Language is a jungle

It’s been five months now since I arrived in Lebanon. After taking my holidays and spending adventurous days in Jordan experiencing the glory of Petra and mastering the culture as a solo female traveller, I took the decision to extend my mission.

It’s been five months now since I arrived in Lebanon. After taking my holidays and spending adventurous days in Jordan experiencing the glory of Petra and mastering the culture as a solo female traveller, I took the decision to extend my mission.

The time has flown by! There has been so much to take in, gather, order, digest, wonder about, learn, study, marvel and wrap my mind around that I haven’t even felt it passing.

I feel I can be of more help if I stay longer – that I give the team more strength and the feeling of continuity and assurance in my assistance. I can deepen my relationship with them and with the rest of the national staff who I have not yet encountered well enough. I have the chance to understand the circumstances of the Syrian refugees, the vulnerable Lebanese and life in the Middle-East – and I have the chance to study Arabic.

In the past four months I have started using my little collection of Arabic words in order to communicate with the patients. The first few times I used the word “waja3” (pain), people looked puzzled, but I kept on trying to pronounce the word with different intonations and loudness until they figured out what I was trying to say. What a success!

But I have a long way to go. Understanding the patients is surprisingly easier, as they use similar words to describe their pain, so I recognise them, and by the time the doctor translates, I have already made out that they have “a little pain like electricity here” (pointing to a part of the body).

Everyday life comes in handy being a doctor: I learned the word for “electricity” when the light in the guesthouse went out and did not return after a long time. When I went to the concierge and his daughter asked me with a shrug of her shoulders where the problem was (body language is truly universal!), I pointed at the fuse box and she asked, “mafi kahraba?” (no electricity?). I grinned and repeated her words, and since then that word has stuck to me.

So this is how I try to find my way through the jungle of the Arabic language without dragging our poor translator with me every step of my journey. It is challenging, but nevertheless the patients are grateful for my attempt.

The day I bought a knife

Days go by and every day we are confronted by patients who are desperate. Things that can be handled in Austria very easily become a great problem in these circumstances.

One day one of our general practitioners called me to ask for advice with a dermatological case. She knows that I am very keen on dermatology and on promoting our online “telemedicine” tool. This tool was introduced to connect the doctors in the field with specialists, who help us online with difficult cases and treatments. 

As I had only seen some blurry photos, I didn’t quite know what was awaiting me. This patient was special – on this point the GP and I agreed. He entered the consultation room leaning on a walking stick. He was so thin that he was barely visible. He was my age, but looked much older. He was in constant pain, he told us, showing us his fingers with a painful hyperkeratotic nail growth [a thickening of the skin of the nailbed]. As I knew that his main complaint was his feet, I asked him to show them to me. He was very much ashamed of his condition, and thought that I wouldn’t be able to take either the sight or the smell, but I convinced him that we were there to help him.

After reassuring him with a smile, he started undressing his feet. I was agog when I saw that he was wearing four pairs of socks, plus sponge in his shoes, to cushion the pain. His condition made walking very painful to impossible.

I was sure I would be able to help him at least find some relief. I don’t quite know why I was so sure – maybe because he really touched me with his friendly demeanour and sparkling eyes.

The next time I saw him again I had the diagnosis and some equipment for him. We explained to him the genetic condition of Pachyonychia congenita (a hereditary disease leading to hyperkeratosis of the skin and the nails). He was startled and relieved at the same time.

Then I showed him the callus knife I had bought at a local pharmacy, plus a special nail trimmer, so that he could take care of his feet. When you have nothing you become innovative. I was happy that he was happy to have found a way of managing his condition. From that day on he has always been on time for the follow-ups while I am the one apologising for being late. He greets me with a broad smile, already waiting for me at the entrance of the clinic.

It is not the first time that I found a way to help people, but never have I felt this gratitude. Medicine doesn’t have to be complicated or expensive. I might not have saved a life, but the help we offered him made his life more liveable.

