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Our Broken Dreams in Syria

Thursday, December 17, 2015

Of the 130 million babies born in the world every year, more than half a million will have congenital heart disease (CHD) requiring treatment. Only a small minority of these children will have access to surgical treatment. For others, the surgical “lottery” offered by charity medical missions is the only hope. This is an international health crisis that is largely overlooked and exacerbated by the traffic of essential medical skills from poorer countries to wealthier nations. The impact of the so called “brain drain” has left pediatric cardiac care in crisis in the developing world. If you, therefore, spend most of your adult life training and then working as a congenital heart surgeon, as I have, it is only a matter of time before you are involved in some of these missions.

At the Bristol Royal Hospital for Children in the United Kingdom, we have been involved in medical missions since 2000 and have performed hundreds of open-heart procedures in infants and children of Kenya, Trinidad and Tobago, Peru, Ecuador, and Romania. For all these missions and these countries, there are many stories to tell, but the one that is still upsetting me is the story of a lost dream in a country hit by a humanitarian tragedy: Syria. Despite a population of 20 million, there were only two heart centers for children with congenital heart disease in Syria, performing only 300-400 operations a year! It was on this basis that we decided to establish a congenital cardiac surgical program at the Al-Dir Charity Hospital in Homs, which had an established adult cardiac surgical program but no surgical service for children. Al-Behr Hospital was a charitable hospital offering treatment to those that could not afford private treatment. 

Hazaim, one of our pediatric surgeons in training from Homs, was the real engine behind this adventure, having seen how children with CHD should be treated and knowing very well the reality in his own country. Dr Mahmoud Al-Soufi, an experienced pediatric cardiologist based in Homs, was our link with the local cardiologists and an invaluable congenital heart disease specialist in the Homs region. We gathered a team that included Andrew Parry and Serban Stoica (pediatric heart surgeons), Rob Martin (consultant pediatric cardiologist), Ian Jenkins (consultant anesthesiologist), Laura and Suzie (intensivists), Beth (junior pediatric cardiologist), Martin, Martin, and Kathy (ICU nurses), William (perfusionist), and myself. We organized our first visit in April 2008.

The flight from London to Damascus was not delayed and all of us gathered at Heathrow full of excitement and enthusiasm – until I discovered that I had left my passport at home! I don’t have to tell you that this episode has been a matter of several jokes over the years regarding a surgeon’s reliability on the part of Rob and the other members of the team. I had to take another flight the day after the others. When I reached Damascus, the main road to Homs was blocked by the snow so I ended up sleeping in the middle of nowhere and causing a lot of anxiety for the team that were ready to start operating. Being Neapolitan and highly superstitious, I should have known that there was not going to be a happy ending to this story.

I finally reached Homs and the mission began. The hospital was located in an old building, but was reasonably functional. We soon met the local doctors and nurses, and were overwhelmed by their hospitality and dedication to work in quite difficult conditions. Dr. Al-Soufi immediately started to exchange views and ideas with Rob, and asked for his opinion regarding the children on whom we were going to operate. After a few hours of discussion, we had a clear plan for the week – we were going to perform ten operations. This was, of course, a drop in the ocean. Every day we had families knocking at the door, asking us to operate on their child. I have learned during these medical missions that despite the immense sadness involved, you cannot treat all; one has to remain focused and think about the ones that are going to be operated on, seeking to make the lives of those ten children worth living. And so it was. We successfully performed the first ten congenital open-heart operations in Homs, and it was an incredibly emotional week for all of us. Of course, it was hard work, especially when two teams were meeting for the first time and had to focus their efforts and start speaking “the same language.” But the daily hard work was followed by the most extraordinary hospitality and social events one could experience. We learned how to make a perfect hummus, and started our belly dancing and shisha pipe classes.

This first experience was followed by two other missions in April 2009 and December 2010. For each of these visits, Dr. Martin and Dr. Al-Soufi scanned more than 50 children and young adults in preparation for the current and the next mission. As expected, there were difficult times to face and problems to sort out, but deep inside our minds remained only the immense joy of seeing the children recovering – ready to grow up and go back to their lives. It was also a great opportunity for teaching and exchanging protocols between the local team and ourselves. We also learned a lot from having to perform complex cardiac surgery with limited intra- and post-operative resources. The intensivists were delighted to be able to undertake early extubation in patients with tetralogy of Fallot, who would have stayed much longer in intensive care in our United Kingdom unit. For all of us these missions were also a cultural journey into one of the oldest civilizations in the world, with beautiful Roman, early Christian medieval, and Islamic architecture.

