Journal of a humedica Doctor in Lebanon

by Joachim Panhans,  2007/05/04

After the cease-fire between Lebanon and Israel in August last year, humedica took over medical care of the returning refugees in southern Lebanon, since the local clinics had not yet reopened. General practitioner Dr. med. Wolfgang Renninger is one of the two doctors who volunteered there for three weeks, from September 4 – 25, 2006. The following is an excerpt from his journal.

Monday, September 4, 2006

The first day in Lebanon – as usual everything was totally different than I had imagined it. Alone the arrival - at the last minute we receive a message that the Beirut airport is closed. We have to re-route to Damascus.

Hectic departure due to the new visa application in Frankfurt, lay-over in Vienna. There I meet up with Regina from Munich, a nurse. As we arrive at the airport in Damascus we are very relieved: a very friendly Lebanese taxi driver is waiting for us. But we don’t make it very far. Uniformed men -police? - stop us, a short incomprehensible word exchange. Get out! Wait! Our taxi driver explains to us that because he is Lebanese, he isn’t allowed to pick us up from a Syrian airport. This is subjective, but what can he do about it? We walk through the entire airport, down long corridors and arrive, by elevator, on a different floor in a run-down office. A lot of chitchat with strange men. Finally money exchanges hands; we receive a small certificate and can finally go on our way. This time, however with a Syrian taxi driver in a yellow Syrian taxi. After about two kilometers we stop again and who do we see? Our old taxi driver! We quickly load the taxi and go on our way. The end result: the two kilometer drive in the Syrian taxi cost us 70 dollars and three long hours. (We discovered later that the certificate was a receipt for a donation in the amount of a dollar. Annoying, but also funny.)

At high speed, with risky passing maneuvers and extensive honking, we drive on. In the middle of the streets are deep bomb craters, we drive around them on the bumpy sidewalks. A huge viaduct lies half destroyed in a gorge, colored red from the sinking evening sun, totally detached from the shadowy mountains in the background. In the desert-like lowlands around Damascus it is 35°, but here above along the pass it is only 18°. Our taxi driver describes himself as a “driver for the street”, and the others - especially the Syrians - as “drivers for the sky”. But everything goes well, no one ends up in heaven and we finally reach Beirut. Regina and I are handed over to a Christian Lebanese – on his car we recognize the humedica logo. In a silent side street with five to six-story houses we spend the night in a private home. Across the street from us people are enjoying their evening on their balcony. The view of Beirut is beautiful - a carpet of light, spread out on the mountainside. A peaceful image. The city of Beirut is large and the bombed area vast.

Tuesday, September 5, 2006

For breakfast a half a pear, biscuits and water. A Lebanese woman picks us up in an SUV and we drive south. We reach the port city Tyros. In the empty house of the director of an evangelical school we meet the employees from humedica. This is our base camp and so we unpack our things. The SUV is immediately packed for our first assignment. In my backpack I pack my personal equipment like my otoscope and stethoscope and we drive further south. Destroyed streets and bridges, slashed up cars, the first bombed houses, military posts, UNO vehicles… In the mountains lies the village where we will be setting up our clinic for the next few weeks.

Braking, driving on, braking, driving on, braking, driving on. A journey full of obstacles. Bomb craters, provisionally filled with stones: Brake! A section of the street littered with plates-sized holes: Brake! Grenade holes, almost always two beside each other: Brake! An approaching tank: Brake! A military post at a crossing, bull-dozer, cranes, herds of goats, a donkey; braking and yet again braking!

Added to that - heat and dust. Karstified mountainsides, sometimes with dark surfaces - remains of the phosphorous bombs. The houses: unroofed, thrown over on their side, scattered about, flattened, burned black. Demolished vehicles and trucks sit on the side of the road. Many cars have only one thing in common: they can move forward - somehow. Doors are sometimes missing, the paint is ¾ of the way gone and the windows completely. And everything, which doesn’t have to do with the lighting, is gone. The police have more important problems.

We stop in the middle of a village; some of the houses are very nice-looking. Beside lightly-damaged mosque is a mausoleum lying partially in ruins. Here we find a room, quickly cleaned of debris, it’s lacking in everything needed for hygiene: water, clean towels… What I learn to appreciate about humedica is, that we have everything we need with us and aren’t dependent on others. We hang up a curtain in the middle of the room, put up the humedica banner and look for tables and chairs. We are greeted from the community representative, on the stairs the first darkly dressed women, children and men are already waiting.

