Response to Phila. Citypaper

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To the editor,

As a physician, I admire Nader Hebela for using vacation time during his training to help treat Arab children in the disputed territories of the West Bank and Gaza, currently under the control of the Palestinian Authority (A good doctor’s mission, June 17-24, 2004). Unfortunately, while his dedication is admirable, his perspective does not accurately portray or explain the tragic circumstances that the people of the Middle East, Jew and Arab alike, confront on a daily basis.

I have had the opportunity to visit those areas, both before and during the current phase of the Arab war against Israel. I have also been a visiting professor at the Hadassah Medical Organization in Jerusalem, and I have sat and spoken with Israeli physicians, both Jews and Arabs.

It is indeed tragic what the current war has done to the children of that region. In the summer of 2000, there was easy travel between the areas of Gaza and the West Bank that were under Palestinian Authority control and Israeli ruled territory. Arab residents were able to travel freely to hospitals in Israel, which, as Dr. Hebela noted, have some of the best physicians in the world.

Hadassah’s campuses, including one on Mt. Scopus that was refurbished after it was restored to full Israeli control and access in 1967, treated their Arab patients side by side with Jewish Israelis. Clinics at Israeli communities in Judea and Samaria (the “West Bank”) such as the facility in Efrat also served as a source of health care for Arab adults and children.

Even after the Palestinians rejected a state and chose war instead in 2000, Israel’s hospitals continued to treat Arab adults and children. In 2002, 15,000 admissions to Hadassah, just one of many Israeli hospitals, were for local Arabs. Ten percent of Hadassah’s staff of physicians, nurses and others are Arabs.

Unfortunately, violence has made the healthcare of all people in the region increasingly difficult. Palestinians have repeatedly used ambulances in an attempt to smuggle weapons and combatants past Israeli troops. Bombs have been strapped to Arab children with devastating results. Palestinian children have served as human shields for terrorist gunman. Israeli children have been the victims of intentional attacks, ranging from bombs planted on the busses they ride to school to the recent point blank shooting of toddlers still strapped in their car seats.

Unlike Dr. Hebela, who was able to safely travel throughout the disputed territories, Israeli healthcare workers have been directly targeted. On February 1, 2001, Dr. Shmuel Gillis, an Israeli physician, was murdered while driving home from the hospital. The last patient he treated was a Palestinian child. On March 31, 2002, terrorists set off an explosive device next to an ambulance station in the Efrat community, the same place where neighboring Arabs had received care.

Dr. Hebela can rest assured that he would be more than welcome to visit Israeli’s hospitals, where he would see other Arab physicians training and treating patients of all backgrounds, just as he does in Philadelphia. Israel’s doctors long to return to the conditions present before the destruction of the last four years of war, when physicians could devote themselves to using their skills to help all of the region’s children.

I have seen it with my own eyes. It happened before and it can happen again. But, the Palestinians have to first decide they love their children more than they hate Israel.

Hopefully, that too is a lesson Dr. Hebela can impart to Palestinian parents next time he sees them.

John R. Cohn, M.D.
Clinical Professor of Medicine
Clinical Assistant Professor of Pediatrics
Thomas Jefferson University
1015 Chestnut Street
Philadelphia, PA 19107

http://citypaper.net/articles/current/cb.shtml

In a message dated 6/17/2004 3:37:14 PM Eastern Standard Time, [email protected] writes:

A Good Doctor’s Mission

A Philadelphia surgeon is treating Palestinian children overseas.

by Amy L. Webb

Phildadelphia Citypaper.net

June 17-24, 2004

Dr. Nader Hebela is a walking, talking, unabridged medical reference dictionary. Accidents? A long scar on the forearm may indicate a previously fractured ulna. Disease? Osteogenesis imperfecta is a hereditary problem with skeletal development and weak bone structure. International medicine? Children in the West Bank and Gaza have deformed limbs or broken bones because they have limited access to health care.

At 30, Hebela is in his third year of residency as an orthopedic surgeon at the Hospital of the University of Pennsylvania, and by all estimations, he’s a very smart man. Ask him why he knows so much about medicine and Hebela’s answer is simple. He had good teachers and he works incredibly hard. But what sets him apart from his peers isn’t what he does at work, it’s how he spends his vacations. Rather than basking on a beach, Hebela travels overseas to treat war-torn Palestinian children who, by fate or by foe, now suffer from debilitating health problems.

