Israel gives Palestinians cancer victims TOXIC treatments
11-18-2007, 02:26 AM
Israel gives Palestinians cancer victims TOXIC treatments
Under guise of humanitarianism, Israel gives Palestinians cancer victims TOXIC treatments
By Esti Ahronovitz
Jamal Harma sits in a coffee shop in the village of Hawara, near Nablus. He comes from the Balata refugee camp. His friendly appearance, his smile and courtesy, conceal a broken man. His daughter Farah died of cancer. Now he and his wife are trying to pick up the pieces of their lives. The couple has two other children - a boy, 15, and a 2-year-old girl. During our conversation, he sometimes struggles to maintain his composure. "I don't wish the loss of a child on anyone," he says.
In January 2005, Farah, then 10 years old, was diagnosed with bone cancer. The tumor was discovered in her right knee after a biopsy at Rafidiya Hospital in Nablus. From there she was referred to Al-Watani Hospital in Nablus, and from there to Assuta Hospital in Tel Aviv for radiation treatment. Despite the gravity of his daughter's illness, her father was very hopeful. And even though the doctors in Nablus proposed that she go to Jordan for treatment, he preferred to take her to Assuta, in the framework of an agreement between the Palestinian Authority and the hospital, which stipulates that Assuta will accept, in return for payment, cancer patients who need radiation treatment that cannot be performed in the West Bank or Gaza Strip. Harma says he knew that there were good doctors here.
"When I went to the hospital in Nablus to get the biopsy results, my heart told me that something was wrong," he continues. "When I asked the secretary if the results were in, and she said yes, I could see on her face that it was bad news. The doctor asked me to come into his office and I said to him: 'Doctor, is it what I think?' And he said: 'Yes, it's cancer. Osteosarcoma. One of the toughest kinds of cancer there is.' After I got the news they had to wet my face with water. I called my wife from there. We all cried. The good news was that the cells were still small. Microscopic. At Al-Watani Hospital, we were told that she wouldn't need chemotherapy, only radiation. That the tumor was just starting to grow."
On February 24, 2005, Farah and her grandmother took the daily minibus that transports patients from Nablus to Tel Aviv, and went to Assuta Hospital. Jamal didn't have the necessary permits to leave Nablus, so he stayed at home, worrying. When Farah returned home, there was a large circle drawn on her leg with a black marking pen, from the thigh to the calf - the area the doctor had marked as the target for radiation. The girl and her grandmother said that he had seen them for a few minutes, drawn on Farah's leg with the marker and sent her for radiation treatment.
According to the civil suit filed two months ago in Tel Aviv Magistrate's Court, Prof. Natalio Walach, an oncologist who heads the chemotherapy unit at Assaf Harofeh Hospital and also served as director of radiotherapy at Assuta, sent Farah for radiation treatment without examining any medical information and without conducting any further examination to determine the exact type of the girl's cancer. He looked at Farah's leg, and based on the referral letter from the Palestinian health ministry, decided on the treatment.
The suit charges that Walach did this without following a standard procedure known as treatment planning, which is designed to ensure that maximum benefit is obtained from the dangerous radiation treatments - in other words, that maximum radiation is aimed at the tumor and minimum radiation at the healthy tissue. This process includes a prior conversation with the patient, a simulation of radiation using a simulator that takes X-rays of and scans the area to be treated. In addition, according to an expert opinion (from Prof. Yitzhak Meller, an eminent orthopedic oncologist in the field of pediatric cancer) included with the lawsuit, there should also be a consultation with a pediatric oncologist.
"In fact," explains attorney Michael Sfard, who filed the suit, "from the moment of diagnosis, the doctor should regularly take part in discussions of the case and decisions should be made by an interdisciplinary team of experts that includes an oncologist and a pediatric oncologist. In this case, Walach did not consult with anyone else."
The suit claims that during the brief meeting with the doctor, Farah and her escort were not asked a single question and did not receive any explanation about the method of treatment. There was no physical examination. This week, Walach said: "I don't remember the case that well."
'Why did you come so late?'
"We didn't tell her it was cancer," says Jamal Harma. "We told her there was a tumor, but not cancer. And that it would be okay. That she'd get well. The only thing they said at Assuta was that she had to have 20 radiation treatments. No one explained anything about the process. Fourteen times my daughter traveled to Assuta, for two weeks in a row. She left Nablus every day with her grandmother at seven in the morning, passed through the checkpoints and got to Tel Aviv."
