Goodbye My Little Friend...Goodbye Samir
Photo: Samir
When she was three years old, my daughter Amal would repeatedly tell me “When I grow up, I want to be a doctor, so that you will work with me”.
Years went-by and Amal graduated as a dentist in May 2015 from Boston University.
As a resident at the prestigious University of Texas Post Graduate Dental Residency Program, one of her tasks was to interview resident-applicants for the General Dentistry Practice Residency.
A question she asked one applicant led to a series of unexpected events. That question and the answer given became the prelude to a life-changing experience for many people, myself included!
A simple question she asked: “What was one of the more exciting things you did recently?”
The applicant answered: “Volunteering at Al-Zaatari Syrian Refugee Camp in Northern Jordan!”
Amal was not a person to keep track of international political events. Knew nothing about Al-Zaatari, and little about the Syrian Crisis and the massive refugee problem resulting from such.
Amal called me and we talked. I briefed her about what had been happening. I thought that was the end of the story and she would go back to her usual areas of interest; dental training, exercise, planning her future practice and other things that young people in the USA are concerned about.
Few weeks later, Amal called and said: “I want to volunteer at Al-Zaatari, I have called SAMS (Syrian American Medical Society) and they have a mission in January 2016. I want to volunteer. Will you go with me?”
Without second thoughts, I said “Yes”.
In the back of my mind, I had recalled what she had told me twenty-four years earlier. I felt she was reminding me of what she had stated as a three-year-old child many years ago!
Next thing I hear was that my youngest daughter Zeena had decided to go with Emma and me. Zeena, a senior in College at Emory University, decided that she would do her senior thesis on “Women’s and Children’s Aspiration for Education at Al-Zaatari, and the Obstacles they Faced”.
Amal and Zeena decided that “Mom” should go with us and make the trip a family experience.
Lina, agreed to join us. Accordingly we all went to Jordan.
Photo: Omar, Amal and Zeena
Amal posted our volunteer travel plans on her Facebook; words of encouragement and commitments for financial contributions to purchase needed supplies started to show up on her FB page.
A dear friend dropped-in at our home on Christmas Eve to deliver a huge bag of wound-care supplies and wished us well on our planned trip. She also made a generous donation to the mission through the SAMS offices; a much need help for all the services SAMS provide.
We arrived in Amman on December 27, 2015. We spent few days visiting with family and friends before the rest of the group arrived.
The seventy-plus group members were mostly from the USA, few from Europe, Canada, and UAE started to arrive before New Year’s Eve. Several medical and dental student-volunteers from Jordan joined us.
On the first day of January at 7 pm, I went to the orientation meeting along with Amal and Zeena. The weather was very cold. Snow was falling, and with the streets of Amman being wickedly slippery during snowy weather, I was fearful of driving my old Honda in Amman’s streets at night.
Amal was clear in her plans. “Dad, snow or not, we need to be there”, she said.
So I called my brother Ahmad and asked him if he would drive us in his four-wheel drive in that snowy weather. He did.
My good friend Bill Burke, President of Prevent Blindness Georgia, and a frequent visitor to Jordan, was already en-route to Amman via Paris. He was arriving that same evening. Bill had decided to join the volunteer team after we had lunch and talked about our respective holidays plans. Bill had been to Jordan many times over the prior two decades, starting in 1994 when I first relocated my practice to Amman between 1994-2000. I felt Bill had missed all the friends and “family” he has in Jordan and wanted to accomplish multiple tasks in one visit.
Before my departure, I called the Offices of SAMS in Washington to ask if Bill could join. I was told the mission was full, but they would make an exception and allow Bill to join, and so he did.
Bill flew out of Atlanta on New Year’s Eve and arrived in Amman on the evening of January 1, 2016. He was too late for the introductory meeting, and thus made his way to our home as our guest.
At the orientation meeting held at a local hotel, a young Syrian doctor named Bassel Atassi took the lead and gave introductory presentation on Zaatari and what to expect, what to do and what not to do.
Dr. Atassi, appeared to be in his early thirties, a graduate of the Jordan University of Science and Technology School of Medicine in Irbid, not too far from Al Zaatari Camp. After medical school in Jordan, Bassel completed his Hematology Oncology training in the USA and currently practices in Chicago.
