Therese Khair, head nurse for the neonatal unit of the Holy Family Hospital in Bethlehem, pored over the patients' charts and staff work schedules laid out in front of her, but her mind was still mulling over the situation in her unit.

With 19 babies under 2 pounds in her 18-bed neonatal intensive care unit and two more on the way, she was facing overcrowding in the unit and was trying to determine which of the babies were ready to be discharged or sent downstairs to the nursery. Still, she said, she would be short two nurses for such a crowded unit.

"Really, it is not an easy job to be a neonatal nurse," said Khair. "It is not just a job, it is a vocation. You need to be empathetic and strong and able to face frightening situations. You need to be able to put emotional distance between yourself and the infant."

Yet it is here in her unit where one can truly see and appreciate the miracle of life, when an infant whose condition has seriously deteriorated suddenly begins to respond to treatment and can be discharged home.

"I am Christian and I believe in God. It is all God's will, everything is in his hands," said Khair, who is Greek Orthodox.

Delicate patients

As the only neonatal intensive care unit in the Bethlehem district, Holy Family Hospital receives referrals for high-risk pregnancies -- including multiple births -- and premature births not only from the Bethlehem area but also from Hebron.

Among the babies Khair had on her mind were the twin boys of Amani Naif Ataya, 25, who were born Nov. 20 at 28 weeks, Adam weighing in at 2.6 pounds and Yassin at 2.4. Adam had begun to have a low heart rate and was showing signs of low oxygen in his blood, Khair said. This is a time when his immunity is low and infections can set in, she said.

Ataya, an occupational therapist from Ramallah, had not planned to give birth at Holy Family Hospital, but when she went into early labor her private doctor promptly arranged for her to come here -- there are no incubators for premature babies at the hospital where she was scheduled to give birth.

It took her more than an hour and a half going through two checkpoints to arrive to the hospital. Every day since, she makes the three-hour round trip journey from Ramallah to Bethlehem to spend a few hours with her tiny sons.

"I have only been able to hold them once," she said as she carefully opened a slot in Yassin's incubator and stroked his thin arm. Adam lay quietly in the incubator next to his brother, and Ataya cleaned her hands with antiseptic gel as she turned to caress him, too.

"There are some signs of improvement," Khair said. "But since he is a preemie, it could go either way. It is too early too tell."

High rate of success

Though there is another neonatal intensive care unit in Hebron, the level of care available there is not on par to that available at Holy Family, a charitable organization run by the Sovereign Order of Malta, which supports the running costs of the hospital, covering 45 percent of the expenses. The rest must be raised by donations through the Order of Malta and the Holy Family Hospital of Bethlehem Foundation, based in Washington, D.C.

Holy Family is the only area hospital that accepts multiple births, and 11 percent of the babies born at the hospital end up at the neonatal intensive care unit. In November, it had three cases of triplets born at the hospital, noted Dr. Jacques Keutgen, director general of the hospital, bringing the total number of triplets born at the hospital this year to eight, in addition to 75 twin births. In 2007 it also had two sets of quadruplets.

The hospital is equipped to accept babies born as early as 24 weeks with positive results, said Dr. Robert Tabash, director of administration, and has a mortality rate equivalent to that of Western hospitals.

Because of poor nutrition and a lack of education in family planning resulting in too many consecutive births, there seems to be an especially high rate of premature births in the Palestinian areas, said Tabash. The hospital is also trying to combat this phenomenon through educational outreach programs that provide mothers with post- and prenatal information.

With 70 percent unemployment in the Bethlehem area, many patients often can't even pay the symbolic amount of $160 the hospital requests, said Tabash. Still, noting the hospitals motto, "The poorest deserve the best," he said all patients are treated with equal respect and no patient is turned away though costs run high. A stay in the neonatal intensive care unit is $400 per day, he said.

Foreign assistance

With funding through the United States Agency for International Development and the Belgium government, the hospital last year increased its maternity ward capacity from 47 to 63 beds and inaugurated a second floor housing a labor ward with seven delivery rooms and an emergency cesarean section operating room, and a larger neonatal intensive care unit. Both units are outfitted with state-of-the-art equipment.

USAID funding will continue for two more years, allowing the hospital to send five doctors to Belgium for specialty training and to give seven nurses scholarships for post-graduate training in neonatal nursing at Bethlehem University.

Through Irish Aid the hospital will also soon begin a direct-entry midwifery program, following the European model, in conjunction with Bethlehem University so that students do not first have to complete undergraduate studies.

The hospital also has an active visiting professors program with Georgetown University, Trinity College in Ireland and the University of Liege in Belgium.

Commitment to care

In the downstairs operating room at Holy Family Hospital in Bethlehem, a team headed by Dr. Saba Abufarha was preparing to do a caesarean section on a mother whose placenta had partially attached itself to some organs other than the uterus. It was a complex operation and there was risk of bleeding, but the hospital staff and medical team alike were calm and confident.

"We have a good team in there," said Dr. Robert Tabash, director of administration of the hospital.

Abufarha is the first of five doctors from the hospital who were sent abroad for advanced studies to return. He has been trained in laparoscopic and hysteriscopic surgery, which allows the surgeon to perform complex surgeries through small incisions in the abdomen rather than having to perform more invasive surgery.

Though he was invited to stay and continue his work in Belgium, Abufarha said he was eager to get back to work with the hospital staff and use the new skills he acquired.

"It is very important to pass on all this knowledge to all the team. This is something we don't have in the West Bank yet," said Abufarha. "If I, as an educated Palestinian, one of the specialists, leave this country, who will stay here? I prefer to come back to my birthplace...where my children were born, and contribute something. I knew I was coming back to a high level hospital."

Judith Sudilovsky writes from Jerusalem. To learn about the Holy Family Hospital of Bethlehem Foundation, visit www.birthplaceofhope.org.