dispatches from here

We see about ten patients in the two hours that the clinic is open each night, mostly with chronic conditions like hypertension and diabetes. Sometimes family members come by for med refills if the patient is unable to make it to the clinic on their own. Last week, an anxious middle-aged man came in to ask some questions about his father. His father had End Stage Renal Disease due to chronic diabetes and was now dialysis dependent, getting dialysis twice a week. About a week ago, the son noticed some redness and swelling around the catheter site, which was apparently an old indwelling central line (high infection risk, which is what was likely going on now). Feeling fatigued, he had missed his last dialysis session and now hadn’t been dialyzed for nearly a week. The son was now even more worried, as his father was tired, nauseous, vomiting, and having hallucinations. These are all classic symptoms of uremia, and the only treatment is urgent dialysis, along with antibiotic treatment for his likely catheter and possible bloodstream infection.

We discussed the urgency of the situation, and the son told us he had called the ambulance a few times but they wouldn’t come. I thought I had misunderstood, so I turned to Dr. Milad for an explanation. “They know Jaramana is where all the Iraqis are, so they usually don’t bother coming,” he explained to me. In addition, they often can’t navigate the narrow streets and alleys with the ambulance, isolating the refugees even more. The son was hesitant to go to the emergency room because of the cost, and explained that he couldn’t carry his father down the stairs alone. Dr. Milad again pressed the urgency of the case. Hesitant, worried, already expecting the worst, the son said he would get help in the morning and go the hospital. With that he thanked us and backed out of the room, slowly closing the accordion style door behind him.

Yesterday we heard that the father had passed away a few days after his son’s visit. I’m not what his underlying medical condition was, or if he ever made it to the hospital, or that even if he had it would of saved his life. But it would have at least given him a chance. Something as simple as ambulances that show up. Can you imagine the fear you would live with knowing that if something happened to you and you called for help, nobody would respond?

Monday was my first day in Damascus, and it was also my first night in the clinic. There were many individuals involved in setting up the clinic, including the Assyrian General Conference and the doctor that runs it, Dr. Milad.

Its set up in one of the poorest districts of Damascus, Jeramaneh. That also happens to be where most of the Iraqi refugees live, and about 80% of the Assyrian refugees. Its really odd to walk down the street and hear people speaking Assyrian, walk into stores to find Assyrian shopkeepers, go to an Assyrian internet café (or café-net as they’re called here).

The clinic is a simple, austere outfit. A small waiting room with nine red plastic chairs and the secretary’s desk. The only wall decorations are a bare fluorescent bulb, a clock with a painfully loud second hand, a cross, and an antiquated fuse box. To right of the waiting room is the sole examination room.

To the left of the waiting room is a plain room with two beds, where I am staying with Dr. Milad. A simple room with no real signs of habitation, except a few pieces of clothing hanging behind the door and a cell phone charger clinging to the wall. He has graciously opened his clinic/home to me.

The clinic exam room, with the bare minimum of supplies to deal with the stream of patients.

The medicine cabinet with an assortment of donated medicine from all over the world. The supply is completely arbitrary and uncertain, and patients only get a week’s worth of meds per visit, even for chronic conditions like diabetes and hypertension. When we have to give patients medicine, I spend a bit of time digging around, trying to find the right meds, struggling to make out the names, sometimes in Arabic, German, French. The problem with trade names is that each country has their own, so I rely on the fine print that usually has the generic name, and usually in English.

The room I’m sharing with Dr. Milad. Simple. Quiet.

The secretary, who volunteers all of her evenings in the clinic, registers patients as they arrive. She also brings us tea and coffee throughout clinic, which is amazing. Dr. Milad I head to her house after clinic a few blocks away and join her family to watch a hugely popular Turkish soap opera, “As the Days Pass” which has been dubbed into Syrian Arabic. I only understand about 20% of the words, but am slowly learning.

There are daily rolling blackouts throughout Damascus lasting two hours. At the clinic, its from noon to 2 pm, which is fine because the clinic is only open from 6-8 pm. However, in addition to the standard rolling blackouts, sporadic blackouts also hit. Tuesday night, we ran clinic with flashlights and candles. A patient brought in her meds, sometimes she takes losartan, and sometimes valsartan depending on availability in the clinic. Valsartan is written in Arabic as “falsartan”, because Arabic doesn’t have a “v” sound. Makes trying to decipher medicine names extra tricky.

Medication headed to a refugee clinic in Syria

Whenever we (UCSF med students) visit a clinic abroad, we try to take supplies and medicine to help out.  A few years ago helped on of my classmates with a student run organization called REMEDY. He founded the UCSF chapter of this group, which collects unused/unwanted medical supplies from hospitals in the US and helps deliver them to clinics in developing countries.  At UCSF, there are bins to collect unused medical equipment otherwise headed for the trash in the main hospital ORs and ICUs.  So I met with one of the med students currently helping with the group and collected a few bags of basic medical supplies, first aid supplies, glucometers + test strips, etc.  But I wanted to take some medicine too, because from what I’ve heard, the clinic I’d like to head to in Syria literally only has a blood pressure cuff and a stethoscope and hugely dedicated volunteer physicians.

So I called my uncle, a family practice physician in San Jose for some help.  I knew he would help a little, but he came through huge!  I showed up at his office to find bags of meds ready for me to take.  Useful meds too, in huge quantities that can probably supply this clinic for months.  I’m not sure the picture above does justice, so for all of the medical people reading along, here’s a short list:

tetacycline 250mg x 300 tabs, 500mg x 200 tabs
penicillin 250mg x 200 tabs, 500mg x 500 tabs
amoxicillin 500mg x 500 tabs
cephalexin 250mg x 200 tabs, cephalexin 500mg x 300 tabs
ciprofloxacin 500mg x 200tabs
septra ds x 300 tabs
erythromycin 250mg x 100 tabs, 500mg x 100 tabs
elanapril 5mg x 200 tabs, 10mg x 200 tabs
hydroxyzine 25mg x 100 tabs
amlodipine 5mg x 90 tabs
atenolol 25mg x 300 tabs, 50mg x 400 tabs
famotidine 50mg x 100 tabs
prednisone 10mg x 500 tabs
paroxetine 10mg x 90 tabs, 20mg x 40 tabs
fluoxetine 10mg x 400 tabs
citalopram 10mg x 500 tabs, 20mg x 300 tabs
erythromycin eye ointment x 2 tubes
triamcinolone 0.1% oint x 9 tubes
ibuprofen 400mg x 500 tabs
naproxen 220mg x 50 tabs
diphenhydramine 25mg x 50 tabs
robitussin x 11 bottles

This is seriously a huge haul…I have no idea how I’m going to get through customs in Jordan or Syria with all of this stuff. I guess this will be the first of many challenges on this trip.

meds and supplies for refugee clinics