Stepping up to save lives in Syria
When James Cook University Adjunct Professor of Traumatology, Dr Herwig Drobetz, decided to work in a gutted hospital in war-riven Syria, his task was monumental, but straightforward – to stem the flow of blood.
“It was a basic war hospital. So all we could do is stop the bleeding – and perform basic orthopaedic procedures,” said the surgeon.
Dr Drobetz is Director of Orthopaedics and Trauma at Mackay Base Hospital and trained as a trauma surgeon in his birth country, Austria. He travelled to Syria in April to spend five weeks working for Medecins Sans Frontieres/Doctors Without Borders (MSF), in a derelict hospital in the north-eastern city of Hassakeh – the only free emergency care available to around one million people.
“The hospital compound reminded me of the film set from Mad Max,” Dr Drobetz recalled. “It was filled with old cars and construction materials, because they were trying to rebuild the hospital as we worked. There was even an old swimming pool full of needles.
“We heard gun fights every day outside the hospital compound walls. At the beginning, that's quite disturbing, but you get used to it.”
Dr Drobetz and a small band of colleagues, including other international field workers and Syrian doctors, performed 10 to 12 operations per day – in two shipping containers converted into surgical theatres.
The casualty list was never-ending. Apart from gunshot wounds, they treated the shattered bodies of landmine victims, who arrived at the hospital on almost a daily basis. Around half of the casualties were children.
“There are hundreds and thousands of mines still hidden in former war zones, waiting for people who are now coming back to their homes,” he said. “You can't get your head around someone who would hide mines in other people’s homes. How cruel is that? Treating children was heart-breaking.”
Despite limited medical resources and round-the-clock surgical demands, the commitment and team spirit of the hospital staff never wavered, according to Dr Drobetz.
“Everybody wanted to work. Everybody wanted to get it done,” he said.
“One of our patients was a 30-year-old woman, seven months pregnant, who stepped on a landmine with her three-year-old daughter. The baby died and the daughter died. Everybody pulled together to save this woman. We did 12 operations on her. The whole hospital was invested in her.”
However, lack of access to some basic equipment was a constant source of frustration.
“We had one wheelchair for 25 people,” Dr Drobetz said. “And we could reconstruct someone’s leg, but then we couldn’t get them out of bed, because we had no crutches. While in Australia, we throw them away after one use.
“These are the things that are really challenging. Knowing that we are living in a society where we throw a lot of things away and waste a lot of resources, when we could use them somewhere else really urgently.”
The community at the MSF-supported hospital in Hassakeh extended beyond the staff and their patients. In Syria, it is typical for relatives to take care of many non-medical patient needs, including feeding, and changing clothes and bed sheets.
“So the relatives are there 24/7,” Dr Drobetz observed. “They often stay in the hospital for weeks and months, sleeping on the bare floors, supporting their loved ones.
“But they were all lovely people. Their lives are so disrupted by this war, but they are stoic and accepting. In my down-time, I spent hours talking with them and drinking tea. We had excellent translators, so we were able to form good relationships.”
By the time Dr Drobetz left Syria, in early May, he was in no doubt about the identity of the true heroes in this country’s conflict.
“I learned that the only heroes in the war are the civilians,” he said adamantly. “It's not the soldiers and it's not the politicians. The civilians are the heroes, because they are the ones that suffer.”
He himself feels “calmer”, since testing his abilities to care for countless people in over-whelming need.
“I feel more settled in myself, because I now know that I can function under extreme stress,” he said. “I can do meaningful medicine, with little means.”
The surgeon also knows that if the opportunity presented itself, he would embark upon another MSF field assignment in a heartbeat.
The road to Syria
Battling to save patients with catastrophic injuries in a war-ransacked Middle Eastern hospital with scant medical resources is not on every doctor’s professional bucket list.
But Dr Herwig Drobetz was hooked on the idea of helping mend broken people in broken countries from the day, as a young medical student in Vienna, Austria, he attended a lecture by Medecins Sans Frontieres (MSF).
“What they had experienced fascinated me,” he said.
And his professional inclinations followed suit. When he began an internship in the trauma surgery department in a hospital south of Vienna, he knew he had found his niche.
“I am a specialist trauma surgeon, a six-year program which is unique to middle Europe,” he said. “We basically deal with stopping the bleeding. So we are trained in thoracic surgery, orthopaedic surgery and neurosurgery – but always in relation to trauma.
“It's immediate medicine – and I like that. I need to do something fast and I immediately know the result. That appeals to my personality.”
A sports trauma fellowship with the Brisbane Private Hospital lured Dr Drobetz to Australia in 2004. He then took up a position as a staff orthopaedic surgeon at the Mackay Base Hospital the following year.
“I registered as an orthopaedic trauma surgeon in Australia, because trauma surgery is not a recognised specialist field here,” he explained. “Seventy percent of all trauma is orthopaedic in nature, so orthopaedic trauma is the closest match to my training in Europe.”
