two-thirds avoided needless antimicrobial prescriptions. In practicing antimicrobial stewardship, most prescribed fewer antibiotics and did not prescribe because of patient pressure. Family medicine specialists, female doctors, and those with high knowledge scores regardless of caseload were more likely to have good practices.

Helsinki in Zion: Hospital ethics committees and political gatekeeping in Israel/Palestine

AbstractThis article looks at six months of the author's repeated attempts to obtain the approval of three Helsinki Committees (HCs, Israeli hospitals’ research ethics committees) to conduct ethnographic research with Palestinian physicians in Israeli hospitals. While the research was eventually approved and carried out in two of these institutions, correspondence with HC representatives, as well as evidence of their informal moves with institutions’ management, reflect their perceptions of the risks the study posed. In the Israeli hospital, acknowledging Palestinian political subjectivity challenges the definition of Israeli nationhood as exclusively Jewish and contaminates the allegedly politically neutral medical sphere. These committees exerted their power to serve their institutions and state ideology. This, I argue, should not be understood as anomalous instances of negligence. I show how the committees’ censorship was attuned to the Declaration of Helsinki as their guiding text and Zionism as their underlying ideology. Embedded in the powerful regimes of ethics, bureaucracy, science, and health, ethics committees employ “unarmed power” that is beyond critique. They are well‐oiled “anti‐politics machines,” rearticulating political concerns into a depoliticized moral discourse. As such, they not only limit academic inquiry but also redefine, in political terms, the realm of the moral.

Covid-19 Fault Lines: Palestinian Physicians in Israel

This essay explores representations of Palestinian physicians in the Israeli health-care system during the Covid-19 pandemic and the dynamics that have played out in that system during the public health emergency from the perspective of a Palestinian physician. It argues that the health-care system, an essential pillar and infrastructural foundation of the settler-colonial project, is naively imagined as an apolitical, neutral sphere. As the site of a metaphorical battlefield against Covid-19, it has been window-dressed as an arena for brotherhood between Israeli Palestinians and Jews, and fantasized about as a gateway to political gain or equality for the Palestinian citizens of Israel (PCIs). Throughout the process, settler militarism, settler symbols, and settler domination have continued to be normalized.

Surgical Treatment of Palestinian Patients With Congenital Heart Disease in a Medical Center in Israel: Challenges and Outcome

BackgroundThe treatment of congenital heart disease patients in the West Bank and Gaza involves both medical and political challenges. Understanding the difficulties faced in treating the Palestinian population is an important step to improving surgical care, better allocating resources and overcoming the region's unique problems. MethodsThe Hadassah Medical Center congenital heart disease database over the 2011–2017 period was analyzed. There were 872 operations performed in patients with Israeli health insurance and 207 operations in Palestinian patients. Patient characteristics and surgical outcome were compared between the two groups using standard statistical practices. FindingsThe Society of Thoracic Surgeons Complexity Scores were significantly higher in the Palestinian patients, p = 0.003 (d = 0.27, 95% CI, 0.12 to 0.42). Israeli neonates had surgery at an average age of 9.5 ± 7.8 days as compared to Palestinian neonates with an average age of 15.7 ± 8.2 days, p < 0.001 (d = 0.78, 95% CI, 0.41 to 1.15), a finding indicative of a possible delay of treatment. Overall in hospital mortality was not significantly different. Late mortality was significantly higher for the Palestinian 5.4% (9/168) compared to Israeli patients 2% (14/698), p = 0.015 (RR = 2.67, 95% CI, 1.18 to 6.07). InterpretationThe findings suggest that Palestinian patients receive later treatment and poorer follow-up care than Israeli patients. Despite the political challenges in the region surgical results are excellent and comparable between the two groups. The challenges described are not unique to congenital heart disease and may affect many medical fields. We believe that extensive collaborations between Israeli and Palestinian physicians may be key to improving the Palestinian medical care. FundingNone.

