HMD RESPONSE PROGRAMME ACTIVITIES IN LEBANON

HMD Response's involvement in Lebanon began following the Israeli "Grapes of Wrtah" operation in April 1996, during which the UN base at Qana was shelled. What began as an emergency response has evolved into a long-term mobile-clinic programme. This is complemented by women's awareness groups presently held at weekends. An equipment programme for Tyre and Tibnin Public Hospitals has been partially funded by ECHO while an additional proposal for a Nurse and Midwifery Education Programme has also been submitted to interested donors. Finally, a proposal has been prepared for a Trauma Counselling Programme, thus demonstrating HMD Response’s firm commitment to the health care needs of the region.

Mobile Clinic

The HMD Response mobile clinic has been in" operation since 11 September 1996. Eight villages, all of which lie close to the Israel's self declared "security zone" are visited weekly. Incidents of shelling are frequent and the population of the region live under constant threat. Due to the security situation, economic development is stunted and many of the population live below the poverty line.

The clinic acts as a mobile Primary Care Unit treating illnesses in the community and in turn, referring more complicated medical conditions to Tibnin Public Hospital. The clinic is staffed by one General Practioner, Dr. Mike Gent and three public health nurses, Helen McAlpine, Kerry Andrews and Paul Mackay, supported by local nurses working alongside. Drugs are provided for the clinic by the Lebanese Ministry of Health and are administered free of charge. Patients who require a regular supply of drugs are referred to Government's Chronic Drug Programme.

Between 11 September and 30 April a total of 4,411 patients were seen, the largest group being women from 16-64 years. The greatest number of consultations are for respiratory and gastrointestinal illnesses, while diabetes, with its attendant side effects is also a significant problem.

Women's Group

The aim of the mobile clinic is to provide health care rather than medical care. The south of Lebanon can only be described as a developing country with an accepted orthodox health care system which is mainly curative and dominated by doctors, rather than one which promotes preventative health care. People expect drugs to be given for all ailments. There is little education or incentive to adopt correct health patterns in place of incorrect ones.

One means of bringing health promotion to the area was the support of women's groups throughout the villages. Aside from their own health needs, women are the primary carers for families. Thus it is appropriate that they are targeted for health education.

The women's groups, conducted at first by Helen on her days off, were started on 23 November 1996 in the village of Jmai Jmai. The support team is predominantly made up of local volunteers, including a staff nurse with an interest in health promotion, an English teacher and a volunteer paramedic with the Lebanese Red Cross (LRC). This programme has been repeated in several villages, where local residents provide their houses for meetings. While Helen attends each one in turn, volunteers keep the others running.

The syllabus for the women's groups is as follow:
Week 1: Physical manifestations of stress and coping strategies. The women identified with most symptoms and a group discussion revealed that most were either young widows or had lost children to the war. Individual bereavement counseling was offered and the stages of the "Rites of Passage" were discussed i.e. Denial, Anger, Bargaining and Acceptance.

Week 2: Child development and childhood illnesses. This proved to be of great interest as they have little media input and mostly learned from their own mothers; therefore many traditional harmful practices are carried out, such as the binding of the arms and legs of newborn infants as a safety measure. This prevents muscle development.

Week 3: Women's and children's rights; education and safety in the home and nutrition and dental care for children. Also skin care and advice on homeopathic and cheap available products to use as skin cleansers and moisturisers.

Week 4: The Menstrual Cycle. Problems associated with pre/ post menopause and an introduction to family planning. Most of the women have their first child when they are 14 or 15 years old; the average family in Southern Lebanon is 9 children, with an under 5 mortality rate of 40 per 1000. They have no idea of how their own bodies work, believing that they can become pregnant at any time. They also develop early osteoarthritis and problems with incontinence and uterine prolapses due to the frequency of pregnancy and lack of pre/post natal care. For example, they stay in bed for 15 days postnatally which causes circulation problems, pressure sores, infections and depression. Pelvic floor exercises are taught, which actually led to an aerobics class starting up in Jmai Jmai. This was despite opposition by the local schoolteacher who initially denied permission for use of the school hall for the class. However, the women themselves put together a petition (with the support of their husbands) and succeeded in gaining permission from the Muchtar (village leader). This was the first step towards their empowerment.

These awareness groups have been supplemented by a number of family planning seminars conducted since January 1997 by Dr. Wafa Kanaan of the UN Family Planning Association. These were the first visits made by the team to Southern Lebanon. The seminars have been well attended and Tibnin Hospital has been identified as the referral source for assessment and free contraception.

Additional seminars have been held on HIV / AIDS. World Health Organisation guidelines have been translated into Arabic highlighting the means of transmission of the virus. Helen gives the lecture to women only while Mike advises men only groups.

Traumatic Stress Syndrome

Through both the clinic and the women's groups, it has become apparent to the team that there is a high prevalence of Traumatic Stress Syndrome among the local civilian population as a result of living close to the Israeli Controlled Area and being in constant fear of shelling and attacks. As a trained counselor, Helen has a professional interest in this area and has developed a three year programme specifically for Trauma Counseling in the region. Candidates for training include teachers, members of the Lebanese Red Cross and others. Professional trainers will be identified from the UK and Ireland to provide two training courses per year, an initial training course to be followed by an upgrading course.

For further details of TSS in the region, please see the article entitled "Traumatic Stress Syndrome among women in Southern Lebanon".

Purchase of Equipment

HMD Response has recently purchased laboratory equipment for Tyre public hospital and emergency equipment for Tibnin public hospital.

Future Programme Activities

HMD Response plans future programmes to complement the work of the mobile clinic. This includes a Nursing and Midwifery Education programme and a Trauma Counselor training program (see "Traumatic Stress Syndrome among civilians in Southern Lebanon"). We also hope to introduce a second mobile clinic to reach those villages in the South not yet served by HMD Response or others.

Funding 1996/7 - Donation of British Embassy

In March 1997, the British Embassy in Lebanon generously donated funds for the purchase of equipment by HMD Response for its mobile clinic and associated projects. A mobile ECG machine was installed in the mobile clinic itself, while a TV, video and slide projector were purchased for use by the women’s groups and future nurse education programmes.

ECHO Funding

In May 1997, a grant of ECU 50,000 was approved by ECHO (European Community Humanitarian Office) for HMD Response’s work in Lebanon. This grant includes support of the mobile clinic and the purchase of laboratory equipment for Tyre public hospital and emergency equipment for Trauma Counseling Programme.

Karim Rida Said Foundation: In July 1997, the Foundation approved the allocation of £20,000 in support of our three year Trauma Counseling Programme.