No more nights in the hospital

كلكم من آدم و آدم من تراب 
Kulkum min Adam wa Adam min turaab 
All of you are from Adam, and Adam is made of earth 

Yesterday there was a bombing in a mosque in Damascus. Sheikh Booti was killed after prayers by a suicide bomber who took around forty others with him. The head of the SCI house spat on the floor, cheering the death of this hated supporter of the regime. He's ecstatic and sees the fact that the bombing was in a mosque, or that it took forty others with him, as necessary evils for a greater good. For emphasis he added "Allah MA yrhamu" - may God NOT have mercy on him.

He tells us this as we're on our way to a funeral for Abu Hussein, the patient I took to the hospital one night a few weeks ago. A man who was shot on the outskirts of Damascus, paralyzed, and slowly deteriorated over two months until he passed away. Another casualty of this war. But Abu Hussein didn't die in a mosque, he died in a hospital, after multiple avoidable complications. Allah yrhamu.

Dr. B and I heard the news after a long day in Za'atari where a patient told me she was going back to Syria that afternoon. I asked about security and why she was going back. "Sooriya ahla" she said - Syria is more beautiful.

We stood on the main street watching kids throw rocks and kicked ourselves. We admitted Abu Hussein to the hospital and visited him once but figured, hey, he's in the hospital, they're taking care of him. What could go wrong.

We admitted him for his breathing, but he had been having diarrhea for weeks before arriving in Amman. While being treated for presumptive pneumonia his diarrhea resolved. But he was not on a bowel regimen, and paralyzed people can often have difficulty moving their bowels. I hear that he had eight days of constipation before he developed a small bowel obstruction. He was taken to surgery and did not do well. After two days in the ICU, he passed away.

We then stood in the cemetery, among the men who arrived in cars with Syrian plates, placing Abu Hussein in his concrete sarcophagus. Concrete slabs wedged over the box and sealed with mud clumps hurled with a thud.

If Adam is made of earth, he seemed angry today. A sunny morning turned into a dust storm that seemed intent on burying us all. The pale orange horizon consumed the mountains in the distance. The dust storm met the funeral procession as we walked into the wind.

Being buried in a strange land means no one knows you're the brother. It means you don't know where you need to be during certain times for certain rituals. But I recognized him by his hands. They're disproportionately large and today he struggled more than usual with where to put them. I love his Arabic. Long, drawn out vowels and his slow speech, like he's ordering a delicacy in a southern restaurant, make him simple to understand.

He recognized us and we hugged; his beard had grown longer but didn't hide his sadness or the clear disorientation. He was late to the line where everyone passes to shake hands. I wanted to ask how did things get so bad so that Abu Hussein passed so quickly. Ask why he didn't call us sooner. When I shook his hand all I could say was Allah yrhamu. He is a martyr now. Insha'allah he said, his eyes full of tears that the orange dust smeared and pasted down his nose.

A man from Abu Hussein's home town said that as the situation deteriorated he told Abu Hussein he was going to get Abu M and me. He died two hours later. He wanted us to know Abu Hussein died thinking we were on our way to see him.

The attendees disbursed with the wind. Abu M and Dr B recited the Sura Ya Sin over the mound marking Abu Hussein's body and we walked back to the car. On the way we passed by the next wave of graves, the cementery:

 

The FSA does not exist

In other news, this is a great post by Joshua Landis on the fact that there really is no Free Syrian Army in the context that we would know any army. Please keep this in mind when you read my posts as well.

My favorite line:

“According to photographic evidence seen by this reporter, it seems like ten guys from a tiny village outside Idleb have recently been lobbing mortar shells at a blurry target in the distance while shouting ’Allahu Akbar’.”

Reunion

The family I lived with in Damascus in 2004 was not your typical Muslim crew. The mother wears a hijab, but the daughters don't. In most places, even having men over to your house is haram - forbidden - but in this house there were multiple single, foreign men living with single, unhijabed women. We were the scandal of the neighborhood, but we also had a lot of laughs. This is where I met Andrew, now one of my good friends. Its where I took my first colloquial Arabic lessons (from one of the daughters) and also where I learned all of my Arabic curse words (from the matriarch, no less). I had recently finished one of my pediatric rotations, so the family liked to humor me, saying I was Adam's doctor, Adam having been born a month before I arrived. Adam is now 8, beat me at chess, and can handle himself in English, Arabic and Danish.

