Doctor ? Is there a doctor in the house ?

October 2, 2016

 

A quick overview of the medical situation in the refugees camps in Greece, septembre 2106

                                                       A G.P ’s point of view.

 

Introduction

Firstly, we all know that by and large the medical situation in Greece is not brilliant: 8 years of recession, unemployment at a level not seen anywhere since the Great Depression has left the greek state, coping with great difficulty with the basic needs of its own impoverished  and ageing population. 

 

So the medical care of the million plus refugees who transited via the country in the last 12 months has not  been left to a large extent in the hands of the international NGO’s, and individual volunteers. Still, as as I will try explain, significant cost both financially  and professional time rests on what is left of the system

 

I will give a account of what I directly witnessed and experienced in term of need and organisation,. I shall fist describe a little the different context and places we have been to, 

then, I will describe some of the consultations and cases I have see.

The first names I modified, or do not mention, and I sampled cases from all over, for the obvious reasons of privacy , and also for other legal reasons you’ll understand as you read along.

 

The Orange House , in Athens.

Located in that part of the city that surrounds the School of Polytechnics, was the uprising that brought down the bloody dictatorship ( ‘ the Colonels’) in the late 70’, it is a lively and  graffitied neighbourhood , with lots of anarchists around, very prone to demonstration, but also very tolerant , generous and safe for minorities of all kind.

 

Indeed , that house has been created to give shelter to the most fragile, endangered,under trod of the refugee population : unaccompanied  young kids, women with very young children, ….. It has 16 beds, in 5 bedrooms, and will eventually house 20 . It also is a day place, when many more turn in for classes, with english, french, german teachers almost 7/7.   Others, teenagers ( boys) , families , or older men come in day time, for socialising.

They usually rely on a good Doctors Without Borders surgery a which until this week was far away, and the pharmacy attached to it.

 

 

Agios Andreas

 

45 minutes north of Athens, 200 meters away from a  beach crowded by athenians, in army camp that was previously, ( and still is for over half, ) a summer camp place  for soldier families. 

Jacky has explained a lot about that camp: 100 % run by the army until a few weeks ago, it shelters about 120 families, and is apparently scheduled for to house over a 1000 tents in a few weeks.

There was absolutely NO facilities in the camp, no tea place, no distribution center for clothes or else, only army food , 3 times a days. ( dot)  Absolutely not meeting any kind of ( low) standard set by EU or UNHCR for the allowance the country is payed by refugee present on its territory. The authorities in charge suddenly got frightened of CNN or BBC passing by with cameras, and showing people (possibly dying )  in the mud and cold, so  the (army ) camp manager called for help a french NGO,  led by a former army officer super efficient Fred Morlet. Fred made himself respected for having organised with very good standard one of the camps on Levos, the Kara Tepe camp, which is NOT the one that that was devastated by fire on sept 16th.

 

There is no medical center, and no mean for the refugees to see a doctor, because in all other camps there are volunteers who will at lest carry those who seek medical help to a nearby DWB  / MSF   or DOW / MDM ( médecins du monde).   In this camp there was on a irregular, arbitrary rhythm, a army vehicle that would take those who needed it to a hospital in Athens . ( Unbelievable waste of time and money) 

We were the very first  in volunteers in the camp with Fred himself and his wife , and one other volunteer from Lesvos except for a group of ladies from the local village that came to teach the children Greek. 

The challenge, in that camp is definitely structural: the inhabitants need a permanent medical spot, meaning AT LEAST a tent,  a focus point, where to go when in need of help. 

If the camp manager gets its way though he is hoping to get a medical tent ( or, better of course, an “Isobox" medical shelter, ) and he will organise a team of volunteers, and a shift of doctors. The difficulty, and it seems to me important to mention what the obstacles are, in that camp, for putting anything semi-permanently on the ground, ( except of course thick lair of rubbish of any kind, which does not worry the greek army to the least ) to put a tent, or a shelter anywhere, you need written permission from ministry of Defence, ministry of Interior, AND ministry of Tourism, and probably the ministry in charge of the refugees as well,  God help us.

But to call him in, early September , asking him to winterise  the camp, it is almost surely to make the CNN blame him if failed. Never mind, he took the immense challenge, making a huge difference in a few week, plowing his way up to the ministers in charge. 

 

 

Oinophyta

 

This is another camp north of Athens, located on a disused Air Force airfield.

Jacky was here last spring time, and had kept contact with some residents, who welcomed us like family.

There is a very good volunteer medical team over there, most of them from the USA, led by very charismatic John ( yes, that him on the photo ) , and his doctor wife  . There was also another GP, and a midwife 7/7 in the camp. A very interesting organisation indeed, giving a fantastic feeling of professionalism, commitment, compassion and spirit. I would say  America as we dream it. 

