Dr. Khalid Kurtom and Team Complete Medical Mission to Jordan
Dr. Khalid Kurtom and his team from UM Community Medical Group - Neurosurgery left April 6, 2017 for a ten day medical mission to Amman, Jordan. Traveling with the Syrian American Medical Society (SAMS) based in Washington, D.C., Dr. Kurtom’s team joined a group of over 70 other medical professionals providing high quality, culturally appropriate medical care to refugees and the local community, including performing neurosurgeries for the first time on a SAMS medical mission.
First UpdateToggle accordion item
Our mission has been full of obstacles and challenges which we luckily continue to overcome. We had to apply for grants from multiple companies to supply us with instrument and implants for our trip. Thousands of dollars donated to our mission and countless hours to ensure that we would have everything we needed to provide neurosurgical care for the Syrian refugees in Jordan. A week before our trip, we were told that all our instruments were not allowed into the country because a required document would not be signed in time. We had to scramble to contact companies in the Middle East to provide some of the instruments, contacted the local hospital in Jordan and utilized other creative solutions with the hope that we would have what we needed. While on the plane, we found out that the US had launched a missile attack in Syria, approximately 1 hour away from where we were heading. We left Easton 6am Thursday morning and arrived to Jordan 4:30pm Friday, almost 30 hours later and thankfully all our bags made it in. We went straight to hospital with expectations of meeting OR personnel only to find out that they had no knowledge of this arrangement. The people in Jordan are so helpful and nice that they gathered a group of nurses and doctors to help us setup our cases for our first OR day on Saturday. At this point our entire team is exhausted but we are finally here, with some instruments that we can use, ready for work Saturday. It feels like a journey even before the real journey has begun. But thankfully despite all the hurdles we thus far have succeeded in moving forward with our mission.
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We arrive at Istishari hospital at 6 am excited and ready to go to find that the hospital is locked up for the night. The night guard lets us in and we are kindly greeted by the overnight OR staff who just a few hours the night before were opening all their sterile neurosurgery trays for us to pick through and re-arrange. If anyone knows sterile processing, they will understand the amount of work that goes into cleaning and re-sterilizing instruments. The staff never batted an eye and graciously accommodated every request.
Our first scheduled patient is an elderly Syrian woman sitting in a wheelchair and surrounded by a loving family. She has been having difficulty walking for over five years and within the last year has been having trouble using her arms. She has two issues, cervical spinal cord impingement and lumbar stenosis both of which affect her ability to walk. It’s difficult to explain that we can’t fix both issues today. The cervical spine must be corrected first and we hope to get her back to functioning to where she was five years ago. Unfortunately, her pre-op evaluation revealed underlying poor kidney function and therefore she would need further work-up and treatments. She was admitted and re-scheduled for the next day.
The team at SAMS quickly adjusted and was able to bring in a patient scheduled for tomorrow to fill the gap.
Ok deep breath. Who is next? We meet a dentist who cares for the Syrian refugees. For 10 years he has had neck pain which was attributed to his long dental career. However, over the last year or so he has developed bilateral numbness in his arms and hands and has been losing grip strength which causes him to drop instruments unawares. He is prepped for surgery and we begin our day. Its 10 am. We find camaraderie with our Istishari counterparts in the knowledge that surgery requires the ability to adapt to any given challenge. This first case proved that challenges come in many forms. From severe pathology to adapting surgical technique to accommodate instrumentation differences was truly daunting. Yet, to see the patient leave the hospital the same day gave us peace in knowing that we made a difference for not only this patient but also those he serves. By 7 pm we have taken care of four people with severe spine pathology. We look forward to see what tomorrow brings.
Now off to the hotel, exhausted, ready to crash and be ready for what the next day brings.
Second Day of SurgeryToggle accordion item
Today we arrive at the hospital at 7 am which seems luxurious. All but one of our patients from the previous day left the hospital yesterday cured of their pain. We round on the remaining spinal fusion patient who was up and smiling. He has been up and walking and eagerly demonstrates (seen at the right). He worked as a driver in Syria before the war and has been unable to work due to severe back and leg pain. He left Syria five years ago with most of his family. A small cloud comes over his face as he tells of his son who remains in Syria. His 19 year old son, who works as a cook in the camp, hopes to come to the US and attend university.
Our cases today were all very challenging with complex pathologies, much more advanced disease that we typically see back home.
Neurosurgery simply does not exist here in any capacity, so people are left devastated for years, sometimes their entire lives, due to illnesses that are surgically curable. What is clear is that the close net social structure here allows these people to survive. Their families and communities rally around them and allow them to survive. One of our patients today has been in a wheelchair for 5 years, with her daughters assuming full care for her without any additional resources.
