Dr. Vivian Huang, an epidemiologist from New York who had worked previously with MSF in Swaziland, reflects on three months spent in northwestern Syria over the summer:

The civil war in Syria has now killed far more than 100,000 people. Millions of others have been displaced. The health care infrastructure has completely collapsed and the government has targeted health care facilities, making it even more difficult to provide much needed health care to the population.

As one of the few international medical organizations responding in Syria, MSF has provided medical support through field hospitals, trauma centers, burn units, and maternity care. It has also recognized the need for chronic disease management and outpatient care.

From June until September 2013, I worked as a general practitioner in an outpatient clinic MSF opened in a five-classroom school in northwestern Syria. It was situated high overlooking a valley, in a place where the staff often heard bombing and shelling in the distance. This took some getting used to.

We converted the classrooms into two consultation rooms, a mental health counseling room, a nursing station with a pharmacy, and a waiting room. About 85 percent of our patients came from the surrounding area, though the number of displaced people coming to the clinic steadily increased during the time I was there.

There were many challenges. One was providing adequate medications in sufficient amounts. Prior to the war, most patients could get sophisticated medications, tests, and imaging when needed. But now, patients were unable to get chronic disease medications to continue their treatment regimens, and we had a hard time filling the gap. In many cases, we had to start them on new medication regimens, providingreassurance and health education in order to assuage concerns.

Due to unreliable supplies of electricity and clean water, people couldn’t refrigerate and clean food, and as a consequence, we saw many cases of food-related illnesses including typhoid fever, shigellosis, and giardia. We gave these patients oral rehydration salt and antibiotics. Some diabetic patients had trouble refrigerating their insulin, too. We gave them insulin that was stable at room temperature andmonitored their sugar levels in the clinic.

We also saw many young children who hadn’t had any vaccinations since birth because of the war, and those who had, their vaccinations were often not up-to-date. As a result, we were seeing about five cases of measles, which hadn’t been a problem in Syria, each day. MSF responded with a month-long measles vaccination campaign that reached 1,600 children and drastically reduced the caseload in our clinic.

What I found to be most challenging in the clinic was listening to patients talk about how the war has affected them. Many had lost children to either direct fighting or bombings and shellings. Some hadn’t been unable to locate family members for months. Our staff had these stories, too. One nurse lost her father and brother during a bombing in a nearby city. Every time we would hear echoes from bombings and shellings, she would become extremely scared and start crying. Many of our staff weren’t eating properly and lost a considerable amount of weight. Most smoked to cope with the constant stress.

We tried encouraging them to eat and provided lunch for everyone. We made it a point to have a break for at least 30 minutes during lunch each day so staff could rest and come together to support each other. The psychologist who joined us one month after the clinic opened offered counseling to patients and staff alike. There was always a line to see her. People would wait for hours. Our staff was reluctant at first, for fear of being stigmatized, but as time passed, they grew much more willing to speak with her.

One day, to lift people’s spirits, we had a soccer match. Everyone played, drivers, guards, nurses, doctors, registrars, and translators. Afterwards, we all ate and talked and even shared some laughter.

I’ve now been home for a month, slowly readjusting to life in New York. Some days, it is still difficult to believe that I was in Syria. However, it was one of the best experiences in my life. I felt I was really needed and that I was able to use my skills to really help people. My eyes and ears are now more attuned to the Middle East and I continue to follow the situation closely, staying in touch with friends I met there through social media. It isn’t easy to hear about the things happening in Syria, but it’s better to know.

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