Salaam to Libya

The people of Libya are very friendly and welcome foreigners with open arms. Theirs had been a closed society and under the long oppressive regime of Gaddafi, they had very little contact with the outside world.




Now that they have gained their freedom, granted that there are still battles to fight to gain control over Sirte and Bani Walid before the whole of Libya is liberated, free from the grip of the dictator; they are free to express themselves. In days of old they could not even trust their neighbors and Gaddafi's name could not pass their lips for fear of being reported and arrested.

A Sign in Freedom Square

In my last run in Misurata, I walked into a building that suffered quite a bit of destruction and did a little bit of exploration. It must have been used as a battle ground. The ceilings were down, shattered glass covered the floor and papers strewn all over the place. It is not unusual to find spent shells and cartridges on the ground.  On the second floor more of the same except up here were windows through which shooting and firing must have occurred.  Through one of the windows, I could see the school that Walid said Gaddafi attended and the gate to a garden on which were scrawled "Fxxx Gaddafi".

A few days ago I ran past the make-shift war memorial that displayed captured Gaddafi's weapons. A father was looking over the display with his daughter and son. When he saw me, he enthusiastically opened the gate to the display and narrated to me what he knew of the various kinds of weapons in his broken English, that Gaddafi had used the heavy machinery to kill his own people and how Libyans captured these weapons and used them against him. He was so into the narration that his daughter had to remind him that she might be late for school.








During my last few days in Twarga and Kararim, I worked with Dr. Muhammad, a Libyan from Tripoli who spent his free time volunteering all over Libya. Volunteering made him happy, he explained that helping people touched a chord in his heart. He showed up one day at the clinic and rolled up his sleeves and worked alongside me. He was quiet, gentle and reflective. He spoke with a calm demeanor and without a trace of bitterness about the situation of Libya then and now. He expressed his hopes and desires for his country and for the people of Libya, that they would respect their new-found freedom and the rights of their neighbors, that they would not harbor malice or ill-will towards pro or anti-Gaddafi factions, that they would look past all that and work together to build a new Libya.

Muhammad was also opposed to big families which he thought was one of Libya's problems.  Each family consists of eight and ten members and some men have multiple wives.  He recalled the biggest family he knew was a fifty-year-old man with four wives and thirty-five children.  One day the man called a boy over and asked him, "Who is your father?"
The boy replied, "You!"
Angrily he said,"Go to your mother."
He had so many children that he could not recognize one of his own.

It rained fairly heavily one afternoon for about twenty minutes, at the end of which a rainbow appeared--a rainbow of hope for the people of Libya? The cool breeze was welcoming.  A tabby cat lurked at the gate of our clinic.  I offered it my spaghetti lunch, by this time she had run and hid under a car, she did not care for it.  I peeled three pieces of laughing cow's cheese and that she ate heartily.  Even a war time cat became rather picky unlike the undiscerning camels.

In my last few days in Libya, I felt in my bones that the war was nearing its end.  I wished very much to remain for a few more weeks to witness the victory and the joy and relief of the Libyans.  In any case I am glad to be here to witness history unfold for the Libyans. The Freedom Fighters and the medics are tremendously brave people fighting for freedom for their country and saving lives in the front lines. The people who are forced to flee the cities are suffering now and I hope it is not for long, insh' Allah that peace will prevail and all of them will return to their homes to rebuild their lives and to enjoy their freshly-minted freedom.

SALAAM!

Kararim and Bloody Friday

A few days ago a group of military police moved into the same building that we held clinic in Twarga. All morning the police carrying guns trouped in and out of the building passing by the clinic, it was not a particularly comforting situation to work in.  The Refugee International came to see the conditions of the IDPs. Time magazine journalist and a freelance photographer came to interview me about our work at the clinic. Because we were not to work alongside the military, we closed the clinic to move to Kararim, a town closer to Misurata. The apartment complex here was a lot better, the grounds were cleaner; there was electricity and running water. The diabetic patients now could keep their insulin in a refrigerator if they could find one. All the Twarga IDPs were moved here. I saw the girl with the gun-shot wound for dressing change. Her wounds had become considerably smaller.