Bassel was at ease in his role as mission leader. He knew all seventy people on the mission. He greeted every one by first name; knew specialties of each, and even slipped-in few funny remarks about the heart surgeon on the mission serving as dental assistant!
He knew all the volunteers before meeting any in-person.
He had done his homework, and did it well. He was impressive.
For me as a cardiac surgeon, it was not possible to do cardiac operations in the refugee camps or any of the small affiliated hospital. Thus my stated role was to “help” Amal with her work. I knew then that Amal’s prophecy was about to be realized.
The next morning at 6 am, my alarm went off. I checked my email. The weather conditions were acceptable for the 120-kilometer trip to northern Jordan. The travel plans were “ a go” as the snow was light during the night and road conditions were good.
The temperature was near freezing and we were advised to dress-up with warm cloth since the Zaatari clinics were not heated.
We left our Amman home at 7 am and drove to the hotel were the rest of the group was assembling. Two buses and a mini-van were waiting to take the group to the designated clinics at Zaatari and other camps in Jordan.
Ms. Jinan Shbat, trip coordinator along with the local SAMS team in Amman had everything organized. We were given sheets of paper with our names listed on which bus we were to ride and what clinical site to attend. Every day for the next 6 days, they provided assignment details leaving no one not knowing all the relevant details. They did an amazing job in organizing all aspects of the trip. They were impressive!
The buses moved. The mission officially started. During the hour and a half bus ride to Zaatari, I was apprehensive about what to expect and emotionally uptight about meeting mothers, dad’s, and children in the camp. Many stories had been written about Zaatari, many were fear arousing; some may have been true and many were probably fiction.
We all were apprehensive about the upcoming encounter.
I prepared myself to an emotionally taxing and possibly depressing situation. Soon I found out that I was not the only one, so did Amal, Zeena, Bill and many others. Everyone who was on this mission was apprehensive in anticipation of the unknown.
As we were driven to the camp, we approached the first security check. We had to show our identification documents to enter the camp. Team leaders presented the required documents along with the approval from the Ministry of Health to provide medical care to the camp population.
As we returned every morning and departed every evening we learned that the police guards would only allow people with special permits to enter or exit the camp. No one could enter or exit without government permission.
Zaatari, we learned, was home for eighty six thousand inhabitants; mostly women and children and to lesser degree older men and fewer young and middle aged men. Many of the women were widowed mothers caring for their orphaned children; all product of a brutal war that started as part of the infamous “Arab Spring”.
The war in Syria has become a war made of several raging wars between so many different parties, armies, terrorist groups and others, each supported or allegedly supported by, or getting direct or clandestine support from regional or international powers.
For me, it was hard to tell who was fighting who and for what reasons. Thus I decided that I would focus on providing medical care to anyone who needed it. No questions asked about ethnic or political affiliation. That was the simplest way to deal with complex and changing alliances; they were too difficult to sort out. Caring for the needy without being concerned about political affiliations was in keeping with my medical oath, and my long training and practice in the United States.
In my career as a surgeon in Atlanta, I operated on and treated many victims of violence; stab wounds, gunshot wounds and others. I treated victims and assailants injured in various altercations. I learned to provide the same best care to hard-core criminals as I did for innocent victims. Once an ill or injured human became my patients, I had responsibility to be his/her best health advocate and never asked questions about irrelevant personal history. All patients deserved best care, no questions asked. I decided to apply those principles at Zaatari. I did not ask what political affiliations anyone had. That plan made my work simpler.
The “refugee camp” was surrounded by barbed wires from all directions with heavy police presence. Apparently at its heyday, the camp housed nearly 200,000 people, coming from differing towns and cities and often from conflicting backgrounds. Until security was tightened, the camp was a place for conflicts not un-similar to those back in Syria. The Jordan government established security for the benefits of all the camp residents and did the best possible to provide much needed help, often with some international support from donor countries when available.
On the first day, I visited the dental clinic; a small 10 feet by 30 feet mobile wooden and steel structure fitted with three functional dental chairs and basic dental care necessities. The dental X-Ray machine was broken. The electricity would come and stop erratically. But thanks to an electricity generator, the work in the clinic was non-stoppable. I quickly realized that my ability to contribute to dental services were rather limited. My experience in dentistry was limited to me serving as a patient at my dentist’s office!
