Tuesday 17 September 2019

‘I am far from home for Christmas again. But I am not alone’ - Dr Eve Bruce

Aid worker Dr Eve Bruce is spending Christmas with war-wounded patients from across the Middle East

Victim: The fighting in Yemen has affected hundreds of thousands of people, causing starvation, malnutrition, as well as horrific injuries that are treated by medics in Jordan. AP Photo/Hani Mohammed
Victim: The fighting in Yemen has affected hundreds of thousands of people, causing starvation, malnutrition, as well as horrific injuries that are treated by medics in Jordan. AP Photo/Hani Mohammed

Dr Eve Bruce

Last Christmas I was in Gaza. This is my 13th mission with MSF, the longest and a very different position. For the first time in my almost 35-year professional life I am not in the operating theatre. I am in Amman, Jordan, as the clinical director of a large tertiary care rehabilitation hospital for war-wounded patients from all over the Middle East.

The mission was begun in 2006 in response to the large number of crippled patients coming out of the Iraq war who needed further treatment and had nowhere to go. At the time, no one imagined that the needs in the region would grow and grow.

Currently, our patients are mostly from Yemen, Syria, and - yes - still from Iraq. We provide staged reconstructive orthopaedic, plastic and maxillofacial surgery as well as intensive physiotherapy, occupational therapy and psychosocial therapy.

Our average length of stay is four months, many staying much longer, and most returning for additional stages in their lengthy rehabilitative quest to return to, if not their pre-war life, at least a more functional life.

As clinical director I am responsible for maintaining quality medical care in this remarkable and unusually high-resource MSF project.

My days are filled, challenging, but in the end rewarding as I manage a continual flow of traumatised patients towards their hope of a better life.

Surgeon: Dr Eve Bruce (left) is helping patients in Jordan this year
Surgeon: Dr Eve Bruce (left) is helping patients in Jordan this year

The emotional toll of the arriving patients' stories about the horrors of war, followed by extended periods of painful surgery and rehabilitation, is balanced by the many success stories. The wheelchair-bound patients leaving independently walking; or the children physically and emotionally scarred leaving with smiles; or the families finding hope far from their destroyed homes.

One of our patients is Fatima, a nine-year-old Iraqi girl who was burned severely on her head and both arms and hands when she was two years old. She was in a burns unit for over a month. She has been coming to our hospital for years for multiple operations involving release of burn scar contractures of both arms and hands and reconstruction of her scalp. We know her for her contagious smiles and her many fun hats which she wears at all times to hide the burn scars and hair loss, as well as the multiple surgical tissue expanders.

Only six months into my mission I have been challenged over and over, and yet I am so grateful and proud of my mostly local national team and our successes - implementing total hip replacement in war-wounded patients, an expanded and effective mental health department including a Syrian peer counsellor, improved nutrition and pain management, enhanced paediatric preoperative sedation, 3D printing of arm and hand prostheses for amputees. I could go on and on.

Yes, once again I am far from home for Christmas. But I am not alone. Every single one of our more than 200 patients are also far from their homes and for this healing opportunity they are filled with gratitude, as am I.

Dr Mike Galvin is an emergency room (ER) doctor from Limerick who will be spending Christmas in Mosul, Iraq, where he is on his first assignment with Médecins Sans Frontières/ Doctors Without Borders (MSF).

My role as a clinician and supervisor involves working closely with and supporting local Iraqi doctors in providing high quality acute medical care for children and adults in the ER of our hospital in the west side of Mosul.

The west side was the worst affected by the battle to retake the city from Isil last year, leading to the destruction of the majority of primary health facilities and public hospitals.

This has left a void in emergency, paediatric, mental health and maternity care that MSF is contributing to fill, as the displaced population continues to return home.

We are focusing on capacity-building among the national staff while Mosul recovers from the conflict, and hope that our facility will continue to serve the surrounding community long after we are gone.

The local doctors are of a high standard, and are very proud of their work, so it makes my job easy. Working with such motivated and competent staff also allows MSF to expand its role, develop its protocols, and try new things.

However, it is tough seeing a city formerly renowned in the Middle East for its quality of medical training reduced to providing care in temporary structures in the disused car parks of bombed-out hospitals.

It never ceases to shock me seeing the level of devastation in the city every day on our drive to the hospital.

However, I am also filled with admiration for the resilience of the people here, who by their strong sense of community and pride in themselves, will rebuild the city that they love and make it a comfortable place to live again.

At home we see our ERs filled with people who have turned to drink and drugs to cope with the setbacks and tragedies they have faced.

But here all the angst is internalised, and every day we see many cases of what is known here as "hysteria", where it seems the mind has shut down and repressed so much that the body starts to follow suit.

There are times we struggle to tell apart the symptoms of physical illness from the manifestations of severe stress. I can only imagine the horrors the people had to deal with during the presence of Isil.

We try to avoid asking things directly, so instead I get a hint of what happened from our doctors and nurses during quiet times between patients late in the night, when they cautiously open up about their experiences.

I really miss my wife while I'm here but I am enjoying the work so much that I'm going to stay in Mosul helping patients for another two months.

I am really looking forward to Christmas. We have a fun group of international staff living in our house here, and we will make the most of our time together away from home.

A team dinner and secret Santa is planned. I'm not sure if we will be able to source a turkey in time but we will try, inshallah!

Dr Eve Bruce, lives in Dingle, Co Kerry. Dr Bruce will be spending this Christmas in Amman, Jordan, where she is hospital director of a reconstructive surgery project run by Médecins Sans Frontières

Irish Independent

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