Our new clinic is housed in the guest room of an apartment on the ground floor. This apartment has three bedrooms, a sitting room for the women, a kitchen, two bathrooms and three balconies. Furniture and cushion, pillows were strewn on the carpeted floor, flour strewn on it as though the owners in their hurry spilled it. The floor of one of the bedrooms was filled with clothes and two open suitcases packed with clothes but abandoned, perhaps there was not enough room in the vehicle. Another bedroom had a photograph of a baby next to an ID card of a young woman, perhaps the mother, stuff animals…The kitchen had a bin with a collection of moldy bread, packed but not taken with them, another big bin filled with pots and pans left on the floor as though the owners decided that they should be abandoned. The scene all seemed very chaotic. I could only imagine the turmoil and the heart-wrenching decisions that the family had to make.






War has its way of tearing people apart and bringing misery to the lives of ordinary people who only wish to have a better life for their children and themselves.


I was requested to do a house call.  Muhammad, my translator and I were brought by a man to another apartment complex.  The patient was a big 75-year-old woman, diabetic and hypertensive.  The finger-stick showed that her blood sugar was low and we gave her some juice.  Then one of her daughters asked me to change her Foley.  The last time I did that was when I was a medical student although I did recently watch a nurse insert a Foley at the Field Hospital.  I had to do this without the help of my translator for men were not allowed into the women's apartment except family members.

A Freedom Fighter walked in one day with an obvious limp to get his dressings changed.  He had a wound in the left shoulder and the right thigh.  The bullets were still lodged in there.  He faced a long period of recuperation ahead of him.

Many more people were leaving the apartment complex, long lines of cars were waiting by the check point to be processed.  A big lorry parked by the complex; two children sat in front with a driver and their mother.  In the back of the lorry out in the open sat several grown women dressed in their ubiquitous black abayas patiently with a mound of blankets in the center.  In one of the pick-up trucks was a lamb standing among furniture and blankets, looking out of place and lost.  Apparently there has been a 48-hour truce to allow the people from Sirte to leave before fighting begins again.

Hani was my new driver. He spoke some English and is actually a Palestinian. His father moved to Libya 44 years ago. Hani is now 38 years old and a school teacher before the war. But because he earned 200 dinars a month which he said was only enough to buy food for himself, he could not save enough money to get married. He was hired as a driver by IMC just five days ago and the pay was much better but in his heart he still wanted to be a teacher.  He fought in Misurata in April and May and did not know the whereabouts of his two brothers for two months and later he found them alive but their home right across from the display of arms in Tripoli Street was all but destroyed. All he said was "Al hamdulillah" (Thank you my God).

Since the weekend truce there had been talks about a big push to topple Sirte. Each day was supposed to be the day of reckoning but it did not happen till this Friday-their Prayer Friday which was destined to be their Bloody Friday. The Freedom Fighters decided to make their big attack today. Casualties were brought to the Field Hospital all day. This afternoon on my way home from Kararim, the road to our guest house which was also the road to the hospital was blocked to enable easy passage for ambulances from the heliport. Hani told the police that he was bringing a doctor through and they allowed us to pass.

It was as though Mother Nature was sympathetic to the situation, out of the blue a fierce wind blew sand, dust, debris and palm leaves through the streets. Dark ominous clouds gathered over the heliport. A helicopter took off having dropped off the injured fighters. The rain came pelting down and almost immediately the streets became flooded. Stream of ambulances came roaring by. The hospital ground and ER entrance were filled with people and the streets were packed with parked cars of relatives looking for their loved ones among the injured. Then all of a sudden the whole place was plunged into darkness except for the hospital.  The fierce wind blew the window shutters senseless and rain came flooding into our apartment.  I was the only one back in the guest house and ran around frantically closing the windows.



As each fighter was unloaded from the ambulance, the crowd chanted "Allah Akbar” (Allah is Great). I was able to get into the ER with my badge to see if I could be of help. Surprisingly it was not full. The fighters there were not seriously injured. The ICU however had five fighters all seemed mortally wounded. There was another room filled with the injured waiting for x-rays or other studies, all were splinted and dressed. As I left the ER, it was quickly filling up.



