A program, led by MAP and co-financed by the Fund, provided special training in pediatric care for Palestinian nurses in Gaza and the West Bank.

Thousands of Palestinian youngsters are now benefiting from access to skilled, high quality healthcare in pleasant, "child-friendly" surroundings, thanks to the successful completion of a pediatric nurse training program at hospitals in the West Bank and Gaza Strip. Spearheaded by the UK-based, non-profit organization Medical Aid for Palestinians (MAP), and co-financed with a grant from the OPEC Fund, the initiative has transformed the delivery of pediatric care, successfully tackling one of the region's most urgent social problems.

Over the past 50 years, the people of Palestine have led lives fraught with hardship. Since the Israeli occupation in 1967, most of the region's inhabitants have been forced to live in unsafe, overcrowded refugee camps, where basic social services such as schools, hospitals and proper sanitation are in short supply. As tight restrictions are imposed on the movement of Palestinians, unemployment levels are high and the inflow of necessities such as food and medical supplies erratic. These conditions have perpetuated poverty for an estimated one-half of the territories' 2.8 million people.

Sub-standard living conditions have taken a particularly severe toll on the region's vulnerable young, many of whom contract pneumonia and other respiratory and infectious diseases, or fall victim to water-borne illnesses. As a disproportionate 50% or more of the population is under 15 years of age, the pressure on healthcare providers is enormous.

MAP is one of a number of specialized agencies dedicated to responding to the medical and humanitarian needs of Palestinians. Active in the region since 1985, MAP works closely with the local Red Crescent and Patients' Friends Societies, as well as charitable hospitals and health committees, providing technical, material and financial support to boost the development of comprehensive health services.

In 1995, when MAP first conceived the idea of a program focusing on pediatric care, concern was mounting over the availability and quality of medical services, particularly for infants and children. Hospitals were understaffed, and only a small percentage of doctors and nurses had any type of pediatric training. Although approximately one-half of all nurses had completed basic coursework in general nursing, the remainder possessed only a few months of on-the-job training. Auxiliary help was also scarce, so ward nurses had to undertake time-consuming, manual tasks, leaving less time for patient care. Training in pediatrics was generally unavailable, and continuing educational opportunities for those interested in enhancing their clinical knowledge non-existent.

In response to initial requests for pediatric nurse training from a number of healthcare providers in the West Bank and Gaza, MAP decided that, instead of meeting isolated, in-service training needs, it would, in the long term, be more advantageous, to explore the idea of establishing an ongoing, self-sustainable training scheme. This idea took shape and, with support from other donors including the European Community, the Overseas Development Association of the UK and the OPEC Fund, a framework was set up for a program to improve the knowledge base and skills of pediatric and general nurses, and to create an accredited, EU-recognized pediatric nursing degree course.

Three hospitals were selected according to their regional distribution and high volume of child patients: the Shifa and Al-Nasr hospitals in Gaza, along with the West Bank's main referral hospital, the Ramallah. A dedicated team of pediatric nurses from the UK identified the specific needs of each hospital and then developed pediatric education programs for general nurses while working alongside the trainees. Supplies such as baby-bottle sterilizers, stethoscopes, refrigerators for drug storage, stainless steel dressing trolleys and other basic necessities were purchased. All nursing staff were encouraged to identify weaknesses in their working practices and helped to make a number of procedural, clinical, environmental and organizational changes within their wards.

Those who completed the in-house training were urged to form their own Pediatric Nurse Working Groups to network with their counterparts in other hospitals. This proved to be a highly productive exercise with participants sharing best practice experiences and pooling ideas and expertise. Senior staff members were also given the opportunity to update their theoretical knowledge and practical skills.

In conjunction with the in-house training, a curriculum for a 2-year Post Basic Diploma in pediatric nursing was developed by faculty from the Al-Quds Institute of Nursing in the West Bank and the Palestinian College of Nursing in Gaza. This program was made available to nurses working at over a dozen hospitals in the region and produced 35 qualified graduates, 34 of whom now hold leading pediatric positions. Throughout the degree program, MAP trainers acted as mentors and later supported the graduates when they returned to their hospitals, providing supervision and encouragement as they applied their newly acquired skills and knowledge.

Supplementary training activities included a four-month pediatric oncology training course in Amman, Jordan, which was attended and completed successfully by five nurses from the West Bank and Gaza, and resuscitation training, which was undertaken by a further 108 nurses at hospitals in Jenin and Nablus. Numerous other staff benefited from additional learning opportunities in the form of study days and weekly teaching sessions.

To complement the clinical aspect of the program, steps were taken to establish a more child-friendly, cheerful environment in the pediatric wards. This was seen as essential to help boost morale among the young patients, especially those requiring long-term care. Together, trainers, local colleagues and the children themselves created playrooms, which MAP stocked with toys, and helped paint the wards with colorful cartoon characters.

The achievements and impact of the program have been remarkable. Specialized, pediatric care is now available at a large number of hospitals and, with a core of qualified nursing staff passing on their knowledge to colleagues, solid foundations have been laid for these improvements to gain momentum and spread to other needy areas of Palestine.

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