Working with a team of Jordanian anesthesiologists, Gupta was part of a project run by a team from Medecins Sans Frontiers, partnered with Handicap International.
Doctors from MSF and other organizations have been working in Syria and on its borders since the start of the conflict, as the country’s medical infrastructure has all but dissolved over the last three years.
Gupta talked to Syria Deeply about the challenges of treating a large number of patients with blast wounds, and why they require different medicines and post-surgery education.
I was working with MSF on their project in a hospital in the north of Jordan, just across the border from Deraa. It’s near one of the main crossing points between Jordan and Syria, so we were receiving lots of injured civilians, fighters, children. I was there from September through late November.
I was there as an anesthesiologist. We were treating patients all day and any emergency casualties during the night as well. It was myself and three Jordanian anesthesiologists we had to hire to work alongside us because of the workload.
We wouldn’t do anything without anesthetics if [the procedure typically] required anesthetics. We couldn’t always treat patients as quickly as we wanted to. There’s always an element of triage [in the field], but it’s perhaps more extreme working with Syrians. We’d get so many casualties arriving at one time: they’d come three or four in one ambulance, and there would be multiple ambulances arriving at the same time. We’d have to decide who went to surgery first.
Initially, the challenge was that we were struggling to cope with the volume and intensity of the workload. The number of patients and the severity of their injuries [got] worse. We hired more Jordanian staff to work alongside us, which helped. One of the big challenges for us was providing adequate medicine to these patients. A lot had injuries requiring amputation and had to return to the operating theater many times for different procedures, and a lot of them had neuropathic pain, which is related to injuries to nerves as a result of blast injuries. And obtaining the medicine needed to treat that [specialized] kind of pain was one challenge.
As you might expect, we didn’t have the facilities to treat every type of injury that came in, like those equipping neurosurgery and cardio-thoracic surgery. Those patients, we’d have to transfer to a different hospital. And when we did, that involved transferring them to a private facility within Jordan, and that incurred a cost. One of the Syrian doctors’ [NGOs] would pay for that.
In some ways, that last point is just a result of working in an emergency field hospital. But that was by no means the majority of patients; the majority had surgical injuries that could be dealt with adequately by us.
The feedback we got from Syrians was that they were very grateful for the treatment we were offering. People were also extremely grateful and somewhat surprised that they didn’t have to pay for it.
Some of the patients were dead when they arrived already, their injuries so critical that in the time it took to travel the the two kilometers from the border to the hospital, they died.
I remember one young boy, about 10 years old, who had lost both his legs in a blast injury. They were amputated above the knee, and it’s harder to walk [later on with prosthetics] if your knees have been amputated. These are the kinds of things I saw: people with legs and arms amputated as well. The nature of the injuries were all blast injuries from shelling. We did have gunshot injuries, but not many.
Blasts lead to horrible multiple injuries. People would come in needing a leg amputated and would also need abdominal surgery and have injuries to their faces and hands.The vast majority survived, but they survived with severe life-changing injuries like loss of sight and loss of limbs.
In the case of people who’ve lost limbs, we were working on this project with Handicap International, and once MSF had completed patients’ surgical treatment and it was a case of them requiring [outpatient] treatment, we referred them to Handicap, and they would then fit them for prosthesis and provide education about what it’s like to live with such an injury.