But her father was restless with worry. From time to time, he would call Maskit Bendel, the director of projects in the occupied territories for Physicians for Human Rights. With the organization's help, Bendel arranged for Harma to submit a request to the civil administration in the West Bank for entry permits for him and his daughter. When she received Farah Harma's medical papers, for the sake of issuing the permits, she suspected that something wasn't quite right. From her work in the organization, she knew that many children from the Gaza Strip and West Bank with bone cancer are referred to the orthopedic oncology department at Ichilov Hospital. This is the unit that coordinates all cases of bone cancer in the country. It has an excellent reputation and patients from all over the world come there for treatment.
In one of her conversations with Harma, he asked her whether the biggest experts on bone cancer were in Italy. "I told Jamal that there's a Prof. Yitzhak Meller here who is an expert in the field and that he should consult with him," Bendel recalled this week. "I called Meller that same day and he said: 'That's exactly my field. Send him to me.' And we made an appointment."
On March 16, Harma took his daughter tor another radiation treatment at Assuta, and afterward they went to Ichilov Hospital, where they met with Dr. Yehuda Kollender, the deputy head of the orthopedic oncology department. "When we met Kollender," says Jamal, "he asked me: 'Why did you come to us so late?' I told him: 'She's being treated at Assuta.' He asked me: 'What are you doing there at Assuta?' I said: 'What do you mean? Radiation.' Kollender took off his glasses, looked at me and clutched his head in his hands. He told his secretary not to let anyone else in the room. 'We're in big trouble,' he told me. I didn't understand what was happening. He called Assuta Hospital, while I was sitting there. I don't know whom he spoke to there. 'How could such a thing happen?' he asked them. 'You'll be responsible. This wouldn't happen to a child from Israel.'"
This week, Kollender recalled: "A little girl came to me with an advanced and neglected tumor, and when her father told me that the girl was getting radiation at Assuta, my hair stood on end. Every expert in oncology, actually every specialist in oncology or orthopedics, knows that the standard treatment all over the world for such a case is chemotherapy, followed by limb-preserving surgery, and then another round of chemotherapy. I called Assuta right away and started to shout and search for the oncologist who sent this girl for radiation. When he called me back he said: 'She was referred for radiation, so I sent her for radiation.'" Harma understood that his daughter had received faulty treatment, and that serious damage had been done.
At the request of Physicians for Human Rights, Bendel received Farah Harma's medical file. "We were stunned to discover that the file of a girl who was ill with an aggressive form of cancer consisted of just two pages," says Bendel. "The first page contained Walach's diagnosis, that Farah had osteosarcoma, and the second page documented the amounts of radiation. You've got a girl with such a dangerous tumor and this is her whole medical file?"
For Palestinians only
The papers show that Farah was given radiation with a Cobalt 60 machine. The lawsuit claims that this is a very outdated radiation instrument that has not been used for medical purposes in Israeli hospitals for years. Today there are more modern machines than the Cobalt 60, but these are used in a limited fashion, and only for very specific purposes. "As far as is known," says Sfard, "the standard method of radiation treatment is with a linear accelerator. As a matter of fact, Assuta Hospital is the only medical institution that still administers radiation with a Cobalt 60, and it does not do so to Israelis. The only use made of this machine at Assuta is for the treatments the hospital gives Palestinians as part of the agreement with the PA."
Sfard, the attorney for Yesh Din - Volunteers for Human Rights, says he hears about awful things that happen to Palestinians every day. "But when I heard this story, I could hardly believe it. It's bloodcurdling. After I started looking into it, I was just appalled. It seems that at Assuta there's a separate medical channel for Palestinians, and they are given inferior care. And that's only the tip of the iceberg. Someone's making money from this. And we're talking about cancer-stricken children here."
At Assuta Hospital this week, they did not deny using outdated equipment. "A Cobalt 60 machine was formerly in use at Assuta," the hospital said, "for those limited medical uses that were approved by top-ranking medical specialists in Israel, and in the past both Israelis and Palestinians were treated with it, as was standard in advanced Western countries like France, Italy, Belgium, England, Spain and in leading and recognized medical institutions in America."
Meller and Bendel decided not to ignore the matter. They requested a meeting with Assuta's medical director, Dr. Orna Ophir. The two came out of that meeting in May 2005 shaking their heads in disbelief. According to the lawsuit, at the meeting Ophir admitted that the Cobalt 60 machine did not meet the accepted standard in Israel and that the use made of it at Assuta was solely to meet the needs of the Palestinian Authority. At the meeting, Bendel reproached Ophir, saying that Assuta had found a way to make money from a service it couldn't sell to Israelis. Bendel says Ophir confirmed this and even added, as the lawsuit says, that she saw no ethical problem in selling an out-of-date treatment to Palestinians. "It's not my problem," she told the shocked Bendel and Meller.