The helicopters that took off a couple hours ago returned and the Chinook was also busy transporting patients. There must be at least 20 ambulances coming into the ER. All night long they continued to come and the chanting of "Allah Akbar" continued late into the night. By some reports, there were over 200 injured and 22 people died on this Bloody Friday.

Sirte Gate 30 the Polyclinic

Desiring to explore another area of Misurata, I decided to run east of where we live.  Destruction was much less here but there were still a few burned out buildings.  Children have started school and school vans came to fetch some of them.  Hordes of young girls and boys carrying school bags smiling at me as they walked to schools, the boys put up their thumbs.  Tankers with slogans in Arabic parked in a big plaza, rust has already begun to set in.

Today we drove to Gate 50 where the Field Hospital is and then changed vehicle and drove with security to Gate 30 where we delivered many boxes of medicine and supplies. We then spent a couple of hours seeing patients there; they were mostly children with diarrhea. Intermittently through the windows sounds of bombing could be heard. The window panes rattled with the blasts. Gate 30 (that 30 kilometers form Sirte) brought us a lot closer to the center of Sirte where fierce fighting is still going on. After we finished seeing the patients we went on to Wadi Inffra, after passing a check point. Again we delivered medicines but we were told that almost all the patients came early in the morning and had left because they feared that fighting which usually is more intense in the afternoon would pick up. A father came in with a crying boy, the father spread his arms simulating a plane flying and then he made the sound of bombing. The boy was traumatized by the constant shelling.



Off to the Field Hospital we went. In the morning there were no patients but in the afternoon there were three, all of them being transferred out of Sirte Hospital after the Red Cross had received safe passage to bring out the injured. One of them was an elderly man with a chest wound that resulted in a punctured lung; he had a chest tube placed, another was a young girl with fractured pelvis and shoulder and the third was a woman who recently delivered a baby, she was in a bomb blast and suffered many shrapnel injuries and was paralyzed from the waist down. Because she was a woman I helped the nurse there to wash her and we dressed her wounds as best we could before all three patients were transferred to Misurata in a helicopter. The man with the punctured lung told me that his family was evacuated from Sirte two days ago but he was not able to because he was injured.




Although there was supposed to be a truce for a few days last weekend to allow civilians to leave Sirte some shootings continued so many people were afraid to leave. The Hospital in Sirte has few doctors most have left Sirte to volunteer outside of Sirte. The hospital is within hostile territory close to Gaddafi's stronghold.  There are many snipers, patients and staff alike have to run through the gauntlet of gunfire and snipers to get in and out of the hospital.  Diesel has long run out so there is no electricity or oxygen and little medicines. Many patients who were brought to the hospital died. The current Field Hospital will be moved closer to Sirte to shorten the distance of transport of the injured.

In the evening I took the Chinook along with a fighter with a broken arm and many other healthcare personnel. We stuffed our ears with cotton wool to cut down the noise from the Chinook.  The noisy Chinook flew far out in the Mediterranean supposedly to be away from the line of fire. In the distance we could see the sunset over Libya, the sun's rays pierced through the gathering dark clouds. The Chinook hovered slowly and laboriously for what seemed like a long time before finally landing.  When we arrived at the Misurata Airport forty minutes later, there was no cruiser from IMC so I rode the ambulance carrying the fighter with the broken arm to the Polyclinic Hospital with the ambulance driver who was an IT guy from Tripoli but he is now driving the ambulance in Misurata during the war. The contributions towards the war efforts of the people of Libya have been tremendous.

Sirte-The Field Hospital and Clinic at Gaddafi’s Beach Resort

This morning we drove for about two hours through flat, monotonous, arid landscape to the Field Hospital and Clinic in the beach resort of Gaddafi, 50 kilometers from Sirte. Signs for camel crossing are posted at regular intervals along the road. Occasional camel carcasses are seen on the road sides.    At night when the temperature of the desert dips, loving the warmth of the tarmac the camels often settle on the roads and are hit by vehicles.  Packs of camels walk slowly and patiently across this unchanging landscape feeding on scattered short clumps of brushes. Their breakfast, lunch and dinner are one and the same; scanty and unappetizing. Like the cats the camels must be wandering about the unrelenting bombings. There seems to be smiles on the faces of the camels.  On our way to Sirte I saw the head of a camel hanging in front of a butcher shop, it still wore a patient smile despite its demise.




