Heal The Sick, Heal My Country
By Anonymous
A Benghazi doctor writes on her experience practicing medicine in a country with no hospital funding and no functional government. Can the deep passion for her profession survive? Given current constraints can the sick, wounded, and downtrodden continue to receive the care they need?
Benghazi Medical Center, my hospital, my life', how can it be just a place of work? We spend more days working than resting at home.
Especially after the Libyan revolution '' 17th of February'' ---The revolution which allowed us to dream for better future , more community respect , understanding , rights, education and development…its been four years now and yet nothing has changed…well except the quality of our patients.
The BMC has a 800 bed capacity, the emergency room is supposed to receive patients twice per week (Saturday and Tuesday) but we cannot stop people from coming. The emergency room contains about 45 active beds which are divided in 4 rooms (one male trauma, one female trauma, one male medical, and one female medical). That is really confusing for me as a doctor and I do not like it because if I have a trauma ward which is a mix of male and female patients, I have to run from one room to another… and what if I have medical emergency at the same time???? That is what we call a '' BMC marathon ''.
Let's talk about the security, '' our big dream''. If you ask any emergency physician what you want during your duty hours, he\she will answer “security staff, toilets, more doctors” and some other fantasy like “water, a good communication system, food, a comfortable chair or sofa, air condition…”.
I had graduated in 2008, from Benghazi University '' the first university in Libya '',and started working in the same year. I spent my first five months of work in the coronary care unit at Al- Jomhuria Hospital (the oldest hospital in Benghazi). Because of a hospital rule, I had to cover two days per week in the emergency room. I loved my work there and in only a few months emergency medicine became my passion .
One of my teachers, felt that passion I had and told me that the Libyan Medical Council was planning to have a new branch called Emergency Medicine . I WAS SO EXCITED,
I registered with the council and started practicing it. Without any team, no seniors, no consultants… it was just emergency medicine without any barriers. I was alone in Benghazi, without a team, covering the emergency room only, and I had a dream of having a better future, medical team, and consultants.
The council, however, neglected our specialty. We had no training program, nor continuing education, and no examinations… but I never loss the hope. I used to save my salary, which is 400 USD per month, in hopes to join some courses abroad to improve my understanding of the field.
To push anything new forward you need voices to encourage and advocate to push your new idea or cause forward. I felt I was one of the few voices in Benghazi advocating for emergency medicine. I decided to sail with the wind and wait until I got the chance to fulfill my dream and vision for the “Libyan Emergency Room” so I joined the Al- Jomhuria ICU staff on top of my two days duty.
In 2009 I joined BMC, which was designed to receive referral cases only. They started with medical, surgical, pediatrics, hygiene wards and an intensive care unit…there was no place for the emergency room.
On the 16th of February, one night before the revolution, I was on duty, we had learned that we will receive Gadhafi's mercenaries who had been injured. As everything in Libya during Gadaffi's non-ethical period of ruling we had to select our patients: “If you receive protesters against his regieme… do not touch them and call the police.” we were told.
In Feb. 2012, I had learned that the Benghazi Medical Center, the newest, largest hospital, and most equipped hospital in Benghazi, had the intension to build an emergency room staff. I was very excited and pleased and applied immediately, was accepted, and left my work at Al – Jamoriha.
Benghazi Medical Center
The staff was composed of me, one junior doctor, and the head of unit who was a general surgeon . The work there was very exhausting. Since we were two active doctors, we used to cover two days in the week but we couldn’t prevent people from coming throughout the other days of the week. Here was the problem. The ER boss had no other solution but to call me and my colleague to cover in the other days with no payment.
After one year, the revolution was over and the hospital needed to hire new doctors and they offered a three months course in USA about emergency medicine. We had around twelve doctors who apply, including myself, and after the interviews they chose four only. One month later we left to America and met amazing people.
In America we have learned a lot about the emergency medical service and prepared a detailed proposal to practice what he had learned back in Benghazi. We built a good relationship with a number of leaders in emergency medicine as well on our trip. Leaders like Dr. Bohan and Dr. Burke who were my first true example of how to really practice emergency medicine. They showed me what real leaders of the field really look like. All five of us doctors, or as Dr.Bohan used to call us '' The Fab Five'', were very excited to apply what we have learnt.
One week before the expected date of returning back home to Benghazi, the retired Libyan military general Al- Hafter announced that he will start his useless war against terrorism and dragged the country to endless chaos. My four colleagues, decided to postpone the work on our project until the country settled down again. Once again I was a lone BMC ER professional with only two other general practitioners who were from India.
