Saleyha Ahsan is a doctor, a journalist and an award winning filmmaker. She was also a captain in the British Army who served in Bosnia. For the past month, Saleya has been working as a medical volunteer with Libya’s war wounded. She started out in a hospital in neighboring Tunisia. In her second dispatch for Latitude News she profiles the chief doctor in the hospital in Tunisian desert, Dr. Emad Abosrewel.
The doctor in blue scrubs who found my patient hand-holding techniques so amusing was Dr. Emad Abosrewel, a 39 year old emergency medicine doctor from Tripoli. He was the first senior doctor to work in Tatouine.
The other medical volunteers lacked authority and the required experience. Dr Emad was the de facto leader. By the time I arrived, he had already been on a gruelling two week shift, on-call 24 hours a day.
A quiet, unassuming man, he was monosyllabic in his conversation, rather serious faced and closed to all but his patients. A cell phone was almost permanently pressed to his ear. Not only was he treating patients as they came in, he was co-ordinating their transfer out.
At 4 p.m. on my first day, the team took a break on the steps of the hospital. The effects of fasting and working in such heat were taking effect. I had never felt such thirst. There had been 24 patients dealt with so far that day. The steps offered a place of shade and respite, where the doctors came to talk cases or to just sit and stare into space as they contemplated the madness.
I sat next to Dr. Emad and tried to break the ice. He was the only one close to my area of speciality and I was next in seniority to him, although the gap in years between us was wide. Despite my initial efforts he kept a distance.
He would prove to be the hardest doctor to form a bond with. I never fully understood why. It reminded me of the “old-school” style of medicine where your senior doctor is your mentor, your teacher, but never your friend. Through him I have learned the most memorable of lessons in medicine I have ever been taught.
A doctor’s life in Gadaffi’s Libya
Dr. Emad should have been in a senior position in one of Tripoli’s hospitals but he had no political connections. His private but obvious anti-Gadaffi views held him back. Climbing the Libyan medical career ladder prior to the revolution had more to do with being connected to the right people at the top, and less to do with talent or passing exams.
At one point he followed the trail of Libyan doctors going to the UK. But that didn’t work out either.
Dr. Emad speaks fluent English but was not able to pass the complex language test that would have allowed him to work as a doctor. He ran out of money and support. He ended up working in the kitchen of a fast food restaurant in the city of Birmingham. He describes this period as the time that he got lost.
He returned to Libya and to an uncertain career. He worked his way around different departments in different hospitals. He gained a reputation as an able doctor. This led to him being head-hunted to join a team of Libyan doctors working in Haiti days after the earthquake. Then he went to Darfur. He found his vocation in relief medicine. He never imagined having to use such skills for his own people.
Earlier this year the pro-Gadaffi management fired Dr. Emad from his job at the Oil Clinic, the Tripoli hospital that cares for workers in the oil industry. He is grateful he wasn’t put into prison; other doctors were not so fortunate. This is something I’ve heard time and again from Libyans. Whatever crisis that has befallen them be it losing homes, jobs, limbs or even family members, they say Alhumdullillah – “thanks be to to God that it wasn’t worse.” I confess to sometimes standing there thinking, “how much more worse could it get?”
Empathy in the ER
There are rare moments when medicine reaches a pinnacle that all doctors aspire to mount. It’s not something that can be learned or trained. It comes from somewhere else. The closest word to describe it is empathy. It is a time when the relationship between patient and doctor transcends all else and instead they exist together alone almost in a parallel universe, distant from the rest of us, as they journey in search of recovery. At that moment there is no-one else. The doctor stands on the bridge between health and illness, pulling the patient towards his side.
I witnessed such medicine in Tataouine.
The patient arrived at 6 a.m. He had suffered a gunshot wound to the left upper leg which pierced his femoral artery. His face was instantly recognizable. Ehssan Massoud Bissa, the 31 year old leader of a Tripoli-based rebel group, had fought in fifteen significant battles. Through YouTube he had become a celebrity with his distinctive protruding upper tooth. Here, was a patient who had served the revolution to the best of his ability, and now Dr. Emad was working his best to serve him. It was obvious how humbled he was to be able to do this.
