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Helping out in Libya.

Dr. Kwan Kew Lai is one of those people who has to add extra pages to her passport. Her global health resume includes a 2009 trip to treat AIDS patients in South Africa and travel to Haiti in 2010 to help those who were affected by a devastating cholera outbreak.

But in 2011 she took on a challenge that gave even this veteran of the skies pause. Dr. Lai traveled to Libya to work in several different clinics during the revolution in the fall of 2011. She made the trip with the help of Medical Teams International, a nonprofit medical relief organization, in collaboration with the International Medical Corps (IMC).

What inspired you to go to Libya at such a dangerous time?

In July I first heard about the possibility of going to Libya to offer medical relief from IMC, but I was still volunteering in Nakivale Refugee Camp in Uganda. My heart skipped a beat. I knew that I wanted to go. I had been following the Libyan revolution closely and felt passionate about the people's desire to be free from a dictator. Going to Libya offered me the opportunity to help the people of Libya. The other part of me liked to face the challenge of working in a war zone, something that I have wanted to experience. I did go with trepidation; the fear of stray bullets and getting hurt was real, and I am not going to downplay that.

Who were your patients?

Mostly I was seeing people in clinics that we set up in places where the internally displaced people stayed. Many of these people presented with garden-variety chronic health conditions, such as diabetes and hypertension, and needed to get more medications for their conditions. I saw many pregnant women who needed to go to big cities like Misurata and Tripoli, and for that they needed to get a letter from a doctor in order to get through the various checkpoints. Between Misurata and Tripoli, there were at least 24 checkpoints. Other patients included injured fighters, and civilians who had been injured in the cross fire. These were the lucky ones who were able to escape the city.

Was it difficult to obtain medications?

I was actually quite surprised that we were able to get the medications that we needed. The local Libyans were able to take us to an unmarked pharmacy to buy medications and other supplies.

Could you describe the facilities where you worked?

The clinic in Awlad Taleb near Tiji is clean but devoid of equipment. They have 28 nurses and 3 social workers, but no doctors. Some nurses were sitting around with no work to do. This facility is meant to serve 6,000 people. We bypassed another hospital that is now nonfunctional because it has been partially destroyed, and the equipment was taken by military forces to another hospital. In Badr we visited a clinic whose daily census used to be 120 and was then down to 25 patients a day. The facility is badly in need of repair. It lacks equipment and personnel, especially doctors. In the front hallway, bullet holes were seen with graffiti spray-painted in Arabic. At Tawarga, we moved our mobile clinic to a former apartment building, and the facilities were better. We took care of many of the displaced persons there. The grounds were cleaner; there was electricity and running water. The diabetic patients now could keep their insulin in a refrigerator if they could find one.

Who were some of the most memorable patients you saw?

We spent some time at a field hospital near Sirte, where we delivered medications and supplies, and then treated several patients who had been evacuated by the Red Cross from the hospital in Sirte. One of them was an elderly man with a chest wound that resulted in a punctured lung; he had a chest tube placed. Another patient was a young girl who had a fractured pelvis and shoulder, and the third was a woman who had recently delivered a baby. She looked like she had been injured by a bomb blast, and she was paralyzed from the waist down. I helped the nurse wash her and dress her wounds as best as we could before all three were transferred to a larger facility by helicopter. The man with the punctured lung told me that his family had been evacuated 2 days earlier, but that he was unable to leave because of his injury

What were some of the other challenges of medical care in this situation?

You never knew what was going to happen next. At one of the hospitals, I was assisting with circumcisions that were performed twice a week. Right when one of the boys was being prepared for his circumcision, a young man with a gunshot wound just below his xiphoid was carried into the ER with low blood pressure and rapid heart rate. Soon he was intubated and fluids were poured in; blood seeped from his back into the stretcher. Several times he lost his blood pressure and was given epinephrine, which boosted his blood pressure transiently He finally got his blood transfusion and was transferred to another hospital. I later learned that this young man did not survive.

Also, in the area for displaced persons, many women were reluctant to leave their temporary apartments and would send men to request medications for them. In contrast to other African countries, in Libya the fathers were usually the ones who brought their children for medical care.

How did you find the people of Libya?

During my last few days, I worked with Dr. Muhammad, a Libyan from Tripoli who spends his free time volunteering all over Libya. He showed up one day at the clinic and rolled up his sleeves and worked with me. He was quiet and gentle, with a calm demeanor and without a trace of bitterness about the situation of Libya. He expressed his hopes and desires for his country and for the people of Libya, that they would respect their new-found freedom, that they would not harbor malice or ill will toward past opposition, and that they would look past all that and work together to build a new Libya.

The people of Libya are very friendly and welcome foreigners with open arms. Theirs had been a closed society and under a long, oppressive regime; they had very little contact with the outside world. Now they are free to express themselves; however, more work needs to be done before the country is completely liberated.

Any advice for doctors who might consider going to a war zone to provide medical care?

Security during an ongoing war can be quite fluid. Pay attention to the shifts in security. Take cues from the local people who seem to know what is going on.

To get more information about Medical Teams Inter national, visit its website at http://www.medical-teams.org/sf/Home.aspx

Think globally. Practice locally.

U.S.-trained internists who have practiced abroad will receive a $100 stipend for contributing to this column. For details, visit the World Wide Med column at www.internalmedi-cinenews.com or send an e-mail to imnews@elsevier.com.

--Interviewed by Heidi Spine. Some of the responses were excerpted from Dr. Lai's blog at libyakwankew.blogspot.com
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Title Annotation:World Wide Med
Author:Splete, Heidi
Publication:Internal Medicine News
Article Type:Interview
Date:Jan 1, 2012
Words:1221
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