Dr. Susan Lovelle left May 30 for a week-long trip to Amman, Jordan. During her time there, she worked with two other providers and performed skin grafts and other procedures for Syrian refugees.
The mission trip was a joint collaboration between the International Society of Aesthetic Plastic Surgery (ISAPS) and the Life Enhancement Association for People (LEAP) Foundation. ISAPS-LEAP Surgical Relief Teams (SRT) is an initiative established to Train, Equip, Connect and Deploy highly skilled plastic and reconstructive surgeons for short-term disaster relief medical missions. As a global platform for surgical care, SRT plans to place teams on the ground within the first week of a mass casualty incident.
Dr. Lovelle wrote about her experiences below.
The trip here was long, but relatively uneventful with the exception of me losing one of my carry-on bags – don’t ask! Luckily, there was a nine-hour layover in Chicago, so I was able to take a cab to a nearby mall and pick up most of the things I lost except for my daughter’s camera. Guess she won’t be lending me her things any more.
The flight from Chicago to Amman was long, almost twelve hours, plus we had an initial delay of about an hour before we took off due to a sick passenger. Luckily, they had individual entertainment consoles, so I watched three full movies and a bunch of TV episodes since I didn’t want to run down the batteries on my phone or iPad. Lots of families and children and I almost felt like I was home – the young boy sitting next to me fell asleep and the next thing I knew, I had feet in my face while he snored on his mom’s lap 😉
Amman has a BIG airport, lots of people, with some in strict Arabic garb and some just as American as you could want – e.g. Nike sweatshirts on the kids from Wisconsin. Wisconsin! I got stopped by a Customs agent who wanted to know what I was doing to do with the large box of medical supplies I had with me, but as soon as I was able to convince him I wasn’t planning to sell them to make a profit, he let me go.
So, first day in the hospital down, four to go.
If there was ever any question that help is needed here, that’s been answered. The doctors here in the program describe the patients they see and the way the OR and floors work as this being a field hospital…in other words, do the best you can with what you’ve got. The facility itself is pretty nice and they have four OR’s two of which have been stocked completely, two of which act as overflow rooms, but don’t have everything needed. Also, there are still some glaring deficiencies…they have a donated microscope but no micro instruments.
We – Ryan, the Director, and Rachel – the PA from New Jersey, and I – had breakfast this morning – scrambled eggs, hummus, pita, and a small veggie plate. Pretty good and filling. Then, a taxi to the hospital. Amman is built on hills, so lots of braking in the taxi. While a little more adventurous than Wichita, their driving was nowhere as “exciting” as what I have experienced in South America.
Everyone is extremely friendly, and welcomed us to Amman and the hospital. First we had a small cup of tea – the first of several “mini-breaks” during the day, and then started on rounds. After so many years of “kiddie lacerations” in the ER, I had forgotten what it was like to experience and manage real trauma. All of the patients we saw had already had at least one or two surgeries, and some have been here for weeks and months. Almost all are peppered with shrapnel wounds, even the little children. It seems it is common for buckets of metallic debris mixed with explosives to be dropped into populations – at the very least causing multiple small, deep injuries, and at the worst – at least for those who survived – eyes, hands, and legs being shattered or blown off.
We then went to the outpatient clinic where we saw several hand cases, most with tendon injuries or status post repairs who were in the process of physical therapy. Patients, though, come up to the doctors wherever they are, though, to ask for opinions…even following them into the lounge. And the doctors take the time to examine them and give advice. Seems there is less concern with malpractice or documentation here.
I settled on two cases for today, both men who had open comminuted fractures (bone shattered to little pieces.) They had both already had external fixators placed to stabilize the bone, but there was infection in one and necrotic (dead) tissue in another. We also planned some of the more complicated cases for the week – one gentleman had lost one leg at the hip, and the other had been amputated at the mid-thigh. He, like a few others, was in such pain when his dressing was changed that it nearly brought me to tears myself. The worst, I think, though, was the little boy who lost a reconstruction flap on his leg to infection and could only whimper and grip the hand of the woman resident physician while we looked at his wound.
More coffee, then off to the OR where I got the first surprise of the week (I’m sure there will be more to follow). The patient on the table waiting for me was a complete stranger to me. I hadn’t seen him, but he needed a debridement (dead tissue to be taken off) of his leg, so he became my first case. Luckily, an orthopedic surgeon scrubbed, too (he had placed the external fixator previously) because it turned out that the patient needed an extensive removal of bone as well, which he did. Got him dressed and went on to the next case, one of the two men I had actually scheduled. We got him done as well and then that was it for surgery for today – don’t ask where the second man went because I don’t know.
Back to the lounge where the doctors had bought lunch for us (it was about 3 PM by then). Shwarma on pita, veggies, and fries. There were several boxes of them, each really full, so we thought we were sharing family style. Turned out everyone had their own box, so we took the rest home for dinner.
Came home, walked to the store to buy some fruit, came to the hotel and crashed until just now. Tomorrow, we start surgery at 8 and I’ll be starting the more complicated cases. I would ask your prayers for me and for the patients so that I can bring some good to them this week.
Today was much busier in the OR. We had six cases scheduled, but one patient ate the same morning (guess patients do that everywhere). We were just about getting ready to leave for the day around 4 when we were asked to see one last patient in the ICU. It was a young boy who had been driven over 100 kilometers that day to the hospital after being hit by an explosion; I can’t imagine what that must have been like, both for him and for his parents. In the end, we had five different surgeons/specialties working on him at once. I did tendon repairs to one hand and a deep laceration to one leg; we left the hospital that night around 9, exhausted, but feeling as if we helped save a life.