Ophir acknowledged that in Harma's case, "a terrible mistake was made," but she backed Walach, saying that "he did what the Palestinian doctor told him to do." The lawsuit also asserts that Ophir remarked: "Farah's parents had given up on her before they came to us. They have fourth-rate doctors, and they want me to give them first-rate treatment."
Bendel was horrified by Ophir's reaction: "Where is the ethical and moral responsibility you expect from a medical institution and the people running it?" Assuta says that Dr. Ophir "does not remember having said the things attributed to her and that anyone who is familiar with her efforts in the matter knows that ascribing such intentions to her does not reflect her efforts at all."
Kids are kids
In the lawsuit, Sfard maintains that Assuta Hospital acted according to a discriminatory standard and followed a much lower medical standard than it does when treating Israelis. "The hospital violated its constitutional duty to preserve human dignity." Sfard adds that "when Assuta was asked to clarify its numerous faults, what was uncovered was an indifferent and racist system motivated by financial considerations, to the point that the hospital's paramount and central role of treating the sick seemed to have been forgotten."
This is a unique lawsuit. "It's a constitutional lawsuit," explains Sfard. "It's a suit about constitutional injustices when an organization or individual infringes on the rights of another person. There's a whole series of human rights here, such as equality and dignity, that were violated." The suit is seeking NIS 2 million in damages. "But it's hard to determine the compensation in a suit like this," says Sfard.
The expert opinion of Prof. Meller is appended to the lawsuit. "It's a very tragic story," Meller said this week. "If something like this were to happen to an Israeli child, who knows how far the case would have gone. In the United States, a lawsuit like this would be for millions of dollars. There are ethical violations here, and violations of the most minimal rules of medical conduct."
Assuta Hospital says that Farah Harma arrived there with a referral for radiation from the Palestinian hospital.
Meller chuckles. "It's as if you were to come to Assuta with a referral letter that said, 'Cut off her head.' Would they cut off your head then? It's not serious. If a little girl came to my department today, no matter where she came from, we wouldn't touch her before going over all the pathology material and doing every possible examination, including a biopsy. Not because I don't trust other doctors. It's a repeat examination for legal defense purposes that is standard all over the world. And they didn't do this; then they compounded the mistake by administering radiation with an outdated machine that they wouldn't dare use on an Israeli patient. The third thing is that kids are kids. You can't treat a little girl with osteosarcoma without the definite involvement of a pediatric oncologist and a multidisciplinary team. Prof. Walach is a retired oncologist who is employed by Assuta. He is not a pediatric oncologist."
What effect does unnecessary radiation have?
"Radiation destroys cells. It causes localized damage and stunts the local growth of a limb. Radiation treatments increase the chances of tumors some years later, which are a consequence of the radiation."
'We didn't give up'
The dramatic day when Harma met with Dr. Yehuda Kollender was the last day that Farah received radiation treatment. Kollender and Meller ordered that the radiation at Assuta be halted and began to treat the girl in their department, in an attempt to save her life. Jamal Harma stopped working and sold his car, which he had used as a taxi, in order to be able to stay in Tel Aviv by his daughter's side. He never budged from her bed. "For two months, we were in the hospital for a week and then two or three days at home. I knew that the situation was bad. Dr. Kollender was always saying, 'With God's help, with God's help.' That was also the time there was a closure and they closed the checkpoints. Sometimes they wouldn't let me out. I'd carry Farah in my arms, or on my back, and trudge all the way through the mountains to get around the checkpoints. Then I'd take a taxi to Taibe, get a taxi from there to Kfar Sava and from there to the Tel Aviv central bus station. We didn't give up.
"When her hair started falling out, because of the chemotherapy, the doctor recommended that we shave it all off. I said to her, 'Daddy's little girl, your hair is going to fall out, it's better that I shave it off for you and afterward you'll grow new hair that's prettier and stronger and you'll be able to go back and play with your friends.' We went into the shower in the hospital and I shaved her head. It was so hard. She cried and I cried."
But the battle was lost. "Farah's condition was very serious and she didn't respond to the treatments," explains Prof. Meller.
"We were at Ichilov for 10 months, and even though the situation was bad, for the first time in my life I felt like an equal among equals," says Harma. "I never felt like I'm a Palestinian, or a Muslim, in a hospital for Jews. The women on the medical team treated Farah like they were her sisters."
