July 27, 2017

It’s 7 pm on a Tuesday in the Bekaa Valley, and Dr. John Kahler has just completed the single most medically challenging day on a medical mission in 27 years.

Since July 13th, Dr. Kahler has been in Lebanon, where he is providing care on a medical mission alongside physicians and translators in the informal settlements of Tripoli and the Bekaa Valley. Dr. Kahler spent 40 years practicing medicine, and 20 years in academic medicine, before retiring and devoting his practice to SAMS.

He and a small team of physicians and volunteers have just concluded two weeks in Tripoli, providing pediatric and family medicine to refugees. Over 1 million refugees are registered in Lebanon and the majority lives in informal settlements. Dr. Kahler emphasizes that the conditions are the worst he has seen on a medical mission: the lack of clean water sources and lack of sanitation are a daily challenge in the informal settlements.  

For three years now, Dr. Kahler has been travelling to Lebanon to provide care with SAMS. Dr. Kahler says that many families have spent three to four years in the settlements, although some refugees had recently arrived. During that time, he’s observed the chronic effects of stress in the settlements.

“Girls are not going into puberty. This year, more than any other, I saw kids who are of short stature – they’re not thriving well. All of these kids have diarrhea. All are exposed to polluted water sources,” he says, adding that children often have superficial skin infections due to the poor water sources.”

By the end of the day, Dr. Kahler and his colleagues have treated patients both in settlements and at a SAMS-supported clinic. In an informal settlement, Dr. Kahler and his colleagues saw forty children in three hours. At a nearby clinic, he provided consultations for some of the most “complicated, arcane cases of hard core pediatric medicine” that he has seen in years.

He met a young child whose medical situation would be difficult to treat, even in the best of circumstances. The young refugee had a unique condition preventing him from feeling pain, and had lost the use of his fingers.

“Pain is a warning system,” Dr. Kahler says, describing how the young boy lost the use of fingers because he cannot feel extreme hot or cold.

When he returns to the United States, he plans to speak to specialists about this child, whose younger brother has already started showing similar symptoms. He will coordinate this care via WhatsApp.

One theme was common amongst families and individuals Dr. Kahler met – the need for care.  

“They [the families] hunger for care,” Dr. Kahler says, but refugees in settlements are up against a labyrinth of obstacles to access that care.

According to Dr. Kahler, there is no system for refugees in Lebanon to access care. Obstacles include cost and transportation. Even the most inexpensive medicine is inaccessible for refugees in Lebanon. Underpinning these obstacles is the dual need of proper hygiene and sanitation.

“My heart just broke for some of the families that I saw.”

Until Saturday, Dr. Kahler and his team will be working in a few more settlements. They plan to conclude the mission with a strategy session, planning how they will coordinate care when they return to the US.

Despite the emotional weight of a difficult day, Dr. Kahler remembers fondly that a few families in the settlement heard that he was back, and came to visit him with a child that he had seen the last time he was in Lebanon.

“To a pediatrician that’s a wonderful thing.”