One of Gaddafi’s beach houses within the walled compound has been converted into the Field Hospital. It has 10 beds two of which are resuscitative beds. An annex room serves as a storage room for medicines and equipment. There was only one patient when we arrived. Later in the afternoon Red Crescent ambulances brought in four casualties, evidently fighting had heated up. The latest news is that the Freedom Fighters have reached the round-about of the city center of Sirte where the west and east flanks of the fighters convened.  They have also captured the port thus cutting off the possible retreat route of Gaddafi and his forces who were fighting back refusing to surrender.  Unfortunately many civilians get caught in the cross fire. One of the patients brought in by the Red Crescent was seriously injured, he was unconscious and intubated, blood pouring out of his mouth and nose. The Chinook that landed this morning at the beach would likely transport these casualties to the Polyclinic Hospital in Misurata right across from where we are staying. Two additional tents were set right outside the Field Hospital for patients who are stable.  Several of the beach houses are being used as dormitories for the volunteers who have to stay overnight and one was converted to a labor and delivery room where I found my Misurata companion, Dr. Fatma.  Helicopters and Chinooks arrive and take off at intervals bringing healthcare personnel and patients.




Muhammad, my translator and I were sent to the Field Clinic right outside the compound by the check point. It is a container with three rooms, one of which is really a room for storing medications. There were several doctors and medical students seeing people who were fleeing Sirte. Outside lines of cars were stopped and searched thoroughly by the Freedom Fighters. They flipped through their belongings and the folds of their blankets. The people were waiting outside their cars patiently in the heat with their suitcases. One Freedom Fighter approached me to look at a veiled woman to see in fact she was a woman and not a man in disguise. She did not wish to have a man peer at her. In the clinic I saw a young woman with a cut on her arm, that was cleaned and dressed and she and her father went on their way. Because there were so many volunteers in this crowded and airless container, Muhammad and I retreated from there and back into the compound. We had a lunch of couscous and some meat which I later found out was camel meat!  It tasted like beef but not as tough as goat meat.



The beach is beautiful save for the trash that has been discarded by the current occupants which is regrettable. I tried my best to imagine the pristine beach before the Field Hospital was set up. There was a lull in the afternoon.  Borrowing a long shirt and pants, I dipped in the crashing but refreshing waves of the Mediterranean Sea in a quiet corner behind some rocks away from the eyes of the Muslims in order not to be conspicuous or offensive.  I wonder how many people could say they swam in Gaddafi’s private resort.

The Twarga Clinic for the IDPs

Despite the fact that we were told medications were ready for us to start the mobile clinic for the IDPs in Twarga, we did not find them. At the IMC office, we went through all the boxes of the International Emergency Health Kits (IEHK) and realized that the promised medicines to set up the clinics were not all there. Amjab wanted me to e-mail a list of needed medicines to the field coordinator who had been unreachable. Fearing that we would lose another day Falid Abood and I requested that we be allowed to buy the medicines. In the end Hassan drove us to an unmarked pharmacy and we spent a few hours purchasing medications. The owner graciously donated some boxes of medications and went to the polyclinic Hospital and obtained some more free medications for us.  He even discounted our total bill.  Hassan stopped at a make-shift road-side store for me to stock up on vegetables and fruits: onions, cucumber, tomatoes, apples and pomegranates with my new dinars.

I checked with Amjab whether it would be safe to run in the streets of Misurata, he said it would be alright to run in the back roads.  One morning I was not sure whether I heard some gun shots when I was running close to the hospital so I avoided the Polyclinic area.  Another morning I went running by the heliport, a few blocks from the guest house, this time I distinctly heard gun-shots.  I quickly turned around and decided to run on the street that ran by the front of the guest house.  This street led straight up to Tripoli Street.  It being Friday, all the streets were eerily quiet.  I stopped for a moment at the road side display of ammunition and tanks captured from Gaddafi's army.

