Brothers Bashar and Ibrahim Mahmoud al Haj, Jalqamous, December 2010
Bashar (14) and Ibrahim (11) Mahmoud al Haj are schoolboy brothers from the village of Jalqamous near Jenin.
Bashar is getting good marks at school and, one day, hopes to be a teacher. His brother Ibrahim likes to play football and would like to be a civil engineer when he grows up.
The two boys live with at home with their parents and five sisters, two of whom are already attending university.
Mr Mahmoud is 45 years old and works as a security guard. He makes 1,600 ILS (£270) per month. In 1991, Mahmoud suffered trauma to his left eye and underwent three surgeries at St John Eye Hospital in Jerusalem. Mrs Mahmoud is 43 years old and looks after the family home.
Mr and Mrs Mahmoud are first cousins and Bashar and Ibrahim suffer from two of the more unusual conditions of the eye.
Bashar represents one of many young people in the Palestinian population with keratoconus. This is a degenerative disorder of the eye in which structural changes within the cornea cause it to thin and change to a more conical shape than its normal gradual curve. Keratoconus can cause substantial distortion of vision, with multiple images, streaking and sensitivity to light all often reported by the patient.
*Bashar Mahmoud al Haj
Keratoconus affects around one person in a thousand. It occurs in populations throughout the world, although more frequently in certain ethnic groups. The exact cause is uncertain, but a genetic link seems likely, as the incidence rate is greater if a family member has been diagnosed. The high levels of consanguineous marriage in the oPt, then, might explain why the disease is relatively prevalent in the population presenting at the Hospital.
Ibrahim has suffered from Vernal Catarrh – or Vernal Conjunctivitis – since he was five years old. This, as its name suggests, is an allergic condition recurring in the spring and early summer that usually begins before puberty and lasts for 5-10 years. It is bilateral and is more common in boys than girls. It is often associated with asthma and eczema.
*Ibrahim Mahmoud al Haj
Symptoms include a swelling of conjunctiva (the thin clear lining covering the eye and lining the inside of the eyelids) and the eyes are usually chronically inflamed with a mucous discharge. In a few cases, lesions may spread onto the cornea, which can lead to permanent reduction in visual acuity.
Before coming to the hospital for treatment, Bashar tended to introversion and – because of his condition – he was unable to take part in his favourite game, football. The academic life of both children was also affected, which – as the boys have the potential to attain a university education – was particularly worrisome for the Mahmoud family.
At the beginning of December 2010, Bashar underwent penetrating keratopalasty surgery – a corneal graft – in his right, and weakest, eye. The graft is taking well and no complications have occurred. As is usual at this stage, the vision is weak. The sutures that were used to repair Bashar’s eye after the surgery must remain in place until it is safe for them to be removed. This could take up to 12 months. While going through the healing process, it is likely that he will suffer from astigmatism, which will then be reduced upon suture removal or subsequent use of contact lenses. Though it will take a while for the success of Bashar’s treatment to be fully appreciable, we are optimistic that the vision obtained will be at least as good as his better eye.
Although short courses of medication are unhelpful – Vernal Catarrh requires long-term treatment with eye drops – Ibrahim’s condition is eminently treatable and the prognosis is good.
With long-term care and follow-up required by both boys – not to mention the regular travel that is required to and from the hospital – it was decided to exempt the bothers’ family from paying for their treatment.
- Case Studies
- Case Studies Archive
- Mrs Khadra Marawa, Tamoon near Jenin, May 2012
- Mrs Fawzieh Mohammad Abu Imayyer, Beit Awwa, March 2012
- Miriam, Tulkarem, February 2012
- Mahmoud Dar Edwan, Qalandia Refugee Camp, February 2012
- Mr Majdi Zaki Asmar, Askar Refugee Camp, February 2012
- Mr Munther Al Dahshan, Gaza, February 2012
- Mrs Mufedeh Salah, Kufer Jamal, January 2012
- Ahmad Rabaia, Jenin, January 2012
- Hiba Karayra, Fondokomia, October 2011
- Mariam Awad, Gaza, September 2011
- Amjad Barakat, Jerusalem, September 2011
- Mahmoud and Mustafa Twam, Ramallah, August 2011
- Mr. Moh’d Jaradat, Idna, July 2011
- Ra’fat and Aseel Yaseen, Asseralh Elshamalieh in Nablus, July 2011
- Jinna Jamil, Bedia, near Nablus, July 2011
- Mohammad Awwad, Talfeet, June 2011
- Mrs Ala’ Mansour, Qalqilya, June 2011
- Mohammad El Foudi, Tulkarm Refugee Camp, June 2011
- Suliman Rastieh, Jericho, June 2011
- Shorouq Mohamadin, Masafer Bani Naim Bedouin Camp, May 2011
- Mrs Bahijeh Fahim, Taybeh, April 2011
- Mohammed Alkharbeesh, Gaza, March 2011
- Mohammad Amro, Dura, February 2011
- Rama Waleed Odeh, Ramallah, February 2011
- Mr Adel Abu El Rub, Qalandia Refugee Camp, February 2011
- The Najar Family, Nablus, January 2011
- Ahmed Elnajar, Gaza, January 2011
- Brothers Bashar and Ibrahim Mahmoud al Haj, Jalqamous, December 2010
- Mrs Shamasneh, Ramallah, December 2010
- The Libdeh Family, Jerusalem, December 2010
- The Thawabteh Family, Bethlehem, December 2010
- Hiba Sahwel, Gaza, October 2010
- Fadi Anwar, Gaza, September 2010
- Mrs Mousa, Jericho, September 2010
- Ayyoub Mohammad, Jericho, March 2010
- Mr. Nawaf Khader, Sawahreh Village, March 2010
- Hamzeh Ziad Mohammad Farawani, Askar Refugee Camp, March 2010