BETHLEHEM – After months of preparation, today is the big day, when I will officially start the Diabetes Micro-Clinic Project. I am thinking about what I would like to say to introduce the project; I want to come across as a person genuinely interested in improving the situation, not as a young college student with some wild idea. Most of the participants who will attend are living in the Bethlehem area and come from varying backgrounds; many but not all are suffering from diabetes.
I get up early and go with my friend Samir to pick up the supplies. Samir, a great help to me, is a recent graduate of Bethlehem University. Like many other educated Palestinian young people in search of a job now that he has finished his degree, his prospects do not look hopeful.
I am able to pick up the glucose machines, but I am still missing the needles. Without them, we cannot measure the blood sugar levels. The man I bought the machines from promised that he would have them for me today at 8 a.m., but he didn't show up on time. After finally obtaining the needles and expressing my disapproval about the delay, which was a breach of our agreement, I go to a few more shops to pick up some last-minute supplies and head off to the Peace Center. Most of the nurses, lecturers and volunteers are there early to rehearse the presentation. Knowing that people would arrive late, I had announced that it would start at 9:45 instead of 10 a.m. I soon realize that I should have scheduled the start time one half hour before, as people trickle in and slowly fill up the auditorium during the first 15 minutes of the program.
To publicize the project, I had distributed about 350 announcements through personal interactions along with the help of local NGOs, health organizations and youth volunteers. The project is organized as follows: Participants attend a series of lectures covering critical topics (i.e. diet, exercise, causes and prevention of diabetes), then participants form smaller groups of 20-30 and attend workshops, where they learn how to use a personal glucose monitoring system and have their blood sugar measured. Lastly, those who have elevated blood sugar levels and agree to form small groups of no more than six individuals will receive a machine to share. These groups will become the "micro-clinics" and meet in homes or business, allowing their members to gain shared access to monitoring and group support. I intend to establish 30 micro-clinics in the Bethlehem area.
Before starting the program, I speak to the audience and describe the project. First, I tell them about my personal motivation for the project – how my grandmother, a Palestinian woman, died from diabetic complications, restrictions on movement, and poor health care education, and also that I have noticed the ways in which many Palestinians continue to similarly suffer. I then describe the structure of the project and what we are trying to accomplish through its implementation. Above all, I emphasize the importance of using the information gained from today's lectures and workshops, coupled with support from each other, to help them control and prevent diabetes and other complications in the future.
During the lectures, which are delivered by three women – two nurses and one faculty member from Bethlehem University – I observe that the project participants do not simply want to sit and learn; they want to interact with the speakers and each other. As they listen to the lectures, some express their agreements or disagreements with what is being said while others pose important questions. One man, dressed in a traditional Palestinian headdress and wanting to be polite, gets out of his seat and walks up on stage to deliver a note to the lecturer, providing an explanation of another participant's dietary question.
 |
 OParticipants having their blood sugar levels tested |
After the lectures, we have a short break and then separate the participants into smaller groups in two different halls. The lecturers and nurses help to measure the blood sugar levels of every participant using the machines; many people have dangerously high blood sugar levels – some even above 300. Since we had asked all participants to eat before coming (approximately two hours before being tested), anything above 140 is considered high. These elevated blood sugar levels can be lethal and often result in the loss of limbs or eyesight and lead to other permanent health problems. The other volunteers, mostly young women from the university, then document the blood sugar levels. They also ask participants to provide us with their contact information so that we can make home visits to the micro-clinics and distribute the machines according to the guidelines of the project. We are very careful not to promise the machines to anyone beforehand, but people still demand that they receive one – even if they openly acknowledge that they do not have a problem.
For me, this momentary chaos clearly reflects the desperate economic condition of the Palestinians that I have written about in previous dispatches.
All in all, I feel that the project is off to a good start and that we are meeting a great need; the test results only confirm my worst fears about the dire health situation of the population. Not only do official statistics from the World Health Organization confirm the severity of the issue, but local doctors and nurses have also described to me the problems which have contributed to the diabetes epidemic in Palestine. They told me that the problem stems from a lack of proper education, for both health care professionals and the general population, poor dietary habits and the stressful political situation.
It is now several days since starting the project. Based on data obtained from workshops held after the lectures at the Peace Center, I have now begun to distribute machines to a few home micro-clinics. During the home visits, I am noticing that many people's readings are still dangerously high. One man I visited attributes his high sugar levels to the arguilla, or waterpipe, which he smokes. I am aware that smoking can have other negative side-effects on diabetic individuals, but I wonder if the fruit-flavored tobacco in the arguilla can introduce sugar into the system.
*
When I am not working on the diabetes project, I have been socializing with different types of people and trying to visit new places. I have found that some of the most intriguing places to meet people are the small shops in Bethlehem. There are three shops that sell household items that are near where I am staying, down the street from Manger Square. The problem is that I was introduced to all three of the owners, and so if I go to one, I feel awkward about walking past the others who sit outside their stores and ask why I did not buy from them. Today, I visited the shop of Abu Mohammed, and he gave me a free falafel (I think as an incentive to return). He also sells water more cheaply than the others. Abu Ahmed is the most pensive of the three. He is an older man in his late sixties with short gray hair slightly visible behind a headdress. His tan, wrinkled face is highlighted by the bright white dress he wears daily. As someone who knows my family and wants my business, he always greets me with a kiss. But his sorrowful eyes reveal his pain over recently losing his 16-year-old son to a bullet as he was throwing stones at Israeli soldiers. Having recently been told the story of his death, I now know why there are pictures of a handsome young man posted all over the walls of the neighboring houses. When these children die, they are called martyrs, and their pictures are subsequently placed on a poster and plastered on buildings all over town. Sadly, the walls in Bethlehem and the neighboring cities are covered with these posters.
I hope a time will come when there are clean walls in Palestine.
—Daniel