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Doctors without frontiers

Just back from visiting beleaguered hospitals in Libya, Italian orthopaedic surgeon Ugo Orestano and specialised Maltese nurse Joseph Garzia speak to Ariadne Massa about the horrific injuries they witnessed.

Beds with injured rebel fighters lined the blood-stained corridors of a makeshift hospital in Misurata, as weary doctors worked incessantly to treat the horrific injuries of young Libyans brought in from the frontline.

Badly injured fighters are keen to be patched up as quickly as possible so that they can return to the frontline

The hospital was heaving with critically wounded patients – one young man had his brain blasted open, another was on a life support system with a bullet lodged in his spine, while another waited to have his leg amputated.

“The medics’ main concern was freeing up beds for new patients, and transferring those who had received initial treatment to other hospitals. They were struggling to cope with the constant flow of patients being brought in from the battles against Gaddafi loyalists in Sirte and Bani Walid,” Mr Garzia said.

Misurata, Libya’s third largest city, has been the scene of heavy fighting since the battle to overthrow Muammar Gaddafi’s 42-year regime started in February, and its main hospital has practically been flattened.

Malta was the only aid line for the besieged city during the worst fighting in March, as vessels were regularly leaving Grand Harbour laden with medical supplies and food.

During the bombardment many doctors died while treating patients, but medical staff were undeterred and created a makeshift hospital from the ground floor of the outpatients block, that remained standing some 200 metres from the ruins of the main building.

At the entrance, photos of missing people plaster the walls, put up by relatives who have not given up hope of being reunited with their loved ones.

In one area was a partition where wounded Gaddafi loyalists were being kept, and although Prof. Orestano and Mr Garzia were not allowed to enter, they could tell these were at least still being treated humanely.

The block’s storeroom doubled as an intensive care unit for emergencies, where doctors have been working round the clock for weeks, attempting to stem the system’s haemorrhage – but there was no end in sight as badly injured fighters continued to flow in.

“The wounded are immediately stabilised, and despite the limitations, are receiving expert care. But the staff are barely coping,” Mr Garzia explained.

“Mostly, patients are fighters in their 20s or innocent civilians caught in the crossfire. When we were there, a baby with bullet wounds was brought in – it makes you weep to witness those scenes,” he added, his eyes welling up.

This is the first time Mr Garzia and Prof. Orestano have been to a war zone, and they were the first two people who volunteered to return to Libya when Saint James Hospital issued a call for staff to visit its clinic in Tripoli to establish what help and support they could provide.

Prof. Orestano, a boisterous Italian consultant orthopaedic surgeon employed by the hospital since it started its operations in Tripoli in 2006, and Mr Garzia, a soft-spoken specialist Maltese nurse who heads the endoscopy unit, set out on their journey.

Reaching their destination was complicated since Tripoli airport remains closed to international flights. They flew to Djerba, Tunisia, and then drove more than five hours to the city, being stopped at 20 checkpoints manned by young men, carrying heavy armaments, checking their documents until they arrived.

Sitting in the comfortable, secure environs of Saint James Hospital in Sliema, less than 24 hours after their return, the two yesterday recounted the tension they felt when they were stopped at each checkpoint and the relief when they were whisked through. Even though the youngsters were “kind”, they were still nervous, not knowing what to expect at each blockade.

So they were relatively surprised to see how tranquil Tripoli was on their arrival. There may be fewer people walking the streets, but the two felt safe to wander around the shops, and have their regular coffee. They only gunshots they heard were those of trigger-happy youngsters celebrating.

Prof. Orestano said it was hard to connect the battle scenes they had watched unfold with what awaited them in the city. The telltale signs of war were mostly the few shops that remained closed, the queues for bread and the empty shelves in some outlets. Otherwise, the Libyans were attempting to restore a semblance of normality.

“Life seems to be returning to normal in Tripoli and it is quite safe,” Mr Garzia added, encouraging Maltese people who had worked there to return so as to reignite the Libyans’ confidence and help them rebuild their city.

The two immediately got to work at the clinic, extracting bullets from wounds during the night, and by day following-up on those patients who had previously undergone surgery, and the non-urgent cases.

All this was being done voluntarily and offered for free.

Saint James Hospital had announced their visit beforehand, so over four days they were running what seemed like a factory production line, seeing more than 200 patients.

Mr Garzia observed how having worked in Libya for the past years he did not remember witnessing any antagonism, but now it seemed as if people could get the frustrations of Gaddafi’s 42-year rule off their chest. Across Tripoli, the word ‘freedom’ was painted in Arabic across the walls.

