Logbook: Medical Shift

Driving home for Christmas

I´m sitting in an airport hall in Athens as Chris Rea’s Driving Home for Christmas blares out of the speakers. I put in my earplugs. The only thing I can think about is 18-year-old Congolese Jack, who saw his parents and sister being murdered in front of his eyes. I still see him sitting in front of me in the clinic, ticking two stones together, suffering from mutism, abruptly turning his head from one side to the other as he catches sight of his visual hallucinations. I prescribed antipsychotics for a few days and referred him to MSF (Médecins sans Frontières), who have a trauma-psychiatrist employed in their team. Only the most severe cases can be seen by this psychiatrist and it can take a few weeks. In the meantime, the only thing I could offer is to see Jack every 3 days to monitor his situation. The call for my flight brings me back to the airport hall: I’m going home for Christmas, but Jack has to call his tent in Moria his home for probably the next year. In reality, Moria is a home to no-one.

This last month, I´ve been working as a junior medical doctor for the Boat Refugee Foundation, a Dutch NGO providing both medical and psychosocial care for the inhabitants of camp Moria, one of Europe’s biggest refugee camps situated on the island of Lesvos in Greece. Originally set up as a transit camp for a maximum of 3100 refugees with a maximum length of stay of 48 hours, it currently houses around 7000 inhabitants who can expect to live in the camp for many months or even a few years. All the words I could use to describe the place – inhumane, appalling, depressing, tragic –  don’t do it justice. The muddy paths; the tents leaking and often housing more than 10 people; the cold wind blowing through the blankets that serve as a door; the open sewage;  the people waiting for hours in the food-line in something that looks like a cage: it’s a demoralizing place.

Together with a group of doctors, nurses, support crew and translators, I´ve worked in a medical clinic, covering the evening hours to make sure medical help is always available to the inhabitants of the camp. Around a hundred patients visit the clinic every night, mainly presenting with primary care or psychiatric problems. It gives courage to know that a group of, often young, doctors and nurses, see the importance of working for the most vulnerable people living in this world, and although we all work in the camp for relatively short time periods, we work like a well-oiled machine. As soon as we are driving out of the camp at midnight, we share our frustrations about how little we can offer most of these patients but, despite all the limitations, we are flexible, inventive and we often find ways to improve our care. Despite our efforts, sometimes the circumstances of Moria can’t be beaten: the best ‘management’ would be ‘discharge’ out of Moria, which is impossible.  

Another day in the clinic: at the fall of night, the first patients with panic attacks get brought in. Often they are the patients from the unaccompanied minor section; a boy from Afghanistan this time – crying and hyperventilating.  I´m not experienced in psychiatry; I haven´t learned much about the techniques of handling an anxiety attack, but I trust the communication skills I’ve acquired over the last years: I ask him to focus on his breathing, I emphasize that he is in a safe place in the clinic. Slowly tatters of his story fill the room. I hear terms like ‘encircled’, ‘Taliban’, ‘beaten’. I notice the scars on his head and his back. It grabs me by the throat. After an extensive talk, I refer him to the stress relief and mental health classes, also run by the Boat Refugee Foundation. I’m relieved that the next patient comes in with just a rash – another case of scabies.

In March 2016, the European Union struck a deal with Turkey. A deal set up to battle migration by sea from Turkey to the Greek Islands, by sending all ‘irregular’ refugees back to Turkey. Whether a refugee falls into the category ‘irregular’, would have to be decided by an individual asylum procedure in Greece. In exchange for accommodating the refugees, Turkey received EU money and the negotiations regarding the accession of Turkey to the EU were resumed. For every migrant Turkey would take back, the EU agreed to settle a Syrian refugee in one of their countries. But Greece is suffering under an enormous amount of refugees. The asylum process is long and treacly and there’s a shear lack of human resources and adequate facilities. The amount of refugees transferred back to Turkey is only a fraction of what was projected. The deal has caused the borders of Greece to close and turned Moria into an end-station for all migrants crossing the Aegean Sea. In the meantime, although at a lower number than at the height of the crisis, the boats keep coming: so far in 2018, almost 31000 migrants have arrived the Greek Islands.

I find it hard to describe how I felt while I worked in the camp and now that I’m home. Frustration and anger dominate at one time: frustration about the pretention of some political parties that the EU-Turkey deal is successful. Then I feel the guilt for having had to send back a young couple with their 5-month-old twins, who lost most of their belongings in the sea, back into the cold. At other times I feel ashamed that this is the EU I live in, ashamed about the fact that I get irritated when there’s no hot water coming out of my shower while in 0 degrees Moria hot showers are non-existent. I feel discouraged for the 10-year-old girl who always accompanied her depressed mother to the clinic, she hasn’t been going to school during the last year. If no action is taken there’s a lost generation growing up in this camp.

Against the pure despair you can often read in the refugees eyes, there are also glimmers of hope: the resilience of some refugees trying to improve the conditions of the camp; the Cameroonian lady who feels empowered after having followed our mental health classes; the amount of inspirational people working for the various NGOs on Lesvos; the help we receive from our translators, refugees themselves, who not only translate but also offer psychological support to their fellow citizens; the refugees taking the bus out of Moria, one step closer to a human life somewhere in Europe. These stories work as silver linings in a sea of despair.

