Health and Wellness Center: Sweetening the Lives of Local Community

April 26, 2004
By Susan Bertoni, ANERA

Overlooking the streets of southern Bethlehem from atop a grassy hill called Jabal Murair, or “Mountain of Bitterness,” the Dar al Kalima Health and Wellness Center is dedicated to sweetening the lives of local community members.  

The Health and Wellness Center contains within it medical clinics (general, dental, optical, and hearing); sports and recreational facilities (a gymnasium, swimming pool and workout room), and a multi-purpose room for workshops, trainings, and meetings.  The Center’s aims are to promote healthy lifestyles and address existing health problems.  Neither are easy tasks in the stressful atmosphere of the Palestinian West Bank.     

The Dar al Kalima Health Center is unique both in its holistic approach to health and also in the special services it offers the public.  It contains the only audiology clinic in the West Bank and Gaza that diagnoses hearing disorders along with balance problems associated with the inner ear.

 The Audiology and Balance Division of the clinic is open weekdays from 8 to 4 p.m. and Saturdays until noon.  Michel Rahil, Msc, is the chief audiologist at the clinic.

 About how many patients do you see daily?

 Michel speaks with a steady cadence which reflects his philosophy and practice of careful and thorough treatment.

 “We see about thirteen to fifteen patients per day.  I give at least half an hour per person.  Whoever claims to see more patients in less time is not giving enough time to their patients.” 

 Who comes to your clinic?

“Most patients are from the greater Bethlehem area, though a small number come from Hebron.  As for their medical conditions, most patients we see are children with middle ear infections or hearing loss caused by a number of factors: weak genes from intermarriage and/or hereditary deafness, deafness acquired from hyperthermia, neonatal jaundice, meningitis, and Waardenburg syndrome, a genetic disorder which affects skin, eyes, and hearing functions.

“I get about one or two patients a day suffering from dizziness and referred to me by an ENT doctor.  This dizziness is caused by a viral infection or by a condition called BPPV (benign paroxysmal positional vertigo).  BPPV causes approximately 13% of most dizziness cases; it occurs when calcium carbonate particles are displaced within the ear through head trauma or – in the elderly – a lack of blood flow. 

“The treatment for BPPV is non-invasive and simple, but it requires study and training to do it correctly.  Once he or she lies down on the floor, the patient’s head is tilted in order to realign the calcium carbonate particles within the ear.  If this does not work, our clinic then refers the patient to a neurologist.” 

You yourself are not a doctor.  Do you ever do the work of doctors because of access problems? 

 “Absolutely not.  I don’t interfere with the work of ENTs (ear, nose, and throat doctors).  I know where my work begins and ends and where doctors’ work begins.  I diagnose.  I explain the degree of hearing loss, and refer patients to other doctors for medical care.

“We have a good reputation and strong relationships with doctors.  We follow up with our patients, type reports, and keep records of everyone we see.  Before a family leaves with a report, they get a full explanation of the patient’s condition.”

 What about hearing aids? 

 “Yes - patients also get fitted for hearing aids at this clinic.  One thing that is extremely important – and I can’t emphasize this enough – is that in fitting a child for a hearing aid, you must set it at the correct amplification.  Too high of amplification will damage the ear and can cause hearing loss; amplification that is too low will prevent language acquisition.  Kids will not tell you that their hearing aids are too loud.”

Michel’s expertise is not confined to Mount Murair.  He consults with parents and teachers at the Eppheta School for the Deaf in Bethlehem and gives regular checkups to the students there.  He also travels to Jerusalem every Tuesday to see patients at Augusta Victoria hospital’s hearing clinic.

Michel is keen to point out to parents, teachers, and health workers that even minimal degrees of hearing loss, even those caused by middle ear infections, can impair language acquisition in children.  He advocates sending hearing-impaired children “who can express themselves” to schools, and equipping them with what is called a Microlink FM System – a receiver in the child’s ear connected to a microphone on the teacher.  The system phases out any background noise and lets the child focus in on the teacher’s speech, thus improving understanding and language processing.  Unfortunately, such a system costs 7500 shekels (approximately 1700 US dollars) to install, a fee that few families in Bethlehem can afford.

