Before 2003, Palestinian diabetes care was characterised by an overemphasis on medication and lacking attention on prevention.
The WDF project “Diabetes prevention and nutrition program” in the West Bank seeks to incorporate nutrition counselling and behaviour change into the medical treatment. A Diabetes Center has been established at the Augusta Victoria Hospital in East-Jerusalem, and the project is carried out in a powerful cooperation with the project partner “DanChurchAid”.
Treatment with a holistic view on the patients
The Diabetes Center provides a model of holistic care for people with diabetes. Clinical service is complemented by social and nutritional counselling and health education sessions. The services combined allow for a more capable self-management and prevention. This is confirmed in the Mid-term report from September 2004:
“While such services may be considered essential and standard components of care of chronic disease patients, they are unfortunately lacking or inadequate in Palestine”.
Walls to be crossed of habits and concrete
Initially the challenge was to change the focus from medical treatment to providing better access to prevention and quality diabetes care in the West Bank. With the political development in the West Bank new challenges have appeared, and today a physical wall needs to be crossed as well.
In order to protect Israelis inside Israel and Israeli settlers living on the West Bank from Palestinian militant attacks, fences and in some places even walls have been built, partly on Palestinian land. Thus, traffic between the Israeli annexed East Jerusalem and the target population living in the West Bank is increasingly difficult.
Both patients travelling to the hospital and health care personnel wanting to perform consultations in the villages struggle with the wall and road blocks set up by the Israeli army between Jerusalem and the West Bank. People experience being withheld for hours on their way to the doctor.
Bringing the hospital to the patients
In a situation where patients struggle to visit the hospital, the need to strengthen the outreach activities is underlined. Team members at the Diabetes Center visit village clinics on a weekly basis to perform diabetes treatment and detection locally. But this solves only part of the problem. As described in the Mid-term report from September 2004, the population is often unable to visit the hospital for follow-up:
“At present, the nurses and nutritionist of the Center participate in the outreach program, focusing on persons with diabetes. However cases identified in the villages often do not attend the Center because of the need for permits and difficulty of transportation.”
Busses may be part of a solution
Four the last six month, the Augusta Victoria Hospital and DanChurchAid have come to an agreement with the Israeli Army, which allows both diabetes patients and people in high risk of developing diabetes to access the hospital from the West Bank when picked up by special busses, transporting them to Augusta Victoria Hospital.
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A long term objective is to strengthen the outreach component in the local clinics by increasing the number of days the team members go into the field and increasing the range of services offered to the diabetes patients in the village clinics. This will be achieved by capacity building in both hospital and clinic staff. |
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