The Good Doctors

Located in the Shatila Camp, AUB’s Volunteer Outreach Clinic offers primary care services to Palestinian refugees and the underprivileged of Lebanon. MainGate reveals how determined these young doctors and medical students are to provide good health care to those who cannot afford it.

Every Saturday morning, a narrow corridor on the second floor of the Palestinian Red Crescent Society (PRCS) building in the Shatila Refugee Camp begins filling with waiting patients. Most are middle-aged women, but here and there are a few men and a handful of children. Someone comes in with extra plastic chairs and threads his way through the hallway, holding the chairs high over his head. Too many patients—not enough seats. Some resort to leaning against the wall; others sit on the stairs. Some mornings, a dietician is there, squeezing among the women and offering helpful advice to the diabetics and the overweight on how to correct their diets.
Crowded together, knee-to-knee and shoulder-to-shoulder, the patients are surprisingly good-humored and cheerful, talking quietly and smiling broadly to welcome the young men and women of AUB’s Volunteer Outreach Clinic (VOC) as they arrive in their white coats. Dr. Patricia Dandach, one of the first VOC volunteers, gets an extra warm greeting from patients she hasn’t seen for a whole year (when she had been away doing her residency in the United States). By 3 pm all the waiting patients have been taken care of—all examined, with medications prescribed and distributed and referrals written as needed.
Each new patient makes a payment of LL 3,000 (the equivalent of two US dollars), which goes to the PRCS. Against that token payment, the VOC volunteers provide primary care services from 10:30 am to 3 pm every Saturday, as they have been doing since the clinic opened two and a half years ago.
It was in the fall of 2001 that the third- and fourth-year medical students working in the Out-Patient Department (OPD) of the AUB Medical Center (AUBMC) decided that something had to done about a growing problem. They found that with the worsening economic situation in the country, patients were no longer able to pay for the proper medical treatment offered by OPD consultations, nor for the lab tests and medication they needed.
To resolve the problem, a group of young AUB medical students brainstormed and swung into action. First, they visited patients at home; then they decided that what was needed was a low-cost clinic, served by AUBMC volunteer doctors and medical students. But where? Rents in Beirut, especially in Ras Beirut and ideally close to the hospital, were out of reach. Nothing was available in the southern suburbs either—until, finally, an agreement was struck with the Palestinian Red Crescent Society to use a small space on the second floor of their installation in the Palestinian refugee camp, Shatila.
Not all the patients are Palestinians from the camp. Some are Lebanese; others Syrian or Egyptian. Some come from as far away as Tripoli, the Akkar, the Beqa’a, and South Lebanon. All are underprivileged members of Lebanese society.
The clinic, situated in the heart of one of the most impoverished mixed communities in Beirut, regularly treats a number of medical problems directly related to poor living conditions. The unhygienic situation of the camp—cramped quarters, with many adults and children living in one room; poor sanitary facilities and a questionable water supply; dampness everywhere, frequent electricity cuts, and the meager penetration of sunlight—exposes the inhabitants to a number of respiratory and infectious diseases. Poor diet, lack of exercise, and generally low health conditions lead to hypertension, heart disease, disability, diabetes, anemia, and other physical disorders.
The VOC goal is to provide medical care for people living in impoverished areas in Lebanon. The clinic’s aims are
• To give those without access to proper medical care the best chance to overcome common and uncommon diseases.
• To provide checkups and optimal care to children living in poor conditions.
• To allow doctors the opportunity to interact with the community by offering their services in a primary health care setting.
• To integrate volunteer community work
into the medical curriculum in order to give students exposure to the variety of cases seen in a primary health care center.
The clinic’s facilities in the PRCS building include the corridor waiting room, a small room for pediatric examinations, and a room containing three scantily screened cubicles for private examinations, five cabinets for medications, and one file cabinet. Medical equipment consists of two blood pressure machines, two dextrose machines, and two otoscopes. The rooms are clean, but some walls are marred by ugly mildewed water stains. With no running water in the examining rooms, physicians wash their hands in disinfectant between patients.
The clinic provides primary care services for cases connected to the specialties of internal medicine, pediatrics, ophthalmology, dermatology, surgery, and obstetrics/gynecology. In addition to carrying out medical examinations and evaluations, it provides or arranges for free-of-charge medication, full coverage of laboratory tests, free x-rays, 50 percent of prescribed imaging studies, and free, quick referrals to the AUBMC Out-Patient Department.
The VOC does not handle serious emergencies, but it is in a position to help in such cases. When one 70-year-old patient with advanced heart disease began suffering from serious shortness of breath, clinic volunteers rushed him to the AUBMC Emergency Room for a pleural effusion, after which they arranged for multiple paid visits to local doctors. The patient’s only source of income was his 55-year-old arthritic wife who brought in small amounts of money from selling gum and begging in the streets. In addition to treating the patient, the volunteers treated his wife’s arthritis.
The volunteers serving the clinic are made up of both medical and non-medical personnel and represent a variety of nationalities, professions, and university affiliations. Most are AUBMC doctors, residents, or interns; some are non-AUB attending physicians; others are paramedics, and still others are medical or pharmacology students from the Faculty of Medicine. The clinic’s present organizing committee consists of six members who meet weekly: Beirut Arab University graduate Faysal Succaria, a dentist; AUB fourth-year medical students Wyel Hakim and Abdul Aziz al Kadri; and three non-medical volunteers who handle secretarial and other administrative tasks.
Two of the non-medical volunteers serving on the committee are Diala Dandach, a Lebanese University engineering graduate, and Zeina Abdallah, a clerk/typist and part-time AUB student. These young women share the responsibility of scheduling patients and organizing charts. They also handle reimbursing patients for the costs of tests and consultations and take care of the clinic’s relations with PCRS and local pharmacies. The other non-medical committee member is Aline Hitti, who is an engineering graduate of Johns Hopkins University. She distributes medications, helps with any other work needs that may crop up, and is also currently busy setting up a database for medical supplies.

