English translation: Erik Abild, NORWAC
Laparoscopic surgery is well known in Norway, but at the Palestinian Makassed Hospital in East Jerusalem, they are just starting. Professional expertise from Oslo University Hospital, Ullevål, plays an important role in cooperation with the humanitarian organisation NORWAC.
Laparoscopy, the medical name of surgery done laparoscopically, requires expensive and specialised equipment. Earlier at Makassed Hospital, they did not have such equipment, but with the assistance of funds from NORWAC, the hospital now has the necessary equipment. Since 2008, they have received training in procedures and equipment, and they are now using it daily at the gynaecological department. Since January, there has been Norwegian doctors and nurses at Makassed for 8 weeks. They have primarily come from Ullevål hospital, but also one gynaecologist from A-hus hospital. Currently, they are doing follow-up work.
Operational nurse Marianne Jungersen, Head Physician Anton Langebrekke and professor & anaesthesiologist Johan Ræder were in East Jerusalem in the beginning of November, 2009. They participated in surgical teams and as supervisors for their Palestinian colleagues. The aim was to contribute to experience in laparoscopy and hysteroscopy. In this technique, as in other methods, experience from many operations gives confidence.
A Palestinian woman in her forties is getting her uterus removed. The doctors have prepared themselves on possible complications based on the patient’s medical history, but they are expecting the procedure to be completed without complications. Gynaecologist Anton Langbrekke is holding something which resembles a knitting needle or a kitchen utensil, one in each hand. On the other side of the patient, his Palestinian colleague is holding the same equipment. Everything is threaded through thin tubes into the patient’s stomach. However, the two doctors are mainly looking at two monitors in front of them, because at the end of each ‘knitting needle’ there is a smal, advanced camera. The “eyes” for the two doctors. On the monitors, they can see what is in front of the small camera inside the patient. The other ‘knitting needles’ are equipment to cut, stop bleeding or being the doctors ‘extended fingers’ inside the area of surgery.
“Could you give me twenty, just for a while?” Anton Langebrekke is asking the nurse to increase the pressure of gas inside the patient’s stomach. Without this pressure, it is hard for the laparoscope to see what is in front of it. In this instance, there was a need for ‘a better view’. “Now you can decrease it to fifteen again”. The procedure is going according to the plan.
OR-nurse Marianne Jungersen is keeping a close eye, but she is giving her Palestinian colleagues the opportunity to do their job. “And they are doing it well. These are skilled professionals” she says. “They are learning quickly, and have good control with regards to the procedures in laparoscopy. The key is to have done it so many times, in order to always be ahead of the gynaecologist who is operating, to have the understanding to be able to tell what will happen, and what equipment which has to be ready” says Marianne.
At the patients head, anaesthesiologist Johan Ræder is standing with his Palestinian colleague. They are monitoring closely, sending each other short comments regarding their part of the procedure. “Here at Makassed Hospital there is always an anaesthesiologist present, but they are working allot by themselves. At home in Norway we are usually working in a team with anaesthesiology nurses, and usually also with other doctors. An anaesthesiologist can have the responsibility for several basic operations and move between the operations while they are underway” he says.
”It is meaningful to be part of this. It is not a one-way thing. Even though the laparoscopic equipment, training and supervisors are coming from Norway, there is much we are receiving in return. We can see our regular work in Norway with a new perspective. We are reminded that we might not have to do everything so complicated when there are easier way’s to the same goal” says Marianne. It is evident that she is cooperating in a good and positive way with her Palestinian colleagues. “We have many things in common, we are thinking very similarly, no matter where we are coming from.”
The three health professionals from Oslo University Hospital, Ullevål sees few negative aspects regarding laparoscopy, except the prise of the equipment. “There is less operational wounds. The procedure is clearer and more people can see what is being done. With the right anaesthesia and modern pain reduction, the patients can get up from the bed and out of hospital considerably faster than with conventional operational techniques. In this way, the hospital frees up beds faster, and the patient can return to work in less time. There is always full occupancy and available hospital beds are always needed badly. This is a win-win technique” says Marianne.
After several hours of concentration with their eyes on the monitors, controlling their equipment with a confident hands inside the patient, there are some stiff doctor’s-shoulders in need of some movement in the break before the next patient. This is also something which the Palestinian colleagues have to get used to.
It was the war on Gaza earlier this year which sparked a strong commitment amongst Norwegians in support of the war-stricken Palestinian population. This commitment was and is further evident in the health sector since Norwegian health professionals displayed a considerable courage and direct solidarity in using their professional skills in order to save lives in the midst of the horror. Staff from Oslo University Hospital were amongst these. Now the professional solidarity work is continuing after the limelight of the media has decreased.
Photo-text (Makassed-01):
Laparoscopy at Makassed Hospital in East Jerusalem: Gynaecologist Anton Langebrekke and his Palestinian colleague Husni Samarah looking at their monitors during the prodedure. (Photo: Erling Bergan)
Photo-text (Makassed-02):
OR-nurse Marianne Jungersen adjusting the monitor for the doctors. (Photo: Erling Bergan)
Photo-text (Makassed-03):
anaesthesiologist Johan Ræder discussing anaesthesia with his Palestinian colleague Mahmoud Hammouda. (Photo: Erling Bergan)
Photo-text (Makassed-04):
Good cooperation between Norwegian and Palestinain health proffesionals. From left: Anton Langebrekke, Husni Samarah, Marianne Jungersen, Huda Abu Khalaf Mosman, Akhdar Bassam, Johan Ræder. (Photo: Erling Bergan)
