Panic attacks

The room is silent. The Arabic men look at me in anticipation. I am the only woman in the room. Trying to think of the correct words and using our hand and feet we managed to cover some generalities – they already had a laugh trying to pronounce my name, we established that everyone is doing alright today and that it’s raining outside. Now we are just waiting for the translator to progress the conversation beyond the pleasantries.

Today I am presenting together with the coordinator of the psycho-social team of the Boat Refugee Foundation, about panic attacks. Now that I am sitting here I am acutely aware of being young, female and surrounded by stern looking, bearded man and tasked with presenting to them about one of the most common psychological problems in the refugee camps.

Slowly the topic elicits the first careful reactions from the men. A thin looking man, with his head bowed down quietly talks about the breathing problems he sometimes experiences, the haunted sensation of being chased on the streets and the episodes of feeling he’s choking. These feelings started to occur after the Taliban attacked his village and murdered members of his family.
Another man helplessness asks how he could best support his wife who can’t tolerate anyone around her when she thinks she’s having a heart attack.

We discuss a couple of techniques that can help during a panic attack or when you see someone else having a panic attack.
Then a man with a red hat, the bravest of the group, carefully starts to speak. He’s grateful for the information we have provided him but is this whole presentation not geared towards people that have a house? A place where they can feel safe and maintain their digntiy? A place where they can wear normal, clean clothes? A place where they can live and not just survive? Is the solution not just to take these men out of this inhumane situation, would that not remove all the problems that we are discussing now? He removes his red hat and I see big bold spots on his head from incessant scratching.

His comments are followed by silence. I can feel the sadness and anger thickening the air in the room. We move on trying to find ways to apply the techniques we discussed to the daily reality of the camp. We can’t change the overall situation but perhaps we can find effective ways of dealing with it. We close off the presentation with an relaxation exercise. During the exercise I peep through my eyelashes to observe that above the beards there are twenty faces with closed eyelids and deep frowns, deeply concentrating on the breathing exercise. We told them that breathing exercises can help during a panic attack but can also be used as a general method to relax the mind and body. Especially when being surrounded by the constant tensions that linger in the camp.

It’s remarkable to see how interested the men are in ways to deal with the situation in the camp and to hear them ask so many questions (how often, how long, where?). I can see that it ignites a spark of hope that maybe it’s within their power to deal with the daily pressures they have to face. It seems to reassure them to know that they’re not the only one facing psychological problems, that this doesn’t make them ‘weird’ or ‘weak’ and that discussing this in a group helps.

The next day, when I walk through Kara Tepe, a man walks up to me. I recognize the red hat and he tells me how he practiced the breathing exercise this morning. There’s a twinkle in his eyes and he promises that he’ll do it again the next morning. I truly hope that they will continue employing these techniques and that it can offer some relief. Hopefully this can be the stepping stone for the foundation to open the conversation to other, frequently occurring psychological problems. There’s no doubt that that is much needed.

Text: Cathelijn Tjaden
Photo: Henk van Lambalgen

We need a wind of change

‘Life is like the wind. It comes, goes and is not loyal just like the wind. It blows away and before you realize it, it passes you by’, say two Iranian poets to me while we are standing outside in the medical area, all being sniveling. These friendly men are already five months in the hotspot on Samos. Five months, because they had to flee their country because of the words they wrote with their pencils.

I think about last week’s news. ‘We will come and get them then!’ has been shouted in Brussels, now that the Dutch demonstration initiative has spread to other countries. The Netherlands have promised to locate 3797 refugees before the end of 2017 as a result of the growing flow of migrants that arrive in the borderlands of Europe. Since February 2016 the first hotspots in Europe have been opened. A hotspot is an official refugee camp located on the borders of Europe. In hotspots refugees are being identified, registered and – before the EU-Turkey deal has been made – they relocated them over Europe. Hotspot could have made it easy for countries like the Netherlands to find those 3797 refugees that we have promised location. However, apparently we do have to come and get them.

There was a time – before the EU-Turkey deal has been made on the 18th of March 2016 – that the hotspot on Samos functioned as a transit camp where most people, depending on the reasons why they fled to Europe, stayed only several days whereupon which they could travel to other places. The EU-Turkey deal has been brought to life to discourage the flow of migrants coming to Europe. Yes, the fifth rapport of the European Commission does state that less refugees come to Greece and that less people drown at sea. However, the number of people arriving to Greece succeeds the number of people that are send back to Turkey. For those in Greece their lives are being paused. After the deal has been made, many things changed in the hotspots. Refugees that arrive to the hotspot on Samos and that do not have any family members in Europe for reunification, are currently stuck in the hotspot. In the best case they can apply for asylum in Greece.