So I offered my help on as-needed bases to the dentists. It was graciously accepted, but used only occasionally. As it turned out later, my relations in the country came in handy.
Photo: Dr. Amal at work.
On the first two days, I volunteered in the emergency room where I saw several children with second degree burns on their arms, legs and chest; all resulting from scolding water falling on their small bodies. I came to know a care provider, named Mohammed; a man in his early forties, tall, handsome, with a neatly trimmed short beard. Mohammed was soft-spoken. He was there all the time, examining and treating the small patients with amazing spirits, kind attention and genuine care. He would console each of the children, clean the burn or injury site, apply soothing cream impregnated with anti-bacterial topical agents, and instruct the parents on further care. Meticulously, he would apply clean dressings to the wound to help alleviate the pain, and keep the wounds clean.
I saw several cases of severe tonsillitis; two in one family of three children ages 9 and 7 years. The dad told me that at night the children would be coughing most of the time and complaining of difficulty breathing. In the USA, we would have admitted those children and closely monitored them for any signs of impending upper airway obstruction. That option was not available at Zaatari.
We prescribed antibiotics with instructions for patient to return to clinic if fever did not go away or symptoms persisted. In several cases, we kept patients in the clinic and gave them initial doses of intravenous antibiotics, then issued additional by-mouth antibiotic treatment.
Being a cardiothoracic surgeon, I was out of my complex specialty as cardiac surgeon for those few days. There was no cardiac surgical operating room, no ICU, and no surgical team. Thus I became the local “expert surgeon” to see potential surgical cases that needed further evaluation or referral.
On one occasion, I was asked by an internist colleague to evaluate a young woman who had fainted in her clinic. To my exam, she was tachycardic with heart rate of 112, had low grade fever of 37.6 and vague abdominal and flank pain. I suggested we obtain a complete blood count to assess if she had evidence of infection, and to obtain urinalysis to assess if the source of her pain was a urinary tract infection. The recommendations were accepted. I left follow-up to the internist, as I was convinced she the patient did not have a “surgical abdomen”. I hope the patient has done well.
Another patient I saw was a young man with dry cough and fever. I ordered a chest X-Ray. To my surprise there was a right upper lobe lesion. My colleagues and I reviewed the film and became concerned that he may have had pulmonary tuberculosis. Thus we immediately, separated him from the rest of the patients and notified the camp administrator to arrange for further testing outside the camp. We learned that in north Jordan there was a “Christian Hospital” that had been in existence for many years treating TB patients. Our patient was going to get an appointment there, the following day.
On the ensuing days, I spent part of my time helping my friend Bill Burke with the visual screening exams he came to conduct. My daughter Zeena would help us too.
The Syrian Clinics’ waiting room was a barely-roofed assembly area with metal benches lined in parallel. With ambient temperatures approaching freezing points, those metal benches were awfully cold.
Every day, we would start our work in the unheated and painfully cold and damp clinics. To stay warm, we kept our heavy cloths on. It took many layers of clothing to keep us from freezing and able to work until the heat of our bodies and those of our patients would warm the metal walled clinics.
In the eye clinic, we started seeing children as young as 2 years of age and older. We even examine patients in their late sixties and seventies. We did not turn anyone away.
Bill brought with him individually wrapped candies to give to each child after her/his exam. Pretty quickly, the eye clinic became the “candy store” for the camp kids. It was difficult to stick to our plans; one exam, one candy. We enforced a policy of no returns for more candy. We had to ration the candy and use it only for the specific purpose intended.
Three young boys, ages nine or ten years each, showed up on the first day for their exams. Their eyesight’s were good. Each was given a piece of candy. They went away, only to come back back with several new young kids, each to be examined and take a candy. Quickly we realized the three children Samir, Abdullah and Abdul Kader, became our strongest recruiters. They would go, inform moms and dads (when present) about the free eye exams, and bring children in. The three boys became de-facto part of our team; recruiting patients and helping other children on where to stand and how to focus.
Photo: Bill Burke with Samir and children
The next day, Samir; most vocal and assertive child of the three, showed up and asked: “Where is Ms. Zeena?” He wanted to help Zeena recruit more children and get their eyes examined.