Last time I saw them, it was 2006 when my brother was in the Middle East. We took a service mini bus up Muhajireen and had a small dinner with the family. Since the war started I'd been afraid to contact them because I'd heard of people who were arrested being kept longer or worse just because of things written by their friends on Facebook.


Then I heard they were in Amman and reconnected. Andrew, who is spending most of his time in Turkey, happens to be in Amman this week, so we had a semi-family reunion.

The youngest was seven classes from finishing a degree in English, but things were too unsafe in Damascus to continue. They've come to Amman, but everything is more expensive - medicine, oil, transport - meaning that the fees one daughter charges for Arabic lessons are barely making ends meet. The matriarch has growing cataracts in both eyes, but surgery is very expensive and must be paid for out of pocket.

Sounds like stories I've heard from refugees in Amman, in Za'atari. But this one hits a bit closer to home.

White man's ice is colder

There is an old joke or fable among the African American community...It goes like this, in this small town, a black man was selling ice to the people of the town. He was making a good living from his ice selling business. A white man, seeing the profit in such a venture started a competitive ice selling business. The Blacks in the town began to buy their ice from the white man. When asked why the change, they answered "the white man's ice is colder".

"White man's ice is colder". I love how succinctly it shows the ridiculousness of internalized, institutional racism even better than the famous Clark doll experiment that paved the way for Brown v. Board of Education. Its a persistent problem in minority communities in the US, in post-colonial societies and its something I've witnessed in the medical community among doctors from Syria, Lebanon and Jordan.

When I was in Beirut, I was impressed with the level of care at the two hospitals I worked at. Residents there knew their stuff, worked their butts off and could handle anything that came in the door. One resident I knew had memorized every diagram in all 1500 pages of Harrison's.

To my surprise, there was a pervading expectation that you MUST train abroad. In one study 95% of Lebanese med students planned to do either residency or sub-specialty abroad. Of those, 3/4 planned to go to the US.

There are a number of factors in this decision, including increased competitiveness for jobs in Beirut (where there are actually too many doctors) as well as cultural norms of emigration.

But ironically, many Lebanese med students ended up in the US getting training of lower quality than they were getting in Lebanon (not to name hospitals). Yet having that "trained in the US" stamp was highly sought after regardless of the actual quality of training received.

This also manifested itself in how people interacted with me in Beirut, where pedigree was paramount. One resident once introduced me to a patient saying, "This is Yale." There was an assumption that whatever medical management we did in the US was the standard of care. Where the reality is that there is a high degree of variation in practice, protocols and quality between different hospitals in the US. To give one example, there is a lot of variation in antibiotic choice, duration and even what threshold to treat cases of ventilator associated pneumonia. In my own personal experience, I've seen vastly different practices from c-section rates to wound management.

It manifests in how those around me are treated. Dr. B, who is a second year resident and whom I have high respect for as a clinician, is often dismissed when he raises medical points with some of the patients we've seen. Yet when I speak, people seem to listen. So we've tried to use this to our advantage - like when one patient was hypotensive and needed fluid (quickly!). Dr. B's requests were ignored when we could see that running one small-bore IV with 0.5L at a time wasn't going to cut it. We only got a second IV when I went directly to the doctor to ask for it.

Granted, there are clear differences in the capacity of different medical services here. Troponins are binary in many hospitals here, meaning that they're either positive or negative. In the US we use these lab values to track not only whether someone had a heart attack (i.e. positive troponins) but how high the troponins go tells us about how bad the heart attack was. And even worse, when kidney function is reduced, these numbers are even harder to interpret. (Troponins are released when there's injury to heart muscle and cleared by the kidney. But if the kidney isn't functioning well, it messes up our ability to tell both if someone had a heart attack and how bad that attack might have been.)

And sometimes there's just poor care, like how it took 30 minutes to even get vitals on Abu Hussein when we took him to ER. Unfortunately, poor care occasionally happens both in the US and here in Jordan. While individual physicians and nurses in both places can be excellent, infrastructure, hierarchy and budget constraints negatively impact care in both places.

Healthcare in the US and here are not equal. In a middle income country, resource and infrastructure constraints have a more palpable impact on the system of care here than in the US. But I've been extremely impressed by many of the physicians I've worked with - from Syria, Lebanon or Jordan. Internalized racism does not subside easily, yet I hope the fallacy that one "must" be trained in the US to be a good doctor can be put to rest sometime soon.

