What We Do   Community Health Care Centers   Specialized Services   Mobile Clinics & Outreach Programs   Lending Centers   Health Education   School Health Program   School of Community Health   Emergency Response Program   Community-Based Rehabilitation   Chronic Diseases Program   Well-Baby & Child Health Program   Women’s Health Program   Community Mobilization Programs   Advocacy & Public Awareness	Chronic Diseases Program The disease pattern in Palestine has a dual nature. Infectious diseases, nutritional problems and childhood diseases common to many developing countries are prevalent in Palestine. However, in addition, mortality rates of "modern life diseases" such as hypertension, diabetes, cardiovascular disease and cancer are growing among the adult population. As Palestine undergoes an epidemiological transition in disease patterns, the task remains to simultaneously address both "diseases of underdevelopment" and "diseases of development," in the face of extreme poverty, political conflict and barriers to providing adequate services. UPMRC's overall goal is to reduce the prevalence of chronic diseases through screening, treatment, data-gathering and developing health education materials in order to enhance the means of prevention which in turn will promote healthy lifestyles. UPMRC has applied its years of experience in preventative primary health care to develop the first national program for chronic diseases in Palestine. The program aims to address the growing problem of non-communicable diseases among Palestinians in the West Bank and Gaza Strip. The program consists of work in UPMRC's primary health care clinics, special Chronic Disease mobile clinics that travel to outlying villages to reach residents, and the new Chronic Disease Center in Ramallah. Main project components include: screening for cardiovascular diseases, hypertension, diabetes and breast cancer; health education on risk factors and prevention; promoting healthy lifestyles, collecting data, providing referrals for follow-up care. In the current situation, the program's mobile clinics have proven vital, as many people are unable to reach medical centers because of closures and curfews. Staff training is another important aspect of the program in order to ensure the best quality care for our patients. UPMRC has years of experience providing training in a variety of health topics to our own staff as well as staff from the Ministry of Health, UNWRA and other NGOs. Our training program in Chronic Diseases focuses on awareness of the different types of Chronic Diseases, prevention methods, and treatment methodologies. Target population: Our target population includes men and women between 35 and 65 years of age for screening as well as treatment. Women age 25 and older are targeted for screenings for breast abnormalities. In 2000, UPMRC screened 1,204 women for breast abnormalities and 210 were referred for further investigation. Finally, the program focuses on targeting the entire population through health education to raise awareness about chronic disease risk factors and positive life-style choices. Data Collection: As the first national program for chronic diseases, it is essential that we collect data about disease prevalence in Palestine. One of our initial steps was to prepare a special computer program, designed by the Management Information System department at UPMRC to organize, store and performs statistical analyze of patient data including age, gender, family history, recent and past medical history and results of blood tests. Qualitative data such as the remarks and comments of the medical providers are also entered into the program database. Initial analysis of data: In 2001, UPMRC screened 2,482 people through the mobile clinic alone for obesity, hypertension, diabetes and dyslipidemia. The preliminary results show the following: Over weight (Body Mass Index > 25) 77% Obesity (Body Mass Index > 30) 47% Hypertension 31% Diabetes 18% Dyslipidemia 49% These preliminary findings support our initial hypothesis regarding the widespread prevalence of Chronic Diseases in Palestine, and our work has become important in shaping health policies on the national level. Health Education: Education is one of the most important aspects of the Chronic Disease program. The program has developed and distributed posters and other materials promoting behavioral changes which will lower the risk of chronic disease. One particular poster developed in 2001 promoted physical activity, a healthy diet and gave information on the hazards of smoking. The program has also developed booklets and brochures addressing such topics as high blood pressure, the hazards of smoking, diabetes and eye health, breast examinations and nutrition. In 2001, the program held 103 lectures focusing on the risk factors for chronic disease, healthier lifestyles and diet. 3,188 people in different institutions and villages attended these lectures. Program staff also conducted a meeting with representatives from 25 organizations with varied mandates (youth clubs, media and agricultural organizations for example) in which program staff spoke about chronic disease risk factors. In order to reach as many people as possible, the program also produces radio and television spots with health education messages. For example, in 2001, there were 5 programs on Palestine Radio and a spot on Palestine TV focusing on the prevention of chronic disease, as well as two hour-long information sessions on different programs, including a lecture on Jerusalem TV's Teletext Magazine program. Helping Children Receive Care Abroad UPMRC's Chronic Disease Program has been active in assisting patients, particularly children, receive care abroad when the treatment they need is not available in Palestine. UPMRC has worked with volunteer physicians and other NGOs such as Terre Des Hommes (Italy) to help patients receive the care they need. The following are the stories of two of the children UPMRC has helped: Yara is from Jenin, which has been under severe and extensive curfew and closure. She suffers from Patent Ductus Arteriosus, a congenital heart disease. Due to the closure, she was unable to come to Ramallah for consultation, so her medical reports were faxed to Dr. Luisi, an Italian doctor volunteering with UPMRC at the time. Dr. Luisi coordinated with a hospital in Italy and UPMRC worked to arrange her visa, travel plans and assisted in getting her out of Jenin. Her surgery in Italy was a success, and she has since returned home healthy and safe. Fourteen-month-old Razan was born with a congenital heart disease known as Interventricular Septum Defect (IVSD). She received the surgery she needed in Italy, and will return for follow-up surgery soon. According to Maha, a staff member at UPMRC's chronic disease center, who arranges travel for children in need of care "It may be said through experience that it is much easier to travel from one country to another than it is from a village inside Palestine to a nearby city, in such extreme limitations imposed by the Israelis in travel. One checkpoint to the other; documents, passports, pictures are bounced around from one colleague to another to finally reach the destination of the Consulate." It takes the UPMRC chronic disease center's staff weeks and months to obtain the necessary information. After that, at least another two weeks are needed to process the visa applications. Finally the physical movement of the child patients and their accompanying relatives may begin. Maha says of the situation: "Let us not forget the tender age of these children and the severity of their illness, which is usually heart disease. No special care or mercy is given; sick or not the children undergo the strict checkpoints, waiting for hours at a time, taking bypass roads, etc."