As far as essential life decisions are concerned, I have always been an intuitive person. My heart tells me where to go and what to do, therefore I don’t need rational planning. So it was a gut instinct to fulfil my dream of working with MSF.
I have been in Tripoli, northern Lebanon, for three months now. This first blog is about what has happened so far.
The first days after leaving Vienna I spent in Geneva. I was very much mistaken when I thought I would be going to the field straight away. Furthermore I misunderstood the importance of briefings. With hindsight, I am glad about having had the opportunity to have some time to process what was awaiting me and being mentally ready for this adventure. I was happy I was not thrown in at the deep end.
So I was passed through several hands in Geneva to prepare myself for the mission and I gathered more information about my position and the work I was supposed to be doing: I wouldn’t be saving lives as a primary goal, but I would be helping people in need.
My major job was to supervise the general practitioners, 13 in number, and two social workers, in assessment of the patient, treatment and follow-up. Also to focus on the mental health programme and on identifying patients with medically unexplained physical symptoms among our clientele.
My briefing schedule in Geneva allowed me to take in the mesmerising atmosphere of the city and the great institutions that humans have created. I visited the museum of the International Committee of the Red Cross (ICRC), and I met Mahatma Ghandi on a tranquil little green and passed by a demonstration on the Place de National. This city is full of jaw dropping experiences.
Finally I boarded the plane which would take me to the Middle East for the first time.
Some information about Lebanon: The number of refugees is estimated at about 1.2 million. Considering the number of Lebanese is four million, this naturally puts great pressure on the country. Therefore the borders with Syria were closed following the stop of refugees being registered. Which resulted in a rising number of people coming to Lebanon illegally.
The health system is not built to cover all the Syrian people in need. Even Lebanese sometimes struggle to pay for their consultations in advance. Next to the refugees, we also have the group of vulnerable Lebanese, their number increasing.
All of this accounts for the high number of NGOs in Lebanon. Through the variety of help offered, together we are able to support the refugees and the Lebanese. But access is no longer guaranteed, as the government has stopped the registrations and has forbidded any informal tented settlements. The people are spread all over the country, living in places far from any medical assistance.
On 1 July I arrived in Tripoli. I was lucky that my forerunner was still in the field and there was plenty of time to do a handover. Being in charge of human resources was totally new to me, so that was the biggest part of the handover. I started working almost straight away, because waiting and just watching is not me. I rather make errors while doing, and then resolve them.
It was a hard thing for the GPs and the social workers to have a new supervisor (again). They needed their time as much as I needed mine to adapt to the new situation, the new ways of approaching things and maybe the different ways of communicating.
I consider myself very lucky because I get along with them very well. I can maintain a professional level of working but also give them the feeling that I am there for their problems – problems concerning work, and private ones as well.
On 18 July it was Eid al Fitr. The city was arising from its hibernation. All of a sudden, life was taking place on the streets and in the many cafes and restaurants.
Participating in the traffic was like a visit to a theme park. On the first Saturday after Ramadan, we were stuck in traffic for 30 minutes – on a roundabout. I didn’t even know this was possible! It reminded me a little bit of the roundabout at the Arc de Triomphe – with the big difference that it was not traffic rules that were put into action, but sheer boldness! All those who weren’t fussed about going the whole way to the last exit would just turn left and disable the entire traffic flow, because they did not expect any resistance from the other drivers. But of course we are in Lebanon, so there was a lot of resistance – even the new expats saw this coming! No cars were moving, an ear-battering bluster of car horns and loud Arabic music started, and we were just in a dither watching this scene.
Tripoli is surrounded by beautiful nature, and only a few minutes away, the turquoise sea awaits. Nevertheless I found it odd to be at the beach with all of this disaster surrounding us. Was I allowed to be there?
Humanitarian aid comes with a lot of sacrifice, fear and resignation. Being part of the local society is not possible, even though we are among them all the time. So it seems that, in order to perform well, we escape the tragedy for a brief moment.
In order to gain a better insight into the conditions in which refugees are living and the challenges they face seeking medical help, we visit an informal tented settlement each month with our health promotion team and medical team leader.
One of the settlements I visited with a social worker was home to a mother with her nine children. We made the visit to assess the case of her 11-year-old daughter, who suffers from type 1 diabetes. The family struggle with giving her insulin at the right time, attending their appointments and other issues.
We found their tent next to a vegetable stall. It looked solid, but not weatherproofed enough to get them through winter. The mother is only 37 and has to take care of the nine children on her own. The father is in Germany – he took a boat to Europe after he was not allowed to come back to Lebanon from Turkey. The only person bringing in any money is her 13-year-old son.
As I am also supervising the social workers, which gives me valuable opportunities to attend their regular group sessions, most of them aimed at female patients, though a group for men will be set up soon.
In one of our clinics, there are regular sessions for teenage girls. It is fascinating to watch how similar teens are, no matter where they live. But still there is one big difference: these girls have lived through many traumatising years, never having been able to get away from their communities. So it is understandable that they are in revolt and trying to push boundaries.
But as long as the differences are not solved, they will continue living in fear and under restriction, only experiencing the wide world through the TV. Only those who are lucky enough to have a wealthy upbringing can break out, but the majority of them are caught in a vicious socio-economic circle.
The benefit of the group sessions is a great one. The girls can express theirselves freely without fearing any problems.
The groups for women are more difficult, as the topics are more sensitive: gender-based violence, grief etc. Gender-based violence is a big taboo. The women are too afraid to come more than once to get help – the fear of their partners finding out that they are seeking help is too great.
The experiences I have had so far around the circumstances of the refugees can easily be compared to the problems they face in Europe. They seem healthy on the outside, smiling and even laughing, coming to see the doctor for minor complaints. But on a closer look, I see their traumas: being away from home, without any security or trust in a foreign country, where they are not accepted, without work or education and with no social network, except for other refugees, and carrying the traumatic experience of being torn away from their loved ones.
The Lebanese people are trying, but disputes are accumulating. The threat the European citizen feels for no reason, the Lebanese are experiencing as well. They feel trapped, bereaved of their resources and safety.
MSF steps in to remove any rumours about offering more help to the refugees. We are constantly stressing the fact that we are here for everybody, no matter who they are.
So far I have gathered more experiences than I can comprehend. I have met so many fascinating people, cried in secret about their sorrows, and laughed with their children. Resilience is a little word, but watching the tragedy some people are facing, I wonder how they manage to keep their resilience despite the darkness they are going through.