Advisers of the VOC are Dr. Kamal Badr, professor and chair of Internal Medicine;
Dr. Nuha Salti, a pediatrician who is also professor of human morphology in the Faculty of Medicine, and Dr. Mahmud Choucair, former president of the Lebanese Order of Physicians and assistant professor of endocrinology at AUB. One of the most recent and committed volunteers on the VOC team is Dr. Mona Nasrallah, an AUBMC attending endocrinologist.
Attending physicians and residents offer free medical consultations, while physicians and major drug companies donate medications. Most laboratory tests are provided at cost by Fontana Laboratories, run by an AUB Faculty of Medicine graduate who modestly wishes to remain anonymous. Wherever additional costs are involved, the VOC picks up the tab. It refunds, for example, the cost of specialist referrals to the Out-Patient Department and pays for electrocardiograms and echograms. Other donations to the clinic include clothing and food for the most needy cases and catering services for its annual fundraising events.
The care provided is often psychological or just plain practical management support. Dr. Salti, taking time off from her heavy laboratory schedule to talk to MainGate, described the case of the seven-month-old twins brought to the clinic, who weighed no more than newborn infants. Convinced by her relatives and neighbors that she could not produce enough proper breast milk, the 34-year-old mother had been feeding the seriously undernourished infants yogurt mixed with water. Dr. Salti gave the woman advice on what to eat, morning, noon, and night—simple, inexpensive recipes to improve her breast-feeding capacity, as well as her overall health and that of her other
children, who were too often snacking on chips and bottled juice. Salti recommended stews made of vegetables and chicken wings, soups, burghul, and macaroni.
“Giving such advice takes up much of my time,” said Salti. “But they need practical help, too, about how to manage their homes—things like putting the children near a sunlit window, keeping them away from the fire, away from the cooking.” Dr. Salti expressed her wish to develop health education programs to maximize the benefits of medical treatment. “The women of the camps,” she said, “cannot abandon their children and household chores to come to us for lectures. We must go to them, into their homes.”
Some weeks after the consultation about the twins, Dr. Salti was startled to hear in the conservative streets of the camp, the young mother calling out in a loud voice, “Doctura! Doctura! I’m breast-feeding! I’m breast-feeding!”
As with any volunteer project, the VOC relies heavily on the good will and financial help of contributors. Like other organizations at AUB, the clinic receives funds to assist in carrying out its activities from the University Student Faculty Committee (USFC), which provided $10,000 as start-up seed money in 2001,
followed by $5,000 in 2002 and in 2003.
Other financial support comes from the
solicitation of financial contributions and donations in kind, undertaken by the VOC members themselves through the fundraising events they organize. Most recent among them was the dinner held in March 2004 at the Metropolitan Hotel. Similar events in 2003 included a musical evening in Issam Fares Hall featuring the oud, as well as a gala alumni dinner held in Amman.
Surprisingly, committee members say they are not currently worried about finances. “Of course, we need money,” they say, “but what we need most are volunteers—warm bodies to help us out.” While human resources form the vibrant core of the clinic, continuing financial assistance is needed to help upgrade and optimally utilize the clinic’s existing space and also to acquire more equipment. For instance, stethoscopes and more dextrose machines and otoscopes are needed, and the examination cubicles need to be made more privacy-proof. With additional funds, the number of patients to be treated can increase—and perhaps lead to the expansion of the VOC into other deprived areas of Lebanon.

The natural turnover of graduating medical and other students, however, sometimes casts doubt on the future of the clinic. But everyone involved says it must go on. “This is a project very dear to my heart,” says Dr. Salti. Asked what they most valued about the clinic, the patients also emphasized continuity. “When the clinic first began, we thought it would last two to three weeks—a month at most.” But the young doctors and students who are now in their third year with the VOC in Shatila have watched the clinic grow from 12 patients on October 6, 2001 to 30 patients every Saturday in 2003 (one memorable day, 100 patients were seen). So far, the VOC’s primary care services have been extended to almost 2,000 people.
Most volunteers feel an inner compulsion to serve the less fortunate. Diala Dandach, explaining why it is so important for her to volunteer, said: “The situation in Shatila is part of our society. We are responsible for this problem, and we cannot turn our heads away and ignore it.”
The patients, of course, are ardent supporters of the Volunteer Outreach Clinic. One 65-year-old woman suffering common complaints of the camp—lower back pain, high blood pressure, diabetes—said the best thing about the VOC was the warm and friendly welcome the volunteers always give the patients. “They treat us like real people, like human beings.”
As for the volunteers, one of them put it this way: “We created a space where we lose our minor identities, our religious backgrounds, our differences—for something greater.”