Surgical Treatment of Palestinian Patients with Congenital Heart Disease in a Medical Center in Israel: Challenges and Outcome

Background: The treatment of congenital heart disease patients in the West Bank and Gaza involves both medical and political challenges. To better understand these challenges' effects on Palestinian patients, we compared surgical results between Israeli and Palestinian patients. Understanding the difficulties faced in treating the Palestinian population is an important step to improving surgical care, better allocating resources and overcoming the region's unique problems. Methods: We retrospectively reviewed the Hadassah Medical Center congenital heart disease database. Between January 2011 and December 2017, there were 872 operations performed in patients with Israeli health insurance and 207 operations in Palestinian patients. Demographics, clinical characteristics, surgical complexities, time to treatment, PICU length of stay, hospital length of stay, mortality and follow-up rates were compared between the two groups using standard statistical practices. Findings: The surgical complexity was significantly higher in the Palestinian patient population (p=0.003) and there were relatively more Palestinian patients with single ventricle anatomy (25.6%, 53/207) than Israeli patients (19.8%, 172/872) p=0.067. Israeli neonates had surgery at an average age of 9.5±7.8 days as compared to Palestinian neonates with an average age of 15.7±8.2 days, p<0.001, a finding indicative of a possible delay in diagnosis or treatment. Overall in hospital mortality was not significantly different. Late mortality was significantly different between the groups, 2% (14/698) for the Israeli and 5.4% (9/168) for the Palestinian patients (p=0.015). Interpretation: The findings suggest that Palestinian patients receive later treatment and poorer follow-up care than Israeli patients. Despite the political challenges in the region surgical results are excellent and comparable between the two groups. The challenges described are not unique to congenital heart disease and may affect many medical fields. We believe that extensive collaborations between Israeli and Palestinian physicians may be key to improving medical care in the West Bank and Gaza. Funding: None. Declaration of Interest: The authors have nothing to disclose. Ethical Approval: The Hadassah Medical Center Institutional Review Board approved the study and waived individual patient consent due to the retrospective nature of the study.

Cigarettes and Water Pipe Smoking Prevalence, Knowledge, and Attitudes Among the Palestinian Physicians in the West Bank.

Background:Tobacco use is one of the major public health threats nowadays. Smoking can affect everybody organ. Health professionals should play pivotal roles in tobacco control, and their attitude and practice toward tobacco use can affect the health of the community. Therefore, assessing and influencing physicians’ attitudes and practice are one of the alternatives to reduce smoking prevalence in the community. We aimed to assess smoking status among medical physicians in the West Bank, Palestine to better understand their future role in any smoking cessation program.Material and methods:A cross-sectional study using the World Health Organization Global Health Professional Survey questionnaire was conducted. A non-probability sampling technique from a total of 6500 physicians registered in the Palestinian Medical Association in the West Bank was used.Results:The age ranged from 23 to 78 years with a mean of 34.92 years. Current smokers represented 60.3%. Of them, 18.5% were both cigarettes and water pipe smokers. The main reason that motivates the physician to smoke is experimenting (57.9%). Also stress (31.8%) and social pressure (26.4%) were of the most common causes to start smoking. Almost all medical doctors have a high level of knowledge regarding the health consequences of smoking. Smokers were less likely to hold favorable attitudes toward smoking cessation and support tobacco control policy compared with non-smokers (P-values < .05).Conclusions:Physicians’ degree of awareness and knowledge about their role in aiding patients to quit smoking are high. However, smokers’ attitudes toward smoking cessation programs need to be improved to increase their involvement in such interventional programs.

Awareness, attitudes, and knowledge of Palestinian doctors about evidence-based medicine: a cross-sectional survey

