JMAP 2022 - Teamwork Makes the Dream Work
Destitute and detached.
In a hidden corner of the Hiteen/Schneller camp.
Deprivation within deprivation.
The depth of struggle is palpable and unnerving.
Have you ever driven in a country where it seems as though there are no rules on the road? Where anything goes? If you haven’t, then welcome to Jordan where you will need all the good luck the Lord can bestow upon you to survive. One lapse in concentration could be costly. I’ve seen it all in the last couple of weeks - wanton speeding, flagrant abuse of mobile phones, dangerous manoeuvres, playful children hanging out of windows and sunroofs, absent headlights at night, nonchalant reversing down the motorway, to mention but the most common blatant infringements of the law and commonsense. Well, apparently anything goes until it doesn’t! Despite my (possibly extreme) vigilance on the roads I was caught on the wrong side of a minor traffic infringement on my way to the Hiteen/Schneller camp this morning. It was a classic ‘light’s just turned amber and I’m too close to the stop line to safely come to a halt’ kind of situation. A recent rule change, I was later informed, has meant that going through an amber light is considered a traffic offence regardless of the circumstances, unlike in the UK where amber means stop unless it is unsafe to do so (i.e. breaking sharply could lead to an accident). I don’t think I could have trusted the breaks on my inadequate - but apparently latest model - Nissan Sunny! As I made a safe and comfortable left-hand turn across the spacious and empty intersection, I was surprised to find myself being waved across by two police officers who slapped me with a fine, gave me a good old ticking off and confiscated my driver’s license for 48 hours - another unusual and potentially impractical rule change. Once their job was done, it was time for them to simultaneously light up and brazenly tune out my honest pleas. I don’t think they quite grasped that contributing to the coffers of the traffic department was the least of my concerns, although I would have preferred to spend my money indulging in my annual fix of gorging some of the world’s finest figs!
Said figs.
Sweet.
Sumptuous.
Addictive.
After a socially stimulating weekend (Friday and Saturday in Jordan) with my vast array of relatives and a busy clinic list at the Talbieh camp yesterday, I made my way once more to the Hiteen/Schneller camp for back-to-back clinics today. My chance roadside rendezvous with our ‘fig-hating’ friends lead me to be 15 minutes late. I parked up, leapt out of my car, galloped up two flights of stairs, quick “salam-alaikum” to the reception staff, sharp right turn and there she was at the end of the corridor, in front of my clinic room. Glaring at me, with a crowd of patients eagerly anticipating my arrival, Sister Rahaf didn’t utter a word. Her silent commands were crystal clear: get in the room and let’s get this clinic started immediately. Sister Rahaf was my first clinic nurse when I started my humanitarian journey here two weeks ago and, without her, I would have barely survived. Our dynamic and working relationship has grown from strength to strength ever since. She knows when I need to speed up, she knows when I need a break, she knows when to assist if I’m not quite getting my message across to patients - especially when I humorously forget the word for bladder in Arabic and inadvertently describe it to a patient, literally, as a p*** bag! Sister Rahaf is the ultimate team player in achieving our common goal of doing the best we can for our patients.
“Medical Aid for Palestinians (MAP) Jordan.
Established 1990.
A journey of good omen and watchful treatment with your support.”
I was delighted to have Dr Mohammed, a young and energetic general practitioner who divides his time between the Islamic Hospital in Amman and the Hiteen/Schneller JMAP clinic, shadow me for part of today’s clinic. Dr Mohammed is a Jordanian who graduated in 2016 from a medical school in Cairo and has a great deal of experience working in challenging and low-resource healthcare settings. He is also likely to follow up many of my patients on immunosuppressive treatment who require blood test monitoring and planned treatment changes. His hunger for new knowledge was inspiring and it just so happens that of the 40 patients I saw today, he was present during the four most interesting consultations (from a rheumatology perspective): flare up of lupus nephritis with anti-phospholipid syndrome, recurrent panniculitis (cause to be determined), a new case of seropositive rheumatoid arthritis and a new case of gout in a 28-year-old overweight, hypertensive, type 2 diabetic. I think Dr Mohammed enjoyed the experience and found his morning informative. He spent the rest of the afternoon covering the Emergency Department in the JMAP clinic.