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This morning, a young patient named Bayan is brought into the clinic in the arms of her father, followed by an anxious-looking young woman in hijab and an older man in his fifties, who is holding Bayan’s small jacket and pink fleece hat.

Bayan, eleven months old, is the first child of Ahmad, 23 and his wife Leila, 18.  Mahmoud, the older man, is Bayan’s paternal grandfather.  They come from the village of Beit Fajar, which lies sixteen kilometers south of Bethlehem.  Bayan was referred to Michel by her general practitioner to detect a possible middle ear infection among her cold symptoms. 

Bayan squirms on her father’s lap, her face flushed and nose running.  Michel crouches next to her so that he is at her eye level and raises his eyebrows in greeting.  Keeping eye contact with her, he asks, “What’s the problem with the little one?”

 Her family answers in waves:  “She’s always crying…isn’t sleeping well...she’s been like this for a few days.”

Michel nods, sterilizes the end of his otoscope, and looks into Bayan’s ear.  Almost immediately the child begins to cry, then scream, clutching her father’s jacket with outrage.  Yet she keeps her head still, somewhat quelled by Michel’s words:  “It’s OK, sweetie, good girl.  It’s almost over.  Shhhh…”

Next, Michel instructs Ahmad to sit in a chair with Bayan in his lap.  Jumana, Michel’s clinical assistant, crouches in front of them and focuses the child’s eyes on a spinning toy top on the table in front of her.  Bayan stares at it as it dances across the table.

Moments later, Michel stands behind the child and shakes a rattle to the left of her head, then to her right.  Bayan turns her head accordingly towards the sounds, thus ruling out further problems in detecting low, medium, and high frequency decibels.

Michel sits back down at his desk and invites the family to sit around.  He folds his hands and leans forward, glancing at all three family members.  “There is no problem with her ears.  She just has a seasonal cold.”

The family members let out a collective sigh and smile in relief.  Ahmad reaches into a thin envelope and pulls out the 35 shekels (approximately $7.80) owed for the visit, and heartily shakes Michel’s hand.  Leila and Mahmoud stand up to help Bayan into her jacket and pull her pink hat over her head and ears before they go out into the cold damp of February.

The next two patients, Ali and Sena’, ages three and four and a half, arrive at the clinic accompanied by their mother and grandmother.  Their home village of Ta’ame, located east of Bethlehem, depends almost solely on herding and agriculture.  The women and children’s wind-burned cheeks and tanned, taut skin betray hours of exposure to the winter elements. 

Michel explains that besides frequent middle ear infections and the accompanying wax buildup, the children face a much more serious problem.  Both children have experienced bilateral hearing loss so that they are now 90% deaf.  This was most likely caused by the family history of hearing loss and exacerbated by intermarriage.  Hearing loss at this level, says Michel, renders hearing aids useless.  It is also clear that the children are unfamiliar with sign language.

The extended family of Ali and Sena’ has promised funds to help them receive cochlear implants, which run $35,000- $40,000 per patient in the United States.  Mother and grandmother smile hopefully, looking up to the sky in short prayer, as Michel explains this possibility. 

During the conversation, the children gnaw on lime lollipops and play a silent game of hide-and-seek, darting and scuffling between the skirts of their mother and grandmother.  For now, they seem blissfully unaware of their condition and its potential remedy.   

  ANERA has helped Dar Al Kalima Health and Wellness Center procure equipment donated by Wheat Ridge Ministries that is essential to the operations of the Audiology Department, including a VNG (Video Nystagmographic) machine (designed to diagnose types of dizziness); an audiometer, a tympanometer (to assess the function of the middle ear), and a hearing aid test box.