Eventually, the doctors said they had done all they could. Farah was very sick. The tumor had spread to her lungs. She had trouble breathing and had to rely on an oxygen tank. "I'm a devout man. As a Muslim, I believe that everything is in God's hands. At that point I understood that her fate was in God's hands, and we came back home."
Take her home, it's better that way
Azam Abu-Qabatya, father of Hayah, is a party to Harma's lawsuit. The two had never met, but fate brought both their daughters to Prof. Walach. Abu-Qabatya, from Yata near Hebron, is very reserved, but when he takes pictures of his daughter out of a little box, his eyes fill with tears. "It's hard," he whispers. In June 2004, Hayah was diagnosed with cancer. Dr. Mahmoud Alian, an oncologist at Al-Husseini Hospital, diagnosed bone cancer and named three possibilities as to the exact type of cancer. He recommended radiation, and Abu-Qabatya was referred to Assuta Hospital, in accordance with the agreement between the hospital and the PA.
"She went to the hospital with my eldest son, Ala, who is 22," says Abu-Qabatya. "They didn't tell them anything, didn't perform any examination, none at all. The doctor drew with a marker around the place where she had been operated on, and that was it. My daughter went to radiation treatments for 28 days. Every day. It's hard to explain what kind of effort was required for us to get to a place like Assuta. Through human rights organizations I got to a lady in Jerusalem who made sure that there was an Israeli volunteer there every day to take my daughter from one of the checkpoints. Sometimes the girl slept over at the home of these volunteers."
Abu-Qabatya talkes out pictures showing his daughter with volunteers she stayed with in Tel Aviv and Jerusalem. "I'm still in touch with these people," he says, his gratitude obvious. Abu-Qabatya thought he was doing everything possible to save his daughter's life.
According to the lawsuit, even though the referral from Al-Husseini Hospital proposed three further tests to diagnose the exact form of cancer, Walach did not perform any further examinations. For reasons that are unclear, he determined that Abu-Qabatya was suffering from osteosarcoma. As in the case of Farah Harma, he looked at her leg and drew with a marker to designate the area meant to receive radiation. The lawsuit says that he subsequently sent her for radiation treatment without doing any medical tests to obtain a more precise diagnosis of the type of cancer and of the girl's medical condition. In this case, too, he failed to go through standard treatment planning or consult with a pediatric oncologist.
According to the lawsuit, Hayah Abu-Qabatya was seen by Prof. Walach for a few minutes and not asked a single question. No physical examination was performed and she also received radiation from the Cobalt 60 machine. "When my daughter finished the treatments, they asked us to come back in two months," says the father. "A week later, my daughter said that her stomach hurt. I took her to Al-Husseini Hospital. She had an X-ray. When the doctor saw the film he went nuts. He said: 'I don't understand, I don't understand! How did the disease spread like this?'"
Further examination found that the cancer had spread into the girl's abdominal cavity and lungs. Hayah began chemotherapy at Al-Husseini Hospital, but her condition rapidly deteriorated, and the treatments were halted. "At the hospital they told me, 'Take her home, it will be better that way," says Abu-Qabatya. "When my daughter began the treatments at Assuta, I started to hear rumors. There was talk that they were using old radiation machines. Machines that were no good. People who'd had radiation there, and relatives of people who'd been treated there and later died, said so. I said it couldn't be. I don't know much about machines, but I just couldn't believe it. And then look what happened." Where does he get the emotional energy now to sue the hospital? "Look," says Abu-Qabatya, "no one is going to bring my daughter back. I decided to sue for the sake of the other sick children. This effort is for them. I can't say for sure that if my daughter had received the correct treatment that she'd still be alive. Because she had a serious cancer. But at least I'd be more at ease, knowing that she received the treatment she deserves as a human being and that I, as a father, did everything. But she didn't get what she deserved. She got the wrong treatment. Who would have believed that they tell you to come for treatment and then treat you with a machine that doesn't work?"
Hayah Abu-Qabatya died at home in the village of Yata, on Thursday, October 13, 2005. She was just 12 years old. In the last days of her life, she slept because of the strong painkillers she was given. "The whole time she was being treated at Assuta, I tried to hide from her that it was cancer, so as not to break her," says her father. "But she quickly understood what was going on. A few days after we came back from the hospital, she asked me, 'Daddy, am I going to die?' and I didn't know what to answer. On the Friday of the Ramadan holiday, I came back from prayers and sat beside her. It was 12 noon. She opened her eyes for a moment, looked at me and then closed them."
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