Jordan: Treating patients at home

14 Sep 2017
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Mohanned and Samir both wear crocs.

“Shoes that are easy to put on and take off are much better when you visit people’s homes frequently,”
says Mohannad

Talking animatedly, they step into a van along with Moataz, their driver for today. The three behave like old friends, teasing one another and laughing.

“We have to be friends and have fun. Sometimes we spend more time with our colleagues than our families.”
explains Samir

Samir is a nurse, and Mohannad a doctor. Each week they conduct home visits to Syrian refugees and vulnerable Jordanians suffering from non-communicable diseases in Irbid governorate, northern Jordan. Today they will be visiting four patients, doing more driving than usual and travelling to new areas in order to reach those living further away from Irbid city centre.

MSF’s home-visit programme began in August 2015.

“Before that we treated patients out of two clinics in Irbid city. We still do that, but there is also a need for home visits. A lot of our patients can’t come into town, either because they are too physically infirm to make the journey, or because they can’t afford it,”
explains Samir.

The first house they visit is home to two patients: married couple Aziz and Azam. The front door is opened by their daughter and three grandchildren. The house is single-storey and sparsely furnished. The ease and familiarity with which the patients greet Samir and Mohannad is telling –

“I’ve known these patients for a long time. It’s a bit like having an extended family.”
explains Samir

Samir and Mohannad begin by taking Aziz’s blood pressure and testing his reflexes. He has suffered a stroke, is diabetic and for the time being, bed bound. Despite his fragile state Aziz takes the time to explain his situation:

“We’ve been here for five years. We left Syria because both Azam’s health and mine were deteriorating, and because of the bombings. I used to run a crop farm. I didn’t own it, but it was a good living. I had my own house too. Years ago, my Palestinian grandfather came through Jordan and settled in Syria. I wish he’d stayed in Jordan, I just wish we hadn’t seen this war. Our daughter is still in Syria and we think of her constantly. It’s not easy for us living here, the cost of rent is high and there are eight of us in one house. We have only one son working, he has to provide for everything, including electricity and bills. We want to go home, but only when there is no more war, no more killing.”

Azam lost her sight 15 years ago. Suffering from glaucoma, she needs surgery and eye drops. But at 23 Jordanian Dinars, even the eye drops are too expensive.

“Living through the bombings and the war was extremely stressful, blind or not. But I’m happy to be here. The community here has welcomed us. Our neighbours visit us and even the landlord gives us a discount on rent.”

Azam suffers from diabetes and hypertension. While Samir performs a blood test and checks her blood pressure, Mohannad picks up her youngest grandson who has begun throwing toys. After a few brief moments of restlessness, he sits contentedly with Mohanned and watches birds fly past the window.

On the way to the second house of the day, Samir speaks fondly of a former patient.

“She was shot in the hip by a sniper, but she survived. We treated her for hypertension and even in her condition, she always insisted on offering us breakfast. Sadly, she died recently of a heart attack.”

The third patient the team is visiting today is called Khairiya. She suffers from Hypertension and is also blind. Making the journey to visit a clinic in town is near-impossible for her, so she’s happy to receive home visits.

“We’ve been here since 2013. It was impossible to live with the violence and unrest in Syria, but the journey here wasn’t easy either. We even had to walk part of the journey. When we approached the border crossing, a guard saw that I was blind. He took me by the hand and walked me the last part of the way. Despite opportunities to go and live in the USA and Canada, I’m happy that we’re in Jordan, we share the same traditions. Our biggest worry now is money. There are five of us living here and our son barely earns enough to cover the rent and the food.”

As Mohannad checks Khairiya’s blood pressure, her daughter makes some coffee, and explains that she too needs to see a doctor. Mohannad tells her that he will refer her to a doctor at the ministry of health. As they speak, her two-year-old son crawls out toward his grandmother, apparently fascinated by the device used to check her blood pressure.

The fourth patient of the day is Saltiya. She is bed bound and has recently suffered a stroke. While her husband, daughter and grandchildren welcome Mohannad and Samir into their home, she struggles to open her eyes. Saltiya suffered a stroke just weeks ago. She was referred to the home visits programme for hypertension.

There are 12 members of one family living in this house, but Saltiya is clearly the focus of everyone’s concern. Despite the cost of electricity, there are two fans spinning to keep her cool in the summer heat. Saltiya’s son finds it difficult to provide for the family; back in Syria he was a baker, and his father owned a supermarket. They used to grow their own vegetables and own an olive grove. Towards the end of their time in Syria, they would see missiles flying directly over their home.

On the way back to town, Mohannad and Samir discuss the involved nature of this programme, and how it differs from MSF’s typical emergency projects responding to the immediate effects of war, epidemic, disaster or famine. However, visiting the homes of these patients presents a stark reality: these are people with real and sustained medical needs, living in highly precarious situations. They may have escaped war, but their futures remain uncertain.

Not one of the patients visited today was able to answer their own door, and without money, or physical mobility the most pressing question is, how will these patients receive treatment without a programme like this one?