By far the most interesting experience has been the crossing between Israel and Gaza.  Along with pushing the boundaries in Al-Shifa Hospital, Gaza.

After leaving the West Bank we had to cross back into Israel to get to Gaza.  As we came down out of the mountains onto the coastal plains it was basically like we stepped into suburban North American.  The contrast between Israel and Gaza is stark, from the greenery of Israel with running paths, bicycles, modern buildings, beautiful roads, palm trees, and orange groves to the refugee camps, bombed out buildings, dirt, and people idle everywhere with unemployment at 40% in Gaza.

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The border crossing between Israel and Gaza

The border crossing between Israel and Gaza can be seen in the picture above. This is the wall between Israel and Gaza. There are no roads in or out, only one check point in all of Gaza that you walk through. The walk is about 500 meters in this caged tunnel and it is guarded by the Israelis. No Palestine is allowed out unless they obtain a permit, and only a handful of people receive these. There are about 1.8million people in 1/10th the size of Rhode Island.

The hospital we are working at is called Al-Shifa Hospital, it is a government hospital.  They have a very good vascular department here.  We along with 7 or so vascular surgeons went through a few of the difficult cases.  There ended up being two patients with ischemic feet, with digit amputations and necrosis. Neither of these patients had adequate blood flow to the feet.  In order to salvage the limb and save this patients foot we would need to do distal bypass from the knee to the artery on the top of the foot.

The benefit of doing this operation in the frontier hospital in Gaza is three-fold.  First it helps patients get medical care that they wouldn’t have gotten otherwise, in this case the patients would have ~0% of saving the foot without surgery.   Second we will be able to teach the attending doctors how to do it.  And third, they have never used certain techniques here, intraoperative angiography (the same one we wanted to do in the previous post).  During this case today was the first time that this hospital and I belive all of Gaza used angiography during the surgery!  We map out the arteries and found an open blood vessel in the foot to attach the distal end of the venous graph.

The operation today went well, but the struggle is real.  Mark says “you just can’t understand how hard it is to operative under these (less than ideal) conditions.”  It was a hard day.  So Mark is exhausted now, but he did very well.  The patient is doing well and has a good pulse in his foot!  I think next time we will bring some of our own instruments.

Tomorrow we do it again!

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The fields of Israel

 

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The remains of a building that was bombed out in 2014
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Mark doing the final anastomosis with the help of Dr. Eimon

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