I worked a little bit with the GP on an very  infected toe, inventing unconventional strategies to avoid amputation, whether GP in LA or Lauzerte, the thing is to do something with what you’ve got.

But that team is totally self supported and self financed , and they were very short of some medicines and basic equipment, which we had in the car brought from France, originally scheduled to go to the Social Pharmacy in Katerina. ( see Jacky’s blog)

So we then went through the emergency  list , and went to buy in the local pharmacy every thing we could find within our budged line.

Now , very interesting was the conversation with the team manager, John, as he explained the legal issues with their presence and action in Greece. I do not really believe it would be easier in France, or the UK, for that matter,  but these last two countries do  not need on their territories a large presence of medical NGO’s.

M.D.s and other medicals are only allowed to work in Greece after their medical diplomas have been viewed by the health authorities. So far, so good. After that the permission is only granted for a period that must be set in advance, for a specific location ( a camp, in other words) , and with a recognised NGO, that must have been formally made a charge of the task.

Other conditions are also to use only medicine and equipment bought in Greece, and to sign some paper that guarantees that you are not taking the job of a greek doctor. 

It could be acceptable, and for instance, indeed, buying the medicines in the country itself makes sense, but other conditions are totally impossible to fulfill, of course, not the least because the Greek administration absolutely never answers any letter, applications, whatsoever. In fact, only two NGO’s are big enough to keep up ( or so we like to think) with the legal aspects of humanitarian medicine: Doctors of the World, and Doctors Without Borders, ( this latter one is BIGGER worldwide then the Word Health Organisation of the UN. )

So in Oinophyta, as in most camps, nobody is registered, at all, and they have a presence there 7 /7 since almost a year, and it is very hard for an american doctor to work without any kind of insurance. It tells about their commitment and superior motivation.

 

Ritsona 

 

With over 1000 residents, nearly all from Syria,  this is  a very crowded camp. Another place where Jacky vas very much involved for a few weeks, earlier this year, and she was pleased eye witnessing that progress had really been made on the sanitation.( see below, the camp is plague by hepatitis A)

 

The commons are quite appropriate: a large warehouse- distribution center, very tidy and organised. Entirely manned by  volunteers. A school, a wood - electricity (and whatever else needs fixing) workshop, in a full-size container. Playgrounds. The camp, like Oinophyta is located on former airbase, the camp is completely open , like a village, the air force personnel in charge are definitely more relax then in the camps under the army ‘s responsibility. 

A long row of Isoboxes ( aluminum multipurpose shelter, like Algeco’s, )  for showers, and toilets, very clean in general, and the camp itself is patrolled by cleaning teams of refugees. This is essential , because it is very crowed, the tents are very close to one another. The camp is absolutely nowhere near winter-ready. Leaking tents, no flooring ( all your belongings on the mud!) no heating.

I have no ideas what the plans are in that respect. One could say that the camp is very fortunate in what it has been offered by the volunteers, but the basic infrastructural needs have not been addressed yet: I must say that the bulldozers had just started clearing and flattening a next bit of land: Isoboxes, are scheduled, but 2000 people to move before the autumn rains would be a daunting challenge in a well run country. Lets put it this way: the Authorities are going to need a LOT of help from the volunteers, who luckily have been  made welcome in the camp. 

On that respect, this is the very contrary of Saint Andreas , ( Ayos Andreas), where the desperately needed  volunteers and structured NGO’s are called in only to be welcomed by impenetrable barbed wire-like red tape.

 

The basic medical support of the camp is provided by the Greek Red Cross. I did not have any direct contact with them, and do not know what they can offer. Anyway, they have a lot on their plate, since Ristona is plagued with Hepatitis ‘A’, ( ‘ jaundice ‘ ) which is transmitted by oral contact with tainted plates, glasses, etc.. I had been warned about this by the french medical authorities before my departure, and that is the main raison why I inflicted my a large set of immunisation. I usually stick to the other side of the needle.

 

Nea Kavala

 

Located in the north of the greek province of Macedon , that army - run camp shelters over 2000 people. Jacky had ( and has) friends there, volunteers Kayra and Manal, whom she worked with on Leros , then on Lesvos , and as she mentions on her blog, we visited families that they relocated in a village, in rented apartments.

We couldn’t really visit the camp, and only went in briefly form a unintentional opening in the  fencing and razorwire. I saw the German RedCross, on the spot, and we saw in town a dozen or so of members  of Save The Children, ( having breakfast ) wearing their badges. There is surely a lot of work to be done ! I can’t tell more

 

Katsikas

 

Is also in the northern Greece, but this time much closer to the frontier with Albania. We didn’t have any contact there, and walked straight into the camp, passing in front of the small group of army and police that stand at the gate, making sure to look like people who mind their own business, looking very professional.