Bissa had suffered a huge amount of blood loss which resulted in him suffering a cardiac arrest. He had been revived by medical teams on the ground but then suffered a further arrest on the operating table. He had not regained consciousness and was being kept on a ventilator to help him breathe. Dr. Emad stayed by the patient’s side until all arrangements were made for safe transfer to a specialist hospital in the Tunisian capital, Tunis. I stood watching from the door and saw Dr. Emad wipe the eyes and the mouth of the patient. I saw him keep flies away from Bissa’s face. Such was the care, intense and oblivious to the rest of us.
Watch Saleyha’s film of Dr. Emad and his patient, Ehssan Massoud Bissa
As an emergency medicine doctor from the U.K. I thought I might have something to offer but instead I found myself clumsy, unsure and disorientated. These were different injuries from the ones I was used to seeing. They were harsh, open war wounds telling the story of a struggle for freedom.
One young man had been shot in both feet. Fighters told of snipers – male and female, Chadian and Ukrainian – hired to do the job for lucrative salaries. I was puzzled, though, by the snipers’ tactics. The pattern seemed to be to aim first at the feet, then the legs and then the chest. Were they terrible shots or were they playing with their targets?
How to become a member of the team?
In the days that followed, the intensity of work continued. But I was having trouble being accepted as a fully fledged member of the team. It became part of my morning routine to tell Dr. Emad that I had come to work, not to rest. But day after day I would find that the doctors had been busy in the early hours of the morning and had not called me.
I confronted Dr. Emad and each time he would promise to call and yet each time he let me sleep. It was cultural. It was a form of respect that I did not fully understand. Waking a woman in the middle of the night to come into work was just too much for him to do. Finally, I decided to appreciate their thoughtfulness even though I didn’t understand it fully.
My moments of being accepted came in other ways. Like being left alone at the hospital during the day when the other doctors were resting. Or arranging transfer of a patient with a head injury to a hospital in Tunis. And finally a moment of triumph when I was given the keys of an ambulance to drive it alone from the border all the way to Tripoli, through the night.
One evening I made an impromptu visit my fellow doctors in their accommodation. I instantly felt ashamed of my own comfortable hotel room when I saw the mattresses on the floor that Dr Emad and his colleagues were sleeping on. The “apartment” was actually a clinic room and had no utilities – no stove, and worse in Tatouine’s baking heat, no refrigerator. No money had been forthcoming to cover expenses. Instead the doctors were surviving the best they could. It was Ramadan and they had no facilities to cook their one meal a day. Nor could they afford to eat out every night. I saw water melons and cookies but little else.
Dr Emad was mortified by my unexpected visit. He felt most embarrassed that he could not offer me a drink other than water. The next day I tried to apologize. He asked me if I knew anything about Arab culture. He proceeded to tell me that women are respected, and that the fact he had been unable to offer me a drink the previous night was a source of huge shame.
I reassured him the best I could. I suggested that for this particular woman, the best way to show respect could come in other forms, like integrating me into the team. It was at this moment that we formed an understanding.
A girl and a boy
On two consecutive days they arrived arrived at the hospital. Both had suffered left leg amputations. Both of them had been hit by.57 calibre rounds normally used for anti-aircraft use. The first to arrive was 16-year-old girl, Sarah, whose family were loyal to the revolution. The other was Ibrahim a 12-year-old boy whose amputation had also resulted in the removal of his anal canal. He was fitted with a colostomy bag and by the time he arrived to us in Tataouine the bag was overflowing.
Ibrahim was by himself. His family was pro-Gadaffi and had fled Tripoli as the rebels advanced but equally were fearful of coming to Tatouine with Ibrahim. His mother had made the difficult decision to let her eldest child make the journey alone. Ibrahim formed a bond with Nader Elamessi, the World for Libya medical co-ordinator working closely with Dr. Emad.
Nader called Ibrahim’s mother to let her know that her son was in their care now. Her first question was, “whose side are you on?”
Nader replied without hesitation,”We are on the side of the patient.”
And he meant it.