From Al Zintan to Misurata
In Al Zintan the new part of the hospital is still under construction. Most of the hospitals had their names taken off from the front facades because many of them bore Gaddafi's names and pictures. Today being Sunday we went to the hospital with Lofti, the Tunisian ER nurse. We visited the Women's and Men's wards, there were no hospital sheets on the bed except what the patients brought with them. There was a boy who accidentally shot off his thumb while playing with a gun left over from the revolution. The pregnant women looked rather old and careworn. There were two OR rooms: one for clean cases and the other septic cases; in the cabinet, they had anesthetics and anti-arrhythmic. Neuza proudly showed us his anesthesia machine and Hassain his pharmacy. There were several Libyan women with hijab running the laboratory.
Mondays and Thursdays are circumcision days. Mothers, fathers and baby boys lined up outside the OR. The baby boys all had angelic faces with beautiful and innocent smiles sitting patiently on the laps of their mothers all covered up in black or floral abayas; behind the veil roving eyes followed me. I wasn't sure whether they were smiling behind the hijab. The babies were blissfully unaware of what awaited them. A four-year-old boy was screaming his head off when he was carted off for his circumcision. It must be very traumatic for him since he was likely to remember this event more than the younger ones.
Right when one of the boys was being prepared for his circumcision, a young man with a gun-shot wound just below his xiphoid was carried into the ER with a low blood pressure, rapid heart rate and he was not breathing. Soon he was intubated and fluids were poured in, blood seeped from his back into the stretcher. He was ashen and pale. Several times he lost his blood pressure and was given epinephrine which boosted his blood pressure transiently. He finally got his blood transfusion and was transferred to Juda Hospital via an ambulance. Later I learned that he did not make it.
We met with the Medical Director of the hospital of fifty beds. He was interested in changing the infection control practices of the hospital personnel and showed us his lectures slides in Arabic. From my previous experience in Hospital Epidemiology and Infection Control, I could not foresee changing behavior in the relatively short period of time we had in Libya and did not volunteer for this education endeavor but my partner volunteer went for it. In the meantime I had been on the phone and e-mail communicating with Tripoli to send me to Misurata closer to where I could provide medical services to the IDP. There are now news about people being displaced from their homes and need medical treatment, food, water, fuel and clothes in Wadi Imrah, Twarga and Washka and the clinic at the Field Hospital in Sirte, 50 km from the frontline also needs a doctor and an obstetrician. The IDP were housed in abandoned homes. Today I will say my good-bye to the friends I have made here and my fellow volunteer who had elected to stay at Al Zintan.
I took the long trip from Al Zintan with Dr. Fatma, an obstetrician from Nalut to Tripoli and from there we were to travel to Misurata. The driver came late and we did not leave Al Zintan till after three in the afternoon. It was well past six in the evening when we arrived at Tripoli and traveling in the dark was ill-advised. Dr. Fatma and I thought we would be spending the night in Tripoli and resumed our journey in broad daylight. However we were told that our new driver was ready to drive us to Misurata that evening. And so we had a brief pit stop and left Tripoli. Soon our driver fumbled for a cigarette, I threw a quick glance at Fatma. Before he could light up, I decided that I had to ask him not to. The driver muttered to himself that this would be a very long journey without a cigarette now and then but he acceded to my request. Fatma tossed a look of gratitude in my direction. To add cigarette smoke to hunger, thirst, fatigue and stress, all triggers for a perfect storm for the setting of a fulminant migraine, I would gladly risk the driver's displeasure. When the evening light was still lingering, we caught glimpses of the Mediterranean Sea and its beaches to our left. There were quite a number of vehicles on the road at this time of the night, the people who drove must have a compelling reason to do so.
We drove in silence for two and half hours through at least two dozen check points, all heavily guarded. I was thankful to have a Libyan woman traveling with me. As we got close to Misurata, our car was pulled over to the embankment twice and the armed guards demanded our IDs and passports. Our driver left Dr. Fatma and me in the car in the dark and went with the guards; this was his chance to light up. It seemed like ages before he finally returned with our documents while the guards checked the trunk. Some check points had 5 to 10 armed guards and tanks. It was dark by the time we reached Misurata. We were in some sense violating the security guidelines that I went through before departure: we were strictly forbidden to travel after dark.