The following day, he returns and asked for “Aunt Zeena” and again he helped in guiding young boys and girls to the eye clinic and exams. To our surprise, he never asked for another piece of candy or failed to follow the rules we had set for him.
Samir was cooperative, always showing-up on our arrival and leaving the clinic at 11 am to attend his school and return back before our afternoon departure.
In the afternoon, Samir would hang around and ask questions about where we came from and how did we become doctors. I could tell that there was a lot of thinking going on in that child’s mind. Ceasing on the opportunity, I encouraged him to take his school seriously. He seemed to understand that in order to become a doctor he had to intently focus on his education. He would nod his head in the affirmative.
Samir became a frequent visitor and helper in our clinic. Before school and after his school, we would find him hanging around, often waiting to talk to Zeena.
He was quiet, inquisitive and with piercing eyes. Samir was a good-looking kid, round faced, light-skinned; burnt by the summer’s sunrays, and with dirty blond hair. He was skinny; barely weighing fifty pounds. He was polite. Always wanting to help, but never getting in the way.
We all took liking to Samir. We would inquire about him when he was not around. Afterward, we all realized that each one of us would look forward to see him everyday. As Bill said: “I could not get this child out of my head”. Interestingly, Zeena and I had the same feelings about Samir!
The dental clinic was very busy on the first two days. Emma and her two dental colleagues; Mohammad who was also a graduate of Boston University a year ahead of Amal, and Tareq; an energetic dentist who had finished dental school in Syria and did additional training in the USA and currently in practice in his new home, the United States.
Photo: Tareq and Omar
In their first two days, they collectively performed over one hundred complex extracts, cavity repairs, and other dental surgical procedures on children and adults. The dentists were the first to start their work and the last to finish. They had so many patients waiting to be treated. They would not leave the camp until the last patient waiting was treated. Every day, the last bus leaving the camp was for the dentists.
On the morning of the third day, bad news came to the dentists! Orders from the camp director instructed the dental team to cease and desist! They could no longer provide dental care to the camp patients. The stated reason was that the clinics were not “certified”!
The bad news came down hard on all of us; particularly on Amal and her two colleagues. They went to Dr. Bassel and to Jinan for inquiry and help. Dr. Bassel and Jinan were dumbfounded and speechless! They searched through their permission documents, and to their surprise they found that one document received on New Year’s Eve, after most of the team had already landed in Jordan, had a sentence at the tail of the approval letter excluding the Dental Clinics!
That finding came down like a lightening bolt on the dentists. They were upset, frustrated and angry.
Amal came to me and said: “Dad, we need your help in getting back to treat our patients, you have many influential friends in Jordan”.
“But rules are rules” I said. “It will be hard, if not impossible to reverse the decision. Lets go back to Amman”, I said.
That was not the answer Amal expected or wanted to hear!
“We came to Jordan for a mission. And we are going to complete our mission. We are not taking a “no” for an answer”, Amal determinately replied .
“Give me your Jordan cell phone. I am going to call the people you know and ask them to help” she said.
And so she did. She called a dear friend who had hosted a couple days earlier a very nice dinner for us, his family and few more friends at one of Amman nice restaurant. My friend, a highly respected former Prime Minster of the Country, took Amal’s call. She complained to him and asked for his help to allow her and her colleagues to finish the task they came for.
In the next few hours Amal was making call to, and receiving calls from important government officials including the Minister of Health.
While the above was happening, Amal through one of the Jordan dental student volunteers, posted the “dental shutdown story” on Face Book and listed my Jordan cell number for “helpers” to call.
A phone call came from a young woman. She wanted to speak to Amal. The caller was the daughter of an official of Zaatari camp. She offered to call her dad and to ask him to help resolve the situation.
Over the next couple of hours, Amal and her dental colleagues were politicking on the phone trying very hardest to get back to work.
Later on Amal learned that the person who came and shut them down was the father of her “new Face Book friend”, who had called earlier. Promptly Amal pulled my phone, searched through the “recent calls”, and called the young woman back. “So he is your dad who did shut us down! What is his phone number? Can I call him and ask him to allow us back to work?”
Amal called the officer, told him she was a “friend” of his daughter and pleaded for help. She told him that they incurred so much expense and hardship to come for a mission to help the needy refugees, with whom they had bonded.