Its funny cause its true

Somehow The Onion gets it right:

Report: Syria Running Dangerously Low On Civilians To Oppress

Scientists Say U.S. May Have Discovered Previously Unknown Level Of Not Caring About Syria

Having Gone This Far Without Caring About Syria, Nation To Finish What It Started

Alien World To Help Out Syria Since This One Refuses To

Less funny, more scathing:

The 6 Best Dresses at The Golden Globes

Match Day

Celebrating the two-year anniversary of the start of the Syrian revolution yesterday, a few hundred peopled gathered in protest in front of the Syrian embassy in Amman. Across the street, the embassy is passive, surrounded by the Jordanian army. In front blares Quranic chants to drown out the chants of the protesters. It doesn't work.

"Takbir!" he yelled.

The crowd bellowed back "Allahu akbar!"

Again he yelled "Takbiiiiir!"

Louder this time, "Allahu akbar!"

Coming from the US, such freedom of expression shouldn't surprise me. I've been to protests and marched on Washington. But when I was in Syria, the ubiquitous photo of Bashar Assad and his father was what passed for political expression. Talking about anything else was dangerous - for Syrians not for me. So no one in Syria expressed dissent or displeasure except once, an elderly taxi driver who had woken up at 3am to drive a friend and me to the airport for $10 spoke about how bad things were under Assad. And I'm sure he only spoke because he knew we were leaving the country.

But yesterday's protest surprised me. Syrians, protesting. I'd never felt that before. Sure, I'd seen the protests on YouTube, of oceans of people in squares I had visited, chanting and singing. I knew, cognitively, there had been protests with hundreds of thousands of people. But yesterday for the first time I felt the pulse.

I saw how eagerly women yelled various popular chants:

Yalla irhal ya Bashar! (Hurry up and leave, Bashar!)

Wahad, wahad, wahad, asshaab assoori wahad! (One, one, one, Syrians are all one)

I saw how elderly men who couldn't stand inched their chairs closer and closer. I saw young men, including some of the injured from apartments I've visited, dancing and singing. And the protesters were diverse. There were rich and poor Syrians, men and women of all ages. Christians and Muslims. I thought of the guys in the SCI house, how they would have wanted to be there.

Protests aren't democracy. There's no way to distinguish a vocal minority from the majority. But coming from a Syria where protests are violently suppressed, it takes courage to stand in front of their estranged embassy. Courage, because they know they're being filmed. Courage, because they're already refugees, because they do not know when they'll be able to return to a safe, stable Syria. If they returned now they'll risk being arrested, not to mention the situation is still so unsafe in the big cities that returning would be unwise.

An hour later I get an email saying I matched at Cambridge Health Alliance in Internal Medicine. I'll return to home to Boston in April, knowing where I'll be for the next three years.

Cotton anniversary

Its the two-year anniversary of the start of the Syrian revolution. Since I'm not on the ground in Syria, I'll leave it to the experts to describe the war two years on:

This is what the Syrian war looks like. Every man with a gun is an authority, and for some the enemy—who was once their neighbor—is no longer a person. How can a man who has inflicted such harm, and become used to that sort of power, let it go and step back—especially if others do not?

Big Women

In anthropological literature, there's a phenomenon of the Big Man in refugee camps. A Big Man is someone who has no formal authority based on their title or position, but is recognized through their actions and wisdom. These are the men you go to when you need something, and depending on how corrupt they are, these are the "tough, self-made criminal-strongman-fixer-and politician" that may call on you to return the favor, Godfather style. They're the ones who make things happen. No elections put them in this position of power. But their role in society looms large.

Here, I've been impressed with the Big Women who have all the positive aspects of these described Big Men. I mentioned Um Z, who is Za'atari's unofficial social worker who just seems to find a way to help someone when there's no where else to turn (See the post "The women of Merje"). By the way, like the kunya "Abu" meaning father of, "Um" means mother of.

There's also Um A who works in Amman. She's also Syrian, and is the unofficial social worker for some of the injured Syrians who make it to Jordan. Many are Free Syrian Army, but there's also civilians. We saw a patient together today in the ICU with shrapnel in his brain. He crossed the border with CT scan images of a head, but since no one knows his name (and he's unconscious), we're not sure if the CT belongs to him or someone else. They're planning for surgery tomorrow, insha'allah, after another CT to be sure of what's in his brain.