After the deal the transit function of the camp on Samos and the relocation of refugees over Europe have been stopped. The original function of the hotspot is halted. As a result, many people are stuck on the island, sometimes for months already, in a camp that was originally planned to host people for several days – at most weeks. Their lives are being paused. Life is like the wind, we let it blow away for the people on Samos. Every day we hope for the people in Samos that the wind changes directions. We hope that there will be a wind of change that takes people to a new life, and a new place. A life where people can move forwards again. Because life is not loyal, like the wind, and before you know it, it passes you by. So yes, come and get them on Samos and take them with you on the wind to The Netherlands.

Text: Rozemijn Aalpoel

Interpreters of Moria (part 3/3)

I was blown away by the interpreters’ dedication and enthusiasm. Over the next couple of weeks working in the camp, we would chat in between seeing patients, and they told me about life in the camps, what their lives had been like in their home countries, and what they were hoping for in the future. We had some really interesting discussions over dinner about different cultures. Waheed told me about how he was desperate to continue his studies; after completing his degree in Mechanical Engineering in Syria, his masters In Nuclear Engineering was interrupted by the war and he had to leave the country. Steve wanted to pick up his work of being a personal trainer when he was settled in a permanent residence. Ben was hoping to become a psychologist, to help people process difficult situations. Harry, who had left his parents and three brothers in Algeria after getting his degree in biomedical sciences, laughed and said he’d be happy to do anything if could move out of Moria.

When I asked Steve about what life had been in Moria over winter, he shook his head. “It seemed like there were no human rights here. In Europe, a child sleeping outside on a winter’s night would not be allowed. Here, women and children sleep in tents in the cold, with no hot water, and no one bats a eyelid.”

For the period of time I was working in Moria camps, I was so inspired by the interpreters’ attitude; living in a situation that anybody would find difficult to deal with, they stayed positive, worked really hard and focused on the goal of leaving Moria to go to Athens. I asked if there was anything they would want the people living in Europe to know. Steve said, “People close their eyes and don’t want to see. But they need to imagine themselves in this situation to know how hard it is. We’re all human… We’re all made from meat and bone, the only difference between us is borders.”

It was a great experience working with the interpreters in Moria; but I was left feeling angry on their behalf. They are all bright, intelligent young men with real drive and enthusiasm for the work they do, and they are stuck living in the refugee camp for months. Not only do I want them to leave the camps for their own sakes, but any country would be lucky to have people like them living and working there, as they are sure to make a positive impact on whatever society they end up living in.

Matt explained he didn’t want to talk about his background, as when he did he experienced flashbacks. But when I asked about he wanted to do in the future, he smiled and said, “I want to carry on doing this… Helping people to communicate. Hopefully I can be involved with work that helps to bring about world peace.”

Text: Jessica Agbamu
*Names changed for refugees’ privacy
Photo: Bas Bakkenes

Interpreters of Moria (part 2/3)

My first night shift was the following day; the first couple of hours were quiet, with the occasional patient popping in for painkillers. The medical team and interpreters sat together in one of the clinic rooms, chatting and playing cards to pass the time. The interpreters worked from 4pm-2am, and because we were an all female team they escorted us to the toilet block before heading for bed.

On our way back, shouting broke out from a cluster of tents. Steve looked alarmed and ran towards the commotion; he lived there with his brother, and was worried he was involved in the fight. He emerged a few moments later looking relieved, as his brother was safe. However a few moments later, a man staggered from the tent and stumbled towards the camp exit; it took a few seconds in the moonlight to realise he was covered in blood.

We acted quickly. The medical team headed back to the cabins to prepare the crash bags, which contained the urgent medical care equipment, while the interpreters retrieved the injured man. They brought him in and lay him on the medical couch; his left nostril was split in two, and he had a stab wound beneath his ribs, and five on his back. We got to work, making sure an ambulance had been called, then assessing his breathing and circulation; however, we did not have oxygen to give for his low oxygen level, and only had two bags of fluid despite his low blood pressure.

The interpreters were amazing; Ben ran to ring an ambulance, Steve was talking to the patient in Farsi to calm him down and take a history, while Waheed squeezed in the IV fluids we had available. After twenty long minutes, the ambulance came and the patient was taken hospital, Steve going with him, as he knew him well and didn’t want him to go alone. While the medical team were still reeling from the unexpected emergency, Waheed and Ben got to work, cleaning the copious amounts of blood from the medical bed and mopping the floor. They stayed far longer than their finishing time of 2 am, and didn’t complain.

Text: Jessica Agbamu
*Names changed for refugees’ privacy
Photo: Bas Bakkenes

Interpreters of Moria (part 1/3)

In February 2017, I arrived on the island of Lesvos to start medical voluntary work with the Boat Refugee Foundation. I received a warm welcome from the other volunteers on my first night, and the next day I headed to my first shift; I was apprehensive, not knowing what to expect.