The officer replied in the most kind of ways, not uncommon for Jordanians, and stated he would do his best to intervene and get them back to work, if at all possible.
By late afternoon, we were becoming more hopeful, yet uncertain, that the goodness of the Jordanians was about to come through and that an exception would be made. We did not know for sure if the dentists would be allowed to work again or not.
The next day, we decided that we would take our chance and make the hour and half drive to the camp, in hope that approval would be granted.
As we assembled at 9:30 in the morning, a gentleman arrived to the clinics, introduced himself as camp vice director with permission granted to resume work in the dental clinics.
Within minutes, patients were in the dental chairs being anesthetized and undergoing much needed dental care. It was another super busy day for the three young American dentists.
The dental clinic had twice as many patients; those who were not treated the prior day in addition to those already scheduled for that day. The dentists had a double load. They worked non-stop all day long. No breaks. No lunch. Just treating one patient after the other until all patients were treated. No one was turned away. They upheld their responsibilities to their patients and profession.
Finally my child of three years of age had convinced me that she had become a serious grown-up professional. Amal’s image changed forever, in my mind. The little girl faded away and was replaced by a serious and determined professional. It took Zaatari to convince me that Emma was no longer a child!
Afterwards, Amal shared with me an encounter she had with the crowds who were competing to be treated. It was very chaotic and disruptive until she stepped out of the clinic and stated her policy.
“Please write your names on this sheet of paper. First come first serve. I will not leave until all of you are treated. Once you enter my clinic, you will be my private patient. In my clinic you will not be refugees you will be patients. You will be treated with the same respect and attention I treat my patients in the United States”. From there on, the clinics ran smoothly.
As we were winding our work in the mission, having examined the eyes of over 350 children and adults, and referred about forty with major vision issues, and Amal and her colleagues had treated another three hundred-plus dental patients, we were ready to head back to our bus to take us to Amman for the last time.
As we sat in the bus waiting for the rest of the doctors and nurses to join us, I noticed a little child sitting on the side of the road with his back to the corner of a small trailer and a nearby water tank. His head was pointing down. He was almost motionless. I watched him for few minutes. He was quiet, and did not move from his position. He seemed depressed, I concluded.
I looked closer; I realized that the boy was my friend Samir. I assumed he knew we were departing and will not be back again. In his own way, he wanted to say farewell, but did not want to impose on us.
I turned to Bill, and said ” Bill, can I have a handful of candy? I want to give to Samir and say goodbye to him”.
Bill quickly reached to his bag and grabbed a handful of candy and said: “Please do, I cannot get Samir out of my head!”
I grabbed the candy and started to step put of the bus to hand Samir the candy when Zeena said: “Dad, please let me have the candy, I want to give to Samir”.
Zeena stepped out of the bus; walked toward Samir, knelt on the ground before him and extended her hand with the candy. I could see from my seat Samir’s hand reaching out for the candy with his head still pointing to his feet.
The bus filled up. The driver wanted to move out. I called for Zeena. She waived me to wait! I did.
Few minutes later Zeena came back to the bus and took her seat quietly and without saying a word.
Her eyes did all the talking with tears flowing down her face.
As the bus moved out, Zeena was sobbing. Bill and I were speechless.
The bus moved out. Samir remained in his position as his view quickly faded away.
But from our heads, we could not remove Samir.
He stayed with us as a living memory of Al Zaatari camp and all the people suffering from a painful war.
Back in Amman that evening, I met with the Dean of the Jordan Medical School and two of my cardiac surgical colleagues. We discussed possibilities of collaboration to provide future cardiac surgery care to refugees. The dean and his faculty were very supportive.
As we departed Amman and returned to our home in Atlanta, Samir became symbol of Al Zaatari camp, and will stay with us for years to come.
We all went to Zaatari to treat refugees and heal patients. We did. Equally stated Zaatari healed my inner soul and made me a more caring physician. Many of my colleagues felt the same.
Zaatari was a life-changing experience. It will stay with me to the rest of my life.
And as this mission came to an end, I said goodbye to my little friend. Goodbye Samir.
I hope we will meet again!
Omar M. Lattouf/Arab America Contributing Writer
(Omar Lattouf is a cardiac surgeon and a professor of surgery at Emory University School of Medicine in Atlanta)
