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[PCUSANEWS] Intimate Implications


From PCUSA NEWS <PCUSA.NEWS@ECUNET.ORG>
Date Fri, 4 Jun 2004 13:40:07 -0500

Note #8265 from PCUSA NEWS to PRESBYNEWS:

04262
June 3 2004

Intimate Implications

Political stress interrupts mother-baby bond in Gaza City

(Editor's Note: This story began one year ago when Alexa Smith was reporting
from Palestine/Israel. When violence escalated in the Gaza Strip in May, the
Presbyterian News Service updated the interviews.)

by Alexa Smith

GAZA CITY, Gaza Strip - Esma Abu-Hussain is a straight talker. Her broken
English, aside.

      She is confirming what another nurse said earlier, anecdotally: Mothers
in Gaza are having trouble breast-feeding their babies.

     When the other nurse, Lubna Sabah spoke, that little bit of data rolled
out. It is one of a number of the medical oddities that are common now in the
Shija'ia Clinic, which sits in a rundown, over-crowded neighborhood in Gaza
City. There isn't enough money. Babies are anemic. Normal development is
slowly being stunted. There's no money to buy formula since men haven't
worked since the Israeli Army closed Gaza over two years ago, in an apparent
attempt to rout out radicals and to pressure civilians to do the same.

      But then she said that breast-feeding, too, is also a problem. And
that's something new.

      Abu-Hussain - a nurse and the clinic manager in Darraj, an equally poor
neighborhood across town - agrees. She doesn't have numbers, but she will
start keeping a tally if anyone wants proof. She guesses that 30 to 40
percent of the women she routinely sees are having trouble nursing.

      Stress, she thinks, is the cause. When mothers stay too stressed for
too long, their milk just won't let down.

      "We try to talk with her, you know? Talk with her about the situation
in general. All of us are in this same situation and we must get used to it.
We must learn to deal with that," says Abu-Hussain, talking calmly, directly,
just the way she might with an over-anxious new mom.

      "We try to teach her that if she gets well, her baby will be well
also."

      Abu-Hussain is sitting in a cramped clinic office, next to the
examining rooms. It is small, semi-private. The walls, literally, are jammed
with manila file folders, crammed with patient information. The Shija'ia and
Darraj well-baby clinics are run by the Middle East Council of Churches and
serve babies from birth to age six. The pharmacies offer free or at-cost
medicine. There is prenatal and postnatal care and family planning, as well
as health education for women. Nurses make housecalls on pregnant women.

      As she talks, rain is pouring down, turning the city's dirt-packed
streets into mud pits. In some blocks - where decrepit sidewalks buttress
old, paint-peeled buildings - teenagers are wading waist-deep in what used to
be the middle of the road.  By stacking wooden packing crates, they're
helping little kids cross the streets, holding their hands as they tiptoe
slat by slat; otherwise, they'd be wading neck-deep in water.

      The rain hit just as school let out. Uniformed boys are hollering,
laughing, splashing around in the mess. Little girls stand at the sidewalk's
edge, unsure how to get home. For mothers - scurrying along in drab olive
overcoats rounding up kids before they dive into the street - it is just one
more catastrophe.

      Maybe it is a metaphor for the quagmire that life has become here. In a
world where political chaos can interrupt the primary bond between a mother
and her baby, anything can happen.

	The odd part is: It isn't a secret that babies are underweight in
Gaza and their mothers are scared out of their minds. It is a well-documented
fact.

     Johns Hopkins University's School of Public Health surveyed nutritional
levels, availability of food in the markets, and household consumption on the
West Bank and the Gaza Strip back in 2002, funded by USAID. The results said
that chronic malnutrition in kids under five reached emergency levels then.
That was two years ago.

      As Peter Hansen - commissioner-general of the United Nations Relief and
Works Agency - put it: "The stark fact is that 22 percent of the Palestinian
children are suffering from acute or chronic malnutrition for purely man-made
reasons. No drought has hit Gaza and the West Bank, no crops have failed and
the shops are often full of food. But the failure of the peace process and
the destruction of the economy by Israel's closure policy have had the effect
of a terrible natural disaster.

      "Nursing and pregnant mothers too are suffering. On an average, they
consume 15-20 percent fewer calories per day than they did before the
outbreak of strife in 2000. The consequent anemia, low folic acid intake and
lack of proteins threaten both their health and the normal development of
their children."

      The report credited the Israeli-imposed road closures, checkpoints and
curfews for trapping Palestinians in a dismal economic situation. Men can't
get to work, inside Israel or in Palestine. Women can't get to markets. There
is a shortage of fresh meat and dairy products - which most people can't
afford anyway.