Twarga was one of Gaddafi’s strongholds. When fighting reached this area, the occupants who supported Gaddafi fled and the town was emptied. Now the rebels use them as transitional camps for the IDPs. On one of the check points there scrawled on some enormous pipes in English and Arabic: We fight for freedom and justice. We will never surrender, we win or die.

In the evenings when we left Twarga for Misurata, we could see smoke arising from burning buildings.  When I asked Walid why the building complex was being burnt, he turned around and laughed but refused to answer me; he only jokingly mentioned that Zoro was at it again.  From what I could piece together from the translator, the Misuratans display their vengefulness towards the people of Twarga by burning their houses so that they have no place to return to when the war ends

At Twarga the Committee swept a room clean for us for our clinic.  There were no tables so we sat on chairs to see our patients. In the back of the complex there was a room with an examination table. There seemed to be a whole lot of pregnant women almost all of them near term or past their due dates. They were often accompanied by their protective husbands and mothers-in-law. We transferred them to Misurata after writing them an official pass to enable them to get through the check points. The solders check the passengers and the trunks for possible infiltrated persons from Sirte. Most of our patients had minor problems. Our very first patient was a 7-year-old girl with a gun-shot wound in the left thigh. According to the father, the bullet came through her bedroom in Sirte, ricocheted off a wall and hit her in the thigh.  It did not go through the thigh and the father  had to cut it out.  X-ray later showed that it just grazed the bone.  A young boy who looked healthy came in with diarrhea but seemed quite happy showing off his victory sign. Most women were reluctant to come out and often asked the men to come asking for medications. As oppose to other African countries, here in Libya, fathers not mothers brought their children to see us.







One pregnant woman was brought in by her husband.  She was covered from head to toes with a black veil over her face and black abaya. When I was ready to see her, the men left the room  including my translator who stayed right outside the door, refusing to come in.  She remained with her veil covering her face and only lifted it up when the room was closed.   I thought she was rather pretty.  After I was done examining her, she gestured whether she could put her veil back.  When she got out of the room, her husband immediately took her to the back room away from the prying eyes of the public to wait for her transfer paper.

Muhammad told me that there is a wide variation of how much a woman should be covered.  Universally all Islamic Libyan women are covered down to their ankles only exposing their faces and hands.  However there are groups that require the women to be covered entirely except for the eyes.  At home they could be uncovered but men and women remain in separate quarters.

Marriage is arranged by the mothers and sisters for the men.  The woman then meets the man in the presence of  her father or brother for a few minutes.  The men and the women could say "no" to the match but sometimes the women are not given a choice if their fathers insist.

Walid our driver lost three uncles in the fierce fight for Misurata in April and May. Like many young Libyans it was the first time he ever held and fired a gun. Cats were used by the Freedom Fighters as decoys for Gaddafi's snipers.  At night Freedom Fighters tied light to the cats and let them free.  The snipers fired at the lights thinking these were the Freedom Fighters and in so doing revealed their positions and were in turn fired upon.  I feel sorry for these cats which probably had no idea what all the shelling was about.

Curious about Tripoli Street one evening I found my way there by foot. A lot of buildings were destroyed; some were riddled with bullet holes and there were enormous gaping holes from bombing. It was said that Gaddafi sent more than twenty tanks there and fired indiscriminately. On one side of the street, the victors displayed missiles, warheads, tanks captured from Gaddafi’s forces. Libyan families gathered there, young and old, women and men to view the spoils. Boys climbed up the tanks, their backdrop being the bombed-out and burnt buildings. At one point an elderly man called out slogans in Arabic and at the end a soldier who stood by him fired, “Tat, rat-tat-tat…” into the evening sky. Now things are quiet in Misurata with occasional shots of celebratory gun fire. Outside our accommodation is a sign that said” Misurata is Misurata, we have broken the dictator”.













