Jordan: Stepping into the Lives of Patients with Chronic Diseases

Scott Hamilton/MSF

Mohannad and Samir both wear slip-on shoes. “Shoes that are easy to put on and take off are much better when you visit people’s homes frequently,” says Mohannad.

Talking animatedly, they get into a van along with Moataz, their driver for the day. The three behave like old friends, teasing one another and laughing. “We have to be friends and have fun,” explains Samir. “Sometimes we spend more time with our colleagues than our families.”

Samir, a nurse, and Mohannad, a doctor, work with Doctors Without Borders/Médecins Sans Frontières (MSF)’s home-visit program, which began in August 2015. Each week they visit Syrian refugees and vulnerable Jordanians suffering from non-communicable diseases in Irbid governorate, northern Jordan. These diseases include diabetes, hypertension, asthma, cardiovascular diseases, and chronic obstructive pulmonary disease, which are among the most common causes of death in Jordan and the surrounding region. 

The high number of Syrian refugees seeking shelter in Jordan put considerable pressure on the country’s health system, so the MSF home-visit program is the only source of care for many patients. Before the launch of the program, MSF treated patients at two clinics in Irbid city. “We still do that, but there is also a need for home visits,” explains Samir. “A lot of our patients can’t come into town, either because they are too physically infirm to make the journey, or because they can’t afford it.”

Read: Jordan: Clinics Treating "Silent Killers" Note an Increase in Patient Numbers

Today the MSF team will visit four patients, doing more driving than usual, travelling to new areas to reach those living further away from Irbid city center. The first place they visit is home to a married couple, Aziz and Azam. The front door is opened by the couple’s daughter and three grandchildren. The ease and familiarity with which the patients greet Samir and Mohannad is telling: “I’ve known these patients for a long time,” says Samir. “It’s a bit like having an extended family.”

Samir and Mohannad begin by taking Aziz’s blood pressure and testing his reflexes. He has suffered a stroke, is diabetic and, for the time being, is bedridden. Despite his fragile state, Aziz takes the time to explain his situation:

“We’ve been here for five years. We left Syria because both Azam’s health and mine were deteriorating, and because of the bombings. I used to run a crop farm. I didn’t own it, but it was a good living. I had my own house too. Years ago, my Palestinian grandfather came through Jordan and settled in Syria. I wish he’d stayed in Jordan, I just wish we hadn’t seen this war. Our daughter is still in Syria, and we think of her constantly. It’s not easy for us living here, the cost of rent is high and there are eight of us in one house. We have only one son working, and he has to provide for everything, including electricity and bills. We want to go home, but only when there is no more war, no more killing.”

His wife, Azam, lost her sight 15 years ago. She has glaucoma and needs surgery and eye drops. But even the eye drops, which cost 23 Jordanian dinars ($32), are too expensive for the family.

“Living through the bombings and the war was extremely stressful, blind or not,” says Azam. “But I’m happy to be here. The community here has welcomed us. Our neighbors visit us, and even the landlord gives us a discount on rent.”

Azam also suffers from diabetes and hypertension. While Samir performs a blood test and checks her blood pressure, Mohannad picks up her youngest grandson, who has begun throwing toys. After a few brief moments of restlessness, he sits contentedly with Mohannad and watches birds fly past the window.

The third patient the team is visiting today is Khairiya. She is blind and suffers from hypertension. Making the journey to visit a clinic in town is nearly impossible for her, so she is happy to receive home visits.

Khairiya shares her story: “We’ve been here since 2013. It was impossible to live with the violence and unrest in Syria, but the journey here wasn’t easy either. We even had to walk part of the journey. When we approached the border crossing, a guard saw that I was blind. He took me by the hand and walked me the last part of the way. Despite opportunities to go and live in the USA and Canada, I’m happy that we’re in Jordan, [where] we share the same traditions. Our biggest worry now is money. There are five of us living here, and our son barely earns enough to cover the rent and the food.”

As Mohannad checks Khairiya’s blood pressure, her daughter makes coffee and explains that she too needs to see a doctor. Mohannad tells her that he will refer her to a doctor with the ministry of health. As they speak, her two-year-old son crawls toward his grandmother, fascinated by the device used to check her blood pressure.

The fourth patient of the day is Saltiya. She is bedridden and has recently suffered a stroke. While her husband, daughter, and grandchildren welcome Mohannad and Samir into their home, Saltiya struggles to open her eyes. She suffered a stroke just weeks ago and was referred to the home visits program for hypertension.

There are 12 family members living in this house, but Saltiya is clearly the focus of everyone’s concern. Despite the cost of electricity, there are two fans spinning to keep her cool in the summer heat. Saltiya’s son finds it difficult to provide for the family; back in Syria he was a baker, and his father owned a supermarket. They had an olive grove and used to grow their own vegetables. Towards the end of their time in Syria, they would see missiles flying directly over their home.

While driving back to town, Mohannad and Samir discuss the how the home-visit program differs from MSF’s typical emergency projects respond to the immediate effects of war, epidemics, disaster, or famine. Visiting the homes of these patients presents a stark reality: these are people with real and sustained medical needs, living in highly precarious situations. They may have escaped war, but their futures remain uncertain.