      In Gaza, 41.3 percent of families said they were selling assets in
order to have money for food. Again, in 2002, the Palestinian Central Bureau
of Statistics reported that more than two-thirds of Palestinian families were
living on less than $1.90 a day.

      That was then; this is now.

      Which is why Sabah is looking for protein-rich meat alternatives; lack
of protein causes malnutrition and anemia.

      She tries to reduce starches, first. When families can't afford meat,
they stock up on rice, bread, potatoes. It's filling. But Sabah pushes
lentils. They are cheap and full of protein. Lentils can be turned into soup
or served as a main dish. She wants new mothers eating vegetables and taking
clinic-provided vitamins. "When the mother eats well," she says, "the baby
will be healthy."

      As Sabah is talking, 26-year-old Itaf Scafi walks into the clinic,
bundled up in an ankle-length tan overcoat, a scarf about her neck and head.
She is the mother of several children; her youngest child is two. She was
already pregnant with her last child when the Intifada broke out. She never
imagined anything like this. Her mother, Hitam Abu-Sacra, 45, with her.

      The mother speaks first. "Yes, it's been a difficult six months.
Sometimes her husband can get bottled milk. Sometimes not," she says, her
voice escalating. "If I have money, I give it to her. We all have this same
condition.

      "Or, I go and try to get money from a friend or a neighbor ... Whatever
we can do, we do it."

      Scafi speaks up. It's been awful, really. She lives close to the
settlements that ring Gaza. There's shelling every night. The kids scream.
There is no way to hide the family's predicament when the bombs start
falling. Her entire family sleeps now in one room. Friends don't bother to
visit; it is too risky. And yes, when she gets tense, she has trouble
breast-feeding. As does a friend.

      Trying to talk women into taking food supplements and cooking with
lentils is the easy part.

      Daily catastrophes in Gaza City are harder to control.

      "This is our situation," says Abu-Hussain, who lives here, too. "We
suffer from anxiety, fear. Every one of us. We don't know what will happen
next, where they will bomb. Maybe it will be us. Maybe our relatives, our
neighbors ...

      "If you don't feel safe yourself, how do you give safety to your child?
How can you give what you've lost? This is a hard situation for us," she
says, adding that she talks with most of her patients as friends, listening
to their sorrows, recognizing in them her own.

Then she starts the litany of what life is like.

      Since the job market bottomed out, there's no money. So men move their
young families back home with older parents. Sometimes several sons and their
wives and their children do the same. All in one tiny house. It is crowded.
There are too many children. Other people's kids get on your nerves. There is
no privacy. Few breaks. Only a few people work - or still have savings left -
and they have to help all of their brothers and sisters. A husband is
humiliated by taking a handout from his brother. But he doesn't have a
choice. The mother-in-law is nagging. There isn't enough food, ever.

      And, of course, there is the shelling. It is virtually non-stop at
night. Heavily armed soldiers break into houses, pulling men and boys out in
the street yelling questions, poking them with assault rifles, or, hauling
them away in jeeps, without bothering to leave a forwarding address or
explain why they've been taken. They can be held without charges for up to
six months, and that sentence can be renewed if a senior officer testifies
that they are suspicious.

      She stops talking. "So, she's nervous," she says, meaning her patients.
And herself.

      Abu-Hussain thinks a moment and then goes on:  "Every little girl wants
to grow up, get married and have babies. Care for them. Nurse them. Give them
love ...

      "If she loses that ability - her job in life - how does she feel?"

      Anemia isn't new in nursing mothers. Not in Gaza. Women here marry
young. And they have lots of babies. When they start young and have little
time between births, anemia is hardly rare. Top that off with poverty and a
lack of education, and you have Gaza of the last few decades.

      Losing the ability to nurse takes more than that.

      When her patients come into the tiny clinic - from 7 a.m. to 11:30 a.m.
weekdays - Abu-Hussain listens, soothes - and pushes. She talks nutrition.
She tells mothers who are able to buy formula to be sure to boil the water
before mixing it. Gaza's water supply isn't the safest; in fact, it is full
of salt. She encourages formula only as a last resort.

      If a woman is upset because her milk won't flow - and using a formula
substitute isn't financially possible - Abu-Hussain tries another tactic. She
tells her to sit quietly, cradling her baby, to make eye contact, to try to
relax.

      She keeps her voice soft. But her instructions are direct.

      "You must try to do it," she says. "There is no choice. We must live in
this situation ... so you must try."

(Visit www.pcusa.org/pcnews to view the story with photos and video clips)

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