This is one of about 50 injured patients that arrived in Jordan yesterday. But he's one of innumerable that Um A is helping by funding their treatment. A social worker by training, she's sought donations from private individuals in the Gulf region (Saudi and Kuwait mostly) and been able to support Syrians with no other support. Along with others, she's also been involved in convincing certain hospitals in Amman to provide discounted services for Syrian refugees.

No NGO, no tax deductions, just people dedicated to helping, leaning on their own private networks for donations. Given the lack of legal oversight, some might worry about corruption. Sure, there's no legal recourse, but from the dedication I've seen from Um Z and Um A, there's few people I would trust more with my money.

I spoke a bit to the organization Watsi.org before I came. They do great work crowdfunding treatments for people in developing countries. I thought that model would surely work for Syrian refugees. In a very positive way, the Big Women helping Syrian refugees have made Watsi irrelevant here.

Hijab

Noor, Reem, Layla (L to R in the photo above) and I were at a refugee camp - not a Syrian one, but one originally established for Palestinians in 1948. Like many "camps" its now a city with buildings instead of tents. Its a poor area of town, so every new wave of refugees from anywhere finds cheap housing here.

I think she was looking at me but her black veil revealed only contours of her face. Hijab means veil but also partition, and it was effective. She spoke of her medical problems, an intractable headache, dizziness, and blood sugar that supposedly drops whenever she eats sugar. She was worried about anemia, but when I asked to examine her she demurred. She was less worried about offending her religion than her husband.

The parts of the physical exam we often take for granted - facial expressions revealing fear or smiles - were shrouded behind a black slate. Based on her voice I thought she was post-menopausal. It turned out she was 25.

A female doctor would have made these difficulties moot. Unfortunately all three of us seeing patients were men.

Aleppo's watery grave

About six weeks ago, over 100 bodies washed up on the concrete banks of the river running through Aleppo. Syria's largest city, Aleppo competes with Damascus for the title of the longest continuously-occupied city on Earth. The Guardian went back to find out the story behind the bodies. Rumors dominate again, but there are heartbreaking accounts of the fear people have in simply crossing from East to West.

Rumors

I happened to be in Beirut in 2006 when the war broke out between Hezbollah and Israel. Information was scarce - even from the US embassy - so we had to rely on rumors. Anthony Bourdain of No Reservations fame also happened to be in Beirut during the war (poor guy had to tough it out in a 5-star hotel for most of it). But the show has some good examples of just how much you have to rely on rumors during a war.

(On a side note, I lost a lot of things that summer that I couldn't take back with me. My travel insurance would pay out in the event of terrorism, but not in the event of war. So since Israel declared war on Israel, it wouldn't pay out. But if I was in Israel, because Hezbollah's actions were considered terrorism it would have. No complaints here - may people lost much more - but good life lesson to read your insurance policies carefully because small words can have big financial impact.)

I'm noticing a similar reliance on rumors among Syrians here in Jordan. Reliable news is difficult to come by from Syria these days. What neighborhoods are safe, which neighborhoods have been freed by the Free Syrian Army. What Jabhat al Nusra has done recently. All are subject of much discussion but very little clear factual basis aside from anecdotes and second or third hand reports.

Youtube seems to be the biggest corroborator of rumors. I hear people saying something happened, or some group is backing another, or killing another. If there's disbelief, the arbiter is always "I can show you a youtube video". Despite this plea to video fact, I have yet to see anyone's mind change because of a clip they saw.

I also hear rumors about people in the army. What I hear is that there are those loyal to the regime, which are mostly Alawite or other minority sects. But word on the street is that even the majority of the army is against the regime. How can the regime survive if most of its soldiers are against it? I hear about a couple reasons. First, the commanding officers are usually Alawite. Second, all men in Syria must report for military service when they're 18. Military service is usually two years, but now there are no discharges. Third, there are rumored to be intelligence officers with each unit. Their job is to anyone who runs or refuses to follow orders (i.e. shoot when commanded).

For example, a friend's brother is a year and a half past his two years of service. He lives on a locked military barracks in the desert. Even though he is clearly against the regime, there is no escape. And if he doesn't follow orders he will be killed.

I hear of a number of people here who are against the regime, as is their family, but they have a cousin - or a brother - who is fighting. I have no idea the extent of this - rumors still - but it reminds me of the American Civil War with many documented cases of brothers fighting brothers.

Who has iltihab?