Hebela is from Bayonne, N.J., where his parents moved to after emigrating from Egypt in the 1970s. Today, if he walked through Queen Village, Hebela would be indistinguishable from the neighborhood’s other young professionals. He wears rimless glasses and keeps his black hair cut very short. His oxford shirts are well-pressed. The bag he carries is equally tidy, holding his computer and the files he needs for work. But Hebela’s hands – he has long fingers with very short nails – are revealing. His wrists look strong. His skin looks fresh and supple. And subconsciously, he speaks through them, inflecting his words with a pointed finger and occasionally cracking his knuckles as he thinks.

“I’ve always just liked using my hands,” Hebela says. When he was a student at Dartmouth, he studied semiprecious metals, and he still makes jewelry today. “I decided then to go to medical school, and surgery was a perfect segue.”

Hebela still has family in Egypt, and he visits them when he can. In fact, he just left on another trip last Saturday. “Since I started residency, I’ve wanted to go overseas, if only to see how things are done differently,” he says. “If I go to one hospital and operate, the techniques used may be very different from a hospital down the street. You realize that the way you’ve learned may not be the only way, which is good. I thought that going to a different country would be a good opportunity to learn and if you’re in a country without good medical care, you get to see the natural progression of a disease.”

At a medical conference, Hebela met a few doctors and a former journalist now affiliated with the Palestine Children’s Relief Fund (PCRF), a nonprofit, nonpolitical U.S. organization. Doctors from the U.S. and Europe were going to the Middle East to treat Palestinian children either wounded in Arab-Israeli fighting or suffering from a lack of medical care.

In 2002, Hebela met with his attending physician and asked to take his vacation time – in a war zone. The PCRF would pay for his air tickets, but not for his time working.

“My attending was supportive, but worried for my safety, of course,” Hebela says.

He then flew to Tel Aviv, and, a short bus ride later, he wound up in a tiny office. The desk was covered with a thick layer of dust, and just outside the door was a slightly larger waiting room. “Word spreads so quickly there,” Hebela says. “By the time we arrived, there were already people lined up, waiting to see the American doctors.”

Because he speaks Arabic fluently, Hebela didn’t have to overcome a language barrier. He is part of a small group of orthopedic surgeons who travel to the Middle East once or twice a year, always to a different location. They find an office, meet with locally trained health care workers and map out a week’s worth of treatment. The team will sort patients through triage, determine whether they are good candidates for surgery, decide whether to fit them with prosthetics or whether to tell them that nothing could be done. In one week, the doctors will see as many as 100 children while working 12 to 15 hours a day.

Hebela expected to see children who bore damage from the second Palestinian intifada, which erupted in October 2000 and resulted in massive Israeli and Palestinian casualties. “But instead, what I saw could have been the same scenario as in India or Thailand,” he says. “There are no pediatric orthopedists in the West Bank or Gaza Strip. There is almost no specialized medical care. And Palestinian children can’t get access to health care in Israel, though Israel has excellent physicians.”

Hebela says that, in his own experience, just trying to cross through an Israeli checkpoint in an ambulance can be too risky.

“Israel does make exceptions for some cases, but most kids are out of luck. There were a few cases of terrorists using ambulances to suicide bomb,” he says. “Since September 2000, 22 ambulance drivers have been shot and killed at checkpoints and 727 ambulances have been denied reaching their final destinations in Israel because they were held up at checkpoints.”

When Hebela went back last February, there were even more people waiting – including some adults. Because the PCRF is designed specifically to help children and because resources are very limited, Hebela says that he had to turn away some adults.

“There was one boy with a horribly mangled leg,” he says. “A few years ago, an Israeli solder was on top of a tank shooting and this kid got in the way. There was a chunk of bone and tissue missing, and he didn’t want to lose his leg. By the time I saw him, his leg was paralyzed at an angle. He wanted to know if we American doctors could fix his leg and help him walk again. There was nothing we could do.”

Hebela treats Palestinian youth who need medical care, but in recent fighting, it is Palestinian teenagers who have strapped bombs to themselves and killed innocent Israeli citizens in buses or street cafes.

“Do I think I gave treatment to a future terrorist? I have absolutely no idea,” Hebela says. “Most of these kids don’t tell their families, they leave notes. When you talk to the average Palestinian, they’re not supportive of bombing, despite what you may hear on the news. Having your son die is devastating. These are kids with injuries – just injuries. And their parents are traveling the earth to find a doctor to take care [of] their kids.

“As a surgical physician, you’re trained with the mentality that your training is designed to help people. Your responsibility is to go out and treat people. Maybe for some the Middle East is too dangerous an area. But there is India, there is Africa. For me the question is not why do I help, but where – and when – can I go next.”

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