Editor’s note: Claire Caldwell, MD, is an emergency room physician at Kaiser Permanente Roseville (Calif.) Medical Center. She was invited this summer to serve on a Doctors Without Borders mission to Syria, which is in a state of civil war. Dr. Caldwell has returned safely and wrote this dispatch.
At the end of July, I had the opportunity to go to Syria with Doctors Without Borders (MSF). The experience was, in a word, intense. I was pushed far out of my comfort zone, both medically and personally. Yet I was able to accomplish my mission, which was to help MSF provide the best care possible to trauma victims in Syria.
I must first say this experience would not have been possible without the support of my own department and physicians in chief . I’m an emergency physician and work primarily at Kaiser Permanente Roseville (and also a little at Kaiser Permanente Sacramento Medical Center). My trip to Syria happened very suddenly. The time from the initial phone call to boarding the airplane was a matter of days. It meant abandoning over a dozen shifts, a burden that fell upon my colleagues. I emailed my group explaining the situation and, in only a few hours, volunteers offered to adopt my shifts. The support from the rest of my department was truly overwhelming and, again, I couldn’t have done it without them.
MSF had only established the hospital about one month before I arrived and at that time, the operation was still clandestine. MSF was in Syria without the authorization of the Syrian government. Since my return, they have gone public with their presence; however, the operation is still unauthorized and, for the safety of the team, certain details remain privileged.
The “hospital’ was actually just a house that MSF modified and stocked with medical equipment. The “emergency department” was really a long covered patio. The rooms indoors were transformed into a trauma resuscitation room (trauma bay), operating room, recovery room, sterilization room, patient rooms, and pharmacy. There was an office for MSF staff and logistics. Most of us slept at the hospital on the terrace. I slept on the roof. Our meals were brought to us there, and I really didn’t venture outside.
I arrived to find a very efficient, albeit somewhat tired, team who quickly made me feel welcome. At the time, the MSF medical team consisted of a surgeon, anesthesiologist, and two nurses. A few local Syrian doctors and nurses worked there too. We also had staff for housekeeping, security and translation. An emergency physician was wanted to help with trauma resuscitations and run the emergency department. Since I was the first, I also helped clean, stock, and inventory the ED, the trauma bay, and the pharmacy. At night I was on call. If anyone came to the gate, the guard would come get me. If it was a mass casualty event, I’d awaken the rest of the team, but if it was something simple, I just took care of it.
The first few days, we didn’t see many mass casualties. The fighting was so fierce it was very difficult for people to leave the city and come to us. Roads were blocked and ambulances were being attacked. Some patients did come from the surrounding area for other traumatic injuries (car accidents, bad falls, etc.) and for dressing changes. By the middle of the week, however, the situation changed and we received more patients. We treated a lot of blast injuries (including tank cannon, bombs, and shrapnel), and gunshot wounds. Many were civilians, including women and children. Families would sit down to break the evening fast for Ramadan and bombs would drop on their homes, killing half the family and sending the rest to the hospital.
The situation was dire when I was there, and I fear it has only gotten worse. Local hospitals were trying to serve the population, but supplies were running low. Even at our hospital, we couldn’t be sure when a resupply shipment would arrive. But, morale remained good because we knew that the work we were doing was important.
Little did I know when I left California what was in store. I don’t speak Arabic, I don’t work in a trauma center and it was, in fact, my first mission with MSF. Being in a war zone halfway around the world was a new experience. The MSF team was fantastic and I learned a lot in my short time there. Because I really burned the candle at both ends while I was there — taking care of the ED during the day and being on call at night — the surgeon and the anesthesiology team were able to catch up on their much-needed sleep.
The Syrian people I worked with were generous, nice, and concerned for their countrymen. For example, nurses who had the evening off came to the hospital in the middle of the night for mass casualty events just to help out. I was the only American on the team and bonded well with the Syrian staff. Sometimes the United States has a bad reputation globally, but this small group of Syrians know that Americans care about them, too.
I hope you have found this interesting. Again, this isn’t just the experience of one person. It represents the sacrifice of an entire department. Please keep the Syrian people in your thoughts and prayers.
Claire Caldwell, MD
Kaiser Permanente Roseville Medical Center