MISSION TRIP TO SYRIA…..PART TWO, THE ROUNDS

A poster of a refugee child at the UNCHCR

Continuing from Part one…………..

THE ROUNDS IN IBN SINA
THE KITCHEN
The rounds began with the kitchen, which was spare but immaculate. I was a little perplexed with this beginning. Two huge cauldrons of food were shown to us, one was a thick bean soup and the other was a rice dish. I remembered eating the bean dish with O in Damascus, which I recalled was delicious.
PATIENT GARMENTS

As we moved to the next room, we were shown the giant sized clothes washing machine where patient garments were washed in high temperatures. I sensed the pride of accomplishment in my colleague, as he reminded me how rampant the skin infections, lice and scabies were before the installation of this high-temperature clothes washer.

FRESH FOODS: We moved along to a cool storage area where bananas and other fresh fruits were stored for the patients.
WATER AND ITS PURITY
As we walked out, he pointed to two giant water towers, which were converting hard water to soft water, the construction around them indicated they were soon to be attached to the hospital water source.
N S (the mental health nurse and mission worker from California) looked at me and we looked at our colleague, acknowledging with wonder, the true empathy that drove this physician to follow the Hippocratic Oath in ensuring the total well being of the patient and not only his current disease, but also persistent and continued effort to improve the general environment of the patient in the hospital.
CLINICAL ROUNDS
We walked back into the patient compound area of the hospital and rounds began in earnest. Starting from under the 100-year-old eucalyptus tree whose fragrance engulfed us giving us a welcome whiff, before we faced what we were going to be shown. We were going to tread a path for a very short time and get a glimpse of where no one wants to go or see a loved one go either.
THE PATIENTS
The first section was an outdoor section and was a courtyard that opened into the wards for the criminally insane.
We saw men who were currently well controlled on their medications, men who looked at you with everyday eyes, but according to their medical history had killed again and again and again. They would discontinue their medications when released and obey the voices in their head to kill yet again. They came from all walks of life, clergymen, lawyers, and others. One thing was common: they all deeply respected their doctor and asked him with an everyday smile if they could be released.
Through the gate that separated us from their open-air courtyard, they could see the same flowers growing right outside their courtyard and I presume smell their fragrance as ordinary people. However, when the voices took over, God only knows what those same fragrances turned into.
THE ABANDONED
The next ward were the insane who were doing well on their treatment but had no one to claim them or to take care of them upon their release. I called these the children of God, for no one else laid claim to them.
When I questioned the physician, he said, “Sometimes people are found roaming the streets and appear insane. They have no one to explain what happened to them. Sometimes they are refugees disoriented by their losses, of house, home and family, they don’t know how they reached Damascus and nobody knows them. By this time, all their resources are gone; they have neither money nor emotional or psychological support and are thus brought to the physicians at Ibn-Sina for evaluation”

THE MAKING OF A REFUGEE
I paused, with a sobering thought: one bomb from a war waged by a faraway country could, drive people out of their homes, into foreign lands, where no one knew them, they had no kith or kin left alive. Having seen so much murder, torture, and pain they appear to have or have actually have lost their mind.

From the corner of my eye, I could see my companions weeping, silent tears, overcome with the stories we heard of these patients.

AN ACT OF LOVE FI SABILLALLAH
Thus, in the outskirts of Damascus at Ibn-Sina, I met my fellow physicians working to right what had been wronged to our fellow human beings. Working on these lost souls one by one, a painstakingly laborious labor of love, Fi Sabillallah (for the sake of Allah).

Refugee tents (courtesy UNCHCR)

SUMMARY OF MY FIRST DAY AS A MISSION WORKER………
I was steeped in humility, and yet I felt I had made some contribution to the larger cause in an indirect manner. If nothing else I had strengthened the bond of one physician with another crossing all national, cultural and political borders to forge together as helpers with only one goal and that is to seek health and healing for our patients.

Thus capacity building was done with the psychiatrists (private practice, academic, and those in training). The psychiatric aspects of childhood epilepsy associated with other illnesses as well as epilepsy masquerading as another illness were addressed. A demonstration of an epileptic child in class was given, and innovative treatment and management options were discussed.

Being in the first line of care, the physicians of Ibn-Sina carry the burden of defining the illness, mental or other wise, sometimes with a remarkable lack of history that has been left behind in the destroyed homes of the refugees.
They have to cull the patients with organic reasons from those with secondary reasons such as war and mental illness resulting from the trials and tribulations of being a tortured refugee.

As war spreads in the Middle East, the physicians of Ibn-Sina with their limited resources will have a continuing and heavier burden to evaluate, treat, and rehabilitate the mental illnesses of the refugees in addition to the general population.

Cloistered within the walls of Ibn Sina I sometimes wonder how they respond to the factors that go into the making of a refugee driven to insanity…….

Patience is the middle name of these physicians at Ibn Sina, they manage problems one at a time, finding a way where there is none and circumventing frustration at lack of resources and knowing that they can only control what they do and not what the world does with its politics.

Physicians underlining each sentence of the Hippocrates oath and carrying it out with precision. While those men, women and children driven by war to insanity steadily continue to show up on their steps without a coherent past, a shaky present and a nebulous future.

Outside the Ummayad mosque courtyard as night falls

Shaam (Damascus), the city where through out history pilgrims have found rest before pushing on to Mecca, still hosts the tired, the destitute, and those driven insane by war.