It was O’s (Sunshine’s) sincere enthusiasm and unflagging optimism that convinced me to sign up for the Medical Mission to Syria. A mission that had to do with helping the Iraqi and Palestinian refugees but was nebulous in details.
Being a Child Neurologist, I have often had to straddle the two worlds of teacher and practitioner, thus flexibility of roles in this mission was hopefully not going to be a major challenge.
Armed with my training in “Tazkiyah Nafs (purification of the heart)” techniques, I laid aside my ego and protocol of the status of an invited physician, and mentally got ready for all contingencies.
Arrival in Damascus was smooth, being met by both my guide and B and whisked to the Girls Apartment on the eleventh floor in Mezze.
Having no experience in working for a mission I was perplexed as to how to best offer my expertise. Ideally I would have liked to see actual patients, but not having a local physician for a partner, it would leave the patients hanging without a follow-up caregiver.
My gestalt was that human resources for patient care were not as desperate in Syria as in many other places in the world. Thus, the mission became the venue for professional exchange and capacity building.
As I saw it, the local physicians were in the trenches and we had to make sure the supply lines of information and new data for patient care were open and easily accessible. Capacity building was to provide them with the resources in easy supplements such that they could use the information instantly without a lot of search effort, thus keeping their focus on refugee care.
The charge of the Georgetown University organizers was much more complex than ours. They had to coordinate efforts between four organizational entities, each of which were doing important work in the provision of health care for the refugees.
These were, as I understood:
1. The Syrian Ministry of Health, which was responsible over all healthcare operations
2. SARC, or the Syrian-Arab Red Cross.
3. UNCHCR who dealt with primarily Iraqi refugees and some Palestinian refugees.
4. UNWRA, which only dealt with Palestinian refugees since 1947, when the first exodus of refugees occurred from Palestine.
Since the mission crossed borders of all four entities, juggling the resources of each of them without showing preference to any single one was a feat well performed by the mission organizer, R.
My first presentation was to the psychiatrists at the state mental hospital, Ibn-Sina, where wandering refugees who seemed to have lost their mind and had no one to claim them were sent for evaluation.
I was to speak on the childhood aspects of epilepsy in the psychiatric patient. I reworked my entire presentation on the morning of the day to fit the needs of the audience. We set out for Ibn-Sina hospital early in the morning with our two interpreters, the organizer, and the UNCHCR liaison staff.
Like all mental hospitals, Ibn-Sina lies in the outskirts of the city, en route but not exactly adjacent to the prison. Entering the compound, one feels time has come to a standstill as the hundred-year-old trees sway in the gentle breeze.
We were guided to the office of what would be the equivalent of the senior hospital administrator and an Arabian drama unfolded. After a very short time of being seated in the administrator’s spacious office, he arrived. Since I spoke no Arabic, I sat silently while the UNCHCR coordinators and social worker spoke with him, explaining, the program and going over documents of permission etc etc, taking the fast lane, and avoiding the red tape.
Meanwhile, Syrian hospitality kicked in and aromatic Arabic coffee arrived in delicate demitasse china cups. Rich terra cotta in color, swirled with delicate lines of gold, offered gracefully to all present and accepted gracefully, I hope.
In anticipation of my upcoming lecture, I felt I needed to visit the restroom and I was shown to an adjacent immaculate restroom, which allowed me to refresh my wudu while the lines of communication regarding the programs, were being ironed out.
When I returned, there seemed to be a change in the climate of the room. It seemed like all steps of propriety and protocol had been fulfilled and I was requested with great politeness and respect to go to the classroom where the audience was waiting for me, and truly they were.
Walking through the large, fluorescent lighted bare corridors of the hospital, going up a spacious set of stairs, we arrived in a medium sized hall into which opened several rooms, one of which was the classroom. I met the expectant eyes of roughly 55-60 men and women, almost all in long white coats. The women with dark and hazel eyes heavily kohled. All of them looking at me in silence with a tinge of cynicism and subdued curiosity. A young physician was designated my interpreter, and one of my original interpreters was whisked off for official interchange.
I don’t think I’ve met a group of psychiatrists more interested in genuine collegial interchange to improve patient care.
I spoke about the darkness of depression hiding under the cloak of epilepsy; epilepsy in children masquerading as ADD or ADHD, and accounting for seriously lost time in treatment and intellectual development of the child.
There were several professors from the medical school who listened, discussed, and politely asked relevant questions with keen interest.
What was missing from this group was the “MD ego,” which was a pleasant surprise for me. Having lectured to men all over the world, there are always some who wish to demonstrate their knowledge with a stamp of aggressive, irrelevant questioning and answering their own questions before the speaker can respond.
I found the audience engaged, journeying with me and the epileptic child through his tumultuous childhood of being branded “stupid” or as having “ADD” or failing academically despite all the extra tutoring.
They made the journey with me to uncover the subtle signs of depression now clearly accepted as a part of epilepsy and partnered with me on the discussion of optimal treatment venues.
They took it gracefully when I threw out the oldest anti-epileptic from the bag of therapy because of its cognitive side effects …………….and so it went on.
I realized that I must have gone far beyond my allocated time, because I saw some younger interns stealing out of the room to attend to ward duties or partake of the much cherished lunch hour.
THE INVITATION: As I summarized the talk, thanked them, folded the question and answer session, I was surprised by an invitation to make informal rounds of selected portions of the hospital by one of the senior physicians.
I was deeply touched by his invitation. I was reminded of the long and arduous process of getting permission to show patients in the mental hospital/institution in the States as well as in Karachi, Pakistan, due to confidentiality and state laws. I recognized this gesture as a mark of appreciation and a sign of genuine collegial hospitality extended to us.
My morning according to the organizers was extremely successful and had opened the doors of confidence from our hosts to share in the capacity building for the care of refugees, who were being actively absorbed in the general medical care given to the Syrian public……….
I somewhat anticipated what was going to be on the rounds, having made similar rounds in the mental hospital located outside Karachi, Pakistan. My fellow workers and I did not anticipate the depth and intensity of feeling that would touch our hearts as we came face to face with human beings who had become lost in the recesses of their own minds while their bodies still functioned flawlessly……………….
To be continued…………..