BackgroundEvidence-based medicine (EBM) is an effective strategy to integrate evidence into decision-making alongside patients’ values and clinical expertise. The main aim of this study was to evaluate the awareness, knowledge, and attitudes of Palestinian physicians about EBM. MethodsThis was a cross-sectional study, in which data were collected between August and November, 2014, using a web-based, 20-item questionnaire adapted from McColl and colleagues to assess awareness of, attitudes to, and knowledge about EBM. We used email and social media to survey Palestinian doctors working in health centres affiliated with the Ministry of Health, the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), academic, and private sectors. FindingsOf 135 physicians who completed the questionnaire, the majority were men (116; 86%), younger than 30 years old (104; 77%), resident or general physicians (117; 87%), who worked in a government health-care setting or UNRWA (104; 79%). Most of the respondents (99; 73%) welcomed the concept of EBM, agreed that EBM is useful in their daily practice (104; 77%) and can improve patient care (109; 81%), and claimed that more than half of their daily clinical practice is evidence-based (84; 62%). However, two-thirds of respondents (90; 67%) thought that practicing EBM would place demands on already overloaded doctors. Only 27% (36) had received formal training in EBM, which was received through the EBM Unit in Gaza for 64% (23) of these physicians. The major perceived barriers to practicing EBM were insufficient knowledge and skills (47; 35%), lack of managerial and institutional support (24; 18%), limited resources and free access to databases or libraries (31; 23%), work overload (27; 20%), and negative attitude to EBM among some colleagues, especially the most senior (34; 25%). InterpretationDespite the positive attitude towards learning and implementing EBM among (mainly young) Palestinian physicians, these doctors feel that they have inadequate knowledge and skills in practicing EBM. They need effective practical educational training programmes in EBM, clinical appraisal, and literature searching skills. Importantly, the attitudes of policymakers and senior staff need to change to promote the practice of EBM within the health services. FundingNone.

Diagnosis and repair of perineal injuries: knowledge before and after expert training—a multicentre observational study among Palestinian physicians and midwives

ObjectiveTo assess whether a 2 days training with experts teaching on diagnosis and repair of perineal injuries among Palestinian midwives and physicians could change their level of knowledge towards the...

Hand Hygiene Knowledge, Practices and Attitudes among Nurses and Physicians

Background: Hand hygiene is one of the most effective ways to control health care related infection. Nurses and physicians are the main health care workers contacting with patients, representing the vector in the chain of infection. Thus, assessing their knowledge, practice and attitudes regarding hand hygiene is very important to decrease the incidence of health care related infection and to improve quality of care. Aims: The aim is to assess the knowledge, practice and attitude of Palestinian physicians and nurses regarding hand hygiene in hospitals. Methods: The study adopted a cross-sectional, quantitative design. Nurses and doctors who worked in the major governmental and private hospitals in the West Bank (Palestine) were targeted. Data was collected using Hand Hygiene Questionnaire. Results: 200 nurses and physicians participated in this study. The results showed that the participants had a moderate knowledge regarding the hand hygiene (m = 6, SD = 1.7). They had a better attitude score than practice with a mean of 82.5 ± 8.8. There was a significant difference between male and female only in practice score (p = 0.015). Older participants had better attitudes, and private hospitals had significantly higher scores for compliance, importance of hand hygiene and practice than governmental hospitals (p < 0.05). Conclusion: The results of the current study showed that there was a further need to focus on the practices of hand hygiene by continuous education for both Palestinian nurses and physicians.

A Doctor’s Testimony: Medical Neutrality and the Visibility of Palestinian Grievances in Jewish-Israeli Publics

This paper follows the testimony of Izzeldin Abuelaish, a Palestinian physician who bears witness to his experiences working, living, and suffering under Israeli rule. He presents his story as a doctor's story, drawing on his identity as a medical professional to gain credibility and visibility and to challenge the limited legitimacy of Palestinian grievances. In this paper, I explore his testimony as a medical voice that at once recounts the suffering and loss endured by the Palestinian people and also struggles to negotiate the values associated with being a "reliable" witness. Consequently, I ethnographically examine the social life and reception of his story in Jewish-Israeli publics. In comparison with most Palestinian narratives, Abuelaish's testimony achieved an extremely rare degree of visibility and sympathy, a phenomenon that calls out for analysis. I identify the boundaries that typically render Palestinian grievances invisible to Israeli publics and suggest how medicine's self-proclaimed ethos of neutrality served as a channel for crossing them. Finally, I reflect on the political possibilities and limitations of medical witnessing to render suffering visible and arouse compassion toward those construed as a dangerous/enemy Other.

