Madaba Refugee clinic

A bit more on the refugee clinic in Madaba earlier this week. As I mentioned, there aren't many organized resources available for refugees who aren't in camps. So this group of volunteers with the Jordanian Women's Association has built up a mobile clinic structure with paper records, and a team of people that includes admin folks, a pharmacist and a doctor. They're based in Amman and go out to various towns on weekend days.

We saw bread and butter primary care with a few more complicated cases thrown in. The bread and butter were lots of upper respiratory infections, many patients with kidney stones (they call it urinary sand in Arabic), and lots of musculoskeletal pain. There was even a plastic surgery request from one teenage girl. But then there's the different cases like a very cute and shy young girl who likely had intestinal worms. A two year old boy with a foreign body in his ear. A five year old boy with an undescended testicle that must be surgically treated or he is at greater risk for testicular cancer. A three year old with a very audible ventrical septal defect, also needing surgery. His mother also thought he had transposition of the great vessels, but that seemed unlikely since the kid was rosy red and playing around with his brother. Once we see the records days later it turns out he has L-TGA, meaning both his great vessels and ventricles are transposed. This explains why he's not blue, but unfortunately he already has severe, irreversible pulmonary hypertension. We're working on trying to get a group to sponsor him for surgery in France.

The more complicated cases were a woman who had a cardiac catheterization showing narrowed arteries but couldn't afford stents. A man in his 60s with high blood pressure he thought was controlled (it wasn't) who had a high fasting blood sugar. Not only does he now seem to have diabetes, but is already having neurological problems in his legs, protein leaking from his kidneys and eye problems, all complications from diabetes. Plus with his blood pressure 190/95 he's at risk for even greater complications. We hope to see him again this Friday to follow up.

But when I say clinical care is a patchwork quilt, I mean that this is one of many volunteer clinics being organized out of Amman. But from what I hear the different groups organizing the clinics aren't coordinating to either concentrate geographically or on certain days of the week. So when the patients came to see us, unless they tell us, we have no idea what other services they are getting, what other clinics they are seeing, etc. There's rumors of this in the camps as well, where there are various hospitals/clinics run by different nations - Moroccan, Saudi, etc. Some patients go to a clinic a day, collecting medications for their ailments which they then sell in the camps.

So will we see these patients again? Who knows? The chances of being lost to follow-up seem very high. We took the names and numbers of those that needed surgeries to try and follow up with them once we can find a surgeon and some funding.

What determines whether a refugee goes into a camp or not? Basically two things - having a passport and the location of crossing. Syrians with passports can get a visa and enter Jordan like anyone else. Those without a passport are often fleeing imminent danger so have no ability to go through the official channels to enter the country normally. They arrive at the border, register with UNHCR and then are processed to go to one of the camps. However, there are a number of refugees without passports that have slipped over the border illegally. These refugees are especially vulnerable because they haven't registered with UNHCR, which theoretically makes them eligible for support from the UN agency.