I remember the moment I was offered my first assignment with Médecins Sans Frontières / Doctors Without Borders (MSF).
I was in an airport, waiting patiently at the luggage carousel for my bag (which never arrived). While I waited, I checked my emails, to find one from the MSF human resources team. I was being offered a nine-month assignment in the Bekaa Valley in Lebanon.
From that moment it was a whirlwind: cutting my trip short, briefings in Sydney, two weeks of training and briefings in Geneva, flying to Beirut. After more briefings, it was through a snowstorm that I finally arrived at the MSF office in Baalbek to start my new role.
MSF first started working in Lebanon during the civil war in 1976. Today we provide primary health care for thousands of vulnerable people across the country.
I was assigned to the project in the Bekaa Valley, an area located to the east of Beirut which covers 4,400 km2 of Lebanon, almost 40 per cent of the country. Despite its rich agricultural resources and numerous industrial facilities, the valley hosts hundreds of vulnerable communities.
Many of the residents are displaced people, often of Syrian origin. They are among the most affected by the declining economic situation in Lebanon. MSF currently runs two primary health care centres here, and as a general medical practitioner with additional experience in emergency medicine, my role was providing support in relation to non-communicable diseases.
While hypertension (high blood pressure) and diabetes were the most common diagnoses, we provided care for children and adults with chronic diseases including asthma, chronic lung disease, cardiovascular disease, epilepsy, hypothyroidism and chronic kidney disease. All these diseases respond well to careful management, but without it can become medical emergencies.
The team also provides other services, including acute paediatric care (predominantly for children with respiratory or gastrointestinal infections), mental health services, reproductive health services, and family planning. Pregnant women experiencing complications are referred for more specialist care, but for those without complications our clinic in the town of Aarsal also has a maternity service.
If any investigations are required, such as simple blood tests, these are performed on site, for immediate results. Acute and chronic issues are treated focusing on health education and we have a pharmacy within each clinic, dispensing medications. Everything is free of charge for our patients.
My role was to help support the MSF clinics in providing quality primary health care to our patients with chronic disease. Every week I had the pleasure of visiting MSF’s clinics in the Bekaa Valley and working with the dedicated local teams.
I provided support for the nurses and doctors, assisted with technical clinical questions, supported requests for additional investigations, reviewed protocols, audited drug prescribing and programmes, engaged in case discussions and teaching sessions, as well as providing training resources.
With the emergence of the pandemic, my role evolved. I was providing technical support on responding to COVID-19 within our clinics, working with our mobile medical unit who offered testing for the virus in the local community, and developing policies to keep our staff and patients safe.
Many people in Lebanon are facing significant challenges. While the global pandemic undoubtedly had a significant impact, the country was already experiencing an ever-worsening economic crisis. According to the World Bank, around 50% of the population now live below the poverty line.
I remember sitting with a patient and trying to understand why her diabetes was becoming worse despite her taking her regular medications. She tearfully explained that due to the economic situation she could now only afford to eat a few potatoes a day. As a result she had no energy to walk regularly as she once did. Diet and exercise are two of the key measures to controlling diabetes, which can have serious and enduring health impacts.
As medics we often talk about how "lifestyle" and social factors impact on chronic disease. It was so confronting to see this woman’s pain and to see how clearly that these tough times would worsen her health and that of so many other patients, despite our best efforts.
During my assignment MSF had to redirect some of its activities in Lebanon, closing projects in some areas while opening others elsewhere. This included opening several emergency interventions to support the public health system with COVID-19, as well as to respond to health needs in the aftermath of the blast.
For an idealistic first-timer, this was a stark reminder that as a humanitarian organisation MSF often faces dilemmas. We have to make difficult decisions about how to use the limited resources and capacities we have, with the aim of supporting the most vulnerable and meeting the most urgent needs for medical services.
A dedicated team
Despite these challenges, there were many amazing moments. I don’t have space to introduce all my wonderful colleagues, but to give just one example: Dr Zahraa is a general practitioner working in the Hermel clinic.
Often the clinic is busy and demanding but she always provides holistic, compassionate care for her patients, particularly those who needed home care. These are patients who have mobility issues, perhaps following a stroke or simply through being very elderly.
She continually improves her skills and frequently advocates for her patients, and I was extremely proud to work alongside her and all the other highly skilled staff at the projects.
Since I finished my assignment I have had plenty of time to reflect. Working for MSF in Lebanon allowed me to broaden my perspective on the different needs of people who don’t have access to even basic levels of care.
I had the privilege of meeting so many strong and resilient people, and was able to see first-hand how MSF provides quality medical care in very difficult circumstances, to those who need it most.
I am now even more determined to do another assignment, and to remain (a slightly less naïve) part of the MSF family as we provide support to those who need us.