I ran in Haiti after the earthquake dodging rubble, live wires, gaping cracks in the roads, scavenging pigs and goats and now in the early mornings I ran in the streets of Libya and on Tripoli Street where one of the fiercest fighting in Misurata took place, it was quite surreal.

From Al Zintan to Misurata

In Al Zintan the new part of the hospital is still under construction. Most of the hospitals had their names taken off from the front facades because many of them bore Gaddafi's names and pictures. Today being Sunday we went to the hospital with Lofti, the Tunisian ER nurse.  We visited the Women's and Men's wards, there were no hospital sheets on the bed except what the patients brought with them.  There was a boy who accidentally shot off his thumb while playing with a gun left over from the revolution.  The pregnant women looked rather old and careworn.  There were two OR rooms: one for clean cases and the other septic cases; in the cabinet, they had anesthetics and anti-arrhythmic.  Neuza proudly showed us his anesthesia machine and Hassain his pharmacy.  There were several Libyan women with hijab running the laboratory.

Mondays and Thursdays are circumcision days. Mothers, fathers and baby boys lined up outside the OR. The baby boys all had angelic faces with beautiful and innocent smiles sitting patiently on the laps of their mothers all covered up in black or floral abayas; behind the veil roving eyes followed me. I wasn't sure whether they were smiling behind the hijab.  The babies were blissfully unaware of what awaited them.  A four-year-old boy was screaming his head off when he was carted off for his circumcision.  It must be very traumatic for him since he was likely to remember this event more than the younger ones.



Right when one of the boys was being prepared for his circumcision, a young man with a gun-shot wound just below his xiphoid was carried into the ER with a low blood pressure, rapid heart rate and he was not breathing. Soon he was intubated and fluids were poured in, blood seeped from his back into the stretcher. He was ashen and pale. Several times he lost his blood pressure and was given epinephrine which boosted his blood pressure transiently. He finally got his blood transfusion and was transferred to Juda Hospital via an ambulance. Later I learned that he did not make it.


We met with the Medical Director of the hospital of fifty beds. He was interested in changing the infection control practices of the hospital personnel and showed us his lectures slides in Arabic.  From my previous experience in Hospital Epidemiology and Infection Control, I could not foresee changing behavior in the relatively short period of time we had in Libya and did not volunteer for this education endeavor but my partner volunteer went for it.  In the meantime I had been on the phone and e-mail communicating with Tripoli to send me to Misurata closer to where I could provide medical services to the IDP.  There are now news about people being displaced from their homes and need medical treatment, food, water, fuel and clothes in Wadi Imrah, Twarga and Washka and the clinic at the Field Hospital in Sirte, 50 km from the frontline also needs a doctor and an obstetrician.  The IDP were housed in abandoned homes. Today I will say my good-bye to the friends I have made  here and my fellow volunteer who had elected to stay at Al Zintan.

I took the long trip from Al Zintan with Dr. Fatma, an obstetrician  from Nalut to Tripoli and from there we were to travel to Misurata. The driver came late and we did not leave Al Zintan till after three in the afternoon. It was well past six in the evening when we arrived at Tripoli and traveling in the dark was ill-advised.  Dr. Fatma and I thought we would be spending the night in Tripoli and resumed our journey in broad daylight.  However we were told that our new driver was ready to drive us to Misurata that evening. And so we had a brief pit stop and left Tripoli.  Soon our driver fumbled for a cigarette, I threw a quick glance at Fatma.  Before he could light up, I decided that I had to ask him not to.  The driver muttered to himself that this would be a very long journey without a cigarette now and then but he acceded to my request.  Fatma tossed a look of gratitude in my direction.  To add cigarette smoke to hunger, thirst, fatigue and stress, all triggers for a perfect storm for the setting of a fulminant migraine, I would gladly risk the driver's displeasure. When the evening light was still lingering, we caught glimpses of the Mediterranean Sea and its beaches to our left.  There were quite a number of vehicles on the road at this time of the night, the people who drove must have a compelling reason to do so.