The situation in hospitals in Libya reminded me why I became a doctor

“There is a sense of relief that they are free, even though they know Libyans had to pay dearly for this cherished freedom,” he added.

He explained how Libyans seem baffled how the one man who ruled them for so long could turn Libyans on Libyans. This was not a war where they were fighting outsiders, but one were their fellow countrymen were the targets.

“They spoke about a sense of malevolence and vengeance unleashed on the people by Gaddafi’s forces. It seemed there was a focus on creating permanent damage. The fighters will not rest until Gaddafi is captured. They want him out at all costs.”

While there, Prof. Orestano and Mr Garzia also visited Tripoli’s main hospital, but the situation seemed to be under control even though it was packed.

It was very well equipped, with doctors united in providing top-notch care to patients admitted with bones fragmented by bullets, and many other serious trauma cases. There, Prof. Orestano was occupied offering consultations to doctors who sought his advice on complicated orthopaedic operations, while Mr Garzia doubled as a theatre nurse.

However, the hospital’s management felt Prof. Orestano and Mr Garzia could be of better service in Misurata, so they set out on a long journey through even more secure checkpoints.

Contrary to Tripoli, the aftermath of the bloody war was palpable during their five-hour drive. Buildings were all pockmarked with shrapnel, houses were crushed and abandoned, and bullets littered the roads.

“Misurata is a disaster. There has been total destruction,” Prof. Orestano said, proffering his mobile phone photos that reveal a battered city.

Mr Garzia added: “Entering Misurata we finally understood the destruction that had besieged Libya. Imagine what state Bani Walid and Sirte must be in as a result of the heavy fighting that is still going on.”

It was clear they had now entered a war zone and the situation awaiting them at the makeshift hospital in Misurata was one of critical injuries, made worse because of the fact that the patients were mostly young men injured in battle.

“Working in a hospital means we’re exposed to suffering, but this was not the same. We were entering an area where nothing was planned, patients did not stop coming in and their injuries were horrific. It was painful to see such young, strong men unconscious in corridors,” Mr Garzia said.

Equipped with two huge bags packed with sutures, medicine and dressing which they donated, the two rolled up the sleeves of their scrubs and got down to business, giving overworked doctors and nurses some reprieve.

“The country is broken, but the people’s spirit is not defeated and there is a sense of euphoria. Even badly injured fighters are keen to be patched up as quickly as possible so that they can return to the frontline among their comrades, fighting for Libya’s liberation,” Mr Garzia said.

While at Misurata, Prof. Orestano and Mr Garzia also entered into discussions – involving the Maltese government, health authorities, Saint James Hospital and the Libyan medics – to establish which patients could be transferred for treatment at Mater Dei Hospital.

“The doctors were keen for us to take as many patients as we can to make way for new admissions. The one day we were there, six fighters were brought in from Sirte – three were dead and three badly injured,” Mr Garzia said.

Together with the team there they helped establish the pressing cases that could be flown to Malta, assessing who required intensive care at Mater Dei and who could be treated at Saint James Hospital.

Medical reports were drawn up and eventually 14 Libyans who were injured on the battlefield in Sirte and two journalists were brought over to Malta last Tuesday night where they are still receiving treatment.

Prof. Orestano and Mr Garzia also visited another hospital in Misurata where the less serious cases were being operated upon.

This hospital too was desperate for space and pleaded with them to take patients out while these recovered to free up operating theatres.

Following the feedback of Prof. Orestano and Mr Garzia, Saint James Hospital is looking into what long-term options of care it can provide to help the country start the healing process.

“It is terrible to see entire cities destroyed, but Libya is rich in oil and these can be easily rebuilt within five to six years. But people cannot be ‘rebuilt’, if you’ve lost a limb you can never get it back and you are never the same again,” Prof. Orestano said.

“There are hundreds of Libyans dead, numerous others who have been seriously injured, and if they live some may never walk again.

“As an orthopaedic surgeon, it set me thinking about the life of Libya’s young generation – these patients are not in their 80s, but in their early 20s and their life has changed forever.

“After this experience I’m geared to return in two weeks. My wish is not to escape these scenes but to go back and contribute in any way I can.”

Looking back on their trip, Prof. Orestano and Mr Garzia reflected on how stripped of the comfort, supplies and equipment they were accustomed to working with, these visits reminded them why they fell in love with their profession in the first place.

“The situation in hospitals in Libya reminded me why I became a doctor. We were back to the basics,” Prof. Orestano said, as Mr Garzia nodded in agreement.

What struck them most about the Libyans was their desire to live and resilience to rebuild their country – “They’re in celebratory mood, and the situation has not left them disillusioned; they’re very focused on the future”, and Malta, they felt, had a lot to contribute.

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