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Medical Students Get an Education Treating Syrian Refugees

BEIRUT—In a refugee camp in Lebanon’s Bekaa Valley, an optometric chart swings in a makeshift school between photographs of a banana and a turtle.

The school has become a medical clinic for the day. Staffed by residents from the American University of Beirut Medical Center, the young doctors are performing check ups on 70 children this morning. The camp holds 280 boys and girls between the ages of 4 and 14. The children are among the one million Syrian refugees in Lebanon and the clinic offers a chance for them to get medical care and for the residents to get valuable primary-care experience.

Maysaa Khalil, a second-year family-medicine resident at the teaching hospital, examines 8-year-old Sanaa as her team of four doctors, a psychology intern and two nurses buzz around her.

“First, we check if her height and weight are fine,” says Khalil, knowing a third of children in the camps suffer from malnutrition and growth retardation.

A shy but smiling girl with a ponytail and a bright blue star sticker in the middle of her forehead, Sanaa complains of ear pain, coughing and sore throat for the past ten days. They’re common complaints among refugee living in close quarters with poor sanitation. Sanaa also has hair lice, like half the children in the camps.

“We find them in a very bad condition,” says Khalil. “Some have heaters [in their tents], some don’t. Some have enough clothes, some don’t. Some children come with only one layer and you can feel the cold on them.”

Khalil’s examination is one of hundreds that have occurred since January, when the university started its program to provide frontline medical attention in the Syrian refugee camps that have sprung up in recent years as the Syrian conflict raged nearby.

Around 60 volunteers from the medical center are regularly working in the camp in pediatrics, emergency services and internal medicine. Emergency medical technicians and ophthalmologists might soon be added to the mix. Housed in a bus provided by the Lebanese nongovernmental organization Ajialouna, the clinics are on track to seeing around 9,000 children in camp schools run by UNICEF and local non-profit organizations.

The program follows a teaching model. Attending doctors participate in the clinics. Residents call senior doctors to consult on rarer conditions. Perhaps most importantly, however, residents learn how to provide humanitarian care in a region that desperately needs it, said Dr. Mona Osman, a family medicine instructor who co-directs the camp visits.

“The doctors and nurses are being prepared for serving the underprivileged and needy population,” says Osman. “They are happy to be doing something positive. Every time, they come back with a new idea about how to help the refugees and make their life easier.”

The program aims to help the neediest refugees. The United Nations doesn’t operate this camp. It’s simply an informal settlement of Syrians fleeing war. The Syrian refugees in Lebanon, a relatively small country of 4.4 million people, increasingly live in such impromptu camps. Lebanese leaders, fearing the refugees will turn into a long-term burden, have refused to build formal camps for Syrian refugees like those in Turkey or Jordan.

The refugees usually put up their ramshackle tents of plastic sheeting on leased agricultural land. It’s uncomfortable. Water supplies are inadequate. Children go weeks without washing. With little or no work available, the refugees are unable to pay for doctors or medicine. Many rely on services like the mobile clinic. The clinic provides basic drugs such as antibiotics and painkillers and refers patients with more serious conditions to other organizations that help them get treatment.

“We once saw a child who had had heart surgery in Syria that needed serious follow-up that he hadn’t been getting,” says Khalil. “They’re not following up their medical conditions. They’re just living [day-to-day], until they go back to Syria.”

The experience has exposed the medical students to patients with extraordinary needs.

“I see the diseases of the low socio-economic class here,” says Khalil. “This is the first time I saw lice, for instance.”

It’s also the first time she’s seen leishmaniasis, a communicable skin disease common in Syria but rarely seen in Lebanon until the recent influx of refugees. She’s learned how to recognize post-traumatic disorders too.

“You can assume that most of the kids have [psychological] problems,” says Khalil. “It manifests in their health. Sometimes, you have a kid with abdominal pain but there’s nothing wrong. It’s a result of trauma.”

As she spoke, Khalil tended to 10-year-old Ahmed. He arrived in Lebanon a week earlier from Aleppo, where government barrel-bombing campaigns have wrought havoc. Out of school for months, he was working as a cleaner in Aleppo.

Ahmed sits in front of Khalil, clutching his stomach. But she can’t find symptoms that would indicate a medical problem. She gently probes him about his experiences and although he isn’t forthcoming, she knows he likely needs psychological and social support.

“In our specialty, it’s important that we care about families and the poor,” she says. “This is educational but it’s also rewarding to help them. If I didn’t care, I wouldn’t come.”


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