Against the odds

Growing up in the Palestinian territories under Israeli occupation and the perpetual harassment that comes with it isn’t exactly a tranquil environment to live in. Imagine a physician trying to fight endemic cases of depression, and one of the highest rates in the world. That’s what 27-year-old Mohammad Herzallah, a graduate of Al Quds University in the West Bank, currently earning his PhD at Rutgers University in the US, does.

It was in his fifth year of medical school at Al Quds University where Herzallah would think about his work and the future.

“It was a very black tunnel with no light at the end with very limited opportunities for Palestinian medical professionals to pursue careers in prestigious institutions,” says Herzallah. That same year he was recruited to participate in a research project with Rutgers to study Parkinson’s disease which then got him thinking about doing something back home for Palestinians.

In 2009, Herzallah set up a lab at Al Quds University with 22 students, about fifteen specialist psychiatrists and neurologists and five therapists. The Palestinian Neuroscience Initiative has collaborated with centres at Harvard, Rutgers, NYU, the EPFL in Switzerland and SISSA in Italy.

Of the 2,000 people that Herzallah and his colleagues examined, they discovered that about 36 percent suffered from depression. That translates into roughly 1 million Palestinians out the West Bank’s 2.9 million people. That’s much higher than rates in the US (12 percent), the UK (5 percent), China (5 percent) and Australia (4 percent).

“We are getting findings that can revolutionise all fields worldwide,” Herzallah says. “This is a golden opportunity for research, science, diagnostics and treatment from research in Palestine because we can have access to patients before being treated and then follow them up after receiving the treatment.”

Herzallah and his colleagues studied cognition and looked at genetics and how the interaction between these two affects a person’s response to medication.

“What we found is that medications like Prozac solved part of the problem but by solving that particular problem with depression they mess up another brain system that is responsible for flexible generalisations in everyday life and therefore affects memory in a very negative way,” he says.  “On the other hand we found putting patients on these kinds of medications such as Prozac deviates patients from being close to normal in terms of their ability to learn from cognitive versus negative feedback.”

A study his lab is about to submit holds that anti-depressants make patients very much less sensitive to punishment learning in a way that makes them super sensitive to rewards.

“If you compare that to a normal state you will find that you are more sensitive to punishment than you are to reward. So this is a total change in personalities and that’s a big problem,” Herzallah says.

In many ways the work of the Palestinian Neuroscience Initiative is advancing the learning curve with its large pool of subjects, the data collected from them and the insight that provides for research. The progress of the initiative is gaining recognition beyond the Palestinian territories and among the medical community internationally.

Last year the work of Herzallah and his colleagues was recognised by the government funded US National Institute of Health, which awarded them $300,000 to look at depression and its impact on people’s ability to learn.

The National Institute of Health only provides funding if entities can prove their work is going to serve science and the well being of people.

“Our proposal was ranked in the top ten percent of proposals worldwide and it showed that we can study depression better in Palestine than we can in the US because we have a very large number of patients and a very large number of unmedicated patients,” says Herzallah.

That has allowed for the better characterisation of disorders and is a good opportunity to expand research and help patients.

“Our priority is to help patients first, to characterise the problem and understand the causes, and contributing factors,” Herzallah says. “It’s not all about occupation and politics. There are many other problems that we need to understand like other environmental factors, families, society structure, stress, in addition to genetics, cognitive function and chemicals. It’s all about understanding data before proposing solutions.”

Proving that the pathology of depression is not entirely attributable to occupation, Herzallah points to preliminary studies in Jordan where the rate of depression in the neighbouring kingdom ranged between 20 and 25 percent.

“If I want to attribute the pathology of depression to occupation I only get ten percent of the population,” he says. “There are many other problems that are contributing to depression.”

Herzallah’s lab is currently assessing daily life stressors and how that contributes to the illness of depression. It’s trying to develop a model that accounts for the viability in the expression of a disorder according to multiple factors including environmental stressors, in addition to determining why one out of every three Palestinians is getting depressed.

It’s particularly difficult for Palestinian patients to get medication or continue taking it given the associated high costs and impact of Israeli-imposed restrictions on movement and access to resources has slowed down economic growth. Overall unemployment in the West Bank and Gaza Strip reached about 23 percent at the end of last year, with Gaza having one of the highest jobless rates in the world at 32 percent, according to a report issued by the World Bank last month.

The average cost of treatment for a patient can be as high as $250 a month, says Herzallah. The stigma associated with depression complicates matters for patients in a society where families or patients themselves may not want to address or recognise depression.

“People don’t want to speak about it, they don’t want to discuss it,” says Herzallah. “Sometimes they fight any opportunity to learn about it to protect their family honour and pride. The mentality of biomedical professionals, almost everyone I meet and speak to here, they ask why are we doing research, let’s go and help the patients first and then do research. The research we are doing is not rat research; we’re doing human research here and in order to understand how we can help we should understand what we have first. The importance of research is the characterisation of the problem.”

Getting support for the work of the Palestinian Neuroscience Initiative within the Arab world has been and continues to be difficult.

“Doing research doesn’t ring a bell and doesn’t seem to excite people,” Herzallah says. “We really face a problem with this. It’s taking us forever to get support for these projects.”

All the students, researchers, the specialists and Herzallah himself are working as volunteers with the support of private donors in the US, people in Jordan, the National Institute of Health and other foundations. Herzallah needs about $200,000 to $250,000 a year for the projects his lab in the West Bank is undertaking.

“We don’t need people to write us cheques only,” Herzallah says. “This is not a dead-end project, it’s ongoing. We need partners, people who are going to be long-time partners and I can assure them in a couple of years they will see the benefit and outcome of that.”

To address depression and other illnesses in the Palestinian territories, the necessary infrastructure that can carry out research and diagnostics at the same time while also training biomedical professionals, and having the capacity to take care of patients needs to be in place, Herzallah says.

“We Arabs tend to look to immediate rewards in order to get accomplished and be satisfied, but that’s not going to happen if you want to build an infrastructure,” Herzallah says.

“I learned it’s all about patience and a lot of hard work to get to where you want to get. We need to invest in people, not in buildings, not in equipment. People, especially young people, are the future. What we are trying to do in our initiative is to invest in people as students or biomedical professionals and in people as patients.”

The work he and the Palestinian Neuroscience Initiative is certainly more difficult as long as the Israeli occupation continues and Palestinians don’t have a state of their own, however it doesn’t mean the PNI’s work is futile, Herzallah says.

“Take a look at history and President John F Kennedy in the early 1960s when the Russians were going against America in terms of space exploration. Kennedy changed the curriculum and it took nine years to see the results. Look at China. Over the past 40 years they invested in education, sending people abroad and look at where China is now,” Herzallah says.

“Focus on our people and what we can change rather than what we can’t change,” he adds. “I want to put Palestine on the map. I want to make sure when I mention the word Palestine, people remember something positive and not tell me it’s [a]war zone where people get killed. I want to wake up at some point and when I say Palestine, people say ‘oh they have that big brain research centre that has been resolving problems with depression and mental disorders’. I want to see the youth in Palestine going forward with their careers and finding somewhere to work and stop the brain drain.”

(Source / 15.04.2013)

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