ActivistDoctorFeatureGiving BackPhysicianSyria

A Doctor with No Cure for His Country

©2014 Jeffrey Ball
©2014 Jeffrey Ball / The Immigrant Story

The rigid, highly competitive public education system of Syria sent Hisham Amin Bismar into engineering. Leaving his country and then watching it explode in civil war pushed him into medical activism.

“I think it was footage of a father carrying his son with his arm completely amputated that actually instigated and affected me,” Bismar said in a documentary, “50 Feet From Syria,” about his first medical mission there. “The thing that struck me most was seeing the children.”

Engineering was certainly a respectable choice for a young man finishing ninth grade and preparing to enter one of Syria’s specialized pre-baccalaureate programs. After all, he noted — fully aware of the irony in his statement — if you can’t be a doctor in Syria, the next best choice is engineering.

For social and professional status within Syria, it may have been the right step. But from day one, it was never the right fit.

Bismar, born in 1967 in the ancient city of Alexandria, Egypt, but raised in Syria, struggled with the decision even after he entered Damascus University. He loved architecture, but his grades and test scores had qualified him for the more prestigious field of engineering. He loved exploring and was good at history and geography — fields that also were guaranteed to get him nowhere.

“That is one thing I did not like,” he remembered. “You do have a choice, but it’s a quasi-choice” — as in, which kind of engineering would you like to pursue? Bowing to peer pressure, Bismar signed up for electrical engineering.

This level of social restraint was one of the reasons he thought about leaving Syria, even as a teenager. He chafed at “the controlled, authoritarian nature of the government,” and thought that “society itself was kind of controlling” as well.

His father, also an engineer, had studied abroad. The United States, he told his older son, had the best educational system in the world.

The Islamist uprising against the Ba’ath Party-controlled government of Syria was at its height in the late 1970s and 1980s, when Bismar was finishing high school and beginning college. Insurgency waged by the Muslim Brotherhood brought government crackdowns that came to be known as the “long campaign of terror.” In April 1981, the government executed about 400 residents of a village near Hama, in west-central Syria. The residents were Alawites, followers of a Shia sect of Islam that identifies as a separate ethnoreligious group, largely within Syria.

The revolt by the Muslim Brotherhood came to an end the following year when thousands of soldiers, insurgents and civilians were killed in what became known as the Hama massacre.

Bismar harbored strong anti-government feelings during this time but did not act on those sentiments. Still, as a student, he was an easy target and was beaten up from time to time. The future of his country did not look bright.

From the Mideast to the Midwest

His initial plan to follow in his father’s path of studying in Egypt was thwarted when his application to study in Egypt was denied. He soon learned that for a Syrian student wanting to study abroad, the best-organized system available was the United States.

At the office of the U.S. Information Service in Damascus, Bismar was presented with three options: Louisiana State University in Baton Rouge, Wright State University in Dayton, Ohio, or Valparaiso University in Indiana. Bismar knew no one in the United States, and while he could read English, speaking it was another matter altogether. 

He enrolled in an intensive English-language program in Dayton and found himself at ease among students from around the world. Once he started college, however, things changed.

“Most people had no interest in finding out where I was from,” he said. “They lumped everyone from the Middle East together. We were all either Iranians or Libyans. That kind of shocked me. They really used phrases like ‘dirty Arab terrorists.’ ”

His first year on campus happened to coincide with the U.S. bombing of Libya in April 1986. Bismar felt the anti-Arab fervor himself when he was stopped by police while shopping at a mall with a friend, also from the Middle East. In another store one day, he saw a poster of Libyan leader Col. Muammar Gaddafi with crosshairs superimposed on his face. When Bismar told the store owner he felt the image was inflammatory, she called the police.

In the United States, Bismar began to find his own political voice. He organized demonstrations against apartheid in South Africa and against the Sandinista forces in Central America.  Engineering by this time had receded to what he called “background noise; I just was not that interested.”

Dr. Hisham Amin Bismar, in his garden in Portland. Photo Credit: ©2014 Jeffrey Ball

He picked up a master’s degree in biomedical engineering at Wright State, just in time to look for jobs in the thick of an economic recession in the U.S. Bismar was pretty sure he kept getting turned down for jobs because employers pigeonholed him as an Arab.

“My best friend was from Hong Kong,” he said. “We both did the same thing and had the same grades. He got job offers, and I got none.”

At last, through his  friend from Hong Kong, he found a job that would sponsor him at a hospital in Detroit. It was a research job, and in the back of his mind, Bismar was sure he would go on for a Ph.D. in a field like medical imaging. But after a year in the hospital, he decided he wanted to go to medical school.

Through his job, he was able to get a green card, and at night he took prerequisite classes for medical school. He did well on the MCAT, the Medical College Admission Test, a standard entrance exam for medical schools. Meanwhile, the people around him thought he was nuts.

“‘You’ve got a master’s, a job and now you want to switch fields?’“ he said they asked him.

But at this point, he felt strong enough to make his own decisions. At 29, he enrolled at Michigan State University Medical School.

It turned out to be a wise move for many reasons. Just a few months after he started med school, the hospital where he had been working in Detroit shuttered his department.

Medicine — and Marriage

This time, he decided not to be restricted by the requirements of his degree. He took anthropology and sociology. He even studied French, just because that was something he had always wanted to do.

Toward the end of his medical program, a close friend said she wanted Bismar to meet someone. Bismar and Jennifer, a University of Michigan graduate with a degree in history, were married in 2003 after Bismar finished his first year of residency in Pontiac, Michigan. They have two children, a son named Nadil, now 12, and a daughter, Lena, who is 9.

