On the occasion of Breast Cancer Awareness month 2019, Dr Philippa Whitford MP and Medical Aid for Palestinians (MAP) are celebrating two years of partnership between Scottish breast cancer experts and their Palestinian colleagues in the West Bank and Gaza, as part of a comprehensive programme to improve access to quality treatment for Palestinian women affected by the disease.
This project, begun in September 2017, involves teams of radiologists, oncologists, cancer nurses and surgeons from Scotland who give up their holidays to travel to the occupied Palestinian territory (the West Bank, including East Jerusalem, and Gaza). There, they perform breast cancer operations together, and teach the latest techniques used in the UK � at all stages of treatment from diagnosis to after-care � to provide effective care and improve outcomes for patients.
The support continues once the volunteers return home, with a video conference between Scotland and Gaza at 7am every Tuesday morning to plan the week’s treatments, and a similar partnership being developed for clinicians in the West Bank. Dr Whitford led on the development of the first Scottish clinical audit standards for breast cancer in 2000, and is now working with MAP to develop the same for Palestine, to enable medics there to better measure their performance and medical outcomes.
This work has proven particularly vital in Gaza, where many clinicians are prevented from travelling to external conferences or training, leaving them cut off from many advances in cancer treatment and with less opportunity to update their professional skills. Just 15% of Palestinian health workers who applied for exit permits to leave Gaza were granted them by the Israeli authorities last year.
This project began after Dr Whitford was shocked to witness how Israel’s blockade and closure of Gaza had impacted the care available to women with breast cancer in Gaza during a visit in 2016. Dr Whitford and her husband previously worked in Gaza in 1991-1992 as medical volunteers with MAP, and she returned to conduct a breast cancer needs assessment soon after being elected MP for Central Ayrshire.
There, she witnessed how shortages of essential medicines and equipment � including limited stocks of chemotherapy drugs and the lack of local radiotherapy services � undermine the care Palestinian cancer specialists can offer their patients. Furthermore, she heard how Israel’s frequent denial of exit permits prevents patients travelling to Palestinian hospitals outside Gaza where services are available, such as the Augusta Victoria Hospital in East Jerusalem. Last year, 39% of permit requests for patients needing to leave Gaza for medical treatment were denied or delayed by the Israeli authorities, meaning that appointments were missed. In 2017, 54 patients from Gaza died after missing scheduled medical appointments, 46 of whom had cancer.
Reflecting on what she witnessed on returning to Gaza after 25 years, Dr Whitford said:
I was shocked to find that, regardless of the size or stage of disease, every single woman I met had undergone a radical mastectomy and axillary node clearance. This is an approach that had not been the routine practice in the UK for more than 20 years, and it had left half of them suffering with severe arm swelling known as lymphoedema.
After two years, the Scottish-Palestinian ‘medical bridge’ project has begun to have an impact on the quality of breast cancer care in Palestine, as described by Dr Whitford:
The progress in just two years has been remarkable, particularly in Gaza. Women are now properly diagnosed before surgery, allowing better planning of their treatment. Surgical practice has also changed, with breast conservation replacing mastectomy for patients with smaller tumours. Undergoing a mastectomy affects not just a woman’s health but her self-esteem and confidence, so it is important that more Palestinian women have the option of breast conservation if clinically appropriate.
Dr Whitford further described how more needs to be done to support Palestinian women with breast cancer, and the local teams seeking to provide them with quality care, in challenging circumstances:
I am proud of what this Scottish-Palestinian partnership has achieved in just two short years, but it is just patching up one of the symptoms of ongoing occupation and blockade. The UK government must do more through international development aid, and particularly diplomatic pressure, to end the closure of Gaza and ensure all Palestinians can access the kind of quality healthcare we take for granted.
Source: Medical Aid for Palestinians