In the colloquial Arabic spoken in this area, the word for inflammation is the same word as infection (iltihab). Antibiotics, while officially called mudad alhawoui are known as mudad aliltihab, implying that if you have iltihab, you should be treated with a mudad aliltihab. ("Mudad" means anti- or against.) To make matters worse anti-inflammatories like acetaminophen are also called mudad aliltihab.

So trying to explain to someone that they have a viral infection becomes a difficult game of “Who’s on First?”

Yes, you have iltihab, but you don’t need mudad aliltihab because you have a virus, not bacteria.

I have iltihab, why not give me mudad aliltihab?

Because mudad aliltihab won’t treat a virus

But I have iltihab...

The women of Merje

In 2004, I was just starting to learn Arabic in Damascus. The Iraq war was a year and a half old and security was just starting to deteriorate. The influx of Iraqi refugees was less visible than audible through their characteristic accents (the Iraqi accent is the only one that uses the "ch" sound from Persian).

One night friends were telling me they saw Iraqi prostitutes cruising in Merje, a downtown square with some of my favorite baklava shops. I created a bit of a ruckus when I said “Man, I wish I spoke Arabic well enough to speak to the prostitutes.” Out of context, it sounded like I was looking for a different kind of sugar in Merje. But my motives were sociological and medical. In a culture where prostitution is a one way street, Muslim women must be at the very end of desperation to acquiesce.

I wanted to know their story. How they ended up in Damascus, in Merje. What exact unfortunate events led to the collapse of their social support. What legal system failed them, what violence caused them to flee and made life on the street a better alternative to what they were living before.

Fast forward to Tuesday. We were parked in a random part of Za’atari to pick someone up, offroading through the rocks and caked mud. Dusty kids threw rocks at fences and peeked through tent holes, laughing and running. We waited for Abu G and Um Z, two kind people who give us rides to the camp, then she climbs in the car. She heaves what looks like an overstuffed black gym bag on the floor and folds herself on top of it. I’ll call her Bint Sowra – Daughter of the revolution.

Um Z is like the camp’s social worker. She finds a way. Your child’s glasses broke? There’s no place in the camp to get them fixed, but Um Z finds a way. Every trip to the camp we make we’re squeezed between crutches, blankets and other provisions Um Z is distributing. Many conversations end with everyone agreeing that only Um Z can help.

I quickly realized Bint Sowra’s easy smiling face and fake Prada hijab were deceptive. She arrived in Za’atari three months ago from a small town outside of Dara’a, the cradle of the Syrian revolution. An orphan, she married young and had three children. But her husband beat her and took another wife. Now in her late 20s, she sought a divorce, which would have been feasible prior to the uprising. But no courts are functioning in Dara'a, meaning she can't argue for custody of her children and can't get alimony.

Having no family and no means, she headed to the border, and like all Syrians crossing without a passport, was registered as a refugee and taken to Za’atari. She set up her tent and received some protection from the Street President (an elected position).

But a single woman attracts unwanted attention. Men suggestively hit on her – not in a dating kind of way. She’s not considered dating material, really, since she’s already been married. And, alone, she’s not trusted. She has no family to protect or vouch for her.

Earlier this week, her tent was burned down. She’s not sure why, maybe some of the guys hitting on her. But now she’s homeless for the second time.  Um Z has offered to take her in.

She finished her story and Dr. B filled in the gaps where my Arabic couldn’t follow. He shook his head slowly and says, “This is how prostitution starts.”

Um Z and Abu G made it back to the car and we started the slow, dusty rumble through the camp, dodging children and passing tents and tents. I wondered how many women here have stories like Bint Sowra. How many women here are going to end up like the women of Merje.

Ma fi musari

Two kids with hepatitis A. Their liver tests are through the roof; their eyes are yellow. One is about a year old, the other two and a half.

Hep A is viral, there is no treatment except symptomatic management. So we tell the parents to feed them sweet things. Here what is sweet is not fatty, and since the liver produces the enzymes that help digest fat, this helps give the liver a rest until the body can fight off the virus. I tell the mom to feed her daughters sweet things. "Ma fi musari," she says.

"Can you give me something to keep the fever down?" the mother asks. We only have panadol syrup, a tylenol-like medication, which is contraindicated in hepatitis because it can hurt the liver even more. Medications are free at the health center, but we didn't have anything that would help, and that a two year old could swallow.