Jennifer and Hisham Bismar, with Nadil and Lena. Photo Credit: ©2014 Jeffrey Ball

His background in engineering may have helped guide him to orthopedics. Bismar said it also didn’t hurt that the chairman of the program had taken a liking to him. He developed a specialty in hands and elbows.

During his residency, he became friendly with a fellow student who was originally from Iran. They studied together and began talking about moving to California to set up a practice together.

But Jennifer had other ideas. She had strong ties to the Midwest. She was willing to go along with her husband’s fellowships in Cleveland and Buffalo, but California was not up for discussion. To Bismar’s surprise, in 2008 she spotted an ad for an orthopedist at a Kaiser Permanente hospital in Portland, Oregon, and encouraged Bismar to apply. They have lived in Portland ever since.

Bismar’s parents followed, receiving permanent residency in the U.S. in 2000. His younger brother, who had come to the U.S. to study medicine in 1996, is a pathologist in Canada.

But Bismar was not about to leave his heritage behind. In 2012, after the civil war began in Syria, he joined the Syrian American Medical Society. Even before the start of the Arab Spring in late 2010, Bismar had closely followed events in the Mideast. He knew things were getting bad in Syria, and he felt frustrated.

“I read these stories,” he said. “I knew people were being tortured.”

He feared the specter of global indifference.

“I had seen this before,” he said. For instance, “the issue with Bosnia, when the world looked the other way and let all those atrocities happen.”

In Syria, he said, “it was the same way. I thought if the world did not interfere, it would spiral down. And I was right.”

With the civil war at “eight years and running” and the official death toll reported to be about 400,000 Syrians, Bismar said he thinks the “actual number of deaths” is between 500,000 and 700,000. About 5.6  million people have fled the country. Another 6.6 million have been internally displaced. Two-thirds of Syria’s physicians have either fled or are unable to practice; the same is true for many other skilled professionals. About 80% of the Syrian population lives below the poverty line.

Mercy Missions

Fifty feet from the Syrian border, Dr. Bismar often worked late at night in his Turkish hotel. Photo Credit: ©2014 Spin Film

Binnmar has observed this catastrophe firsthand. Six years ago, as part of the Syrian American Medical Society, he began making medical mercy trips to the region. He has been back a half dozen times, most recently in the fall of 2018.

Bismar took a risk in returning to the area — and not just because of the warfare. Syrian men are required to perform military service, and Bismar had never done so. Syria’s borders are porous, and kidnappings are not uncommon. If he were to be detained or kidnapped, he knew he could be forced into Syrian military service.

Finally, “I decided the risk was worth it,” he said. “I wanted to be able to help.”

Part of his impetus was to help the people of his home country, he said. “And part of it was to help myself, to channel my frustration.”

Often he treated Syrian war victims just 50 or so feet over the border in Turkey. He also worked out of Jordan until that country also shut its border with Syria. 

“Some of the actual injuries, even for me, they have been difficult,” he said. “I remember seeing a patient in his 20s. Both his legs had been amputated at the upper thighs. He would hobble in on his arms, and he had developed all these ulcers on his buttocks.”

These cases, he said, are known as “multitrauma injuries.”

Barrel bombs, created by the Syrian government and made of TNT, fuel, shrapnel and scrap metal, have been “extremely destructive,” Bismar said, so much so that “it’s very, very difficult to figure out where to start with those injuries.”

Also, he has faced the challenge of trying to treat patients with injuries more than a year old. Patients hear about a doctor from the United States and flock to see him with high expectations.

“But what I can provide is not that much because their injuries are so old,” he lamented. “That has caused me a lot of frustration. I wonder: ‘Hey, am I helping these people? Should I be offering them surgery that may not make that much difference?’”

On his first mission, the border to Syria was controlled by ISIS. Bismar was so close that he could hear shooting from inside Syria.

He regrets that while Syria lives under the iron fist of a dictator, the problems of that country seem to have fallen off the U.S. political radar.

“I understand, our government can’t police the whole world,” he said. But, he went on, “the U.S. should do something when it comes to human rights and human dignity. You think of the situations in Bosnia, Rwanda, Cambodia, Darfur — in a lot of those conflicts, the world could have done something.”

An Ongoing Spiral

Syrians have a saying, he said: A donkey cannot fall in the same hole twice. And yet, in confronting mass killings, torture and profound violations of essential human rights, “we keep making the same mistakes. The same problem keeps happening, over and over, and we are not doing anything different.”

The world may be made up of hundreds of countries and dozens of political systems, but “to me,” he continued, “I think that in the world, we live in one community. We have become interconnected as a world community. We have a responsibility to do something before things spiral down.”

Bismar said he recognizes that the U.S. did not want to expend political capital on a place like Syria. He called the policies of President Obama around Syria “useless.”

In any case, “it’s pretty short-sighted to say, ‘Hey that stuff is happening way over there.’”

It is not just the U.S. that Bismar holds culpable.

“I think we have a duty as the world to try to prevent these mass atrocities from occurring,” he said.

To perform surgery for Syrian war victims, Dr. Bismar brought donated equipment and often used recycled metal implants. Photo Credit: ©2014 Spin Film

Bismar has personally financed all his medical missions to work with Syrians. He has had some help with equipment from the Syrian American Medical Society and has received donations for certain implants from some vendors. He has made a habit of holding on to the old metal plates he replaces for U.S. patients so he can reuse them when he works with his Syrian clientele.

On his first trip, he took along a film crew led by Skye Fitzgerald to document the experience — and, he said, to help spread information about what is happening in that part of the world.  The result was “50 Feet From Syria.”

“I did not save lives,” he said. “But maybe I made some peoples’ lives better by operating.”

His voice heavy with sad resignation, he calls his homeland “a petri dish for radicalism.”

Syria, he said: “What is left? What is going to happen?”