Assessing the effects of reported torture in the Israeli-Palestinian context: A struggle for psycho-political thirdness

A group of Israeli and Palestinian physicians and mental health professionals was trained to assess the physical and psychological evidence of torture according to the Istanbul Protocol. This paper describes the effects of one such assessment on the author, an Israeli-Jewish psychologist. It explores the phenomenon of politically-related dissociations, and the individual and group efforts to overcome them.

The Influence of Palestinian Physicians’ Patriarchal Ideology and Exposure to Family Violence on Their Beliefs about Wife Beating

The influence of Palestinian physicians’ patriarchal ideology (PAI) and exposure to family violence (EFV) on their beliefs about wife beating was examined. Self-administered questionnaires were completed by 396 physicians. The results revealed that notable percentages of the physicians expressed some level of willingness to justify wife beating, tendency to believe that battered women benefit from beating, and that battered women are to blame for their beating. Nevertheless, between 27 and 59 % of the physicians expressed some willingness to help battered women. The results also revealed that significant amounts of the variance in physicians’ beliefs about wife beating can be attributed to their PAI and to their EFV during childhood and adolescence..The implications of the results for future research, theory development, and training of physicians are discussed.

Grassroots medical peace building: training Palestinian physicians in Israel

Based on new scholarship on the importance of health in times of conflict, this paper examines the training of Palestinian physicians in Israel from the 1990s to 2010 as a test case for the theory. It shows that although Israeli governments have adopted a passive policy towards such training, and the Palestinian Authority is officially against such cooperation; in practice, individuals and hospitals on both sides work at the grassroots level with the aid of several NGOs to increase cooperation. Thus, grassroots activities are leading to better cooperation between Jewish and Palestinian health professionals, improving Palestinian health capabilities and establishing a bridgehead for better professional cooperation when a peace settlement is achieved. Health, like other social areas, is part of the explanation why the conflict remains stable and how mutual beneficial cooperation has planted the seeds for future cooperation.

Attitudes of Palestinian Physicians Toward Wife Abuse

The article presents results from a larger survey, which examined the attitudes and perceptions of Palestinian physicians (N = 396) toward wife abuse. The instrument was a self-administered questionnaire, with open-ended questions in which participants expressed their definitions of wife abuse, their perceptions of the causes of wife abuse, and their perceptions of appropriate interventions with wife abuse. The relevance of the sociocultural contexts of Palestinian society in particular and Arab societies in general to the participants' responses is highlighted in the article. The limitations of the study as well as implications for theory development, future research, and professional training are discussed.

Assessment of physicians’ knowledge and awareness about the hazards of radiological examinations on the health of their patients

Previous studies have shown that physicians tend to underestimate the risks to patients of radiation exposure. This study in 2 Palestinian hospitals aimed to assess physicians' knowledge about the risks associated with the use of radiological examinations. A questionnaire answered by 163 physicians revealed many gaps in knowledge. Only one-third of physicians had received a radiation protection course during their undergraduate study or in the workplace. Few physicians were able to answer correctly many scientific, knowledge-based questions. For example, only 6.1% of the respondents were able to identify the ALARA principle and 98.2% did not know that there is no safe dose limit according to international recommendations. Physicians' practices in terms of frequency of use of routine X-rays and discussing the risks with patients were also poor. These results clearly indicate the need to increase Palestinian physicians' knowledge and awareness about the potential hazards associated with the use of radiological examinations.