I arrived with the rest of the medical team (another doctor, a nurse, and a crowd controller), and we made our way into Moria camp towards our clinic (a portacabin which had two clinic rooms inside). After a brief tour and explanation of the process of seeing patients, the interpreters (who are refugees living in the camp, hired by BRF) popped up; Ben*, a 21 year old Syrian refugee who had been living in Moria for eleven months and Steve*, a 26 year old refugee from Afghanistan. They both shook my hand, welcoming me to the team, and started chatting away with the rest of the volunteers.

I saw my first patients; although I was initially nervous and unsure of what kind of problems were going to walk through the door, the POCs (person of concern) came in with lots of standard primary care problems; coughs, colds, rashes, headache and tummy pain. As patients from different countries came in, I met the rest of the interpreters; Matt*, a cheery 21 year old from Afghanistan, Waheed*, a friendly 21 year old from Syria, and Harry*, a 28 year old from Algeria who spoke both French and Arabic. The interpreters greeted the patients warmly and immediately put them at ease, and during my first shift helpfully pointed out the location of various medicines and equipment as I found my bearings in the clinic room.

Working with these interpreters was a vastly different to my experience of working with interpreters in the UK. In England, working with interpreters usually involves talking into a phone with two receivers while a bored sounding person at the end of the line translates the history. Occasionally, translators come to the ward clutching time slips, and sit in an awkward silence next to the patient, speaking only to ask when the consultant would come so they can get their attendance forms signed and leave as quickly as possible.

The Moria interpreters were completely different; from the moment the patient stepped into the cabin they established a rapport with them, asked questions with interest and responded appropriately, and while I was writing notes and packaging medications they would chat together.

Text: Jessica Agbamu
*Names changed for refugees’ privacy
Photo: Bas Bakkenes

Camp of contrasts

Contrasting and bizarre Moria with your thousands of people. What a confusing rollercoaster ride you have given me as a new doctor. Let’s start with an obvious example: Lesvos is a beautiful island. The people are friendly, the sea is beautiful and the days are bright and sunny. But this sea is the same sea where everyday so many refugees still risk their lives. The bright days are followed by ice cold nights. Is the friendliness available for all?
But still, with a little sunshine on your head, a drink after work and enjoying hamburgers in the volunteers’ house, some moments do feel like a holiday. When you are not on duty there is time to explore the island or visit the hot springs. A place where for a moment the refugees are far away. Literally and figuratively, because no refugees are allowed at the hot springs. Or you can do some shopping. Especially bags made out of life jackets are a huge hit among tourists. With a nice ‘safe passage’ stamp for those who might have a heavy conscience. All proceeds go towards the refugees, but still…

There are many contrasts inside camp Moria too. With every blink of an eye you discover a new contrast. A fun volleyball match taking place right next to the long line of people waiting for some dinner. The most unlucky ones stand in the food line looking forward to yet again an evening with rice and beans. The more fortunate refugees go outside of the camp and get falafel or fried chicken in one of the self made restaurants a few savvy Greeks created.

From the long line of patients waiting to see us most leave satisfied with some paracetamol and a throat lozenge (for many ‘papers’ and ‘Strepsils’ are the first English words they encounter), but then a woman who was raped by her traffickers slams you back into to the raw reality. Take the translators who work with us day and night, who are very committed, play card games and with every new shift ask you if you have had a good day. Each one of them as smart as the next, not one over 25 years of age, who inside the camp taught themselves new languages apart from their mother tongue and even speak a good bit of medical English. The type of young man that at night after a long shift will make the rounds to check if all is quiet inside the camp and that we are safely left behind. You almost forget these young men live inside this camp too. We can sleep on camp beds, while they retire to their tents. Young men who have fled because of the war in Syria or from the Taliban in Afghanistan. It hurts to know that deep inside they are thinking about going back, because you will only die once there, but in Moria you die each day, over and over again.

Contrasting, bizarre Moria, with your brave people who despite all hardships never forget to whisper a ‘thank you doctor’. I hope we can make a small difference in your lives. With some paracetmol here and a band-aid there, it doesn’t seem much. Please know that no matter where you are from, no matter your background or your trauma, you are always welcome to spend a moment with us.

Text: Stephanie van Straaten
Photo: Bas Bakkenes

Flying a kite on Lesbos

Today, another volunteer and me are picking up a family from a shelter. We are taking them on an outing for a few hours. It’s a beautiful day. Father, mother, grandma and four children are already waiting for us. We drive to the Roman aquaduct to have a picknick there. On the way over there I worry a little, would the children like this, or would it be boring for them? But as soon as we leave the town of Moria and the aquaduct comes in sight, I hear ‘Wow…. Amazing!’ from the back seat. I think we’re fine!

