My father had dementia. He also had Parkinson’s disease. He died at age 85, a week after the Parkinson’s pills arrived, their having taken more than 5,000 miles and two weeks to get to Syria. I am not sure that the lack of medicine is what caused his death, but it might as well have.
Until eight years ago, my father was a pharmacist in Homs, Syria. During the war, his pharmacy was destroyed, as was the town center. My father and his wife were forced to stay mostly at home for almost two years to avoid the shelling and gunfire exchanged by the Syrian government and the rebels. They would sneak out only for basic necessities. I tried to persuade them to return to the U.S., but they kept hoping that the conflict would pass. My father’s forgetfulness began after he was essentially trapped in his home, and it worsened over time. I believe this was because of the stress of the war, the lack of social interaction and the lack of basic life necessities. The symptoms of Parkinson’s disease started a few years after the forgetfulness began.
The first “pill journey” was about two years ago. That is when my father’s advanced dementia and increased agitation became apparent. The scarcity of medical professionals in Syria has been a continuing issue, as most practitioners have fled the country. The lack of proper medication was caused by the collapse of the Syrian health care system and was worsened by economic sanctions. “Syrian-made” medications gave my father debilitating side effects. They caused his body to stiffen to the point that he could no longer walk; once discontinued, he recovered though was weakened.
These problems prompted me to attempt to send the medications from the United States. At that time, the pills traveled fewer miles. I could send the pills from the U.S. to Beirut, Lebanon, and then on to Homs. Friends in Beirut could easily find acquaintances traveling to Homs in a week or two to deliver the medication.
The second “pill journey” occurred in the past two months. This time, the Parkinson’s pills took a longer and more difficult journey. Using social media, my family members found acquaintances to facilitate the medication’s travels. The pills were sent via FedEx from my hometown, Charleston, W.Va., to Washington, where a friend of my sister-in-law, a college student, was leaving to travel to Dubai, in the United Arab Emirates, for the holidays. The pills transferred to another acquaintance, who took them from Dubai to Beirut, and a family friend transported them to Aleppo and then finally to Homs.
They traveled through immigration offices in a number of cities, demonstrations in Beirut, around war zones in Syria and through checkpoints set up by different fighting factions in the country. Bribes were paid and taxis took narrow mountain roads to avoid armed conflict zones. Similar journeys for medicine take place frequently among Syrians trying to help family members. Facebook community pages are full of requests for overseas travelers to carry and deliver medications to relatives.
I’m a physician, and I had been able to manage my father’s health over the past five years on the phone through WhatsApp when the internet and electricity were available, but my arms couldn’t reach to check his pulse moments before he passed last month. Nor was I able to help with the funeral arrangements or to even attend the ceremony because the Syrian government requires burials within a few hours of one’s death. My last remaining high school friend in Homs, who braced the poor living conditions and stayed in town, stood in for me at my father’s burial. He’s in his early 50s, and he told me he was the youngest person in attendance. All the young people are gone.
I am fortunate to have had the means to pay for such a journey for the medication, but not every sick person in Syria has that privilege. Still, money doesn’t guarantee ease. My aunt had a terrible, painful death from metastatic breast cancer a month ago in Homs. Talking with my cousin on the phone, I could hear her in agony in the background. There was no morphine available to ease her suffering and pain. No one should die this way.
My father’s death is a consolation; he didn’t fall and break a hip, or have a paralyzing stroke or a debilitating heart failure. The fear of not being able to provide end-of-life care always gripped me. Electricity in Syria’s big cities is a luxury, and doctors must sometimes operate with flashlights. The country’s entire health care system is in a shambles. Many Syrians do not have access to the basic human needs of medicine, food and shelter. According to the World Health Organization, over 80 percent of the population lives below the poverty line in Syria, and 13.2 million people “need health assistance.” Because of repeated attacks or staff shortages, “only about half of Syria’s public health facilities are fully functional,” the World Health Organization has reported.
The best solution to the health care crisis in Syria is political, but with many rival factions on the ground, there is no resolution on the horizon. The burden for remedying the situation falls on the W.H.O. and nonprofit entities such as the Syrian American Medical Society that staff and operate many hospitals in the country. Increasing the support for the W.H.O. is an effective way to bridge the need for essential health care in Syria. The W.H.O. supports over 1,700 health care facilities in Syria. It helps in the detection of disease outbreaks, provides vaccines, delivers medical supplies, trains health care workers and provides the desperately needed mental health services.
The last time I saw my father was three years ago. My brothers and I traveled to Beirut to see him and his wife. Beirut had become the meeting place for separated Syrian families. Throughout our five-day visit, my father believed he was in Homs, the old, war-free Homs of years past. I realized that his mind was in another time zone because he said he wanted to go to work at his beloved pharmacy and asked me to take him there. His pharmacy now lays in rubble in the Homs no one recognizes.
Dr. Sammar Atassi, who was born in Syria, is an internist and sleep physician.