The muezzin officially opens our clinic from the minaret. The patients keep coming: children with fever, many with dysentery, a few patients with respiratory problems, in addition to diabetics and heart patients, who've run out of medicine. Inflammations, injuries and war injuries which must be re-treated. Our translator Maria is always with us. She translates everything very empathetically, and I get the feeling she is always able to tell them exactly what I mean. We learn that the hospitals in Tyros and elsewhere were well-equipped in handling the wounded. The Hezbollah saw to that. What is missing country-wide, are medicines for the villagers and returning refugees.

The waiting line keeps growing. A little authority is necessary, at times, in order to send the impatient back behind the curtain - which separates the waiting room from the treatment area - and also to quiet the loud talking. But someone always manages to lift the curtain in order to get a peek at us.

All of a sudden about a dozen people rush up to our treatment table, everyone’s talking, no one can understand anything, empty medicine boxes are held high. Chaos. They are justifiably concerned that we will leave without having treated everyone. Against the regulation - we must be back in our quarters before dark – we lengthen our treatment time an hour.

On the way back we drive into the sunset, the ruins are illuminated red, bumpy roads, a lot of dust. We telephone with headquarters. We arrive at night – our way lit by the bright moon, and so, we protest, by light – completely in accordance with the regulations.

I received the small children’s room in the house of the school director. It looks like as if it was abandoned only a few hours ago: toys everywhere, the closet and drawers filled with clothes. Before the fighting, the family brought themselves into security and has made their house available to humedica for the three weeks in which we are here. The fan runs on full-speed, as long as there is electricity, and I can sleep for a few hours.

Wednesday, September 6, 2006

The village we are visiting today lies deep in the mountains. We open our clinic this time in a gorgeous town hall, or rather – in a once gorgeous town hall. The marble stairs which we climb with our aluminum boxes, have been destroyed through bomb fragments, the entry door is bent and has no glass, the once beautiful stone floor is now filled with holes, the ceiling is hanging down, the iron grid from the concrete creates a snarling pattern in front of the blue sky. The walls are blown away; we look down upon the village street and on the wide, late-summer, sun-drenched and rocky-looking landscape. We find a few dusty armchairs. After we locate two tables, the waiting and treatment areas are quickly set up.

Again a lot of patients: 70 to 80. Babies, young mothers with head scarves - large-eyed, like Maria on old pictures, elderly people with interestingly creased faces. Almost all of the patients are well-kept; the children dressed up, many women conspicuously well-dressed. They have prepared themselves for the doctor's visit. It becomes clear to me that the residents have only been isolated from medical treatment because of the war, and therefore now need our help.

On the way home we search for a gas station. “Search” here, being the operative word, since almost all of the gas stations were specifically targeted and destroyed. In the end, a local leads us to an intact gas source.

Because there were problems somewhere today, we were made familiar with the security rules again. We should always remain on our route, not even leaving it for a few meters. More than 1.3 million cluster bombs were dropped, and a large part haven’t yet exploded. I also heard that the military lost some men. Several soldiers were killed during the recovery and disarming of the left-over bombs. Civilians are also injured or killed by the bombs from time to time. All of this added up to an adamant and thoughtful speech by the mayor of our village.

An evening at home – that’s right: we feel at home in the school and director’s house – we sort the equipment, replenish our supplies, write our reports and fill in the numbers for the statistics in the prepared forms. Some of the diagnoses must be sent on to the UNO. A case of typhoid fever will continue to be monitored from the official side.

Only a few drops today and the water is cold. But nevertheless I enjoy the shower. A luxury in comparison to my preconceptions before the journey. Now all that is missing is a glass of wine. But all of my colleagues from humedica: Alexia, Joseffa, Regina, Dimitri, Josef, Schorsch and Dr. Eduardo - are “resolute Christians”, and abstain from drinking alcohol.

Thursday, September 7, 2006

I didn’t sleep well. Due to the relatively high humidity, the heat here in the port city is difficult to deal with. In the hills, in our villages, the temperatures are much more comfortable.

Again another village. We have our usual consultation hour: lice, fleas and worms are the problems today. Severe infections. In addition, more diabetes and heart patients who’ve run out of medicine. “Libado!” “Next!” “Libada!” “Next!” - So it goes the entire day. Some patients are very touching with their thankfulness. An elderly man takes me in the arm and gives me a rough, bearded kiss on the cheek. The mayor has food and drink brought in for us. But we don’t have time to eat, the number of patients waiting is continually growing.