The stories above are just a few stories. There are 7000 more stories to tell from the people that currently live in Moria. They are all searching for a brighter future; I can only hope their next ‘home’ is a better one.

Text: Manon Heldens
Photos: Bertina Kramer

Running for Lesvos

Almost a year has passed since I worked as a medical volunteer for Boat Refugee Foundation on Lesvos Island, Greece, to provide medical support for refugees in dire need.

This summer, Lesvos reached the dubious record of hosting over 10.000 refugees, where the 2.500 refugees of last year did not even have acces to basic human rights: enough food/water, sanitation and basic medical care.

That’s why I took up the challenge to run the half marathon of Ghent, Belgium on October 28th, 2018. This challenge was no comparison to the hardship refugees face on their challenge to find a safe shelter, a new home. But it was an opportunity to provide some relief!

These results definitely exceeded my expectations!

The fundraiser collected € 1.050; far more than the € 500 I initially set out for. What’s more, I ran the half marathon a lot faster than expected (1 hour 47 minutes vs. simply trying to finish).

Boat Refugee Foundation supported me with fundraising tips and flyers, as well as a T-shirt, which helped for the fundraiser as well as BRF to become more visible.

I’m proud of the good job BRF is doing in trying to provide some relief to fellow people in dire need.

I’m also proud of my well-wishers and donors, for caring about these people.

Many, many thanks, it is appreciated!

Rick van Uum
GP trainee / former BRF volunteer

Interview with support crew volunteer Helen

Every night the medical team rushes to Moria, to take care of the medical issues that people from Moria experience. Together with a team of around 5 to 7 medical volunteers and 2 support crew volunteers, refugees are helped with acute problems, injuries, wounds, panic attacks, other psychological issues, and regular medical needs. An important part of the medical mission in the evenings is the managing of people who have to wait. This part of the medical mission is called: ‘support crew’.

Every night two volunteers stand at the gate of the medical cabin of Boat Refugee Foundation. These volunteers talk to the refugees in line who wait for medical treatment. I talk to one of them: Helen O’Dowd (33).  Helen came over to Lesbos for 6 weeks to assist the medical team. Striking enough, Helen herself does not have a medical background. She is a secondary school teacher, specialized in English, history and coaching children with a poor socioeconomic background with their social skills. Helen tells me: “I work as a secondary teacher for youngsters aged 12-18. I work with those who come from a poor socioeconomic background, and help them to develop socially and educationally”.

Helen came to work at Lesbos in 2017, at that time she was a part of the psychosocial (PSS) team of BRF. She really liked working for the PSS team, especially given her background. But after she gained experience as a crowd controller at a different organisation, Helen decided to return in 2018  to BRF as a support crew volunteer. Helen explains to me: “The PSS team is great, and the work is amazing. However, I really wanted to add my experience as a crowd controller and my background with working with young people who have social and emotional problems to the medical team”. Her social skills and experience create a valuable bonus to the work of the medical team at Moria.

But what exactly does a support crew volunteer do? Helen explains to me that it is really about managing people. The support crew volunteers try to keep the balance between urgent medical matters and medical needs that can wait until the morning medics arrive. Even though there is a lot of medical assistance and help at Moria during the day, there is a big line and crowd in front of the medical cabin at Moria at night. Moria is a place where there is only one toilet for every 76 people. Where there is almost no space to relax. People sleep during the day because they feel safer to sleep when it is light. No wonder why there is so much medical need at night.

But agitation rises at night, especially after dark. Many children are brought in to the medical cabin around nine o’clock with Harara (fever), Helen explains. Furthermore, a lot of people in Moria have to deal with psychological problems. The start of the evening and the darkness of the night worsens their condition.

Translators from Moria help Helen communicate with the big crowd in front of the gate of the medical cabin. Because people from Moria differ in their cultural background, there are a lot of languages used in the camp. Helen explains that the work of these volunteer translators from Moria is indispensable and might be more important than what she does. The volunteer translators are part of the communities inside camp Mora, which makes them trustworthy. The translators allow Helen to communicate with the patients and the crowd in their own language which is invaluable. She can explain why they are or are not going to receive help. Helen explains that it’s about creating a friendly environment and using empathy and affection. She doesn’t mind the big crowd and the groups of men who demand help: “I am a small girl, so I am not intimidating for them. Also, their culture is really respectful of women. I always try to listen carefully and give them time and attention. Then I explain to them why I need to make the choice to let them through or have to make them wait”. Saying no is not hard for her. She says that she doesn’t say no to the person, but selects together with the medical volunteers who has the most urgent medical problem. When you take the time to explain this to the people with the help of a translator, people are more willing to listen and respect you and the decision. “Because we respect them.

At the time I conduct the interview with Helen, she only has to do one more shift before heading home. I ask her what she has learned the most during her time in Moria as a support crew volunteer. She answers that respect has to be earned, not just given. You have to show respect to people, to their culture. Take time and try to comfort them using their own language. Also, Helen says, is Moria not just despair and tragedy. Through the darkness, Helen learned that there is also a lot of fun in the camp. “Moria is my home from home. I have family here now. I will come back for sure.”