Behind closed doors

Visiting patients at home is an essential part of my job. I go on home visits with the social workers once a month, if the security situation allows.

My first visit was to an old lady who had been injured during the clashes in 2013. She was living on a hillside, making it very difficult for her to move. She was injured in her left leg, and underwent several operations for reconstruction.

We assessed her case in order to determine whether she was fit for physiotherapy. The scars had healed very well. She was suffering from neuropathy (symptoms caused by damaged peripheral nerves) and was tied to her couch.

She was being cared for by her sister. The house was easy to find as it had a door of fading azure. As we opened the door, we found ourselves in the middle of the living room/bedroom. The room was crammed with furniture, but nevertheless it was tidy. The two women were taking good care of their little shelter.

The old lady could hardly be mobilised – her sister had to help her to the bathroom.  Her sister was earning the money to provide her with medication, which cost more than US$200 a month. I was irritated to find that some medications were double prescribed, and that they could have saved a lot of money if somebody had told them.

We visited her again four weeks later. She was improving, already trying to walk on the walking frame, taking some steps around their small house. However she was still in pain. The physiotherapy could not be initiated yet – though the reason for this was not very clear to me.

We will keep visiting her and emphasising the importance of the physiotherapy, as it is crucial to her so that she can help her sister and pay her back for the love and care she has received from her. I could feel how stranded and useless she felt suddenly becoming housebound.

We visited another patient to assess the family’s need for social assistance through Caritas [an NGO which provides social services]. The family lived off the main road on the sea side of the hill. Only a very steep flight of stairs would get you there. Climbing these stairs is a pure nuisance, and is hazardous at dawn or night.

When we stepped into the apartment, we found the patient’s mother preparing chicken on a small plastic table fixed with duct tape, just next to an overflowing ashtray, in the only room suitable for visitors, the living room.

Two photos were hanging above the black and gold settee, one showing her small family: the late father, herself and their son. In one corner there was a TV surrounded by odd teddy bears and a small plastic Christmas tree.

It came out soon that she was under economic pressure, having no money at all and depending for the welfare of her family on her neighbours, who provided her with a little money and groceries.

Her whole day was concentrated around caring for her 15-year-old son, who was mentally ill and blind. She told us that he was aggressive towards other people and would only accept her.

The chicken she was preparing while talking to us was for his lunch. The only thing he would eat was chicken with za’atar (a mix of spices) in a sandwich.

The boy’s father had died seven years ago after having cancer, but it seems his death came suddenly to the wife.

Already, when we entered, I could sense the hopeless state the little family was living in. The mother was sharing the one bed with her son; the room they were sleeping in was in a bad state. She stated blankly that she could not clean the room as her son would not move out of the bed for any length of time. So there was food from last night at the bedside, and an oppressive smell due to the lack of air and the dirt all over the place.

The kitchen was a black, dimly lit corner next to the toilet, serving simultaneously as the bathroom. She washed herself and her son with a bucket.

The mother appeared very depressed to me and in a state of despair. She was clearly in need of help for herself and assistance with her son. She made it clear that without help from other people, she would be lost.

After being here for five months, one thing I have observed is that you cannot always tell the dire straits people are in from their appearance, as it is of great importance to them to always appear well dressed and put a lot of effort into how they look. But visiting them in their normal habitat, I could see the austereness they were living in, and the pressure of their circumstances destabilising the whole family. This is not visible on the outside – thus the importance of our work in assuring them that they have not been abandoned.

Saving lives is a major part of becoming a doctor – the holy grail of medicine, if I may put it like that.  But then one discovers the many facets of this life task. Being a doctor is not solely about dragging somebody out of his bomb-shelled house and performing an operation to save his life – which one could consider the supreme discipline. It is also about helping rescue people who have so little left, to ensure that they can live a life of dignity and give them the spirit to continue. For what is the value of a life without dignity?