These two kids also have a genetic disorder called G6PD, called "fowol" in Arabic. A derivation of the word "fool," which means beans generally and usually fava beans in particular. Fava beans cause a hemolytic reaction in these patients, so do some antibiotics. The mother tells me they were given antibiotics a couple days ago and don't remember the name, but now the child's urine is extremely dark.

I'm worried she may have had a hemolytic reaction, meaning that it has caused many of her red blood cells to burst. I tell the mother to make sure she is well hydrated with water or juice.

"Ma fi musari," she says. There is no money.

The Emperor's New Treatments

Treatments are sometimes less about the chemical and its effect and more about the manner in which it is given.

I’ve run into issues with oxygen. Patients come in saying they’re having a lot of coughing, some chest tightness, especially at night. The dust in the camp is extremely fine seems to seep into your pores. Not coincidentally, asthma is very common. So inhalers are prescribed frequently (when the pharmacy has them – they didn’t today). But one patient got angry because we didn't provide her with oxygen when she wasn’t short of breath (and had an o2 sat of 99%) or complaining of any current asthma symptoms. She didn’t buy or didn’t understand my explanation that oxygen will only help while she is breathing it, but its effect wears off immediately. She looked at us with incredulity, then stormed out.

A colleague saw a patient complaining about the care he got at the Moroccan Hospital. There he received only diclofenac pills (an NSAID like aspirin). “Stupid doctor,” he said, “I need an injection for my pain.” So my colleague gave him an injection of diclofenac. “Alhumdillah!” he yelled – Thanks be to God! – then praised the King of Saudi Arabia.

Faux pas 2: Bag of coal

Got a ride home today from the head of the SCI house, Abu Mumtaz. A no-nonsense kinda guy from Baba Amr, a rough neighborhood in the Syrian city of Homs that was completely destroyed last year in a long and difficult siege.

I hand out gum to everyone in the car, and Abu Mumtaz asks for a second piece for his wife. As I hand it over, I get to thinking that in the past month, his wife hasn't come by the SCI house. So I say to him, "we haven't met your wife yet."

He explodes - "mumnou'a!" - Forbidden!

Everyone in the car is laughing. Its an absurd concept to want to meet his wife, it seems. Half jokingly, half in his no-nonsense kinda manner he says:

"Hea kiis fahm (كيس فحم)" - she is a bag of coal.

It took an explanation from someone else to learn that when leaving the house his wife dresses in all black, head to toe. Black robe, black hijab, black veil. I've seen plenty of women dressed this way, especially when I lived in Muhajariin, a conservative area of Damascus. But I didn't know this style of dress was known as a bag of coal.

Za'atari above and beyond capacity

In case you missed it, the Washington Post has a great article today on the situation in Za'atari.

While things are getting bad there, we hear that the humanitarian situation is even worse in Syria. In addition to security deteriorating in various parts of the country, we hear of shortages of food and clean water. Also, the Syrian pharmaceutical industry either has collapsed, or is unable to distribute medications to the South (many of the plants are located in the north, around Aleppo). Regardless of cause, we hear that there are no medications to buy in Syria. People in Za'atari have come to the clinic seeking medication refills for epilepsy and diabetes to send back to relatives in Syria.

Ever since we got here

“Ever since we got here”

That’s the most common response when I ask “how long have you had these symptoms?”

That could be 10 days or 3 months. But since they arrived in Za’atari.

Their dusty faces blend together into one composite patient.

Rash-ha oo gaha oo skhoun – cold and cough and fever

Ma binoum bilail – he doesn’t sleep at night

byibki oo byibki – he cries and cries

Is-hal, harara – diarrhea and fever

Waja’a oo doude – pain and worms

Al-lozat? Fi shi anshan al-lozat? – My tonsils/lymph nodes? Is there anything for them?

There’s medicine for the tonsils. But no medicines to treat worms. We saw at least five people yesterday with worms and had nothing to give them.

Medical Snuggies

At the friendly neighborhood medical supply store, it turns out there's ample supply of snuggies. No scabies treatment in Jordan, but plenty of snuggies. Awesome.

Nystagmus

A young girl with a neurological sign called nystagmus. According to her mom, her cranial sutures fused too early and she needed brain surgery at 6 months old in order to relieve pressure on her brain. Now she's older and it looks like the pressure in her skull may be building, leading to her rapid eye movements. We're working on trying to get her a neurological/neurosurgery consult at the University of Jordan.