A day in the life of medical students in Lebanon

The port explosion: memories of sweat and blood

The explosion at Beirut’s port made international headlines, but few readers could have imagined the experience of a medical student who lived near its epicentre. Hussein Noureldine recounts what he saw before and after his arrival at the Lebanese American University Medical Center-Rizk Hospital on the night of the explosion: “I was in my apartment when the blast happened. It started with a shockwave which I thought was from an earthquake, but a few seconds later came the loudest ‘boom’ I had ever heard. Glass was everywhere. People up and down the street were stunned, in shock, and screaming. Lebanese American University Medical Center-Rizk Hospital sent out a crisis call to all residents and students who were still in the area around 18:00.

“I rushed to the hospital and found a scene of devastation. The main entrance had been opened wide, but the passageway was blocked by masses of patients arriving with traumatic injuries, and an even greater mass of people searching for missing loved ones. Just walking through the halls was a challenge—with glass doors and windows shattered and blood on the walls and floor. Patients were being treated in the corridors; the packed treatment rooms could not accommodate any more people.

“Though I felt the unmistakable rush of adrenaline, a perceptive senior resident cautioned me against overzealous behaviour. Injuries ranged from minor to severe, but the majority were lacerations from broken glass. My role was basic yet essential: I took histories, cleaned wounds, and applied dressings.

“It was a distressing scene, but the fast pace kept me going. By the end of the night I was bothered not by exhaustion but by the dwindling medical supplies. No hospital in Lebanon was equipped to handle such an onslaught of patients, yet we managed to attend to the needs of all who sought our care.

“The acuteness of the situation did not allow for thorough covid-19 triage. Treating patients at the hospital at that time was different—it was a war zone. But I knew, as we all did, that a peak in covid-19 incidence was on the way and it would hit us hard.

“I left the hospital at dawn. As I walked home alone in the calm of early morning, the scent of dried blood and the crunch of glass beneath my feet kept me company. It had been a tough night, but I’m glad I was there to help.”

Taking care of refugees at a government hospital

A few weeks after the Beirut explosion, Georges Chedid was rotating in obstetrics at a state hospital. “I noticed the extreme lack of resources—often countered with patience and some ingenuity. We were learning to perform screening ultrasonography on our pregnant patients, but the petroleum gel that was usually applied to the skin had run out. For much of the rotation, we used rubbing alcohol as a substitute. Later that week I was helping to secure fetal monitoring machinery to a patient in labour, only to find that we had none of the requisite cloth belts. The nurses showed me a trick they had devised to quickly wash (in the sink) and dry (in a newborn’s incubator) the single available belt between patients.

“I learnt a lot from the patients. These women came from all over the region, and beyond: Syria (many were refugees), Palestine, Bangladesh, Lebanon, and other countries. Most hailed from underserved communities with limited access to education and social services. Some of them shared their good humour; some patients would joke about how their unborn children’s faces on the ultrasound monitor looked just like their own.

“My teachers impressed me too. One afternoon, I was observing a major surgical procedure as the doctor calmly dodged drops of water that fell from the ceiling; the port explosion had damaged pipes somewhere in the building. Not once lifting his eyes from the operating table, he calmly quizzed us. ‘Which antibiotics would we give this patient . . . if, by chance, such water were to violate the sterile field?’”

Serving local people at a community based hospital

A month after the Beirut explosion Jad Gerges Harb worked at a community based hospital serving an impoverished Lebanese community: “I rotated for two weeks at a community hospital as part of my surgery clerkship. The economic meltdown is putting a strain on the operating room, but people are adapting. For example, specialised suturing methods can replace the commonly used stapled closures, thereby reducing equipment costs. The experienced surgeons that I shadowed and assisted had begun their training in the 1980s, and they were comfortable with older manual techniques as well as newer mechanical ones. This versatility assumed great importance in the setting of limited hospital resources, and limited patient finances and insurance coverage. However, for complex procedures like colorectal anastomoses, I saw first hand how the intricate suturing techniques—in contrast to the nearly instantaneous stapling methods—could place a burden on theatre time, anaesthesia time, and the surgeon’s schedule.

“Lebanon’s economic collapse is not only influencing surgical decision making, but also affecting postoperative care. Incentive spirometers in the community hospital were running low. The surgical staff would debate about which gadgets could substitute for the spirometers if they ran out of stock. Should the patients practise blowing up balloons? Were there viable means for cleaning and reusing spirometers in the middle of the covid-19 pandemic?”

Fig 1

(Left to right) Hussein A Noureldine, Georges Chedid, Jad Gerges Harb

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