Academic Medicine as a Bridge to Peace: Building Arab and Israeli Cooperation

Can you imagine Canadian, Israeli, Jordanian, and Palestinian medical students singing, volunteering, and working together to develop programs to address issues related to global pediatric emergency medicine? Such a program was first held in Toronto in 2003 and continues annually. Can you imagine Canadians, Israelis, Jordanians, and Palestinians jointly teaching and developing solutions, via video teleconference, to address behavioral neurological problems affecting elderly populations? Such an initiative began in 2006 and continues to expand today. Can you imagine senior Jordanian and Israeli ear surgeons operating together, successfully carrying out pioneering cochlear implant surgery on deaf infants, on Jordanian national television? Such a surgery was performed in Amman in December 2003. Can you imagine every newborn baby in Jordan having her or his hearing tested? Such a program began in January 2005 as a result of Canadian, Israeli, Palestinian, and Jordanian service, educational, and scientific research cooperation, becoming national health policy in Jordan in 2007. All of this and much more are the result of the Canada International Scientific Exchange Program (CISEPO) and its cooperation network of knowledge. CISEPO is an international cooperation network of academics, researchers, educators, medical, public health and allied health professionals, and students working as a team of individuals and institutions. During the past 15 years, through ongoing professional engagement and dialogue across religious, political, and cultural borders, CISEPO has created opportunities for building cooperation and trust, identifying and sharing knowledge, building capacity, and leadership within key academic and health care institutions across the Middle East, serving as a role model for dialogue and cooperative development in regions of conflict.1–3 CISEPO believes that sharing health expertise, techniques, and knowledge can build a bridge to peace. Some argue that successful peace-building initiatives should start only after a political resolution has been established. CISEPO teaches that a bridge to peace is not a “bridge too far.” CISEPO believes in harnessing academic theory and medical relationships for three very practical purposes—to turn war into peace, to turn despair into hope, and to turn poverty into wealth. CISEPO initiatives are guided by a bilevel model for peace-building, which integrates project-specific goals for improving health services, clinical, and population health outcomes with meta-level goals for building cross-border cooperation and knowledge exchange.2 CISEPO started as a Canadian nongovernmental organization to provide continuing medical education for Israeli, Jordanian, and Palestinian physicians in the field of otolaryngology and allied health disciplines. The priority need initially identified was hereditary deafness, a significant public health issue for Arabs and Israelis alike that is 6 to 10 times more prevalent in the Middle East than in the West. This nerve deafness, a genetic condition, has a major economic, social, and health impact on infants, children, their families, and entire communities in the Middle East. To find and treat disadvantaged Arab and Israeli newborns and infants in a comprehensive program, CISEPO brokered the establishment of the Middle East Association for Managing Hearing Loss in 1998. Today, this association thrives as the first joint Arab and Israeli professional association to address hearing loss issues in the Middle East.1–3 Other successful projects established by CISEPO in recent years include providing residency training for Palestinians in Israeli hospitals, conducting cross-border dental public health research, establishing Jordanian-Egyptian-Israeli-Canadian fellowships on dive and emergency medicine, creating youth social engagement through photography, and instituting the critical study of water pipe smoking cessation. Building on these successes, CISEPO has expanded beyond otolaryngology to include medical education, public health, nursing, and other clinical disciplines. To broaden the scope and reach of such initiatives, American CISEPO was established as a sister network to work closely with the CISEPO family of programs. American CISEPO is a registered U.S. charitable organization and has initiated an exciting portfolio of cooperative projects ranging from organizing the first Arab and Israeli genetics conference in Jordan to supporting a cross-border cardiac resuscitation training program. The success of so many CISEPO programs proves that, despite the many challenges, academic health initiatives in conflict regions can bring health professionals together in cross-border collaboration to build mutual respect, trust, and understanding, benefiting all who are involved.

Palestinian Physicians’ Misconceptions About and Approval of Wife Abuse

The article presents the results of a study that examined Palestinian physicians' misconceptions about abused wives and abusive husbands and the extent to which Palestinian physicians approve of wife abuse. Self-administered questionnaires were completed by 396 physicians. The results revealed that between 10% and 49% of the Palestinian physicians held misconceptions about abused wives and between 15% and 63% held misconceptions about abusive husbands. The findings also revealed that substantial percentages of physicians tended to approve of moderate and severe violence against wives. Significant amounts of the variance in the physicians' approval of moderate and severe wife abuse can be attributed to their exposure to family violence and to their patriarchal ideology-variance over and above that which can be explained by the physicians' sociodemographic characteristics. The limitations of the study are discussed, as are the implications of the results for future research and theory development on the approaches of professionals toward wife abuse.

What Remains to Be Done

I feel a little like Mary Lasker, who was asked late in her life if she had to start over again whether she would consider a career as a scientist. She replied, “Oh no! I couldn't cut up a frog! And I certainly couldn't perform surgery! Nobody would have me in their laboratory for five minutes