In the spring of 2011, six months after our last visit, the Syrian civil war began, within the context of the Arab Spring protests. The ongoing conflict gradually moved from prominent protests to an armed rebellion, after months of military sieges claiming the lives of more than 200,000 people. The tragedy in Syria continues to affect many Syrians' access to quality health care, including the Syrian refugees in neighboring countries. About 207,000 people, most of whom are civilians, have been killed. According to UNICEF, by the end of 2014 at least 7 million Syrian children (including nearly 2 million registered child refugees) had been substantially affected.

The Siege of Homs started in May 2011 and has destroyed entire areas, including many hospital facilities. Hundreds of doctors, nurses, dentists, pharmacists, and paramedics have been killed. More than 75% of health-care professionals have been forced to leave for neighboring countries or further afield, leaving a huge gap in experience and expertise that cannot be filled.

All those smiles we experienced and joy we gave and received are now fading memories. We lost contact with many of the people we worked with. All that remains is the memory of common people working together to help other people, and the broken dream of building a congenital heart program for the children of Homs.



Thanks a lot for your efforts for children of Homs I am from Homs, and I finished my training in cardiac surgery in university cardiac surgery hospital in Damascus. We are continuing our operations even their complex ( such arterial switch) despite very bad circumstances. In Hom, we still operating adults only, but I hope to work with you for that dream for the children of Homs.
It has been a few years now (1986?) since I had the privilege of visiting and helping in cardiac surgery in Damascus (it turned out that they were much more competent than I), but I will never forget how wonderful ALL the people were.
Thanks for every one who still remember syrian children and I hope that syria will recover and we will worke to gother again to build up our dreams I and Dr AlSoufi are working in UAE
Thanks to all of you for your comments and for the great effort Syrian surgeons and physicians have been putting over the years to treat CHD in this terrible situation. I hope in the near future we could all start collaborating again to make CHD services in Syria a great reality.
What an excellent human story. Shows that individuals can and must make a difference. Hopefully Syria will start its recovery back to becoming a stable country and you can continue the excellent work you all started.
This is a great success story, and the dream is not broken; I am sure it is just suspended for a while ... I am a pediatric cardiac surgeon in the American University Hospital of Beirut. A very important part of the Syrian population is now living in Lebanon. The Syrian babies are not forgotten; we are helping and operating more and more Syrian babies, with the support of the UN and many other humanitarian organizations. We provide them with a very high standard, accredited, level of care. Any baby in need of medical or surgical cardiac care is welcome, at no charges, to the Children's Heart Center, while Syria is recovering.
All of us here in Greece sympathize with the sufferings of the most friendly people of Syria, and many Syrians have sought refuge here. Our pediatric heart surgery team at Athens Heart Institute and Iaso Children's Hospital stands ready o take care of any children with heart disease who, due to the difficulties of the war, cannot be teated in Syria. Colleagues and families in need are welcome to email me directly.
War under no circumstances can be justified. It leaves none.Every one suffers and worse hit are so innocent beautiful Childrens.It is so nerving to see them walk in desert, deprived of food and getting drowned in water.I cannot believe we live in 21st century. I studied GANDHI's Philosphy of Non Violence extensively.As a very young youth although I had little insight into life to understand him but now as a grown up responsible doctor I fully relate with it.A lot could be solved just by having multiple talks and negotiations. Imagine India was a country under occupation and we got freedom from British rule without any major violence.We faced huge amount of cross border terrorism and are still facing a lot of terrorist separatist issue in many part of India yet we choose to negotiate. I truly admire the British value to respect and be tolerance.Things remain undercontrol and sooner or later the opposing sides reach to a constructive domain eventually.I would rather opt for such a delay then the devastation Syrian people suffered.It was so pitty to see the people being blood thirsty for each other in the name of ideology and for grasp for power.My heart bleeds and eyes feels with tear when we see how humanity have to suffer again and again. It is so agonising to see the defunct UNITED NATION which cannot send some peace keeping force. I just wonder what is the mindset of people involved in such a heinous act. I feel helpless, May almighty save all Syrian people and world.
There has been so many sufferings in our border-country Syria. Frankly speaking, I would like to express my gratitude to people taking care of not only the children with congenital heart disease, but also the victims of armed conflict. Although I am currently a congenital cardiac surgery fellow in Turkey, I experienced many casualties during my obligatory duty in Hatay Antakya State Hospital which is a border city to Syria located in the middle southernmost of Turkey. Alongwith a variety of injuries, we intensively dealed with the mangled extremities from a 3 to 70-year-old. Hopefully we be helpful to them. Our gratifying results are in the way of publishing by the "international Journal of the care of the injured". It's my wishing that theconflict ends as soon as possible.

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