We drove in silence for two and half hours through at least two dozen check points, all heavily guarded. I was thankful to have a Libyan woman traveling with me.  As we got close to Misurata, our car was pulled over to the embankment twice and the armed guards demanded our IDs and passports.  Our driver left Dr. Fatma and me in the car in the dark and went with the guards; this was his chance to light up.  It seemed like ages before he finally returned with our documents while the guards checked the trunk. Some check points had 5 to 10 armed guards and tanks. It was dark by the time we reached Misurata. We were in some sense violating the security guidelines that I went through before departure: we were strictly forbidden to travel after dark.

Our driver took us to the IMC office.  Tired and hungry as we were, we were kept in the office for a security briefing and updates on the possibility of setting up a mobile clinic for the IDPs.  After an hour the driver was told to take us to the guest house.  Since we had not eaten in a while we asked him to take us to a store to buy food.  The store keeper refused to take my 10 dinars calling it “Big Money” and “Gaddafi’s money” and looking at it with disdain. I changed my dollars to dinars in Tripoli which supported Gaddafi during the uprising and evidently the people in Misurata did not accept the currency. Misurata received one of the worst and brutal attacks from Gaddafi's forces.  The 10 dinar bill in Tripoli was much bigger than that in Misurata in size, perhaps as big as Gaddafi's ego.  Fatma loaned me some dinars. There were not much food to choose from but we had to cook something to eat for the night and for days afterwards.  I settled for some pasta, rice, onions, eggs, tomato paste, bread, grapes, canned tuna which seemed to be in abundance. In Misurata we had to be our own cook.

Back at the guest house, the sheets were unwashed, I was glad to have my travel towel and large shawls that I could wrap myself in bed for the night.  Tomorrow I would contrive to wash the sheets.  Because of the war situation, we were asked to pack lightly for Libya so that we could pick up and leave at the spur of a moment if the need arose.  I did not pack sheets.



In the early morning I took a walk around the guest house.  Many of the stores remained closed, some with screens riddled with bullet holes but there were a few cars roaming the streets.  Pictures of Gaddafi and his strong men wearing hideous make-up and draped in colorful hijab adorned the door and walls of an office. Long lines of men queued up in front of a bank.  On the ground floor of our guest house was a man who could change some money for me so I could have the dinars that Misurata would accept.  From the kitchen window I could see a huge "Free Libya" sign and several significant dates scrawled over the walls.

One tends to forget that Libya is in North Africa and as such it is still part of Africa and therefore African Time is still at play here.  Our driver did not show up for at least two hours.  He showed only after I made several phone calls to the logistician borrowing someone's cell phone.  His phone was out of range for a time and he could not be reached. Despite a promise for the use of a cell-phone at least for security reasons, I did not get one.  The field coordinator had turned off her phone.  As one traveled closer to  the Field Hospital, one could not be reached except via a satellite phone.

Walid, our driver finally appeared and drove Falid Abood, Ikrimah, two Jordanian nurses and me to Twarga, a town 20 miles south-west of Misurata. These two nurses have been here for the last five months volunteering in the hospital.  The big highway was cut up with wide trenches by the Freedom Fighters to trip up the tankers of Gaddafi during the fighting.  A line of cars came up from the opposite direction carrying people fleeing from Sirte where fighting is active, some carrying furniture and mattresses. They had to pass through several check points. Along the road sides were strewn mangled war machines, spent shells and burnt tires.  Miraculously many of the date palms stood intact with a few charred ones and one sustained a hole in its trunk but still stood tall and erect.  The dates are in season and many goats are seen feasting on the fallen fruits.  The landscape was one of dusty, hot and arid semi-desert.  Walid fought in Misurata and knew many of the Freedom Fighters manning the check points, we had no trouble passing through them.



