WHO online trainings help medical staff in Syria’s besieged areas save lives

WHO/Sheahen

From Turkey, Dr Abdulhannan Aljouja teaches health workers in besieged eastern Ghouta, Syria, about diabetes management.

“There was no health staff. Only 1 veterinarian and 2 first-year dentistry students with no experience.” Yasmine *, a Syrian nurse who left the besieged town of Madaya, describes her small, inexperienced team’s struggles to care for patients in a place cut off from the world. “There were no certified nurses – only 3 non-trained nurses, including me.”

“Before the war, I was working in a clinic. After the war started, I had a chance to join a hospital to save lives,” she continues, explaining how her team tried to cope with patients who needed Caesarean sections and other care. “I’m not a certified nurse, and learned by experience.”

In the first half of 2017, the WHO field office in Gaziantep, Turkey, across the Syrian border, provided financial support to health partners for online training on noncommunicable diseases designed for health workers in Syria’s besieged areas.

In this way, trained doctors from partner organizations in Turkey were able to reach over 200 health staff in besieged areas. They provided online training on diagnosis and treatment of diabetes, hypertension, respiratory diseases, mental illness and others. Courses consisted of 3 sessions, each 8 hours long, with approximately 15 students per class.

Limited staff, limited resources

In Syria’s besieged cities, few health workers remain. Many managed to get out earlier in the conflict. In areas like eastern Ghouta, near Damascus, it is estimated that up to 90% of health staff have left.

Remaining staff must attempt to manage, for example, vaccine-preventable diseases they didn’t expect to see in what was a middle-income country. “We see many cases of measles in children aged 1 to 5,” says Rezan, a young nurse in eastern Ghouta, where vaccines ran short from autumn 2016 until March 2017.

Even when medicine and equipment are available, things can go wrong. Sometimes the power goes out during the online trainings, shutting off the computer connection. “There’s difficulty with electricity for the facility,” says Rezan. “Our department has incubators, but we don’t always have electricity.”

Those who stay in the cities’ health facilities grapple with heavy caseloads and limited medicine, equipment and knowledge. “Communicable and infectious disease rates are high when there’s malnutrition,” says Adel*, a medical doctor working as a health coordinator for a Syrian organization based in Gaziantep. “People are living in basements to be safe, in high-humidity places.”

Online trainings help staff save lives in dire situations

“I didn’t know anything about hypertension, diabetes and other noncommunicable diseases,” says Fatima, a nurse in eastern Ghouta. “We’re getting many asthmatic cases, acute cases. In the past, we used syrups or injections,” says Yaya, a young man working as a nurse who attended the online training in May 2017. “Now, I know how to treat it with inhalers.”

“Staff in besieged areas are being trained on how to approach the patient and treat the disease according to what’s available,” says Adel. “They can’t refer patients elsewhere because they’re besieged in a small area. We have to adapt to the situation.” This is why the online training is so vital.

“There’s an increase in patients with hypertension in their 30s and 40s,” says Rezan. “Now I can differentiate between chronic and transient hypertension.”

“When it’s late at the hospital, the doctor might be at home,” says Noor, another nurse in eastern Ghouta. After the WHO-supported training, she explains, “I can deal with patients using my acquired knowledge in a more professional way, with oxygen and inhalers … I can take care of them and solve problems until the doctor comes.”

Assistance continues after the training

After the training, teachers keep in touch to offer follow-up supervision. Dr Abdulhannan Aljouja, one of the trainers, uses a group text-messaging app so his students can consult him when they’re not sure of a diagnosis. As he scrolls through the texts on his mobile phone, photos of severely swollen feet and X-rays appear, with questions from students. “That’s a pulmonary tumour,” he says, pointing to a chest X-ray.

“Online trainings are an easy and affordable approach that also allows teachers to stay in contact with their students,” says Adel.

WHO’s online training of health workers in besieged areas is generously funded by the United Kingdom’s Department of International Development.

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* Some names have been changed for security reasons.