People here are kind and generous, happy despite not having all the resources they need. There is always laughter, food and good time. They are welcoming and grateful for anything and everything. We all wish we could do more.
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Our first patient today was a 21 year old Syrian refugee who was shot along with one of his cousins in 2013 outside their home by a riffle. His cousin became a quadriplegic. He was shot in similar location but was extremely lucky. The bullet stopped a centimeter away from his spinal cord at C2. If the spinal cord was injured at this level, he would have lost his ability to breathe on his own and died immediately. Luckily he survived but continued to have severe neck pain radiating to his head with every head movement. He was severely disabled, now unemployed living in the refugee camp. We did his operation this morning, a very difficult task of extracting the bullet from this location. When the bullet came out of his neck, people were clapping in the OR and most were in tears. This was miraculous. He woke up pain free, very emotional, in disbelief. He was discharged home an hour after surgery but decided to come back with many of his friends to take pictures with our team. He now has his life back. We are blessed to have been part of it.
We had another patient who is a Syrian refugee living in the camps who had several lumbar spine surgeries starting 18 years ago, the last surgery 10 years ago, left her with foot drop and inability to ambulate immediately post-op. She had severe pathology at the same site of her previous surgeries and clearly a fluid leak and nerve injury that was not repaired. We decided to undertake this difficult operation and perform a decompression and fusion. Technically extremely challenging but the operation went smoothly. We established clear expectations prior to surgery that her foot may not fully improve, if at all.
We were shocked when she had full strength in her foot on the morning after surgery and was able to walk without any assistance. She just continued to pray for our kids and families. That is the best gift and reward we can ever ask for.
These cases are not only technically very challenging but emotionally draining. We continue to search deep within us for the strength to continue this journey.
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Our patient in the picture to the left is a young man of 21 who came to the Za’ atary camp after he completed the 9th grade in Syria. His parents fled Syria before the end of the school year, leaving him to finish school. He wanted to stay in Syria and complete high school but it became too dangerous so he joined his family in 2014. He has been in great pain for three years and has been unable to work. He is very worried he won’t feel better after the surgery as so many people he knows have surgery and do not seem to recover fully. We reassure him and his mother that he will walk upright again and that he will have no restrictions. You can tell they were not convinced. His spinal fusion surgery is completed without complications. Upon rounding the next morning we find a young man lying in bed afraid to move. He remains convinced that he should lie in bed and keep still. His worried mother is with him.
We encourage him to get out of bed. With trepidation he sits up and stands up straight for the first time. His mother can’t believe what she is seeing. He seems to transform from a child to a man in an instant. As we take a photo he asks to be tagged in Facebook reminding us that we are not so different after all.
Our next patient had 2 previous laminectomies without much relief. She has been wheelchair bound for five years. Her previous postoperative course from her last surgery consisted of bed-rest for 45 days. We completed her operation without complications, which was very difficult due to previous scar tissue and the degree of compression on her nerves. In the picture is Mona walking for the first time in 5 years, surrounded by her family and friends who could not believe their eyes. Just incredible recovery! After another long day of surgery we rush back to the hotel for a quick freshen up and prepare ourselves for meeting a group of Syrian refugee children and adults injured during the war. Souriyat Across Borders is a non-profit organization founded by 5 Syrian women who had a vision to help children rehab their injuries and return to normal life. Their staff is comprised of primarily Syrian volunteers with a budget supported solely on charitable donations.
The organization has expanded its mission to offer rehab and provides education for computer classes as well as language studies that include English, French, and German. This is an experience we will never forget.
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Neurosurgery in this part of the world is scarce and usually avoided due to the high complication and mortality rate, even for the more straight forward operations. After being here for a few days, a reputation developed and people started to take notice. Doctors, nurses, hospital employees and friends of patients that we operated on began to request consultation for their family members. For the past couple of days, we had to sneak out of the hospital to avoid the crowd outside waiting for us with their MRI's and films. We want to help everyone but it is clear that the resources and time is limited and we can't help everyone. The disappointment that we feel for these people and their suffering is tremendous, and emotionally tasking. So much hurt and need exists here and people are desperate. We leave this mission completely drained, and full of emotions that will take us some time to absorb and understand. We are forever changed. We are so appreciative of everything we have back at home and how lucky we really are. To anyone reading this we have two requests: Please call everyone you care about and tell them that you love and appreciate them; and always keep things in perspective because things can be worse. God bless.