THE BLOG
02/29/2016 04:42 pm ET Updated Dec 06, 2017

Dealing With Underserved Populations: Lessons From 13 Visits to Refugee Camps (Part 2/2)

... Life lesson 7:
It was one of the visits that I cannot forget. On that rainy day, I saw a blond girl waiting for her turn to be examined. I asked her to come forward; she only smiled. I asked her again and she smiled again... I knew later from her teacher that she is deaf mute. I also met during this visit a 6-year-old boy who was blind. Communicating with both of them was a bit hard, but they strike me with their intelligence and imagination.
I told the blind boy that I will give him a balloon, and surprisingly he replied, "I want a blue one! I want a blue one like the color of the sky, the big sky!"
I was impressed by his words. I remembered what Helen Keller said, "The most pathetic person in the world is someone who has sight but no vision."

Life lesson 8:
During all my visits to the camps, there were faces that I could not forget! During this visit, I added voices to the unforgettable memories of the mobile clinic! A young girl with a fruity pleasant voice stood next to our bus when we were leaving the camp, and sang a chant describing her grief and sorrow. We were all listening to her attentively. I learned from her voice that each one may have hidden talents that may be revealed if well supported and nurtured. Her song filled the silence of injustice that she was living in, and I realized that among those underserved ignored children, might come persons who add to humanity.

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Life lesson 9:
An adolescent boy was arranging the line of the children in elementary classes whom our team was examining on that day. Hadi was a 14-year-old boy, with well-formed muscles. I was upset when I noticed his long nails with black dirt beneath them. When I asked him about his daily activities, he told me that he was obliged to leave school to work in agriculture in order to earn money for his mother and five little siblings after the death of his father during war. "I wanted to become a doctor, but now it is impossible", he said in a croaky voice, before he asks," Can I use your stethoscope for a minute?" I certainly agreed. He held the stethoscope as if he was holding tight to his lost dream! He touched it carefully, put it on his chest, stared away and whispered "tub tub tub tub tub..." He then laughed, put it on the table, and ran away!
This child is one of thousands children all over the world, who are victims of war. It was shown in a study done on individuals who experienced the death of a parent during war that around 60% of them were more likely to have major depression and anxiety disorders.5

Life lesson 10:
The main issue in that visit was the case of a girl with severe undiagnosed untreated skin disease that was mutilating her face and hands since months. All the team got involved in looking for the cause and ways to manage this condition! After a thorough literature review, we were able to put a differential diagnosis and reach an accurate diagnosis later on. Revealing the mystery of a mutilating disease and finding the suitable treatment is extremely satisfying. It builds self confidence and self-satisfaction and makes us feel as physicians the worth of our role in reducing the suffering of patients.

Life lesson 11:
I thought that I was always ready to perform procedures, until I met "Zahra" whose name means "Flower" in Arabic. Zahra had a painful skin abscess on her leg, and it evidently needed to be drained. I was hesitant to do a minor surgical procedure in a setting lacking the necessary measures. For me, minor surgery needs a comfortable stool, a sterile surgical set and draping, in addition to being in a well-equipped clinic for emergency backup in case of complications!
However, a senior resident in our team suggested doing the procedure immediately to help relieve the patient's pain and avoid worsening of the infection. We asked for the consent of Zahra's mother and here we go: the procedure was done in the bus under the most possible sterile conditions in this setting. We also gave her antibiotics to take at home; and we were very happy to know later that she improved dramatically. Immediate decision making is crucial when facing such situations! It is always important for the physician to weigh the harms and the benefits of any clinical decision for the patient.

Life lesson 12:
The team was welcomed by the drawings and quotes of children decorating the tent. Two among these quotes affected me deeply: "No for violence" and "It is my right to have a doctor who helps me have a healthier life". I stayed all day thinking about these few words. Are we really satisfying their health needs and their rights to have access to healthcare? Are their rights respected?

Life lesson 13:
It was a regular visit until we heard kids shouting outside the tent, "Doctors! Doctors! Help us! A baby is burnt" We all left our examination stands and ran out to see a mother crying and holding a baby whose arm was scalded with boiled water! We tried our best to attend to his burn within our limited capabilities. The mother was very satisfied with the care we offered her baby; especially that she could not afford taking him to a hospital. She kept on saying "Thank you" to all the team members who were there for her child. At that moment, I realized how precious every single baby is for his parents, and that we cannot keep dealing with those displaced individuals as numbers. The extent of their crisis is far beyond the numbers reported!

I learned a lot from these visits, as a physician, as a family medicine resident, as a team member, as a team leader, as a volunteer, as a mother, and most importantly, as a human being.
Children and their smiles cannot be forgotten. "Princess", "Flower", and "Hope" are only few examples of hundreds of children whom the war has affected. They fled the bombs, the chemical weapons, and death to what they considered a safe refuge. By leaving their country, they left also their childhood there in their ruined houses!

References:
1- Morris, Carl G.; Lesko, Sarah E.; Andrilla, Holly A.; Chen, Frederick M. Family Medicine Residency Training in Community Health Centers: A National Survey. Acad. Med. 2010 Oct;85(10):1640-4. doi: 10.1097/ACM.0b013e3181f08e2b.
2- Goldstein, Adam O. Calleson, Diane. Curtis, Peter. Hemphill, Brian. Gamble, George. Steiner, Beat. Moore, Thomas K. Community service by North Carolina family physicians. J Am Board Fam Pract. 18(1):48-56, 2005 Jan-Feb.
3- Juang, Kai Dih. Yang, Chin-Yi. Psychiatric comorbidity of chronic daily headache: focus on traumatic experiences in childhood, post-traumatic stress disorder and suicidality. [Review]. Current Pain & Headache Reports. 18(4):405, 2014 Apr.
4- Xierali, Imam M. Tong, Sebastian T. Petterson, Stephen M. Puffer, James C. Phillips, Robert L Jr. Bazemore, Andrew W. Family physicians are essential for mental health care delivery. JABFM. 26(2):114-5, 2013 Mar-Apr.
5- Morina N. von Lersner U. Prigerson HG. War and bereavement: consequences for mental and physical distress. PLoS One. 2011; 6(7): e22140.

Rim Taleb is a young Lebanese doctor, mother, and wife. She is about to finish her residency in family medicine at the American University of Beirut Medical Center. She is interested in providing primary healthcare for underprivileged population in addition to medical education, and narrative medicine. Rim is convinced that writing reflective pieces on special clinical encounters helps her understand the patient's illness, and improves her effectiveness as a clinician.
You can reach her at rimtaleb@icloud.com