Arriving in the field

Greetings all! My name is Aoife and I am a medical doctor working with MSF on a mission in Lebanon.

Greetings all! My name is Aoife and I am a medical doctor working with MSF on a mission in Lebanon.

On February 13th, I arrived in Geneva, in the headquarters for MSF Switzerland. I was there to attend a two-day briefing. This involved meeting the Geneva-based MSF staff from various departments, who were involved in coordinating MSF’s work in Lebanon. An unfortunate venue in meteorological terms: It was minus temperatures and snowing heavily. Unsuitable conditions for the clothing I had packed (ie light airy clothes to withstand sweltering Middle Eastern Summer heat)!  It was an exciting launch into MSF all the same. I took the opportunity to explore the United Nations headquarters as well as UNICEF and the Red Cross buildings. At the briefing in HQ, I got some more information about the mission itself, daily activities in the field, and the cultural/political setting that I was entering into. I left Geneva on Friday morning, eager to get stuck into work.

I arrived in Rafic Hariri airport in Beirut late in the afternoon. An MSF driver was there to collect me from arrivals. As we left the airport, we were caught up in a great gust of wind and torrential rainfall. A scene similar to what I had just fled in Ireland!  I soon learned that at this time of year Lebanon is a land of four seasons in one day.  And as we drove off towards Beirut, the skies cleared, the sun shone, and a heavy snowfall could be seen on the mountaintops.  Fantastic!

On arrival in Beirut, I was brought to the coordination office where I met the Head of Mission, the Medical Coordinator, HR Coordinator, the Communications Officer and Logistics Coordinator for MSF Lebanon. I was given a thorough briefing about the mission, and a comprehensive overview of MSF’s operations in Lebanon. This also included an overview of the complex political context in which MSF is operating in Lebanon. After the briefing I had two days to spend in Beirut. This I really enjoyed.

Beirut is such a bustling, energetic city. It is steeped in so much history and there is so much contrast within the city. There is evidence of destruction from the civil war era in the seventies and eighties (with dilapidated buildings exhibiting blast and gunshot damage on the concrete facades). There are beautiful mosques, and there are manicured streets full of designer fashion houses! There are fantastic views of the coast of Lebanon on a stroll of the busy 'cornice'. There are delicious Lebanese eateries in abundance and the diversity of Beirut’s inhabitants astounds. I've never heard such a vast array of languages being spoken in one place. Arabic, English, French, Spanish, Italian, Armenian….You name it, someone is speaking it! This phenomenon owes itself to the diverse ethnic backgrounds of the Lebanese people, and to the new immigrants who have come to settle here settled in Lebanon in the early 20th century!

The following Monday, we set off for Tripoli - a coastal city in the north of Lebanon - my new home! Tripoli is Lebanon’s second largest city (after Beirut) and is located 80km from Beirut. It is quite a conservative city relative to Beirut and religious customs are strongly maintained. Tripoli has experienced its share of violence and civil unrest in recent years, owing largely to opposing political and religious views. Since the crisis began in Syria in 2011, Tripoli has experienced a considerable influx of Syrian refugees seeking asylum in Lebanon. The city is located only 31 km from the Lebanese/Syrian border.

Arriving in the MSF office in Tripoli, I was greeted by warm friendly smiles and welcomes from the Lebanese and expatriate staff. Amongst the expatriate staff there is a field coordinator, a logistician, another medical doctor and an administrator. These people are my housemates for the next six months! Amongst the national staff, there is a strong and enthusiastic team of doctors, nurses, a psychologist and a psychiatrist, social workers, drivers and administrative staff. I was delighted to see great camaraderie and positivity in the mix! The field coordinator welcomed me and gave me a briefing about the mission and Tripoli itself. I then met with Katharina, the medical doctor from Austria whom I am to replace here. She had just come to the end of her six months with the mission, and she had a huge wealth of information to impart with me!

The team brought me for Lebanese food that evening to welcome me to the project. This was the beginning of an intense love affair with Lebanese cuisine that I will continue to cultivate throughout the course of my time here. Manoushe, Taboulleh, Halloumi. I could go on ad infinitum. In fact, I believe that the quality of the food is such that it should have its own devoted blog, but that is an issue for another day!

Throughout the following few days, Katharina took me to the various clinics where I will be working. My role here is as a 'PHC doctor'. This work involves overseeing the activities in the primary healthcare clinics which MSF have established in Tripoli. I work alongside local doctors, and implement MSF treatment guidelines and management plans for patients who attend clinics. We see patients who present acutely for various reasons (for example coughs, fevers or trauma).

MSF provide care to Syrian refugees and vulnerable Lebanese people in Lebanon

Tripoli. MSF provides primary health care consultations, including antenatal care in its clinic in Dar al Zahraa hospital in Tripoli. © Nagham Awada/MSF


One of the main elements to the programme is chronic disease patient care. Our aim is to provide care to those who have medical needs and who have limited access to healthcare. This includes providing services mainly for vulnerable Lebanese people and the Syrian refugees who have arrived here. Many Syrian refugees arrive here with prior diagnoses of chronic diseases such as diabetes, hypertension and chronic obstructive pulmonary disease. They have come from situations where they had access to sophisticated medication to manage their conditions. They now lack this essential treatment and MSF in Tripoli aim to provide for these people, and ensure that they can access evidence based quality care for chronic diseases. Tackling chronic diseases is a major venture for MSF, so we are constantly seeking to improve care, monitor outcomes and implement appropriate guidelines. There are challenges to this work (with limited resources at times), but the team are motivated and enthusiastic, and great work is being done to ensure the best possible care for our patients.

Meeting the patients in the clinics is indeed the most interesting and rewarding part. The patients that we treat have really incredible (and often tragic) stories. So many people have lost their loved ones to the war in Syria. So many of the older men and women we see have lost sons in violent circumstances, and more often again, they do not know the whereabouts of their sons. They have simply no idea whether they are alive or dead. They have incredible resilience in the face of their adversity, to pick themselves up, make the journey to Lebanon and fight to build lives here for their families. But their sadness and their pain is palpable, especially when they open up and tell their stories, about the losses and suffering they have endured and about their worries for the future.

The people here (Lebanese and Syrian) are welcoming and open. The national staff translate for me from Arabic to English, and for this I am deeply indebted. I am eager to learn some basic Arabic terms myself, enough to extend a welcome and some friendly words.  Not the easiest of languages, this may prove difficult. But the national staff tolerate my terrible efforts with enthusiasm and correct me appropriately.  I will hopefully improve slightly with time!

I already feel that I am settling well into the work here, and I look forward to giving you more insight into this exciting venture with MSF in the Middle East.

All the best,