Erica L Nelson
And that, nestled beside simple human compassion and lofty
Hippocratic imperatives, is why it is so compelling. The delivery of healthcare
or, in this case, the delivery of patients to healthcare, is complex,
context-bound, political and socio-economic. Systems that efficiently and
effectively deliver healthcare, whether it be a Public Health Department or an
Emergency Department, a ‘medical mission’ or a longitudinal development
initiative must continuously examine the environment that surrounds their
patients and their institutions. Any initiative, study, treatment plan
or discharge that ignores context, will at very least lack generalizability and
at worst, fail.
Resident in Emergency Medicine at Massachusetts General
Hospital and Brigham and Women’s Hospital
PGY-4
October 9th, 2016
Sandwiched in between
Rosh Hashanah and Yom Kippur, volleying between Jerusalem, Hebron, Ramallah,
Nablus, nine different hospitals, multiple check points, cups of mint tea and strong
coffee, Arabic, English, Hebrew, check-point, vibrant market, dingy office,
immaculate NICU and disquieting ED, I find myself in a (needless to say),
politically tricky situation. In a context wherein the origin
of a mashed chickpea dip is contentious, I somehow have the audacity to attempt
to examine the Palestinian/Israeli medical referral process. Even writing a
blog post about it, trying to to craft each word to be perceived as politically
neutral, is giving me tremendous anxiety.
Perhaps a year ago, when this project to study and
potentially improve the Palestinian medical referral process started to take on
solid form, I knew how wrought it would be. A feasibility assessment in January
uncovered numerous interpretations of the non-standardized, untracked process
that brought a Palestinian patient to East Jerusalem or Israel. A several
month-long struggle with Western-trained empiricists trying to lend statistical
validity to a study that inevitably could be nothing more than convenience
sampling stalled international IRB processes. Imperative, quantitative data lay
in distant hands, on paper, in spreadsheets, awaiting data-sharing negotiations
before the woeful process of cleansing and justification even began. And
politics colored every word and movement, document, grant application, border
crossing and hospital visit. Nothing about this is easy.
This reality, as an intellectual concept, is easy to
understand. But the cognitive and logistical burdens it creates, the resources
and time required to complete a comprehensive needs assessment and contextual
analysis (of a system in crisis or a patient in crisis) often feels
insurmountable. More than the tangible Likert-survey distribution and database
creation, the logistical regressions and geoanalytics, this experience has been
about tenacity, continuous re-calibration and humility. Whether it be in a
Ministry of Health meeting or in Acute Bay 1 at Massachusetts General Hospital,
these are the attributes that I must take a moment (to breathe) and summon.
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