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.

From Malta to Tripoli

Saying my farewell in the wee hours of the morning to lovely Malta, we boarded the UNHAS (UN Humanitarian Air Service) plane with 50 or so members of various NGO's to Tripoli. Some were heading towards Benghazi in different capacities.

Before leaving for Libya we had to take the International Medical Corps' (IMC) 4 to 6-hour online course on security and score a 100% on the examination, otherwise one had to review the different scenarios again and retake the exam.  Medical Teams International (MTI) is collaborating with IMC to provide medical services for the internally displaced people (IDP).

Tripoli from the plane was miles upon miles of pale yellow flat-topped buildings with a moderate array of high rises. As we drove through the streets of Tripoli, graffitis in Arabic and occasional French and English were scrawled over the walls: Revolution Feb 17, Freedom or Free Libya, Gaddafi go to hell; pictures of Gaddafi in various poses of humiliations and indignities, fleeing with bags in hands, being punched in the face and Libyan flags were everywhere, flying from cars, buildings and painted on the walls: red, black and green with star and crescent in the center. We saw remnants of road blocks: spare tires, concrete blocks, sand bags. Some road blocks were unmanned and the ones that were guarded were manned by men toting AK-47; some in fatigue but many in civilian clothing and trucks with anti-aircraft artillery.

We drove through streets where the fighting did not happen in the war so we saw little destruction.




We stopped briefly in the IMC office in Tripoli where the seemed to be a whole lot of confusion among the IMC personnel where they were to send us. They were even surprised at our arrival.  It was also the day when the old country director was eagerly preparing to leave for US and the new country director from Croatia who happened to be on the same plane with us was just arriving.  He had not been briefed.  When we told the IMC personnel in Tripoli that MTI had the notion that we would be sent to Sahba in the desert area, south of Tripoli, one of the Tripoli personnel glibly said, "They want you to be killed!" Apparently it is still fluid and dangerous in the field hospital there.

Unfortunately with the confusion and changing of the guards, we felt somewhat put-off and unwanted.  There was to be a security briefing when we got to Tripoli and that never took place.  After some to and fro, it was decided that we would be sent to Al Zintan to make assessment of the four to five clinics there, the goal is to eventually establish a comprehensive clinic which would include maternity service.   If and when we are no longer needed there, they may send us to other places.  Right now, active fighting continues in Bena Wali and the birth-place of Gaddafi--Sirte, to the east of Tripoli.

We were driven south-west for 3 hours to Al Zintan in the Nafusa Mountains.  We were also told that the staff there was aware of our coming but that we were to call them when we were two-thirds on the way there. On our way we saw a cavalcade of 4x4's with men and anti-aircraft artillery- a victory parade of sort honking down the street flashing victory signs. We passed a military base where Karim, our driver told us Gaddafi tortured the Libyans. When Tripoli fell, there were no signs of Gaddafi's men.  Several buildings on the street were partially burnt and riddled with bullet holes: the hide-outs of Gaddafi forces. One was completely destroyed by NATO bombings and reduced to bent metals and concrete rubble. Parts of the roads were filled with shallow potholes from air bombing. There were many more road-blocks with men toting AK-47, stopping us and asking questions.  IMC signs are prominently displayed on the front of the land cruiser and on the driver's side to enable us to pass check points more efficiently.  Tripoli was taken over by the rebels in two weeks and the destruction here was much less compared to Misurata.  Life however seems to have returned to Tripoli; some shops were opened and we were able to change money and buy some food.

We stopped in front of a tank on which was scrawled "Gaddafi's Killing Machine". Locals stood on top of the tank posing with victory signs. An enthusiastic young Libyan pulled me up the tank and I stood up there flashing my victory signs. They offered us dates and grapes. Passengers in passing cars honked, smiled and waved victory signs at us, all seemed happy and friendly. A young man fired into the dry vast desert terrain from an anti-aircraft artillery, he was being trained to use it.


Al Zintan is situated in the western mountains. Gaddafi's men were defeated because the locals here knew the terrain better than his men.

Arriving late in the day in Al Zintan, Lotfi, a Tunisian ER nurse showed us around the hospital. He spoke mainly Arabic and French with very little English. I did not think he showed us the entire hospital. We passed quickly through the ER with separate sections for women and men, the CT scanner, pharmacy, x-ray rooms and an empty 3-bed ICU.  Many of the medical personnel here are from Tunisia where the first revolutionary wave of the Arab Spring started. They are very sympathetic to the cause of the rebels.  In the evening we met with the clinical coordinator and the logistician in charge of security, again we had the distinct feeling that they did not know why we were sent to the mountains where they were either assessing the needs for clinics or closing some of the clinical services which are now being covered by other NGOs.

The citizens of Al Zintan prided themselves on their refusal of Gaddafi's offer of 100,000 dinars per person for not fighting against him. The city itself was dusty, all yellow and brown with sparse vegetation. The few women seen on the streets were covered from head to toe in long dark dresses and hijab or head scarves. Most women were driven in cars. This is a post-war area and things have calmed down, perhaps they will now need a long-term healthcare setting, although occasional injuries are incurred through firearms used by civilians left over by the rebels.

At first we were told that we should not go out without the escort of a man and to take as few trips as possible to and from the hospital but this rule was relaxed or abandoned because most men were busy and eventually we went out on our own.  One morning I even managed to work in a run in the back roads meeting several camels fenced in a back-yard.

We had a cook who prepared lunch and dinner for us, mainly goat meat and sometimes entrails with spaghetti which was not very appetizing.  One afternoon I walked into the kitchen and was startled by a sad-looking goat's head left by the sink to be used later in a stew!

  Throughout the night we heard artillery fire, some very close to our building, making our sleep very fitful. We were told the Libyans were firing their victory volleys.  After a while the firing became a normal background noise for us.