Even old su­tures are re­cy­cled by doc­tors un­der siege

The Weekend Australian - - WORLD -

DOUMA: Sur­gi­cal con­sul­ta­tions via Face­book, reused su­tures and gloves, and half-doses of ex­pired drugs: doc­tors in a be­sieged op­po­si­tion en­clave near Syria’s cap­i­tal are im­pro­vis­ing to cope with short­ages.

Blood and skid marks stain the floor of a dimly lit op­er­at­ing room in Douma, a rebel-held town in the East­ern Ghouta re­gion, where a sur­geon was hard at work ex­tract­ing med­i­cal su­tures from a pa­tient.

The UN warned on Thurs­day that about 400 civil­ians were in ur­gent need of evac­u­a­tion from East­ern Ghouta, in­clud­ing 29 who would die unless they were al­lowed to leave im­me­di­ately.

“Af­ter we fin­ish with the thread, we wash it and ster­ilise it again” for use on an­other pa­tient, says 23-year-old nurse Anas Da­her.

With the op­er­a­tion over, Da­her re­moves his sur­gi­cal gloves and, in­stead of dis­pos­ing of them, scrubs them with wa­ter and soap and tosses them into a red bas­ket full of other pairs. They are taken into an ad­ja­cent room, pow­dered and placed into a sealed jar with ster­il­i­sa­tion tablets for 24 hours so they can be used again.

“We doc­tors in East­ern Ghouta are tak­ing steps that are med­i­cally un­de­sir­able,” says Mo­hammed alO­mar, the head of the sur­gi­cal de- part­ment at the Da­m­as­cus Coun­try­side Spe­cialised Hospi­tal.

“We are re-ster­il­is­ing most of our sur­gi­cal equip­ment, from gloves to tubes and even the sur­gi­cal blades and su­tures — even if it’s for a sin­gle stitch, and just one cen­time­tre long.” Omar said he and his team were aware the ma­te­ri­als were meant for a sin­gle pa­tient, but they had no choice.

Since 2013, Syr­ian govern­ment troops have im­posed a dev­as­tat­ing siege on East­ern Ghouta, lead­ing to food and med­i­cal short­ages and sky­rock­et­ing prices for what­ever is avail­able. Res­i­dents of the rebel en­clave have found cre­ative ways to se­cure their ev­ery­day needs, in- clud­ing burn­ing plas­tic to gen­er­ate crude fuel and us­ing so­lar pan­els to power wa­ter pumps.

East­ern Ghouta’s doc­tors, too, have had to make do with what­ever is read­ily at hand. They ra­tion med­i­ca­tion, giv­ing pa­tients half the re­quired dose of drugs or ex­pired med­i­ca­tion, Omar says.

Hos­pi­tals limit op­er­a­tions to emer­gency surgery and the few re­main­ing sur­geons are forced to con­duct pro­ce­dures out­side of their spe­cial­i­ties.

For guid­ance, they have turned to the in­ter­net to carry out re­al­time con­sul­ta­tions with spe­cial­ists.

Hus­sam Ad­nan, a 44-year-old sur­geon, was one of four doc­tors who op­er­ated on an in­fant with an esophageal de­for­ma­tion last month. But none of the gath­ered sur­geons were chil­dren’s spe­cial­ists, so they used Face­book’s video mes­sag­ing ap­pli­ca­tion to get guid­ance from a col­league on the out­side.

“Nor­mally, this kind of op­er­a­tion would be re­ferred to Da­m­as­cus. But be­cause of the siege, we’ve been forced to carry it out here, via in­ter­net com­mu­ni­ca­tion with a chil­dren’s sur­geon out­side Syria,” Ad­nan says.

The pro­ce­dure was nerve-rack­ing, but ul­ti­mately suc­cess­ful. “The child’s heart slowed for a few mo­ments, and we felt our own hearts stop with him. We re­vived him, his pulse started up again and the smiles re­turned to our faces,” Ad­nan says. But within 48 hours, their young pa­tient — frail from a nu­tri­tional de­fi­ciency caused by food short­ages — died from med­i­cal com­pli­ca­tions.

As well as ra­tioning, Douma’s med­i­cal ser­vices have also turned to lo­cally made sup­plies. In a small cel­lar, mem­bers of the al-Shi­faa med­i­cal or­gan­i­sa­tion, their faces cov­ered in sur­gi­cal masks, fill brown glass bot­tles with a white lotion. “We pro­duce serums to clean wounds be­cause it’s rare to find high-qual­ity serums. We also pro­duce anti-lice med­i­ca­tion and other creams for skin ul­cers and sca­bies,” says phar­ma­cist Am­mar Abdo.

The or­gan­i­sa­tion is even us­ing a large elec­tri­cal loom to make its own gauze, but they can only pro­duce about 8kg a day.

“It’s barely enough to cover any­thing but we’re do­ing our best... It’s just an al­ter­na­tive for the sit­u­a­tion we’re in,” Abdo, 30, says.

De­spite be­ing one of four “deesca­la­tion” zones in Syria agreed by regional stake­hold­ers, there has been an uptick in govern­ment bom­bard­ment on East­ern Ghouta in re­cent days.

Hu­man­i­tar­ian groups have warned of a mal­nu­tri­tion cri­sis in the area, with at least two chil­dren re­ported to have died from mal­nour­ish­ment or re­lated com­pli­ca­tions in re­cent weeks. More than 1100 other chil­dren suf­fer­ing acute mal­nu­tri­tion.

Fam­i­lies rely on mix­tures made from rice, wheat and bar­ley as sub­sti­tutes for baby food.

In an un­fur­nished home in Douma, Suzan mixes rice pow­der with a lit­tle wa­ter and brings it to boil over a coal-burn­ing fire.

The blend will be her ninemonth old daugh­ter’s main meal, with pow­dered milk and other baby food un­avail­able. “This rice won’t be enough for a month... Most days, I just give her yo­ghurt.”


A doc­tor di­als up a con­sul­ta­tion dur­ing surgery in Douma

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