When Hafter started his war last summer it was one of the worst events in Libya's history. It split the people and spread a spirit of hatred. Many people lost their loved ones and families. One of them was the oldest sons of BMC’s manager was even killed by an explosion. Everything was closed. Schools, banks, markets and quickly Benghazi became a ghost city… but of course we doctors and nurses where very busy working. Fixing what people had damaged.
To be honest, driving the car every day to the hospital was like a huge adventure. Bullets fly right in front of me. Every day when I leave the house to work I hug my parents and my pets, because I am not sure I will meet them in the next day or not! The most terrifying moments on duty is when I receive patients. The first thing I do after getting to the emergency room is to make sure that the patient is not one of my family members. Coming to duty is really stressful in many aspects.
On August 2014, we had four new junior physicians. They did not have any passion for emergency medicine, but I tried my best to make them like it. I can't blame anybody who does not like our department, especially in these circumstances. The future is not clear and there is no active training for the specialty in Libya although the country is facing a transitional phase full of violence and conflicts.
The emergency service MUST get more attention and awareness from the stakeholders. Although the Ministry of Health changed the minster three times since the revolution not one of them has had a contingency plan or disaster plan.
During Hafters war on extremism, the situation became challenging , I am now the senior physician with four younger doctors who have their own families and live in conflict areas. Some of them stopped coming to work because they lost their houses during bombing. The ER manager left us in this critical time and had vacation for two months. The BMC manager left two weeks before October 2014 due to a threatening message she had on Facebook. We became on the brink of losing control of everything since all hospitals in Libya are owned by Ministry of Health and because the Ministry of Health is supplied by the government and because Libya has not agreed upon a government….BMC did not get a 2014 budget. As a result we did not buy the medical equipment we need to operate the hospital.
Signs of poverty started to rise. We have to be extra careful with everything we have since anything that gets broken can't be fixed. Gradually and along the whole year we started to lose even the basic stuff like tongue depressors. I used 5 ml syringes instead of tongue depressors to check peoples throat and sometimes ,if I have money, I buy my own box which contains a hundreds pieces to work with. Soon we had no syringes and now if I want to inject somebody intramuscularly with 5 ml of something I give them two shots, which I think is an abuse. We don’t even have biochemical test tubes, which some patients can offer to buy and others can't. If they can manage to buy them, usually, because of the war, if they are buying anytime after 4 pm it is nearly impossible to find any of the stores selling these products to be open. If he\she has a serious condition and I have no idea about their electrolytes, bilirubin and other biochemical value, I may lose a patient.
We had a shortage gloves. We had only size 8, which is too big for my hands! Doing stich, inserting a CVLine, and other procedures which need fine movement are challenge. Now, even the sterile gloves size 8 went missing so now we use non-sterile gloves! What is next? I am scared that one day we will not find gloves and there will be the question: “Will I treat the patient without gloves or ….. ?” How can we solve that!
I rely on medical history and physical examination for medical cases and, as result, I do unnecessary hospital admission, due to the closure of whole hospitals in Benghazi who were closed because of being dangerously located near the front lines of the fighting. Whole hospitals gathered in one of BMC’s buildings and their staff members ,who are not from Libya, have moved to live in our hospital…therefore we evacuated some patients. As result, our bed capacity shrunk dramatically in half.
What makes everything worse is the location of the Benghazi Medical Center. BMC is located between the two fighting groups. The hospital was, at one point, was totally occupied by Hafter’s militia or ,as they call themselves, the “National Army”. At our entrance they had made a checkpoint, so no one can go in to get medical advice without their permission. Any suspicious person gets arrested immediately. The definition of '' suspicious '' in their dictionary seems to be 1) Anybody against their point of view 2) Anybody with the “other side” and 3) Anybody who posts any comments or status against them on Facebook or social media.
The media, like anywhere else, has played an important role in this war. It increased the hate and division of Libyans into groups and also has been used to make charges against us doctors and nurses.
The reality is we are doctors have to treat everybody. Every single person has the right to receive the best service at the hospital. Many doctors escaped and stopped coming to work for this reason. Others prefer to select their patients and the treat military only or quit working at the hospital to work in the military camps to prove their loyalty to Hafter---A variety of reactions and unexplained behaviors which has left me confused . What was forbidden in the past (to only treat the patients that align with your political views) is very accepted now!
The sad thing is the hospital management can’t do anything about it. At the hospital’s front gate, Hafters militia parks their own cars with anti-air crafts mounted on the top of them. Every time I come in or out of the hospital I think “This could be my end”
The war is going on, and everywhere is targeted, people started to leave the city and go to safer areas ,which was also the case of the some of the staff we lost. Some left the city and others left the country. The number of the patients increased, the resources are missing, the tension is growing on the streets, no electricity, no gas, no money and this winter was the coldest one in my whole life. Life in east Libya has become intolerable.