We visited the committee center that oversaw the IDP (Internally Displaced People) who left Sirte to stay in the abandoned apartment complex in Twarga. Twarga was a strong supporter of Gaddafi and when the Freedom Fighters moved in the people in Twarga fled.  In contrast to other refugee camps I have been to, there are no tents here.  The IDP live in the relative comfort of an apartment minus the amenities.  Apparently 10 families live in this complex each with between 10 to 15 members. Water is supplied via a tank and they also receive ready-to-eat food as there is no electricity. A pharmacy was just set up on the day of our visit.  Amjad, our logistician told us that he was sent the wrong pallet of supply so we could not deliver the needed medicines.  The committee quarter is piled high with food, trash and kitchen supplies and a roomful of boxes of medicines that just arrived today; they have oral hydration solutions but request medicines for diabetes, hypertension, analgesics, cough medicines...In this same room a row of menacingly looking Kalashnikov's lines the walls.



One of the Freedom Fighters in his traditional clothes with an AK-47 slung over his shoulder and the pharmacist, Abdul Rahman, accompanied us to visit several families. We greeted each other "Salamu allaikum" " Allaikum al-salaam".  Women stayed out of sight inside the apartment while the men lounged on carpets outside. Inside the apartment was littered with mattresses. A fierce wind whipped up sand as high up the third floor, coating the stairs with sand. The women were just as curious about me as I was about them and they brought my attention to the few pregnant women there. Hypertension, diabetes, diarrhea and headache are some of the complaints. The children are the ones suffering from diarrhea.  The apartments reeked of human waste.  Children played  around the water tank and with buckets of water to get cooled and inevitably drank the contaminated water as well. The grounds of the complex were filled with garbage and plastic bottles. There were large pits to bury some of the trash but these did not seem to have kept up with the trash that was being generated daily.  Spent shells were found scattered on the sandy soil. Our hope is to provide some medical care for the IDPs in several of complexes here.

Nafusa Mountains

This morning I saw the crescent moon through the window hanging just above the minaret of a mosque, a gentle cool breeze blew softly.  A lone dog sniffed around in the backyard where a few dust-covered fig trees grew.  Some of the men in the guest house escaped the stifling heat indoors and slept on the roof deck which must have been lovely.

Before our arrival in Libya we were told that we might be sent to Sahba, south of Tripoli where a field hospital might be set up. Now we are learning that is not the case. Misurata and Benghazi are now post-war and are not in dire need of medical help. In Sirht, the birth-place of Gaddafi where fighting is still going on, they need surgeons and anesthesiologists.

Today we traveled west of Al Zintan to Kabaw to close a program in the hospital there, pulling out a Tunisian doctor who had spent two months there. He will be reassigned to Misurata. The hospital director vehemently disagreed with the move, leaving him with two doctors, one from Egypt and the other from Croatia.


The mountains from Kabaw to Tiji were dotted with century-old houses carved into their faces and this created their own air-conditioning system.

Our progress was slowed down by numerous road-blocks and check points manned by Freedom Fighters carrying kalashnikov. The checkpoints were of chairs, tires or mounds of earth creating a meandering path to slow down the speed of vehicles.



From Kabaw to Tiji we traversed over winding mountain road and came upon a huge crater created by the freedom fighters strategically placed by the Freedom Fighters to impede the advance of Gaddafi's forces and attack them when they were forced to slow down.

The goal today was to assess the needs of the locals for clinical care by visiting a few clinics in the towns of the mountain region.The clinic in Awlad Talib near Tiji is clean but devoid of equipment. They have 28 nurses and 3 social workers but no doctors. Some nurses were sitting around with no work to do. This facility is meant to serve 6000 people. For some reasons we bypassed the hospital at Tiji which is non-functional because it has been partially destroyed and the equipment were taken by Gaddafi's forces to Nalut Hospital in the western border of Libya near Tunisia.



In Badr we visited another clinic whose daily census used to be 120 and now down to 25 patients a day. Again the facility is badly in need of repair, equipment, medicines and personnel especially doctors. There are 70 nurses. In the front hall way, prominent bullet holes were seen with Fxxx Gaddafi spray-painted over the top in Arabic.


We stopped at an IMC guesthouse right across from Jadu Hospital for a late lunch of couscous with some meat, a salad of tomatoes, onions and cucumber and finished off with mounds of pink pomegranates and delicious dates.

The mountain region in the west seems to be quiet now and the people that we met on the roads and in the clinics are mighty proud of their new-found freedom. Life is returning to normal.