We have taken a picknick tarp and sit between the olive trees, close to a tiny stream. We listen to the sounds around us. Father tells us he enjoys the sound of the water so much. He hasn’t heard this in a long time. Mother, grandmother and the girls are picking flowers. They even find the tiniest flowers. We make floral wreaths out of daisies to put in our hair. We check on the chickens and try to find a rooster. We blow bubbles. The son makes boats and lets them float on the stream. I see a family really enjoying themselves.

Father tells about the choices they have had to make. Choices I never hope to make, that nobody ever should have to make. It really hits home with me. Especially because the contrast with this beautiful day is so great. He tells about how sad he is that his children have not been able to go to school for a year now. I see the children enjoying things that should be normal for every child. But everything is different here…

My colleague has brought along a kite. The kids have never flown a kite before. We try it together. From the corner of my eye I see father and mother talking together on the picknick tarp. A moment to themselves, a moment without worries. The kite takes some practice, but it works. It goes higher and higher and the responses from the children echo throughout the valley. It seems so small, but is at the same time priceless. To me, the kite represents freedom. The freedom I have, but others don’t. The contrast is so big. I am glad I was able to do this. I hope I have been able to bring some light and air in a very difficult situation. Judging from the red cheeks and grandma’s smile in the back seat, we have succeeded.

Text: Manon Mol
Photo: Manon Mol

The power of kindness

As President Trump’s proposed U.S. refugee travel ban continues to work its way through the courts, I make a plea for benevolence and tolerance rather than that of fear. I recently returned home from working in the refugee camps on the Greek Island of Lesbos. I was volunteering with the Boat Refugee Foundation, a Netherlands based NGO. I spent the majority of my time in the notorious Moria Refugee Camp.

The camp is beyond description and is a surreal mix of an interment camp and shanty squatter community encampment. Based in an old army compound it is defined by the steel gates, high fencing and barb wire from the outside and an amorphous sea of tarps and tents on the inside. A few days prior to my arrival, the weather had turned brutally cold. Over a foot of snow was followed by freezing rain. The cold and dampness penetrated to the bone. Food queues, inadequate unsanitary toilet facilities and ubiquitous garbage were the norm.

There are over 4500 refugees. They had traveled from Syria, Iraq, Iran, Afghanistan and Pakistan from the Middle East. They came from across the African Continent with families from the Democratic Republic of the Congo (DRC), Ghana, Uganda, Somalia, Eritrea and Sudan. In addition, I treated families from as far east as Bangladesh and west from Haiti and the Dominican Republic.

Almost all had experienced trauma. Some beaten, shot, tortured, and raped and all had experienced the stress of living in unlivable conditions. The complaints were a blur of physical, mental, and spiritual aliments. Yet there was a palpable hope that one-day things would be better with aspirations of a better future. Daily they expressed their gratitude that someone would listen as they shared the story of their journey, affirmed their worth, acknowledged their struggle and celebrated their humanity. You could see it in their eyes and their smiles that each was seeking a better life for themselves and their children. I saw no terrorist. I just saw families, children, men and women-all vulnerable and suffering. So let us remember that our kindness will make us safer than any ban.

Text: Charles Oberg
Photo: Bas Bakkenes

Dentist

Every day a young man comes to our cabin, clutching his mouth and wincing as he waits. He can barely eat, because of the pain. Every day I ask him to open his mouth and spray around his decaying teeth to numb it for a little while so he at least can have his dinner. Is it not horrible that a man can only eat, once we have numbed his mouth of all sensations?

“Every patient we see, also has some sort of dental problems,” one of our doctor says. In our medical cabin we give advice to best manage their dental issues given the complex situation in the camp. This, unfortunately, is only something to battle the pain and not something that focusses on diminishing the causes of all these dental problems. Perhaps in the future we will extend our advice in the shape of posters and short videos playing outside our cabin in the future. This, however, is no solution to the actual problem.

Luckily we, together with other organisations in the camp, finally managed to invite Dentaid to the camp. They will provide check-ups for the list of more than sixty people that we have made over time in hope of this sort of opportunity: sixty individuals who are all eagerly and desperately waiting for a dentist to relieve them from their suffering. Dentaid will arrive this Monday and will stay for a week. We can only hope that after Dentaid’s stay, other actors will also be convinced of the urgency of having a permanent dentist in the camp.

Dentaid will come and the person who comes to our medical cabin every day to receive a little bit of spray, will be treated. We as a team are very happy to welcome Dentaid in the camp: there work is more than needed.

Text: Rozemijn Aalpoel
Photo: Bas Bakkenes
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