By Robert P. Granacher Jr., M.D., M.B.A.
Dr. Phil Hall never dreamed while growing up in Lexington, that someday he would practice anesthesiology in a war torn area such as Syria. During his last service there, an indigenous female nurse came into his hospital with a gun and began asking if “there were any Americans present.” She fired the gun into the air. As an exercise in caution, Dr. Hall was evacuated from the area, taken back to a bordering country, and returned to the United States. This was the last occasion Phil was able to serve in Syria and a few months after he left other medical colleagues were kidnapped, held and then released months later.
Many years prior to his missions to Syria, he completed medical school at the University of Kentucky, thereafter finishing a residency in anesthesiology at the Mayo Clinic. These accomplishments fulfilled a childhood dream to become a doctor. After returning to Lexington, he has practiced at St. Joseph Hospital for more than 30 years while adding mission trips to his practice routine in the last decade. Phil and I discussed his traveling medical missions one afternoon on the surgical floor at the St. Joseph Hospital on a gray December day prior to Christmas. He related that about seven years ago, he was asked by a nurse anesthetist colleague to become a participant in the Knoxville Medical Mission.
This organization has been traveling to provide benevolent medical care for about 15 years. For seven years since her inquiry, Dr. Hall has flown to Antigua, Guatemala where he has practiced anesthesiology at the same hospital each time. He has provided services to medically deprived Guatemalans to assist his general surgery, urology and gynecology colleagues. By chance encounter, my wife and I met again with Phil and his Lexington team in January at Bluegrass Airport as they were embarking again to Guatemala.
More recently, Dr. Hall has become associated with Doctors without Borders (D.W.B.). He sought out this organization in order to be of service in areas other than Guatemala. Prior to his service in Syria, he provided D.W.B. anesthesia services in the African south Sudan. The patients he served there were severely deprived, had no running water or electricity, and resided in a very small population in the south of this primitive country. His operating room environment was within a large tent, but he had to live in a small personal tent while on his
Doctors without Borders first began in the 1970s in France. It functions as a nonpolitical, non-religious organization, and it avoids taking sides in politics, war, or other geopolitical issues. After Sudan, Dr. Hall was sent to Syria twice in 2013 by D.W.B. During his first trip he found the Syrians to be very friendly and helpful.
However, while he practiced his skills in a hospital rather than a tent, the conditions were quite primitive, as this war torn area had lost its previous wellestablished medical system. During surgeries, he could hear exploding rocket warheads daily that often fell on the hospital grounds. With inadequate resources, medical supplies had to be obtained from a neighboring country.
He found the political conditions had changed dramatically when he returned to Syria later in 2013. Now the area was infiltrated with members of I.S.I.L while Syria’s political control had changed for the worse. He had to land by plane in a country outside Syria, be transported to the Syrian border, and then walk across as there was no passport control. Not only had conditions changed politically, the means of anesthesia practice was very primitive due to the destruction of the Syrian healthcare system by the war. He could only use equipment that was easy to operate in adverse situations. He and his colleagues were unable to obtain oxygen canisters, and moreover the hospital had no oxygen lines. He could provide oxygen to patients only by using concentrators. Fortunately, he did have available end-tidal CO2 monitors and ECG monitors.
While smiling he told me he had his choice of any gaseous general anesthesia he needed, “as long as it was halothane.” Due to the frequently injured civilian population, much of the surgery provided was trauma-based but he also assisted in Cesarean sections. For the more severe injuries, and those requiring subspecialty surgery, the patient could often be referred out locally or sent to a neighboring country. Patients had to be transported to the border of the neighboring country and then be moved to hospital. Dr. Hall did not have the benefit of an ICU nor ventilators; and much of the time, he had to provide postoperative care himself to the patients rather than follow the postoperative routine he was used to at St. Joseph Hospital. His medical team generally consisted of a surgeon, himself, and a nurse.
These frightening conditions and primitive equipment have not dissuaded Dr. Hall from future missions. While he does not plan to go into a combat area, he will continue to provide services to needy, medically underserved populations in other countries. He enjoys the challenge to his anesthesia skills. Moreover, the medical colleagues he meets are extremely interesting and they have varied and diverse medical backgrounds. His experiences have taught him how medical systems do and do not work. Dr. Hall notes sadly that we Americans, as not unexpected, have a significant misunderstanding of the immense geopolitical issues in Syria. One-third of the population where he practiced has been displaced by the war to other countries or regions, and no one feels safe living there. Yet, Phil has enjoyed these challenges, and he possesses a great sense of accomplishment after providing anesthesiology services to those needing him under the direst of circumstances.