“We are fighting with blunt weapons. Together”
Our programme to contain the spread of Covid-19 in North Eastern Syria is continuing. Having established 4 dedicated Covid-19 wards in the region and trained the health workers to run them, we went to see how intensive care wards in Italy were coping. And we started working with 4 doctors who helped us adapt the International Guide Lines for treating Covid-19 in a war zone. Our Medical Advisor in Syria, Chiara M., explains.
“For us the help offered by these doctors is priceless: here in Syria there nobody has the expertise to treat the most seriously ill Covid-19 patients and there is very limited equipment and technology. So the chance to be trained by doctors who have so much experience after treating the disease in Italy for months is a huge help.”
Chiara has been in North East Syria since August. After working during the pandemic in Italy, she came to work with us, and traveled all over the region so that we could equip 4 dedicated Covid-19 wards in the Kurdish Red Crescent hospitals we have been supporting for years.
Together with the other members of our medical team, Chiara has helped train local staff in handling serious and moderately serious cases of Covid-19 in Sub-intensive Care.
Because in Syria, there are no Intensive Care wards. And the few that exist, are not nearly as well equipped or well-staffed as their equivalents in Italy and Europe.
That is just one of the many consequences of 10 years of war.
“The work carried out by doctors elsewhere, is done here by nurses who have received some extra technical training in handling intensive care. But there is still a massive difference between treating non-Covid-19 patients and patients with Covid-19; they just do not require the same kind of treatment. There is a shortage of equipment and medicine, and the specialist skills for which nobody here has received training, so far,” Chiara explains.
The numbers corroborate this situation: the mortality rate of patients admitted to intensive care in Syria is 96%. Which means that a serious case of Covid-19 here is basically a death sentence.
So we were very enthusiastic when a group of doctors from hospitals in North and East Italy (Udine and Rimini) offered to provide assistance, training and advice to our local staff in Syria.
“These are people who have been working in Italian Covid wards since the very start of the health crisis. So they are used to working in situations which require flexibility and adaptability. We began discussing the project over Skype in November and our first joint initiative was to review The International Guidelines for treating Covid-19 patients in the Syrian context. To ensure they were applicable here, despite the massive differences in terms of availability of technology and resources”, adds Chiara.
“The technology available in Syria is completely different to what we have in Italy: We don’t have any of the equipment, specialised laboratory tests, or even sufficiently trained health workers: we are fighting the same battle but with blunt weapons”, she adds.
Then at Christmas time, Chiara came back to Italy together with Maria, another UPP Medical Advisor. They were invited by the doctors from the hospital in Rimini to visit their intensive care ward, to see for themselves how it was organised and take that knowledge back with them to Syria.
“That was extremely useful because we could get first-hand experience of the monitoring and treatment techniques used in Italy and review the Guide Lines together based on a better understanding of the context we would be working in. Corroborating our information meant we could adapt the Guide Lines specifically for North East Syria, and they are currently awaiting final approval. A meeting of all local and international actors who were involved in the region’s Covid crisis will soon be convened. We are all proud of our achievement”, explains Chiara.
Among the most challenging aspects that are faced by healthcare workers at the moment, one is coping with the loneliness felt by patients.
“One of the most striking characteristics of the Italian intensive care wards was the silence. Patients on ventilators are usually asleep, health workers are wearing PPE, relatives cannot visit, it was as if time stood still. A separate world, which felt very strange”, continues Chiara.
“Our wards here are sub-intensive areas so the patients are usually alert and able to interact with the healthcare workers. In fact, that is a key part of the therapy we provide. I am struck every day by how much our patients miss their families, but also by how caring and affectionate our staff is while trying to comfort them“.
The number of tests being carried out is dropping, as is the number of people coming to hospital with early symptoms of the virus. Not many people wear face masks or practice social distancing. But fortunately “there haven’t been any cases amongst our staff, which means we are doing a good job”, she adds.
So far there is no sign of the vaccine in Syria, whereas healthcare workers, including our friends in Udine and Rimini, are already getting their first dose, which means they can make plans to come and see us again in the field.
“We were always keen to come and join the team in Syria, but lockdown and quarantine restrictions meant it just wasn’t possible yet. We are hoping that the positive impact of the vaccination campaign will allow them to travel to Syria. They are very enthusiastic about our project and would love to be able to train field staff, which would be extremely helpful for us”, Chiara explains.
The most fundamental aspect of this new bridge that has been built between Syria and Italy is solidarity; the desire to work together and help each other: because that is the only way to free ourselves of this crisis.
Whoever is leading in the fight against the virus must reach out to help everybody else, so that nobody is left behind.