Our driver took us to the IMC office. Tired and hungry as we were, we were kept in the office for a security briefing and updates on the possibility of setting up a mobile clinic for the IDPs. After an hour the driver was told to take us to the guest house. Since we had not eaten in a while we asked him to take us to a store to buy food. The store keeper refused to take my 10 dinars calling it “Big Money” and “Gaddafi’s money” and looking at it with disdain. I changed my dollars to dinars in Tripoli which supported Gaddafi during the uprising and evidently the people in Misurata did not accept the currency. Misurata received one of the worst and brutal attacks from Gaddafi's forces. The 10 dinar bill in Tripoli was much bigger than that in Misurata in size, perhaps as big as Gaddafi's ego. Fatma loaned me some dinars. There were not much food to choose from but we had to cook something to eat for the night and for days afterwards. I settled for some pasta, rice, onions, eggs, tomato paste, bread, grapes, canned tuna which seemed to be in abundance. In Misurata we had to be our own cook.
Back at the guest house, the sheets were unwashed, I was glad to have my travel towel and large shawls that I could wrap myself in bed for the night. Tomorrow I would contrive to wash the sheets. Because of the war situation, we were asked to pack lightly for Libya so that we could pick up and leave at the spur of a moment if the need arose. I did not pack sheets.
In the early morning I took a walk around the guest house. Many of the stores remained closed, some with screens riddled with bullet holes but there were a few cars roaming the streets. Pictures of Gaddafi and his strong men wearing hideous make-up and draped in colorful hijab adorned the door and walls of an office. Long lines of men queued up in front of a bank. On the ground floor of our guest house was a man who could change some money for me so I could have the dinars that Misurata would accept. From the kitchen window I could see a huge "Free Libya" sign and several significant dates scrawled over the walls.
One tends to forget that Libya is in North Africa and as such it is still part of Africa and therefore African Time is still at play here. Our driver did not show up for at least two hours. He showed only after I made several phone calls to the logistician borrowing someone's cell phone. His phone was out of range for a time and he could not be reached. Despite a promise for the use of a cell-phone at least for security reasons, I did not get one. The field coordinator had turned off her phone. As one traveled closer to the Field Hospital, one could not be reached except via a satellite phone.
Walid, our driver finally appeared and drove Falid Abood, Ikrimah, two Jordanian nurses and me to Twarga, a town 20 miles south-west of Misurata. These two nurses have been here for the last five months volunteering in the hospital. The big highway was cut up with wide trenches by the Freedom Fighters to trip up the tankers of Gaddafi during the fighting. A line of cars came up from the opposite direction carrying people fleeing from Sirte where fighting is active, some carrying furniture and mattresses. They had to pass through several check points. Along the road sides were strewn mangled war machines, spent shells and burnt tires. Miraculously many of the date palms stood intact with a few charred ones and one sustained a hole in its trunk but still stood tall and erect. The dates are in season and many goats are seen feasting on the fallen fruits. The landscape was one of dusty, hot and arid semi-desert. Walid fought in Misurata and knew many of the Freedom Fighters manning the check points, we had no trouble passing through them.
We visited the committee center that oversaw the IDP (Internally Displaced People) who left Sirte to stay in the abandoned apartment complex in Twarga. Twarga was a strong supporter of Gaddafi and when the Freedom Fighters moved in the people in Twarga fled. In contrast to other refugee camps I have been to, there are no tents here. The IDP live in the relative comfort of an apartment minus the amenities. Apparently 10 families live in this complex each with between 10 to 15 members. Water is supplied via a tank and they also receive ready-to-eat food as there is no electricity. A pharmacy was just set up on the day of our visit. Amjad, our logistician told us that he was sent the wrong pallet of supply so we could not deliver the needed medicines. The committee quarter is piled high with food, trash and kitchen supplies and a roomful of boxes of medicines that just arrived today; they have oral hydration solutions but request medicines for diabetes, hypertension, analgesics, cough medicines...In this same room a row of menacingly looking Kalashnikov's lines the walls.
One of the Freedom Fighters in his traditional clothes with an AK-47 slung over his shoulder and the pharmacist, Abdul Rahman, accompanied us to visit several families. We greeted each other "Salamu allaikum" " Allaikum al-salaam". Women stayed out of sight inside the apartment while the men lounged on carpets outside. Inside the apartment was littered with mattresses. A fierce wind whipped up sand as high up the third floor, coating the stairs with sand. The women were just as curious about me as I was about them and they brought my attention to the few pregnant women there. Hypertension, diabetes, diarrhea and headache are some of the complaints. The children are the ones suffering from diarrhea. The apartments reeked of human waste. Children played around the water tank and with buckets of water to get cooled and inevitably drank the contaminated water as well. The grounds of the complex were filled with garbage and plastic bottles. There were large pits to bury some of the trash but these did not seem to have kept up with the trash that was being generated daily. Spent shells were found scattered on the sandy soil. Our hope is to provide some medical care for the IDPs in several of complexes here.