A Rhode Island Hospital physician's experience in front-line field hospital in Libya

Adam Levine, M.D., an emergency medicine physician with Rhode Island Hospital and a volunteer physician with International Medical Corps, was deployed to a field hospital near Misurata, Libya, during the conflict there. He and his colleagues cared for over 1,300 patients from both sides of the conflict between June and August 2011. In a paper now available online in advance of print in the African Journal of Emergency Medicine, Levine describes his experience and the lessons he learned that he hopes will aid in future humanitarian efforts.

In the paper, Levine sets the stage for the conflict, and explains, "As physicians working with the humanitarian aid organization International Medical Corps in Libya during this time, we witnessed many of the direct human costs first-hand." Working originally from an old farmhouse near the front-line of the fighting, the goal of the was to treat and send home patients with minor wounds and to stabilize critically injured patients who would subsequently be transferred to two major receiving hospitals.

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Though rudimentary, their capabilities were remarkably sophisticated, with X-ray and ultrasound equipment, the means to perform like intubations and chest tube placements, and an operating theater used on a selective basis to provide for those who might not survive a 30-minute transfer to a hospital. The staff generally included two or three expatriate physicians with emergency medical experience, along with three to six Libyan physicians and four to eight nurses. With that limited workforce, the field hospital was able to treat over 1,300 patients in an eight-week period, ranging from less than 10 patients to more than 60 in any given day.

The take-away from his experience, however, is the lessons he learned. As Levine says, "Hospital management is always a complex enterprise, and no place more so than in an active combat zone. However, there are several important lessons that can be drawn based on our experience in Libya, which we believe may be applicable to field hospitals in other parts of Africa or the developing world."

Levine explains the importance of strong logistical support and supply chain management. "Do not assume that the most important functions in a field hospital are performed by doctors and nurses; without the logistical support and supply management, the hospital will not be able to provide quality care for patients and may actually worsen outcomes by delaying transfer to a facility that can adequately manage patient needs." He further comments on the logistics that are involved in moving a field hospital due to the rapidly shifting context of an active war.

Another lesson learned is that community support is vital in any global health project. As Levine says, "Though the hospital was managed by International Medical Corps, the majority of staff and volunteers were Libyan, and most of the supplies and medications used at the field hospital were donated by individuals, hospitals and pharmacies in Libya."

The third is one that medical professionals must face regularly, but more so in such a humanitarian effort. Levine explains, "While strict adherence to humanitarian principles can often be difficult in these contexts, upholding the basic ethical principles of humanitarianism remains vitally important." He explains that the hospital treated more opposition fighters and civilians than wounded Gaddafi troops due to its location; however, patients from both sides of the conflict were treated with the same skill and compassion.

Levine, who just returned from another humanitarian effort providing care in Rwanda, also kept a blog of his time in Libya. He is an emergency medicine physician at Rhode Island Hospital, a member hospital of the Lifespan health system in Rhode Island, an assistant professor of emergency medicine at The Warren Alpert Medical School of Brown University and a physician with University Foundation, all in Providence, R.I.

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