The US-Middle East Partnership approached Carol to take on an assessment of this size and scope in the Palestinian Territories because breast cancer has long been a significant problem with few resources available to address it. Carol, who has been working on breast cancer issues for over twenty years in the Territories, was a natural choice for the job. She has spearheaded several innovative breast cancer initiatives in the region and has worked with local government officials and international organizations. Carol’s accomplishments include: helping establish the first mammography unit in East Jerusalem; drafting the National Breast Cancer Screening Guidelines for the Palestinian Territories; establishing the Reach to Recovery program—a training program that instructs people on how to do outreach to breast cancer patients; and founding the Patient Friends Society, the only organization in the territories that offers psychosocial support for breast cancer patients.
Regardless of Carol’s familiarity with the Palestinian Territories, gathering the requisite information to distill a clear picture of breast cancer conditions on the ground was still a difficult undertaking. To start, the healthcare infrastructure of West Bank, Gaza and East Jerusalem is still in disarray from years of conflict with Israel and there is a lack of services for the more than 1.5 million women who live there. In addition, the Palestinian Authority grapples with the challenge of providing services with limited resources across a fractured geographical area. As a result, access is a huge problem and it is very difficult to reach people with the myriad checkpoints, military zones, and security walls that crisscross the landscape. Finally, cancer statistics, the responsibility of the Palestinian Central Bureau of Statistics and the Ministry of Health, are questionable and the health information system is not integrated, comprehensive or fully functional.
Despite the difficulty of the task and the obstacles that lay in their path, Carol Jabari and her team were undaunted. The team did in–depth personal interviews with hospital directors, administrator, and other key personnel across the three main health sectors. The team conducted focus groups of well women in four different communities in Nablus, Hebron, Bethlehem, and Jerusalem districts and interviewed women living with cancer from Gaza, the West Bank and Jerusalem. These women shared their experiences living with cancer, detailed the difficulties they had accessing care and shared their hopes for the future. They got the information they needed first-hand from in-depth interviews and focus groups. When checkpoints prevented them from doing interviews, she did them over the phone. Overall, she found that despite all the obstacles, people were very receptive to what she was doing. Ministry of health officials lent their full support to the project. “People were quite forthcoming,” she said. The women trusted her and were eager to share what they knew.
After Carol and her team had gathered all the information they needed, the next step was to analyze their findings. Although she was not surprised by many of her findings, such as the and physical barriers to care and lack of infrastructure and capacity to handle breast cancer cases, what amazed her was the lack of awareness among Palestinian women about breast cancer. For example focus group of well women from Hebron and Nablus revealed a consistent lack of understanding among the women who participated. At the end of the session, “I was shocked at how uninformed they were. They didn’t know anything!” In fact, they found that because NGOs in the past had focused their breast awareness campaigns at rural women, “we found that women from rural villages actually knew more about breast health than city women did.” It was proof that the Palestinian Territories still have a long way to go and a lot of work to do to improve breast health awareness.
Based on the results, Carol believes that there are several aspects of care that need to be addressed immediately, including:
- Upgrading the knowledge and skills of the professionals in West Bank and Gaza, through web or video conferencing and disseminating treatment guidelines through educational sessions.
- Training and recruiting more qualified x-ray technologists, including more female technicians
- Tackling the dearth of knowledge about breast cancer by funding programs that inform the public about screening protocols, referral mechanisms and the importance of early detection
Despite all the challenges, Carol remains hopeful about the task ahead. What gives her hope is number of people she met who are committed to improving breast care in the Palestinian Territories. The Baseline Assessment is a first step in the right direction. Now government officials, NGOs, and implementers in the development world have a better idea of where the need exists and can strategically plan and implement concrete programs that work towards improving awareness and breast health care in the Territories. With the assessment in hand and a little bit of elbow grease, advocates in the Palestinian Territories are helping pave the ways towards meaningful long-term change.
Read the Baseline Assessment of Breast Cancer awareness and Care: West Bank, Gaza, and East Jerusalem
Carol Al-Jabari is the US Middle East Partnership for Breast Cancer Awareness and Research’s local representative in the West Bank. She is a trainer to promote breast cancer screening among professionals and student nurses. Currently she works as the executive director of the Patient Friends Society in Jerusalem.
Posts
