Who Will Listen To The Suffering Syrians?

Dr. Hussam Jefee-Bahloul, a Syrian psychiatrist, writes poetry that reflects his deep longing for a lost homeland.

"Poetry and art is another way to cope," he says, "we are all grieving in our own ways. The country is no longer the one that I left and it still haunts me in my dreams." (Click here to read one of his poems.)

He has turned his grief into an action plan. From the United States, where he's lived since he arrived for a medical residency in 2009, he's using his mental health expertise to help Syrians traumatized by years of violence and displacement.

Syria was still intact when Jafee-Bahloul arrived in the U.S. His journey west was fueled by medical ambition.

Jefee-Bahloul wanted to become a psychiatrist in a country that only had an estimated 70 psychiatrists for a population of 23 million.

Advanced studies in psychiatry, unavailable in Syria, would mean a long stay in the U.S. When he finished medical school in Damascus, he came to the University of Southwestern Medical Center in Dallas and furthered his training at Yale Medical School.

He became a successful immigrant, securing a position as an assistant professor at the University of Massachusetts. His specialty: addiction psychiatry. He treats Americans caught up in this country's opioid addiction crisis. But his distance from home weighed heavily as his country descended into a protracted war.

"The problem with our situation, it's chronic, it's keeps on producing suffering and people who are displaced by the day," he says about a war that has entered its sixth year.

In 2014, he launched the Syrian Telemental Health Network. It's an online platform to help mental health workers inside Syria and in clinics around the region. The site offers basic training. But the key to the project, says Jefee-Bahloul, is its ability to connect health workers in Syria, including the small band of trained psychiatrists, to mental health specialists in the West.

"For every mental health provider there is a specialist who is holding their hands through difficult cases and help[ing] and train[ing] them," he says.

Jefee-Bahloul's network links therapists and health-care workers in Syria to a growing list of volunteers — more than a dozen Syrian psychiatrists practicing in the U.S., the U.K. and Canada.

Such consultations can be critical for an undertrained health-care worker, who can upload video and audio of a patient to the secure platform and ask for advice. The partnership has led to better outcomes. In one case a 15-year-old Syrian boy in a refugee camp in Turkey was diagnosed with autism. When his behavior became dangerously aggressive, his case was referred to a Syrian psychiatrist in the U.S., who diagnosed a severe case of PTSD.

When the site first opened, Jefee-Bahloul conducted role-playing exercises with health-care workers in a clinic near the Syrian border to show them how to interact with patients in distress. He showed me a video of a session subtitled in English. A woman has come to the clinic because, "the world is closing in on me," she says. Two of her sons are dead, her daughters are grieving, her husband is disabled, and her family lives in a warehouse with more than 100 other refugees. Jafee-Bahloul offers a guide to "active listening," a technique outlined in the World Health Organization's Psychological First Aid concepts. The next steps are helping a patient prioritize their problems and then linking them to available resources.

"The most important thing is to be able to listen to people. Most of these people they don't have anyone to talk to. They need to tell their stories," says Jafee-Bahloul.

These training sessions target the young volunteers at the clinic, with no medical training or clinical experience, who could take some of the cases from the only trained psychiatrist on staff.

"The main thing is trying to help the people to regain control of their lives. It's the thing that gets lost. There is a sense of loss and despair and loss of control, basically," he says. It is a concept that he says is common in treating opioid addition as well as refugee trauma from displacement. It can takes years of work, but Jefee-Hussam says it's important to help people re-create their routines. For refugees, he encourages them to "re-engage in activities they used to like an enjoy, playing soccer, talking to friends, praying.

In a conflict where the needs are so great, Dr. Jefee-Bahloul hopes he is doing his small part with this long distance learning. It's not as flashy as surgeons who are consulting long distance, he says.

"In psychiatry, the nature of change is slow," he says and adds, "From that aspect, it might be demoralizing because you can't really change much. It's better to be a surgeon because at least you've saved someone's life."

But there is no denying that the war has created a mental health emergency as acute as the medical crisis.

Jefee-Bahloul says he's learned some lessons about long-distance training. The one-on-one role-playing exercises have now been replaced by a series of video lectures based on mental health first aid as outlines in a World Health Organization manual to deal with survivors of trauma and war.

Now, field workers can carry out the role-playing exercises on their own. More than 1,000 have signed on for the courses, he says.

"It's really practical. In these situations you cannot be anything but practical. The main thing is really trying to help the people to regain control over their life," says Jefee-Bahloul. "I'm doing this because I'm Syrian. It's my way of coping."

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