I have to correct many of my preconceptions. Lebanon is not a poor country. On the surrounding mountain cliffs I see some sizeable villas decorated in an oriental style. I talk to a Lebanese, who actually lives in Germany, but was surprised by the war while on his vacation here in his hometown. Just like many other Lebanese living abroad, he built a house here which remains empty outside of the summer weeks spent there with his family. He tells me that from his village alone, 130 men live and work in Germany, have married German women and invest their money in Lebanon. Millions of Lebanese live abroad, and this is how a lot capital comes into the country. Added to that, the Lebanese have been far-travelling traders for thousands of years. So regardless of the many wars, Lebanon is still a relatively prosperous country: the Switzerland of the Mid-East, were it not for the continual wars.

Friday, September 8, 2006

Security briefing in a Lebanese garrison in Tyros. Replica mines everywhere, machine guns. Weapons, weapons, weapons. A fully-tattooed - including his face - security representative explains to us, how we can minimize our risk. It is important to always keep a cell phone readily available. We write down telephone numbers which we can call in case a critical situation occurs.

But barely outside the garrison we quickly forget that the situation here in Tyros can be dangerous. Everything appears so normal: the traffic, the people busy on the street, the municipally-clothed juveniles who fill the cafés and ice-cream parlors.

The sea and the countryside are beautiful. When driving along, we see many roman towers, pillars, amphitheatres. We don’t have an opportunity to look around. But this evening we went swimming with the school director. The moon shining on the sea, the flickering lights from the city of Tyros, the sea comfortably warm. Vacation for an hour.

Sunday, September 10, 2006

Sunday. We have the day off. I don’t completely agree with not using every day available. But what is for me and nurses Alexia and Regina a volunteer operation, is for the others a job, since they are employees of humedica. And the work week has far more than just 40 hours in it.

We drive together to the local church, a normal building with an inscription in Arabic. The simple room can hold around 100 people. As we enter, a handful of believers are already there. The reverend introduces us; we have to explain what we are doing here. The service begins with a song - unfamiliar, but very enjoyable. The reverend’s strong voice serves as a replacement for the organ. He preaches long and with vigor; I daydream, with the unintelligible Arabic in the background. After the service everyone gathers in a side room with comfortable seating, and the reverend offers us fruit juice.

Later in the afternoon we drive with our work vehicle to Tyros’ official swim beach. It is separated from the street by shack-like bars. We sit down at one of the many plastic tables which have been placed on the beach. An idyllic family setting. Fathers and mothers playing with their children. The light-colored mountains and the tall houses create a picturesque backdrop.

Among those swimming are also women, fully-clothed and with headscarves, who slowly walk into the water until it is up to their necks. It reminds me of film scenes of people who are willing to commit suicide.

We are being watched. In the water I am spoken to in German and in no time we find ourselves in a large circle of men: uncle, grandfather, brother-in-law, nephew, son. The traditional “where from” and “where to” questions. Hussein works in Germany and talks about his bombed hometown and of the confrontation between the Israelis and Hezbollah. A doctor hasn’t been there since the war. We promise to come within the next few days, as soon as we’ve coordinated it with the mayor. We got a little work out our Sunday after all.

Monday, September 11, 2006

We drive to Hussein’s village near the border to Israel, which now belongs to my villages. The landscape is impressive; there are many beautiful houses, but many also lie in ruins.

Hussein is already waiting for us in his Mercedes at the city limits. He brings us to the damaged civic center, our workplace. We are greeted from the mayor and enjoy a coffee with him. We set up our clinic in no time - we’ve had some practice. The patients are already waiting in line, and are happy that I examine every one: infections, heart problems, high blood pressure, diabetes, dysentery, sometimes ulcerated wounds.

Hussein insists on inviting us to dinner. Because there’s no electricity, we have cold flatbread and warm Pepsi. Once again we drive home in the darkness - against the rules – but we stay in constant contact with the headquarters.

Tuesday, September 12, 2006

It is hot, as usual. There are so many destroyed homes, but also a lot of excavators and cranes. Things are being leveled, repaired and cleaned up.

After we have worked for two hours in a bombed, but for our purposes useable, civic center, an ambulance with a red Iranian crescent drives up. They, too, have planned to attend the people here today. The waiting patients signal to us that they would rather be handled by the Germans. A short, not unfriendly, discussion takes place, and then our “competitors” drive off to another village.

Just like every day, we see about 70 people. And even when it’s nothing more than a large family who need treated for worms, everything costs a lot of time. I lay value in asking many questions, and my translator, Maria, has a laborious job. In addition, she must write all of the dosages correctly on the medicine bottles for the patients.

We are a good-functioning team. We work together and are in good spirits. And just like every other day, the mood is good. I am thankful that we can work effectively. Humedica was well-prepared. All of the medicines and other resources which we need were either previously flown in or were locally acquired. I believe that the donors’ monies have been well-invested.

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