West Bank - May 2010

The UNC affiliated part of the surgical cleft team left Raleigh, NC on May 13th, passed through Atlanta, and then on to Tel Aviv. The group consisted of John Butz, Surgical Technician, Emma Marks, RN, Bobby Silvers, CRNA, and John van Aalst, MD. Two other group members, James Liau, MD, UNC Craniofacial Fellow, and Ron Herring, DO, Anesthesiologist, travelled through Newark, NJ, and onto Tel Aviv; the last two members (Libby Wilson, MD, and Tim Hatcher, CRNA) flew from Los Angeles to Tel Aviv. The following afternoon, we reconvened at Ben Gurion Airport: the flights arrived at 3:15, 4 and 5:15 PM. A large van then took us to Hebron, in the Judean Hills, where we checked into the Hotel of Hebron, the only hotel in this city of 750,000. The rooms were clean; everyone woke up to the sounds of dogs barking at 2 AM, the call to prayer at dawn; a breakfast of hummus, olives, cheeses, hard boiled eggs, and flat bread was served in the morning starting at 6:30 AM.

Saturday was spent seeing the facilities at Al Alia Hospital, the Government Hospital of Hebron (three operating rooms, the clinics, the ENT Department ward where patients would stay before and after surgery), and meeting people in the hospital. Muhammed, the head nurse in the operating room, was one of the first people we met: always thinking about some problem, but quick to smile, and helpful. Soon, we met the head of the Division of General Surgery, the Director of the Hospital (Dr. Said Sarahneh), the head of ENT (Nabil Abdel Nour), as well as nurses and various other staff. We would see these people repeatedly during the week at the hospital.

On Sunday, May 16th, we screened patients. By report, there were over 400 patients waiting to be seen; we managed to see the first 200, and the remaining patients and families disappeared as the day wore on. Our first cases were on Monday May 17th, then operated every day, with the exception of Friday May 21st, the traditional day of rest among Muslims, until Monday May 24th.

Days generally started at 7:30 AM, with morning rounds, a targeted 8 AM start time for the first cases. We were given two operating rooms and worked non-stop until 9 or 10 in the evening, with the exception of Tuesday, when we were invited to Bethlehem by the Nabil Abdel Nour (Head of ENT), and the Director of the Hospital (Dr. Said Sarahneh). Our dinner consisted of twenty different salad appetizers, followed by grilled chicken, lamb, and beef. On the way back from Bethlehem to Hebron, we were invited to Dr. Sarahneh’s home, where we drank midnight tea, and finally returned to the hotel by 1:30 AM.

On Thursday afternoon, Dr. Libby Wilson and I travelled to Jericho to speak at the 6th Annual Conference of the Palestinian Otolaryngological Society. We stayed until Friday early afternoon, at which time we went to Ramallah to spend time with Hanine Al-Sheikh, a speech and language pathologist (who has been a visiting Fellow at UNC), and Dr. Wa’el Halaby, an Oral Maxillofacial Surgeon, both of whom have become very deeply committed to working with Palestinian children with clefts. We were accompanied by Dr. Ibrahim K. Lada’a, a German-trained ENT, who is one of the Founding Fathers of ENT on the West Bank.

Friday evening, we returned to Hebron, for a full surgical schedule on Saturday, Sunday and Monday. Two surgeons who were routinely with us during the surgical trip were Wa’el Halaby from Abu Dis (near Jerusalem) and Sayf Yacoub (from Bethlehem). Both have made great strides in learning the intricacies of caring for children with clefts. In addition, two ENT surgeons from Al Alia Hospital participated in surgeries. The ENT surgeons were particularly interested in the rhinoplasty and microtia cases.

Cleft Repair: Before and After

On Monday morning, I travelled to Soroka Hospital at Ben Gurion University in Beir Sabaa with Dr. Sayf, where I gave lectures to medical students and to the Department of Plastic Surgery. Later that evening, I returned to Hebron, said my goodbyes, and traveled briefly to Abu Dis (a suburb of Jerusalem), where I visited Dr. Wa’el Halaby’s family.
In total, we performed 64 surgeries, most of which were cleft-related, but also included ear and nasal abnormalities. There were no immediate operative or post-operative complications. We worked well as a team, and with the local health care practitioners. This was a tribute to the flexibility and commitment of team members from the States, and the generosity and graciousness of Hospital administrators and staff.

My last day in Jerusalem was a quiet day of reflection. I had dinner with an Israeli Oral Maxillofacial Surgeon, Omri Emodi, in Airport City, ten minutes from the airport. My flight departed from Ben Gurion Airport at 11:35 PM.

John van Aalst, MD
Chapel Hill, NC