Another case which captured my attention, reflecting the hardship of the Gazan refugees in the Jerash/Gaza camp, was of a 29-year-old Syrian woman from a different refugee camp around Amman who, in desperately trying to seek medical attention, checked into the clinic today with symptoms indicating multiple sclerosis. Refugees residing outside of a camp affiliated with a JMAP clinic pay a nominal fee of one Jordanian dinar (£1.20) to be seen by a JMAP doctor. This patient couldn’t even afford that, so the clinic manager, Yaseen, waived the fee and sent her in to see me. It was therefore no surprise that when I explained the need for specialised investigations and a neurology review at the local government hospital, she was left deflated, perplexed and helpless. Much like the refugees in the Jerash/Gaza camp, Syrian refugees are treated - in effect - as third-class human beings in terms of healthcare. National numbers (similar to our national insurance numbers) are not offered to them and consequently they are not granted basic necessities, such as access to necessary healthcare, to build a semblance of a ‘normal’ life. And when I say ‘normal’, what I really mean is a life where the focus is purely to survive, not thrive.
Yaseen cooked bamya for me today.
A delicious okra stew for lunch.
Served with warm Arabic bread.
It was outstanding.
Yaseen certainly delivered on his promise.
Continuing the theme of food.
Yaseen also rustled up a separate dish to feed the rest of the team.
From the cleaning lady to the clinic manager.
We all gathered together.
The team spirit here is unwaveringly strong.
You may recall last week I talked about our multi-talented clinic manager, Yaseen, who promised to cook me one of his special homemade dishes – bamya (okra). I joked that this former chef-come-restaurateur, who successfully turned his hand to delivering a healthcare service to refugees, did his very best last week to lower my expectations of his culinary skills by treating me to a take-away polystyrene box filled with shawarma covered with fries. I have it on good authority that Yaseen is as good a chef as he is claimed to be. He, reputedly, brings together a multitude of different flavours to create an authentic and joyous experience. Yaseen seems to have transferred this skill to his dealings with people. Whether it’s pre-clinic, lunchtime or post-clinic, Yaseen would always invite us to his office to discuss all matter of things: politics, economics, family, food, healthcare systems, Levantine culture and a lot more. The core objective of what he is doing, implicitly or otherwise, is letting his colleagues be heard and voice their opinions. He is gentle in his demeanour and has a fantastic knack of never interrupting others while they are speaking. I’ve noticed he always leaves a three-second pause, whilst subtly nodding - allowing ample opportunity for others to continue speaking, before he responds. Furthermore, not a single errand is run by the cleaning or kitchen staff without him giving a proper thank you. Yaseen, who would do well at MasterChef Arabia, is the epitome of a great leader - assertive, courageous, sensitive and at one with the team. I look forward to catching up with him again on my final day at Hiteen/Schneller later this week, and he and I have agreed to keep in touch regarding any clinical or organisational matters once I have returned to the UK. I also intend on coaxing him to ‘lend’ me a recipe or two from his culinary repertoire!
Some images I’ll just never forget.
My customary journey through the Hiteen/Schneller camp in the late afternoon haze was as sobering as ever. The perverse polarity of feeling so connected to my patients yet so distant from the reality of their hardship is tricky to comprehend. I have two more days of work with JMAP before I fly back to the UK so I took a fleeting moment to pause and reflect during my drive home. I’m at the Jerash/Gaza camp tomorrow followed by Hiteen/Schneller again the day after. I am determined to squeeze as much out as I can from the remainder of my time here in Jordan. My learning curve - from a humanitarian, medical and social perspective - has been immensely steep. Not only have I connected with patients and colleagues, I have also managed to bond with close and dear relatives of mine who have been wonderfully supportive and proud of my work. They each have their own insights of these refugee camps either having provided charitable support themselves or by simply being erudite students of the world. Not least, my mother - who has patiently put up with me on a daily basis in our family home in Amman and ensures I visit all of my relatives no matter how exhausted I am - deserves at least a preliminary mention and a token of gratitude for her care and words of encouragement and wisdom, particularly when I’m debriefing about my challenging experiences. I’ll say more about my appreciation for her during my closing piece.
