Young Damascus Doctors Are on the Pandemic’s Front Lines in Hospitals and Patients’ Homes

Young Syrian doctors fresh out of medical school and serving their residencies in hospitals have been on the front lines of fighting the coronavirus pandemic, putting their own lives at risk.

Damascus became the epicenter of the coronavirus pandemic over the summer with patients waiting in public hospital corridors and lined up at hospital gates hoping to get treatment.

Officially, Damascus has only recorded 1,552 Covid-19 cases since March, but doctors estimate informally that hundreds of thousands of the city’s inhabitants have been infected.

Halting the usual rotation of hospital residents among medical specialties and some public health and treatment programs the students themselves started probably saved thousands of lives in the Syrian capital during the peak of Covid-19 cases in July and August.

“At the beginning, the biggest fear among doctors was infecting their families at home,” said Raghad Ibrahim, an internal medicine resident at Damascus University. But due to close contact with a huge number of Covid-19 patients, most residents themselves got infected, three resident doctors said in interviews. “We would ask each other; ‘Have you caught the virus yet?’” Ibrahim said. She believes she infected her whole family.

Medical residencies at university hospitals in Syria usually takes between four and five years depending on the medical specialty. Students rotate through different medical services to learn on the job about the various aspects of their occupation, including diagnoses, treatments, surgery and intensive care.

Changes in Shifts

The structure of the young doctors’ shifts was changed to give doctors a few days quarantining at home before resuming work, said Haitham Zamzam, the head of internal medicine residents at Al Mouwasat University Hospital in Damascus, and a resident himself. The monthly rotation of residents was paused to restrict spreading the virus among stations, and non-urgent medical procedures, known as “cold operations,” were also halted to cut risks to patients and dedicate staff time to the emergency room and intensive care patients.

“It was an effective approach,” Zamzam said.

At each station, medical tasks and responsibilities are shared among residents depending how much experience they have. Junior residents take care of patients’ diagnoses and treatment under the supervision of more senior classmates. Professors and heads of stations are responsible for assuring a seamless workflow and to answer students’ questions on more complicated cases.

During the first wave of the coronavirus, those responsibilities fell upon senior graduates who preferred to keep their older professors away from the intensive care unit and emergency room, since Covid-19’s risk of causing death increases with age.

“I think we did the right thing,” Zamzam said. He added that the residency system in general puts responsibility on residents so they can learn to independently handle patients.

Senior doctors and supervisors were consulted by telephone or in person when needed.

“We wouldn’t have been able to cover patients’ needs without resident doctors, pressure was big on them,” said Mohamed Nobough Al Awa, the former dean of the Faculty of Medicine at Damascus University.

Many Doctors Died

Still, at least 70 doctors died of Covid-19 in Damascus, according to the Damascus Doctors Association. “We lost a large number of experienced doctors and compensating for this loss will take a generation,” Al Awa said. A few professors who contracted the virus survived, he said.

Hussein Al-Mohammed, the former head of Assad University Hospital, was among the few who survived a coronavirus infection. But he has been in intensive care for weeks due to coronavirus-related complications, according to the hospital’s Facebook page. A new hospital director was named last week.

The pause of “cold surgeries” for months during the pandemic’s first wave resulted in junior doctors not learning how to do such procedures, Al Awa said. Non-emergency surgeries have since resumed, though. Assad University Hospital announced earlier this month that it had stopped taking patients with Covid-19 to focus on “proper functioning of the education and training process for graduate students.”

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During the pandemic’s peak in Damascus in July and August, hospitals were overwhelmed with the number of coronavirus patients, with their capacity and infrastructure already weakened by nine years of war.

“Those were very difficult days,” Ibrahim said. “Almost all of Damascus got sick at once.”

To take pressure off public hospitals, a group of young residents started an initiative to help patients with less serious coronavirus cases get treatment at home.

‘Sanitize It’

The initiative started in March under the name عقمها, “sanitize it,” to encourage Damascus residents to use hand sanitizer and to disinfect public places to fight the virus.

Khaled Awad, 28, an internal medicine resident, was on leave and getting ready to move to Germany in the spring when his plans were stalled by travel restrictions.

“I felt guilty,” he said. “I thought that I should return to work and help my colleagues but then I decided that I could help outside of the hospital to take pressure off them.” He and 20 other graduate students developed the sanitizing initiative by offering 24/7 coronavirus hotlines and in-home medical treatment.

They offered their services at no charge, with donations supporting their initiative. His team treated more than 1,000 patients at home during the two-month peak in summer, providing them with oxygen cylinders and necessary medication. Their hotline processed more than 700 phone consultations a day at the pandemic’s peak.

“People were dying at home with no one checking on them, but we were brave enough to go in and treat them,” he said.

Ebtesam Zahra, a supervisor in the emergency room and intensive care units at Assad University Hospital, said she noticed how the initiative eased the hospital’s workload. There was no direct coordination between the initiative and the hospitals, Zahra said. “But we trusted their judgement when they sent us the more serious cases since they were also our students.”

“I was very happy with the initiative. I didn’t expect that they would have such courage and motivation,” she added.

But while residents’ efforts were much appreciated by the local community, their salaries for working more than 60 hours a week in government hospitals don’t reflect such appreciation. A resident doctor in Syria earns around 45,000 Syrian pounds a month, less than $30, due to soaring inflation and the drop of the Syrian currency against the dollar.

But the students say they get some rewards. “We cannot say we are working for free or volunteering because we are learning here as well and there is a certificate that we will get at the end of those years,” Zamzam said.

Zamzam said that this dire economic situation applies to all Syrians and not only doctors. “We cannot complain but this economic situation is pushing more doctors to leave,” he said, noting that about a quarter of his classmates have left the country.

With winter approaching, exhausted staff and resources, and rising coronavirus numbers in neighboring countries, Damascus medical residents are bracing for a second wave of infections.

“We are holding our breath,” Ibrahim said. “The first wave exhausted us. We are still recovering from it.”