Gaza Strip: Silvia, cardiac and respiratory physiotherapist, reports back on her mission

The Israeli blockade in place since 2007 makes it extremely difficult for anyone to leave the Gaza Strip, so Palestinian health professionals have not been able to go abroad for training and to update their knowledge and skills. One of the objectives of MSF's programme in Gaza is therefore to transfer competencies from our specialised expatriate teams to the local medical teams. And this is why Sylvia, cardiac and respiratory physiotherapist, has just spent a month and half in Gaza.

My name is Silvia Helena Cesar Thomaz de Aquino. I'm Brazilian and I'm a cardiac and respiratory physiotherapist. I've been working at the Sao Paulo hospital in Brazil for the last twelve years.

I qualified in 1998 and a year later, in 1999, MSF was awarded the Nobel Peace Prize. This is what brought the organisation to my attention and made me want to work for it. I think NGOS offer a future to those who find themselves put aside in some way, ostracised by a society that's becoming more and more standardised.

In July 2010, I went to Haiti with MSF as a generalist physiotherapist – that was my first posting. And a month and a half ago, I went to the Gaza Strip to provide ten Palestinian hospital therapists with training in cardiac and respiratory physiotherapy.

The Gazan health authorities have just launched a heart surgery programme. This speciality has not been available in Gaza until now and the medical personnel have not been trained and have no experience of providing the post-operative care and follow up that is essential and very specific to this type of specialised surgery. Without the appropriate postoperative and rehabilitation care, a patient who has undergone heart surgery will not be able to return to a normal life, to his or her daily routine. Nor will it be possible to avoid the risks factors that could lead to a relapse; without the right help and support the patient could suffer another cardiac incident.

So I tried to share my expertise with the physiotherapists in Gaza. They were very interested in the training: they were keen to know more and eager for any opportunity to learn and improve their knowledge so they could help their patients recover. They are looking to change things and were obviously really committed to this training, revising in the evening and coming back with questions the next day.

The different training activities that are part of this medical project which offers free care to patients needing plastic surgery and post-acute care make it quite an unusual mission for MSF. I think that what the healthcare personnel over there need most of all is to learn more to improve their competencies still further. This type of training is of potential benefit to the whole population. At MSF, we have the expertise in the areas they most need – so, why not allow them to benefit from it?

The people I met in Gaza, whether working for MSF or in the hospitals and public health facilities, are dedicated and committed, open-minded, motivated and ready to learn. I found them to be very supportive of each other, especially in difficult situations. They give new meaning to the word "network": "If I know how, I'll teach you, and then together we'll teach the others and we'll all progress".

In addition to its surgical programme, MSF has also set up a rehabilitation centre specialised in the functional rehabilitation of the hand and upper limbs.

People come from all over the Gaza Strip to this centre which offers adapted care by specialised physiotherapists and also produces the orthotic devices needed for patients' post-operative follow up and recovery. The aim is to obtain rapid results and adapt the patient's reintegration to his or her disability.

Functional rehabilitation of the hand and upper limbs calls for very specific theoretical and practical knowledge. At the beginning of 2012, the physiotherapists working at MSF's centre were given some initial training in this speciality and work protocols were put in place. This summer a second more detailed and comprehensive training session was run to help them consolidate their skills.  

At the same time, seven hospital physiotherapists from Gaza were introduced to this type of specialised rehabilitation. The objective is for this type of care to be available in public health facilities so that, in conjunction with MSF's action, all upper limb pathologies can be treated inside the Gaza Strip.

MSF's action is part of a comprehensive approach to patient management: specialised care (surgery and physiotherapy) and training of local medical and paramedical personnel to enable them to contribute towards or ensure the continuity of care.

Gaza Strip: MSF shares its experience with hospital physiotherapists
This summer, at the request of the Gazan health authorities, MSF provided training in cardiac physiotherapy for ten or so physiotherapists working in Gaza's main health facilities (European Hospital, Al-Shifa hospital, Nasser, Al-Aqsa and a number of clinics).

Physiotherapy is an essential component of the rehabilitation care provided to patients after surgery: it speeds up the healing process and reduces pain levels. This is particularly true for people who have undergone heart surgery or are in cardiac intensive care - sometimes still in a coma .

This training in cardiac physiotherapy focused on the different stages in the recovery of a patient: while in hospital, but also once they are back at home. Ten Gazan physiotherapists received theoretical and practical training in cardiology (anatomy and physiology, acute and chronic pathologies, radiography and electrocardiograms, treatment of patients in a critical condition, etc.).

The objective is to share these specialised techniques with hospital physiotherapists and to teach them to assess a patient's condition and put in place personalised and adapted treatment and care in accordance with standardised and approved protocols. From now on, throughout the Gaza Strip, anyone needing this kind of care will have access to it. MSF will continue to follow up and support the work of the ten physiotherapists who have received this training. An information leaflet has also been produced to answer patients' and their families' most frequent questions about risk factors and cardiac rehabilitation.

The cardiologists and nurses in the Gaza cardiology unit have also been informed about the importance of cardiac physiotherapy in post-operative care and are now aware that they can call on the services of trained and competent physiotherapists to improve the management of patients, even once these patients have been discharged from hospital.