July 17, 2018
You have to imagine the “pharmacy” here. The physicians are in the sweltering heat, and fans help…when the electricity works. Each doctor sees 20+ patients with most encounters ending in a prescription scrawled on a chit of paper. The patient clutches a script and makes their way outside to our Syrian pharmacist – who sees all of his patients outside, without our comforts. His backstory is fraught in ways we can’t describe in this post, but he somehow survived to become the focus of these streams of prescriptions, with an unwavering smile.
Ahead of time we had each come with two suitcases of medications and supplies. SAMS had already gathered their own collection of drugs as well. During this trip, we’ve learned so much pharmacology. We had to remember what Benzoyl Benzoate treats (hint: it’s not acne). We McGyvered salbutamol MDI spacers using water bottles. In this place, vitamin prescriptions have real meaning because of the prevalence of malnutrition and iron-deficiency. And overall: so much albendazole to treat worms. The pharmacist pulls each thing out of what is literally a pile, and he freely substitutes the closest medication. Easier to do when no one is allergic to anything ever (hello hygiene hypothesis).
In a room with a pediatrician, an emergency medicine physician, an internist, and a cardiologist, it was common for one of us to step out and consult with each other. Since there were many more pediatric patients than adults, the cardiologist and internist also became pediatricians. The female physicians became gynecologists, and the emergency physician trained the internist on the use of transabdominal sonography for pregnant patients. This was seamless, despite the differences in institutions and training. All ego was stripped away, there were no turf battles, and all that remained was ensuring that the patients in front of us got the best care.