Career move: Medical missions

Wael Hakmeh, D.O., FACEP, has served on multiple physician medical missions with the Syrian American Medical Society (SAMS), a nonpolitical organization that does medical relief work in Syria and around the world. He has arranged his schedule as a locum tenens physician in a way that enables him to make trips several times a year. 

Prior to arriving in Syria, he taught an emergency medicine/critical care course to Syrian health care workers in Turkey, preparing them to treat the traumatic injuries commonly seen there. Hakmeh was honored for his volunteer work with the 2016 MedicalMissions.org Physician of the Year Award.

What do you like best about being a medical missions physician?

Medical mission work gives me a chance to practice medicine for the reasons that many of us went into medicine: to help those who need it the most. In Syria, more than 95 percent of the physicians who were once there have been imprisoned, fled the country or were killed. 

A lot of health care providers get killed by indiscriminate government bombings. The Syrian patients I met are some of the warmest and kindest people I’ve ever met, so to be able to practice medicine there is the most rewarding thing I’ve ever done professionally.

Did you specifically request to go to Syria?

Yes, a couple of my colleagues shared with me their experiences from working there—I’m very grateful to them. Several times I planned on going into Syria, but for different reasons, of the five times I planned to go, I was only able to twice. While I’m confident working there helped patients, I always left there feeling I benefit the most personally. 

The strength and perseverance of the people there are uplifting and difficult to put into words without doing injustice. The presence of volunteers lets them know they are not there alone and that the world has not forgotten them even though in reality, it has. So I think what I and the other physicians provided was as much of a psychological boost as any life-saving procedure we could perform.

How long do you spend there?

It was a short time, usually about a week. You have to factor in that you can get stuck at the border, and there’s a lot of uncertainty with the bombing. The roads can be closed. At the time I was last there, there was only one road in and out of Aleppo, dubbed “the road of death,” and now that road is cut off [before the siege against the entire city ended]. There’s a lot that has to be taken into account. 

If I could have stayed longer, I would have. We spent the greater part of a week training Syrian physicians and medics in emergency medicine and ICU training courses in Turkey prior to my work in Syria. My whole trip is usually 2 1/2 weeks.

How many trips have you made?

I’ve been to southern Turkey seven times, where we had the training courses. I was able to go into Syria twice. For a number of different reasons, I wasn’t able to go into Syria. One time, the border was closed and they would not let any health care professionals cross. . . . Another time, I tore my ACL a few days before playing basketball.

What don’t you like about medical missions?

There wasn’t much that I didn’t like about it. The biggest thing that bothered me was the number of preventable deaths and injuries. For example, my first day there, a barrel bomb was dropped on an open market as people were shopping with their kids. Fifty people were killed that day for no reason. 

These aren’t people on battlefields, just people shopping for fruits and vegetables trying to figure out what to cook for dinner. This part of it was frustrating. The lack of news coverage about the deaths and injuries was, too. One night, 40 people were killed and the bodies were lined up . . . a lot of horrific scenes. I went online that night to different news outlets, and there was no mention of the incident. That’s why the people feel that the world has turned their backs on them. Medical missions expose its participants to uncomfortable truths of grave injustices.

What surprised you most?

The limitation of resources. The destruction is beyond anything that Hollywood could produce—the oldest civilized city in the world with a population of 3 million, reduced to rubble. It’s an unbelievable level of deprivation. 

It surprised me that the surgical room had a bug zapper in it, particularly in a country that had an excellent health care system 10 years ago. What appeared to be a soda machine was actually a blood bank. There are shortages of all medicines. Bringing narcotics across the border is not possible. I had to put a chest tube in a man with no analgesics at all. He begged me to let him die. Pain medication has to be rationed. This should never have to happen.

Do you have any advice for physicians considering medical missions?

The first thing to do is to find something you feel passionate about. Look for a credible and trustworthy organization to work with. Preferably, find something you can benefit from in whatever field you are in. 

Working as an emergency physician meant working in Aleppo made more sense than on the periphery where people by definition are stable. Talk to other physicians and learn from their experiences. Insight into which medical missions are good is generally [gathered] through word of mouth. 

If you decide to go somewhere where you could be in danger, you really need to give it a lot of thought. Pray and make sure you are 100 percent mentally and psychologically onboard.

Is there anything else you’d like to add?

As I just mentioned, pray about it. Make sure it’s what you want to do, particularly if it’s a dangerous venue. Once you are there, fear should not drive or dictate anything you do. Take a lot of stuffed animals as kids really love that. 

A lot of times, it’s not the medical work that we do; it’s your actions and genuine caring that people notice. It’s very meaningful and uplifting that somebody came thousands of miles across the ocean to care for them. That will do more good a lot of times than any application of medical knowledge will. Do your homework. Learn about the culture of those you will be serving as provision—culturally sensitive care maximizes your effectiveness as a physician.