By Roxanne Mehdizadeh
FaceForward is a project aiming to help address the oral and facial needs of the refugee population in Jordan – more than 760,000 people. Many are living with the physical, mental and social consequences of untreated facial injuries and other head and neck conditions.
In this blog, sixth year medical student and Junior Clinical Fellow Roxanne Mehdizadeh describes the initial scoping visit to establish FaceForward’s relationships with the groups working on the ground in Amman, the capital city of Jordan, as well as to identify the hospitals and resources required to carry out surgeries.
Roxanne’s visit was funded by Thriplow Charitable Trust and supported by CGHP. Here she tells us what she got up to during the placement.
Can you tell us about FaceForward and what it’s trying to achieve?
FaceFoward was founded by Oral and Maxillo-Facial Surgery (OMFS) specialty trainee Shadi Basyuni, and OMFS consultant Mr Vijay Santhanam, part of the Addenbrooke’s Hospital Oral and Maxillofacial Surgery Department.
It involves local organisations including Asia Development Training, a charity in Amman, that aims to help rehabilitate refugees who have suffered ballistic injuries. They will help to identify OMFS patients requiring surgery both from their own patient base and through their links to the refugee camps within Amman, as well as providing support for, and psychological assessment of, those undergoing surgery.
The project seeks to form a long-term, two-way partnership between the Addenbrookes-based Oral and Maxillo-Facial Surgery (OMFS) team and the Jordanian surgeons working on the ground in Amman, by carrying out regular trips to Jordan to provide surgeries for the refugee population. As well as carrying out the surgeries themselves, the project aims to establish virtual multidisciplinary team meetings, with collaborative teaching between teams both online and in-person during future trips. Away from delivering surgery, secondary aims are to develop educational and research partnerships in the region.
Roxanne (third from right) with the FaceForward team and stakeholders.
What was the aim of the visit?
The purpose of this trip was to meet with stakeholders in Amman including clinicians, hospitals and charitable partners to establish joint goals; identify the locations and resources that future surgical missions will involve; identify the patient groups who will receive treatment; and develop an electronic patient record.
What did you do during the placement?
We met the CEO of Asia Development Training (ADT) – an organisation working to rehabilitate refugees who have suffered limb loss. We learnt about the work they carry out, with around 10 staff members treating around 200 patients each year. As well as physiotherapy work, the charity runs art therapy sessions for children, and the paintings we saw were particularly poignant, highlighting the immense trauma the children had been through. The team explained that unfortunately, most of the charitable funding they receive had been redirected towards efforts to help in the Ukraine war.
ADT offered to help us to identify future patients who will benefit from Oral and Maxillo-Facial surgeries, and a clinical psychologist working for the organisation will help with both the psychological support of the refugees, as well as the assessment of their psychological wellbeing, to determine the impact of the surgeries. These assessments can be attached to the patient’s electronic medical records, and subsequently analysed to determine outcomes. We also visited four hospitals in Amman (The Arab Medical Centre, The Gardens Hospital, Abdali Hospital and Al Khalidi Hospital), and met numerous clinicians – both surgical and non-surgical – to better appreciate the socio-political context within which we will be working. They gave us a better insight into the Jordanian healthcare system and some of the attitudes towards the refugee population within the country.
Paintings from refugee children’s art therapy sessions.
What was the biggest success of the visit?
We were able to achieve our aims of meeting all the individuals and hospitals we had planned to visit. The in-person interaction is paramount to establishing trust, and determining common goals as well as how we aim to achieve them. I felt the individuals we met were extremely positive and enthusiastic, and it was clear all the hospitals were well-versed in hosting such missions. We were also able to form links we had not anticipated, such as connections to the UNHCR and the British Ambassador, which may be beneficial in identifying patients for the surgeries. Overall, I feel we gained a better understanding of how the project will be taking shape, and the key next steps we must complete to achieve this.
What challenges did you face?
Prior to arriving in Jordan, it appeared difficult to arrange meetings. When attempting to pin down an exact time and location, many responded with “InshaAllah (Godwilling) we will meet”. This left us concerned at the possibility that some of these appointments may not materialise. However, once we arrived, it became clear this was simply a cultural difference, as everyone remained true to their word and arranged a time to meet us. Another difference was the preferred means of communication, which appeared to be WhatsApp and phone calls, rather than emails.
What differences did you observe between the Jordanian and UK hospital systems?
It’s estimated that 55% of the Jordanian population as a whole, and 68% of Jordanians, are covered by private health insurance. Understanding the significant percentage of the local population unable to readily access medical care highlighted the need to broaden the mission. In Jordan, healthcare relating to cancer and trauma is covered for all Jordanians by the state, however other healthcare related expenses must be covered by the individual, either through insurance or upfront. Whilst free-at-point of care, state provided healthcare exists, the system is strained with capacity issues and it was unclear how and which patients can access this. The influx of around one million Syrian refugees has put pressure on the Jordanian healthcare system, in addition to its already growing population.
While all the hospitals we visited appeared to provide good quality care and had hosted many charity missions, there were clear differences between them. Abdali hospital (pictured above) was particularly striking – a 30 storey new build, with modern equipment and impressive theatre spaces. Many of the clinicians we met had also completed some or all of their training in the UK or USA, so the environment did not feel too dissimilar to the NHS.
What surprised you?
Because FaceForward aims to establish a long-term, two-way collaboration, it was paramount that we deepened our understanding of Jordan, its history, its people, and the local culture. We had many meetings with local clinicians, both surgical and medical, with whom we were able to discuss, ask questions, and above all – listen. I was curious to know what the perception of refugees was in Jordan, considering the huge displacement of individuals into the country. One neurologist we met commented that they were not viewed as “other”, but as neighbours in need. He noted that prior to the refugee crisis, it was commonplace to spend a weekend in Damascus, renowned for its vibrant nightlife. Or to drive over to Beirut, often referred to as the ‘Paris of the Middle East’. Like many Jordanians, he had spent time studying in Iraq, owing to the comparatively low tuition fees. These sentiments were echoed by others we met when visiting hospitals and charitable organisations, and there was great enthusiasm and support surrounding the project.
What was a highlight of your experience?
Jordan is a beautiful country and I took a few days after the scoping trip to explore the Dead Sea, Petra, and Wadi Rum. The standout experience for me was spending two days in the Wadi Rum desert, camping with a Bedouin tribe. After a day exploring the desert, hiking and climbing rocks, our guide took us to a flat plain to watch the sunset and drink traditional sweet Bedouin tea. The view was breathtaking, and he told us about the structure of his huge family, with one member of each household selected to be in a WhatsApp group representing over 2000 members of the wider family. He described no greater joy than to share a tea with a friend under the stars, and in the stillness of the desert. Having mostly lived in cities, I agreed that I could not recall a time I had experienced such a stillness and calmness. The view of the night sky was truly breathtaking, and it was the first time I had been able to see the Milky Way. It was an incredible landscape and setting to be in, and the hospitality of the Bedouins in welcoming us and sharing their stories and experiences made for a truly unique experience.
- Continue fundraising efforts: we aim to raise £15,000 for the first mission to provide the first cohort of surgeries (aiming for 5-10 major surgeries). You can support FaceForward’s work via their Just Giving page.
- Continue work on the electronic medical record: this will be completed by the first trip planned for the summer of 2024.
- Broaden our collaboration: there has been interest from neighbouring surgical specialities to contribute to the project and foster an interdisciplinary approach.
- Involve medical elective students: there has already been interest from medical students looking to complete their future electives.
Roxanne’s trip was made possible by funding from the Thriplow Charitable Trust.