By Vanessa Powell
DUHOK, Kurdistan Region – A team of foreign doctors spent their Christmas holiday volunteering with the Global Surgical and Medical Support Group (GSMSG) at the Duhok Emergency Hospital.
It is 8.30am and the day is beginning for the GSMSG team.
Aaron Epstein is sorting supplies in a backroom of the operating theatre. “I’m just dumping some supplies here,” he says, unpacking packets of sutures, bandages, IV sets, catheters for radiology procedures, and orthopaedic instruments.
Aaron Epstein, in blue, prepares for a busy day ahead working alongside local health professionals. Photo: Vanessa Powell
Each day brings about 30-40 patients for consultations and 9-12 surgical cases.
Dr. Khaled Emera is soon at the door. In green surgical scrubs, hairnet, and mask he is ready for a long day ahead. “This guy is a world famous orthopaedic surgeon,” Epstein interjects.
“Most doctors are lucky enough to get one fellowship. He’s had three fellowships”, referring to the ultra-competitive selection process doctors must undergo to train in a specialty. Dr. Emera completed fellowships in trauma and orthopaedics in Sweden and the United States.
The Cairo-born and trained doctor volunteers one week of his time every year for pro-bono work. This year, he is in Kurdistan.
But it is Epstein who is the brains behind the GSMSG, a humanitarian organisation that aims to bring the highest calibre medical and surgical professionals to conflict-torn regions.
This trip, their 8th to the region, was arranged by the Kurdistan Regional Government (KRG) to treat injured Peshmerga who need specialist orthopaedic surgeries and could not be sent overseas.
It costs European and US governments tens of thousands of dollars to ship one patient to an overseas medical facility. In a two-week period, the GSMSG are able to treat more patients than other countries can treat in a year.
So successful have the GSMSG been on this trip that the Peshmerga ward, which was once full, is now almost empty, the team having performed 40-50 surgeries in a week.
Epstein, 31, left behind a promising career in the defence industry, which included graduating from the prestigious Georgetown University with a Masters in Intelligence, feeling largely disenchanted and with a desire to do more.
It was only when he was in Lebanon that he realised the necessity of medical knowledge and its immediate benefit.
“I remember when I was in Lebanon I could put a tourniquet on someone and instantly save a life”, he recounts. “And that’s more important than security objectives.”
He eventually went back to the United States and began working as a medic with the fire department. Every time he would take a patient to the emergency room he would ask the doctors a lot of questions until someone said “Man, you’re annoying the hell out of me. Just apply to med school already,” Epstein recalls.
So at 28-years old, Epstein enrolled in medical school. He is in his final year now. Combining his knowledge of security networks, former military contacts, medical know-how and a desire to help has allowed GSMSG to fulfil a unique role unlike any other NGO operating on the ground.
Out in the hospital corridor, the first patient of the day is being wheeled out of surgery, still asleep, into the recovery ward. She is a little girl with a congenital hip defect, a problem corrected through specialist surgery.
Dr. Glenn Miller, an attending trauma and critical care surgeon from Miami, Florida, is still on the sidelines, leaning up against the wall.
Through the door comes a young couple with their ten-month-old son. Dr. Miller whips into action examining the child, who presents with enlarged digits on both hands. A congenital defect he ascertains, a problem throughout the whole of Iraq.
Parents bring their 10-month old son for treatment. Photo: Vanessa Powell
For Miller, this is his first time in Iraq, in fact it is his first time in the Middle East, and navigating the differences in health systems is proving challenging.
“Don’t get me started on the lidocaine”, he says. An anaesthetic, it was donated to the central government by a neighbouring country and eventually made its way into use at the Duhok hospital. When they came to doing suturing on patients they realised it was fake and did not work.
Epstein recounts the case of a 45-day old child with a piece of hair deeply wrapped around her thumb. If the embedded hair was not removed, amputation of her thumb might have necessary. The surgeon had to take the scalpel to a baby and remove the embedded object with the child feeling everything because the anaesthetic did not work.
“It’s the stuff they get handed to them by the Iraqi government,” Miller explains. There is no way to check the quality of donated medications.
“It’s the ugly side of conflict and IDPs and just being in a war zone or post-war zone. Infrastructure is bad. Supply is bad. They don’t have resources to go around,” he explains.
Dr. Miller examines an x-ray. Photo: Vanessa Powell
There are not enough ventilators to give lifesaving critical care.
“The instruments are all beat up, from use. It’s a high volume medical facility,” he says. “It’s a question of the rest of the world helping to avoid the humanitarian apocalypse.”
The word is out that a team of American doctors are in town and a crowd is swarming through the door and into the corridor, all seeking the chance for a consultation. “This is what happens when we don’t close the door,” Dr. Miller says.
A 22-year-old Peshmerga with a gunshot wound to the foot sits solemnly on a bed in the corridor awaiting a consultation. He is still young so the bones in his foot should heal Dr. Emera advises.
Next up is a diabetic man who has come thinking he needs his leg amputated. Amputations are a common complication associated with diabetes. “Man, this is a good foot,” Dr. Miller says. “Your foot’s still good.”
A new pair of shoes and better blood sugar control is recommended and out the door he goes.
In the operating room, Dr. Emera is preparing to perform a joint fusion foot operation on a man with arthritic pain.
"X-ray," Dr. Emera calls, and it is time to duck out of the room. There are no lead vests in this hospital. “I don’t like getting radiated,” says Dr. Miller who is observing the procedure. “Next time I’m definitely bringing lead with me.”
It is a rainy Christmas Eve in Duhok. Dr. Miller had to take time off work during the holidays to make this trip. “I’m going to working for the next two Christmas’ because of this,” he says.
This is his first Christmas off but he is not taking a break. As for their Christmas plans, as doctors, they are already under the realisation that they will spend the holidays not with their families but in public service.