On the medical frontline of Libya’s uprising – day one
A fortified granary in the Tatatouine district of Tunisia (Stephanscherhag)
I arrived in Tataouine, a desert town in southern Tunisia, on an oven baked 113 degrees day. Sand filled the air. It was the end of August and still Ramadan – the Muslim month of fasting.
There is something ‘otherworldly’ about this stark landscape. This may explain why George Lucas chose it as the setting of Luke Skywalker’s home planet. But I was not visiting as a Star Wars groupie. I’d come to work with a group of Libyan volunteer doctors who had left their Tripoli homes to care for the war-wounded being evacuated out of Libya into Tunisia.
At only 930 in the morning, beads of sweat were already lining up on my forehead. It was my first day of fasting in this heat. I was concerned that instead of being of help I might find myself becoming a patient too.
As the revolution swept across Libya this past spring and summer, the call went out for medical volunteers. I was in London, an experienced locum doctor working in ER. I watched the news reports and wanted to go. Following the story on-line, I tapped into the Libyan diaspora in the UK and went out for the first time in July.
It was by some bizarre fluke that returning home from that first short trip that I sat next to Nader Elhamessi, a Libyan, a Londoner for many years and one of the founders of the aid organization World for Libya. I expressed a desire to come back to Libya. The opportunity came sooner than I had planned.
In August, I found myself working as a volunteer doctor with World For Libya. Nader proved to be a man of his word and the most efficient logistician I have ever met.
Being totally hands-on Nader drove me to the hospital that first morning where I was thrust into the one of the most challenging medical episodes of my career. On arrival I was led to the small emergency department where there were already three patients.
All of them were young Libyan fighters, their injuries mainly gunshot wounds. They were dressed in fatigues and were not many days off the battlefield. They looked tired, dirty and in pain. All had been transferred from Tripoli, a seven hour drive on difficult roads. It was an excruciating trip for the patient, made nerve wracking for the drivers by the likelihood of Gaddafi fighters shooting at the tires of passing cars.
The ward in Tataouine (Ahsan)
As the fighting intensified and reached Tripoli in August, the increasing flow of war casualties coming out of Libya and into Tunisia created major challenges for Tataouine hospital. The wounded were from both sides of the fight and included civilians.
The Tunisian staff were overwhelmed by the numbers. They had little experience with war injuries. Tensions flared between the overstretched Tunisians and the disoriented Libyan patients. And so it was decided that Tunisian doctors needed the support of Libyan doctors. This made perfect sense. Libyan patients could relate better to Libyan doctors and it seemed only fair that they absorb the additional workload.
However, like most things out here, this was not the result of a planning effort by Libya’s interim government. Instead, somehow, a group of Libyan volunteer doctors came together in response to the crisis situation.
The Libyan doctors quickly organised themselves into an effective team. They sent out the word for help from around the world. There was little in terms of financial support, no doctor’s accommodation or medical supplies. The doctors came all the same.
There has been and continues to be simmering resentment of the way Libya’s interim government has dealt with the war wounded. This was a forseeable problem, doctors argue, given the situation but it was poorly managed. Now that resentment has spilled into the street. In the past few days there have been public protests across Libya about the lack of medical care for the rebel fighters, the people who gave their all to overthrow Colonel Ghadaffi .
To date the exact number of casualties of the Libyan revolution is unclear. The official figures are that 30,000 people have been killed and 50,000 wounded with 20,000 seriously. Trying to get a sense of how many patients are in Tunisia where medical facilities are better equipped than in Libya is difficult. World for Libya’s Nader Elhamessi says 289 people in total were treated in Tataouine in the last three weeks of August but that is probably an underestimate.
As Nader made my introductions on that first day I observed the ward. The room was full of people moving about the beds. A large trolley with swabs, a bucket and various bottles was pulled to the end of the first bed. A Tunisian nurse was gloved and changing a wound dressing on the leg of one of the patients under the instruction of a Libyan doctor, dressed in sky blue scrubs.
The young dishevelled bearded man was called Ayman and looked no more than 25 years old. He had been in the fight for Tripoli the previous week when he got shot by a sniper. He was originally from the Nafusa mountains and had been part of the revolution since it had started. This was his first injury.
What I then witnessed was wound care, Tataouine style. The lower leg was exposed and I saw a large hole in the soft tissue of his shin, with angry, irregular edges. It was deep with the early signs of infection visible. The smell of rotten skin hung in the air. Ayman had been transferred from Libya the day before. He said it had been a few days since his dressings had been changed.
The doctor in blue scrubs quietly instructed the nurse as she proceeded to clean the wound. The young patient asked the nurse to go slowly as she scrubbed the wound area. She didn’t flinch or hesitate: she was right in there. Neat betadine – a brown, syrup-like, strong antiseptic- was poured into the wound.
My toes curled as I imagined the deep pain it would cause. The patient grimaced in agony, arched his back and held his breath. In an attempt to offer comfort I grabbed his hand and told him to squeeze it. He looked shocked at my gesture and for a moment was distracted.
Cultural boundaries permeate into medical care, boundaries I was still adjusting to. Then the moment was over as the deep sting began to subside. I wondered what the patient must have thought, having arrived at a place where the nurse showed no mercy and a female doctor wanted to hold his hand.
In amidst that awfulness it was my first moment of comedy. The doctor in the blue scrubs walked away looking amused. That was the first time of many more such incidents when my western approach to medicine would cause light relief in this forgotten desert place.