It was morning. We were packed in a car, driving through the dusty streets of Amman, Jordan, among a cacophony of yelling vendors, evocative spices and colorful clothing. Eventually we would drive on to the well-paved country roads in the deserts of Jordan. Normally at this hour I would be in Wisconsin, driving to the college to do research or to clinic to see patients using state-of-the-art software in a clean, disinfected hospital. Instead, I was half a world away on my way to the refugee camp of Zataari to treat Syrian refugees.
Our mission was to provide medical aid to Syrian refugees forced to leave their home due to civil conflict. Two of us naively took pictures when we arrived to the camp gate, but quickly learned this upset the intimidating guards who yelled threats about taking the phones away. For two hours, our leader, pediatric neurologist Tarif Bakdash, MD, fought with the Jordanian authorities in the camp. This wasn’t exactly the reception we’d expected, nor was it anything like my typical commute to Froedtert Hospital every morning. The guards claimed to have no record of our arrival, until a piece of paper suddenly (and conveniently) appeared after Dr. Bakdash mentioned that he and the camp director shared Jordanian tribal origin. Everyone hugged, and we started our first day in the camp. The rest of the day lay in as stark a contrast to my typical day in Wisconsin as this rough outset promised.
This journey began for me in late March 2016, when I had the privilege of boarding a plane with a group of dedicated health care colleagues bound for Jordan. The opportunity arose from a chance meeting with my friend from Cleveland, Dr. Bakdash, whose entire heart is devoted to the plight of Syrians. He mentioned he was going on a medical mission to Jordan, and asked if I would consider coming. I knew Dr. Bakdash’s connection to Syrian refugees in Jordan was unique: He was born of a Jordanian mother and a Syrian father. Despite living in the United States, he finds creative ways to help care for children with neurological disorders owing to the devastation of the Syrian civil war. My interest in Dr. Bakdash’s cause was piqued, and my family and I spent several days discussing his proposal. We decided I should go without my family because of the dangers we thought I might encounter.
But I did not go alone. Dr. Bakdash had accrued several other recruits with his stories of the tragic health situations for Syrian refugees in the camp. Stories of children and civilians lacking basic medical care, experiencing deep emotional trauma for which they had no treatment for their physical symptoms and living in desperate conditions proved to us that it was, as the U.S. State Department mandated, “absolutely necessary” we should go. Besides Dr. Bakdash and me, our newly assembled team included two public health nurses, including Froedtert Hospital RN Joanna Balza. A Froedtert Hospital Emergency Department social worker Stacey Volkman also joined us, and an emergency medicine physician Fred Tzystuck, MD. We also partnered with four interpreters from the camp and a couple of journalists from Milwaukee.
On our first day, the local Syrian health care workers welcomed us with visible relief on their faces and cups full of Jordanian (Turkish style) coffee to drink while we chatted about their patients. I had spent some time learning Arabic before coming, but my words were too few to be useful.
The clinic was very simple, consisting of just three or four clinic rooms with a place for physical therapy with a single treadmill, a large outdoor waiting room under a tent and a well-equipped pharmacy with a small selection of free medications for the sick. They asked me to see a new patient every five to ten minutes because of the sheer number of people who needed care, so I began right away.
My first patient had pain in his back and in his right leg. The pain had persisted for 10 years. He explained that he had fought with the rebels for two years in Syria against the government, but eventually had to stop fighting because of his pain. Pain killers helped little. His examination showed his L5 root, connecting his spinal vertebrae to his leg, was damaged. I explained this diagnosis and wrote “L5 radiculopathy” in English in his medical diagnosis booklet. There, I saw a discouraging list of his other diagnoses: PTSD, kidney stones and osteoarthritis were all listed in his book, his rudimentary version of electronic medical records. I prescribed physical therapy and gabapentin after learning he would be able to afford to go to town with medical permission to obtain water therapy. I quickly learned refugees were not allowed to leave the camp for medical care without requesting special permission, and this proved a lofty barrier for many.
I saw many patients afterwards, making rapid assessments of their conditions and developing plans for each one. Common diagnoses were fibromyalgia, depression, PTSD and chronic pain of every type, all of which worsened for them the longer they were in the camp. It took me about a day to understand the relationship of the emotional desolation and trauma they had experienced with their physical ailments.
Women had lost their brothers, their husbands and their fathers. The lucky ones had died immediately of gunshot wounds; the unlucky were tortured to death. My patients spoke of Syrian torture chambers where so many people were put into a single room that they were forced to stand for days with a small hole for air, insufficient to provide for everyone. When someone in the back of the room, furthest from the oxygen, would fall down and die, soldiers would come to open the door and take that person away.
Many of my female patients would internalize the cruelty they saw, sometimes feeling (wrongly) guilty that they should have done something to prevent these events. They had no one to turn to, to speak with or with whom to share their deep sorrow. It was as though the hopelessness and impending death of the tortured spread like a plague to their families, my patients in the camp. They were demoralized and devastated, and this was showing up as physical ailments. Even in the camps, the refugees were not wholly protected from corruption: without our realizing, certain patients were allowed to cut in line to see us based on their knowing interpreters or clinic officials. Even though the camp had reasonable physical amenities, the feeling I had was more akin to being in a concentration camp.
I had neither the time, resources nor skillset (particularly in Arabic) to educate my patients about the connection between their emotional trauma and physical ailments. But with my team, we were able to help some patients with their ailments. Stacey, our social worker, was truly sent from God to help our patients. Once I understood what she did and how she worked, I would send many of them to talk with her. Through miraculous, often non-verbal communication, she would enter their world and encourage them to share their sorrow with friends and family. Some patients came back with a smile to tell us how much of a burden had been removed. Some shared their physical symptoms were also better.
I also referred and received referrals from my roommate, the ED physician. I worked closely to help him diagnose neurological issues in his patients, and he helped me greatly with some medical issues like diabetes, heart failure and kidney failure. A local internist stayed with me throughout the first day. He knew an enormous amount about local health issues and best practices in the camp. I relied on him for translating the true meaning of what patients were saying. He would spend time with me throughout our stay, requesting to learn more neurology, much like residents and students I work with at the Medical College of Wisconsin. We talked about pain, epilepsy, migraines and multiple sclerosis, the primary complaints I saw.
In the evenings, our team ate meals together. One evening, we went around the table, a Muslim, 2 Jews, 2 non-believers, and a few Christians, and prayed wholeheartedly for the refugees and our work with them. This became a habit for us during the trip that none of us felt we could omit from our meals. We became closer as a group each meal, and came to know one another quite deeply. The depth of human suffering we encountered and our commitment to do a tiny little part, here, far from home, instilled depth in each conversation, and hope that as a multidisciplinary team, we could provide relief for people devastated by conflict.