Experiences of pain among Palestinian advanced cancer patients: A socio-cultural reading of reports from the Israeli occupied West Bank

Rita Giacaman ^1* Weeam Hammodueh ¹ Suzan Mitwalli ¹ Abdullatif Husseini ¹ Richard Harding ²

• ¹ Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
• ² King's College London, London, England, United Kingdom

This paper explores how pain is conceptualized, defined, expressed and managed among Palestinians with advanced cancer living in the Israeli occupied West Bank of the river Jordan. Utilizing qualitative methodology, the study was conducted in three Palestinian governmental hospitals located in the north, center and south of the West Bank. We used a socio-cultural lens which frees our writing from subjugation, and exposes further the need to continue decolonizing knowledge production. Participant verbatim colloquial Palestinian Arabic quotes were extracted and translated to English focusing on meaning rather than semantics. The quotes were integrated into the text to illustrate the identified themes and subthemes accompanied by selected information about the participant including age, gender, residence, and cancer diagnosis. Arabic colloquial terms written in both Arabic and English were included. Two dimensions of pain were reported: physical pain due to the effects of the cancer and its treatment, and existential pain, which we defined as the sum total of the human experience of having and dealing with cancer physically, psychologically, socially, economically and spiritually. In addition to treatment with cancer medications, participants reported dealing with the frequent unavailability of pain medications and interruption of supplies by resorting to herbal medications and medications of local plant origins to alleviate their pain. Participants also emphasized that social support and solidarity from families, friends, neighbors and their community play an important role in helping them come to terms with their illness and pain, and standing by them during difficult times. This social support/social solidarity, is generally regarded as a wajib واجب)), or obligation and duty people fulfill and cannot be neglected. Dependence on God (Allah) and Tawwakul (the reliance on Allah), which they drew upon for support and endurance, was also emphasized. The notion of Tawwakul and reliance on Allah is of particular importance in assisting patients and their families in coming to terms with their sickness and pain, and in confronting death, as revealed by our participants. However, the incorrect interpretation of Tawwakul as fatalism is rooted in colonial and racial perspectives, and needs to be undone in the process of decolonizing knowledge production.