On a visit to Damascus this December with the Questscope team, I met three Syrian physicians providing primary medical care in some of the most challenging locations in Syria. I asked them what it was like working in remote areas with patients, families, and communities with such incredible need.
Yes, of course, they said, they could do with better equipment and more access to important medicines. But I was surprised by how much they pointed to education and basic health literacy as overlooked factors affecting their patients.
All of us were shocked when Dr. Ziad told us about a child with a cold that two parents brought to his community center outside of Tartus. He discovered that the three-year old had Down's Syndrome, and his parents not only were unaware, but had not heard of the condition.
Later, Dr. Ali told me how he sees a number of patients, especially children, with severe tooth decay. He's spent a lot of time teaching patients about the need to brush their teeth and have good oral hygiene. For an aspiring surgeon, he never imagined he would need to teach such basic health skills when he started working just outside of Hama.
Most disconcerting was what these stories implied. The doctors told us how many Syrians were returning to their homes after nine years of crisis, but the social fabric that previously held these communities together was frayed and sinewy. International aid groups can build clinics and provide doctors and medications, but unless these communities are rebuilt, key knowledge and wisdom about things as simple as Down's Syndrome and brushing teeth stops being passed from one generation to another.
This, I thought, is where Questscope fits. In a war-torn country where many hospitals and health clinics have been destroyed, health isn't just about rebuilding hospitals and clinics – though that is also needed – but about having the human resources to care for people in dire need. As Curt Rhodes emphasizes, "Syrians aren't the problem, Syrians are the solution!"
I'm a physician. I joined the Questscope board six years ago not because it worked on health issues directly, but because I saw how its work changed lives and how those changed lives led to better health. I met refugees and marginalized children, people at the fringes of society, who told me how their experience with Questscope gave their lives new meaning and purpose.
I saw how Questscope was not simply interested in "development" – often shorthand for one-dimensional improvements in someone's economic situation – but it was interested in helping people develop themselves through relationships. And through that, building and reinforcing communities. Much of Questscope's work is trying to prevent or mitigate the negative consequences that marginalization can have on someone's family, friends, job, and health.
Now Questscope's plan for health in Syria is similar: to focus on community engagement as a conduit to improving health. It starts with a community center, where a number of community engagement activities take place, rebuilding a sense of identity and strengthening the ties that bring local groups together – adding consistent, real-time help to the sporadic or non-existent efforts for health improvement after years of conflict and displacement. Primary care "Health Points", like the ones run by Dr. Ziad and Dr. Ali, are located in community centers, each staffed with a physician, two nurses, and a case worker.
Embedding a health clinic within the community center is a deliberate way to ensure access to basic health services for all. There, Syrians can receive a complete assessment of their health needs – in the context of restoring their social connections and relationships. Questscope works with its partner, the Syrian Society for Social Development, to fill the yawning gaps between what people need and what services are available. And the need is immense – Dr. Ziad sees over 100 patients per day.
Hearing about such immense need reminded me of when, in 2013, I travelled to Jordan as a medical volunteer to help refugees in Za'atari Refugee Camp. I was shocked by the enormous gap between the needs of the refugees and the services available in the camp.
I was similarly shocked during my December visit to Syria. But I'm excited and honored to be working alongside Syrians on this visionary extension of Questscope's unique model of putting the last, first. It will start to fill that gap by supporting Syrian efforts to rebuild lives and communities by embedding health services within communities to make both stronger.
-Dr. David Scales
Physician and Questscope Board Member