I have been reading about some of the recent controversy about women wearing hijabs, the headscarves that Muslim women wear. Here, even in the hospital, almost all of the women I see do wear them, as well as very conservative dress. Even the medical resident who works with us does so as you can see in the attached photo. Even though no one has mentioned it, I wonder if my having (short!) uncovered hair is distracting to the hospital workers and patients. I would imagine it is to some extent, especially since at times when we walk down the street, little children will stare and point at us, something that amuses me.
Our midday meal today included some foods I haven’t experienced in our Wichita restaurants: Two types of patties with meat inside – one was sort of sweet and had nuts, the other more savory, and then the flat breads which had ground lamb. Those you ate by taking one layer, rolling it up, and enjoying! All of which, of course, was following by more hot, sweet tea.
At prescribed times during the day, you will hear the Muslim call to prayer (adhan) by the muezzin, the person who is appointed to do so. This is actually done from a tower outside the mosque through loudspeakers, so everyone can hear (the last picture above was taken at around 10 PM during one of the calls – the muezzin stands at the top). The hospital has several rooms set aside so that those who wish to stop to pray may do so. There are even prayer rugs left in the dressing rooms in the OR. While not everyone in the hospital stops – perhaps not even most – there are provisions made for those who do, even to the point of having replacements for them if they are scrubbed in at the time. There is even a call to prayer in the early morning, about 3:30 AM which woke me up the first two nights. Either I have already adapted to it (I have been known to sleep through fireworks!) or I was way more tired last night…perhaps a little of both.
It is actually 5:30 in the morning as I write this. Although I tried to write last evening, the long day and the late meal did me in. I’ll be getting ready to go to the hospital pretty soon for what is planned to be our biggest day – two latissimus muscle flaps and more debridements and closures. This evening, one of the surgeons is taking us to a special dinner, so I probably won’t be writing again until tomorrow.
So, I did promise to get you updated after the late dinner, but good food, jet lag, and a busy day in the hospital means sleep: in the taxi, in the lounge waiting for cases, basically anytime, anywhere there was downtime. It’s a little embarrassing, I must admit, to wake up to a room full of doctors and nurses laughing at the “doctora” who had drifted off during the tea break.
Tuesday, we continued with surgeries and consults of patients on the floor. Things remained a little haphazard because emergencies occur not infrequently and patients come in at all times and with all sorts of requests. It isn’t uncommon to be walking to see a case with one surgeon and then get pulled off to see another or down to the OR for a case. I’m getting a little better at going with the flow and not worrying about missing something critical since even patient management appears to run more or less by committee. I guess that has developed because so many of the patients have multiple injuries and cross so many disciplines, as did the young boy who had five surgeons working at once. So, unless it is clearly one specialty or another, surgeons will pop in to assist as needed, and I have quit worrying that things won’t get done. The surgical case list remains really fluid, too – people flow off and onto it almost faster than I can keep track. A patient may have been scheduled for a skin graft, but developed an infection or an outpatient may have walked in with an easily correctable issue and is placed on the schedule for the next day.
Tuesday evening’s dinner was with the head administrator of the Syrian Program. He, himself, was a physician in Syria and managed to get to Jordan before he was detained. He told us how another physician friend had been able to warn him from prison and how that friend had not been as lucky as he. Although he is very grateful to be alive, he also mentions that it is difficult living in Jordan since Syrians lost many of their rights once they became refugees; for example, he is not allowed to have a driver’s license and so must take taxis everywhere. I don’t want to make this a political statement, but I will say that there is much to be done here, both nationally and internationally.
We had an amusing example of Middle Eastern hospitality at the end of the meal. Needless to say, just as with our other meals, there was an abundance of food – appetizers, breads, entrees, and dessert. As we were preparing to leave the restaurant, Ryan, our LEAP director, mentioned that there was one Syrian dish he had not had in a while and that he missed it. Our host was almost distraught, stating he wished he had known sooner, and wanted to order the meal immediately, even if Ryan had to take it as carryout.
Today we did General Rounds with the other surgeons in the hospital, and went from bed to bed checking on the patients upon whom the team had operated. Unfortunately, most of the comments were in Arabic, and so after a while, our smaller team decided to break off and see other consults, some of whom were placed on the OR schedule for tomorrow. I did two smaller cases and then we were finished for the day as the sterilizer in the OR was down. We were asked to return for a presentation and dinner that evening by a drug representative, so we went back to the hotel, rested for a bit, and then returned for the talk. It was actually about Meropenem and Imipenen, two antibiotics with which I am very familiar. The third drug was Precedex, an IV sedative that has analgesic qualities as well. Although two of the presenters spoke English well and tried to accommodate our presence by speaking in English, the third presenter did not speak it well enough and spoke only in Arabic, and the fourth did an amazing mix of rapid fire Arabic mixed with English, bouncing back and forth between the two languages – I’m not even sure she was aware she was doing it.
After the talk – which was surprisingly well attended for a meeting that started at 8 PM – we saw the secret of the drug reps’ success: the meal they catered for those attending was essentially a banquet, including one dish called, I believe, al kabsa, a chicken and rice dish as well as another that had lamb and a bulgur mix. Both were delicious, and you may see a bit of the lamb dish in the photo; our American drug rep lunches of sandwiches and cookies pale in comparison (I’m not complaining, though!). Back to the hotel again to get prepared for our last day in the OR – I can’t believe the week has gone so quickly. It was a little sad to see some of the patients and know that I would not be able to get them finished on this trip, but it was good to know that another team of plastic surgeons will be starting Saturday. All in all, a great week and wonderful experience so far.