Text: Roëlle de Bruin-Boonstra
Photos: Roëlle de Bruin-Boonstra (photo 1), Kenny Karpov (photo 2 en 3)

Human beings

Ellen Spoelstra worked as our field coordinator in Moria refugee camp on Lesvos. She said goodbye this week. How does she look back on her time in Moria and what did she experience in the crowded refugee camp?

On my last day in Lesvos, I’m looking back on my last few months working in this chaotic camp where not one day has been the same. However, one thing that has unfortunately remained the same is the static, unimproved conditions in the camp and the way people are being treated. From December until now, I’ve seen the situation go from bad to worse in my time here. There are a lot of clearly visible problems; the housing is not proper and the hygiene is poor in the camp. Not too long ago, there were more than 9000 people in Moria – capacity for the camp is 3100. Then, huge news broke that 2000 people would be moved from Lesvos to the mainland. What the news articles didn’t say, was that last month alone around the same amount of people arrived on this island in boats as would be leaving it.

There are other issues in Moria which are even harder to explain to the world. I’m speaking about the mental health situation of the people living in Moria. People have been through a lot in their home countries, but also along their journeys to Lesvos. They come from war zones, have been tortured and/or raped, lost family members and have left everything behind in a search of safety. These people are now all living together in the overcrowded, unsanitary and unsafe Moria. This is not a stable or safe environment, thus causing the troubles of those who already suffer from trauma and PTSD to continue to grow bigger and bigger.

In the clinic, in addition to the wounds and infections, we see a lot of people who suffer from trauma and are in need of professional help. Some people are feeling suicidal, others are brought in with severe panic attacks – watching this it looks as if the patient died and their body stopped working – others are psychiatric patients who are still re-experiencing their past in the form of flashbacks and hallucinations.

The medical team is working hard to address these issues 7 days a week, 2000 consultations a month to cover just a portion of the necessary health care inside the camp. But more is needed.

The PSS-team is working to address this as well with mental health and stress relief classes. The team also makes it possible for children to go to school. There are thousands of children living in Moria, just a small amount of them can follow a structured educational program. Other PSS-programs teach English and computer skills. During library hours, there is space for people to relax, read a book and socialize. The programmes are facilitated by the BRF-volunteers but run by people living in Moria. People who were teachers, IT-managers or students in their home countries and are now helping others with their skills.

I’m honored to have met so many inspiring people living in Moria that are still trying to do their best to help others, despite their own situation. They are volunteering for the PSS programs as teacher, librarian or interpreter and for the medical team as an interpreter. I was lucky enough to work with a group of medical interpreters who are doing an amazing job interpreting critical information to our team and our patients in French, Arabic, Farsi and Somali.

Another great thing to see was the hundreds of volunteers who came to the island the last few months just to work with BRF. People came from different countries and backgrounds, but all had at least one thing in common: the motivation to make a contribution, to help this cause and to not turn away.

It is time that more people in Europe or even in the world are going to take action to make a difference. Especially those who are in power to make a structural change. There are too many camps like Moria where people are being treated like they don’t exist. I’ve used the word ‘people’ 16 times in this post, because that is what the inhabitants of Moria are, human beings.

Text: Ellen Spoelstra
Photo: Kenny Karpov

Tell my story, please

As directors of Boat Refugee Foundation, we visit our team on Lesvos a few times per year. On the one hand to show our involvement, on the other hand, to support – wherever possible – in the heavy lifting they are doing, but also to evaluate the situation in camp Moria, so that we can make the best choices for our foundation policy in the coming period.

During our visit, we speak with the team, the motivated volunteers and coordinators, but also with the inhabitants of the camp (Persons of Concern). During our last visit, we meet Aaron. It has started to rain. Chilled to the bone, we stop to talk to him. Aaron and his wife and two daughters are from Kabul, Afghanistan and have a small tent outside the camping fences in ‘The Olive Grove’. This sounds idyllic, but the pictures tell another story. It has been raining for a while now. Their tent floods and the stuffy blankets are wet. The girls are dejected and his wife is silently crying.

We deliberately choose not to photograph Aaron and his lovely family. It may put him in jeopardy, now and in the future. It’s our foundation’s policy not to do this. Furthermore, camp management has forbidden us to do this. Going against this rule may result in us not being able to do our lifesaving work in camp Moria anymore.

We ask Aaron what has brought him to make this trip which took months, and if he knew what situation he would be getting himself in to. Three months ago the Taliban has made it clear to him that he should leave, otherwise he and his family would be murdered. He packed his things and has started the journey, however hard, a journey of almost 5,000 kilometres. What would you do? His older brother already lived in Germany. They lost his younger brother and his wife in Iran, along the way. Nothing has been heard from them since.

Despondent, he asks us to tell his story to everyone willing to listen, in the hope that he will be able to leave this hell soon. He hasn’t been on Lesvos very long, 22 days. He has been registered upon arrival and his next interview is on October 25. Winter is coming, what should he do?

Text: René Berg