Initially for one year, his Mackay position was repeatedly extended. “Somehow I never managed to buy a return ticket to Austria,” he laughed.
Fourteen years later, he is the hospital’s Director of Orthopaedics and Trauma, and also coordinates the surgical training of James Cook University Year 6 medical students at the hospital.
Daily life, including professional and family commitments, had placed his international humanitarian aspirations on hold. But not forever.
“I knew I still wanted to do it,” he said. “It was just a question of when.”
In 2017, when his teenage son began to spread his wings, Dr Drobetz took the plunge and emailed Medecins Sans Frontieres. He was invited to Sydney for an interview.
“They were looking for people who don’t mind being outside their comfort zone,” he recalled. “MSF need people who can work with little, improvise, and work well in a team, because you are thrown into a situation where you have to work with people you have never met before. And when you have to do complex things with little, communication is everything.
“MSF also need people who are flexible and don't care whether they sleep in a tent or whether they sleep in a room with four other people, because that's what it is like sometimes. It's not a five-star holiday.”
Dr Drobetz passed the interview and was invited to attend a three-day MSF introductory course in Sydney, where the emphasis was on psychological and team preparation for what lay ahead.
“You do group exercises, so they can see how well you play with other kids,” he quipped. “There are exercises about how to organise a humanitarian response to a crisis, so you get to appreciate the whole scope; you are not just working with doctors and nurses, but also technicians, logisticians and HR people. It's all about what you can expect.”
What followed was more pedestrian; finding an assignment that would fit in with the surgeon’s pre-existing work commitments.
“They send you emails. Can you go to Afghanistan for six weeks, in two weeks’ time, or we have an opening in Yemen for three months. Syria was the one that fitted my timeframe perfectly,” he said.
“MSF has projects in over 70 countries, so there is always a need for doctors and nurses. They always find something for you.”
Dr Drobetz set out for Hassakeh, in north-eastern Syria, on April 1 this year. The journey took one week. He first flew to MSF International headquarters, in Geneva, Switzerland, for a project briefing before finally landing in Syria.
At no stage prior to or during the journey did he lose sleep about his personal safety.
“MSF is a massive organisation and they are extremely well-organised,” he said. “They have an amazing network. They organise every aspect of your trip. You get instructions on what you can and can’t do. They do everything to keep you safe.”
Once he reached Hassakeh, he was advised never to stray beyond the walls of the large hospital compound. While the sound of gun fire was a constant backdrop to his work – and he frequently dealt with the bloody aftermath – no guns were ever turned on the hospital.
Hassakeh is no longer an active war zone, but Dr Drobetz quickly began to appreciate that the hospital’s reputation was its real shield against ongoing violence.
“The hospital treats everyone. It doesn’t matter whether you are a civilian, a soldier or a rebel. Everybody gets treated. Full stop. And everyone knows that,” he said. “So that is why nobody is interested in attacking the hospital, because they would be robbing themselves of treatment.”
Dr Drobetz was one of a small team of doctors from around the world, including two surgeons, two anaesthetists, an ED doctor and a gynaecologist.
“I became really friendly with the other surgeon, who was from India,” he said. “He was a general surgeon, who had done nothing but war surgery for the past eight to 10 years. He was extremely good – highly trained to do a lot with little. I learnt a lot from him.”
The foreign doctors worked closely with Syrian colleagues, including three orthopaedic surgeons, three general surgeons and an anaethetist, aided by a team of translators who took part in every operation and ward round.
“The Syrian doctors usually didn’t speak English, so the translators made it much easier to communicate and form good working relationships,” Dr Drobetz said. “We all got on extremely well. It was an excellent team. We learned a lot from them and hopefully they learned a lot from us as well.”
The Australian surgeon also had high praise for the Syrian nurses, who were mainly men, for cultural reasons.
“They were very, very good,” he said. “They could suture wounds and were also very experienced in dressing changes for burns victims. Because apart from gunshot wounds and mine blast injuries, we also saw people with severe burns, due to accidents with oil stoves used for cooking. Some arrived with burns to 60 to 70 percent of their bodies.”
While surgeries took place around the clock, and he was regularly summoned to operate in the early hours of the morning, Dr Drobetz said he had plenty of down time.
“While I worked clinically longer hours than I work in Australia, I didn't have all those other noises, like administration work or domestic chores,” he said. “When I wasn’t operating, my time was my own. So I actually talked a lot to the Syrians. I spent hours with them, drinking tea.”
When his tour of duty concluded in mid-May, Dr Drobetz left with no mixed feelings.
“I really wanted to do it again – immediately,” he said. “It changes your horizons. It's exciting. It's rewarding. It's tough. It's depressing. It's all these emotions condensed into a short space of time. I really enjoyed it. Some people don't. But for me it was the right thing to do – and I want to do more.”
Médecins Sans Frontières Australia is looking for surgeons to help deliver medical assistance to the people who need it most. You must be able to commit to a minimum of three months and be a resident of Australia or New Zealand. Find out more.