The camp turned out to be very open, life there ( at lest survival, I mean) helped by quite a large number of volunteers of all kinds from all over europe and north america. 

Medically speaking, there is a in-hard installation of Doctors of the World, with 3 Isoboxes,   set in a U shaped disposition and regular presence of nurses and doctors.

The space between these 3 ‘ covered by a tarpaulin,turning it into a waiting-room, crowded with mums and kids of all ages when we went around

 

 

The Social Pharmacy

 

 

 

Before visiting the place, I was very puzzled by the very comprehensive list of medicine they told us was in dire need.

I only realised when we went how big end efficient the organisation actually is.

Fully run by volunteers, I would call it a masterpiece of organisation and commitment.

The way their storage for medicine was organised, thousands of difference references, stored in boxes on the four walls of the room, easy to get to , easy to resupply , with the help of only one vintage PC, is quite amazing.

On their list of mostly needed medicines I had picked everything that was available in one  of the Athens pharmacies. I wished we had done more there, because not a penny is lost over there. 

 

 

A Doctor in the House

Knowing that a doctor was going to be there, quite a few people turned in.

Who did I see? 

First of all, mothers !, bringing their children with all the usual range of not life threatening problems : temperature, sore throat, earaches, coughs of all kind. All the throats I tested for streptß, and  all of  these tests turned to be positif, (that raises questions I will not develop here)  requiring antibiotics, which we provided.

The usual procedure at the social surgeries and pharmacies is that the patients must turn in daily to get their daily doses of medicines. This is to avoid black market, mostly. It has  some side effects : it is time consuming in transport, can be a nightmare of organisation for single moms with very young children, (Athens is a HUGE town) and decrease dramatically the observance of the treatment. For not life treating cases as theses, once more or less reassured, treatments are stopped too soon with devastating consequences in term of bacterial resistance.

Since I was able to make my own decisions, under my own responsibility, I decided to deliver the treatment for 3 days , with a proper explanation, written in english + a Syrian translation.

Secondly, I saw hugely more serious cases.

A young man , 22, from Aleppo  very recently arrived in Greece was introduced to me. His eyes were red, and he was breathing with difficulty. He told me he was a mechanic, had no previous history of allergies, hay fevers, asthma or lung problems. His present condition began when  the surroundings he was in at Aleppo was heavily shelled, and ‘The Dust’ , as he call it, and how his translator called it, caught him, and left him with burning eyes, and burning lungs.

He was rescued and evacuated by the volunteer civil volunteer, still active in Aleppo, these same courageous people, the White Helmets, that the Russian warplanes so severely shelled 4 centers on September 24 ( if I’m right),  the last non partisan organisation that was still active, among the 475,000 inhabitants of the besieged city.

To cut the story short he was evacuated with others to Turkey, where he was told his lungs were burned, and was given cortisone, orally and by inhalers, and Ventoline®cc.

He he had  heard of the gas , of course, but knows nothing about it, ( neither do I !, despite a very ancient training in NBC medical consequences, 40 + years ago, and at the time, the prospect of having to deal with the consequences of  chemical warfare was so remote that the C part of it was viewed almost on historical - almost archeological ground) 

Back to the story of ‘Ahmed’ , after a few months in Turkey, he found a passage for Greece.

When I saw him, his eyes  were still burning and lungs certainly were still spastic. He had had medical help once since he arrived in Athens, but he did not  have a translater on that day, was given Ventolin, but he doesn’t know what the doctor thinks of the situation.

And I do not know what to think of it either: Warfare gas? or indeed, regular dust from collapsing building, a syndrome that we know about only since  the consequences of 9/11 .

Anyway , I renewed, and delivered supplies of medicine, and advised him , with a letter of recommendation , to see a DWB , asking to be referred to a general hospital.

A serious problem is the total lack of follow up for these people. No records from Turkey, nor from nowhere. 

Another remark, it would be absolutely stunning ( statistically) that in just a few hours of my ‘medical awareness’ among the refugees I would come across a civil victim of chemical warfare. Well, dust , or gas,  we will probably  never know. 

 

Eventually, an even more ( if possible ) distressing story.

A young woman, was introduced to me , form north east Syria, with a very Christian first name; each of her eyebrows were bearing the scars of  deep burns, probably made by a cigarette. She was covering these with a large coat of make up. That was not what she wanted to talk about. Her english was quite good, and the translater ( she chose)  was of course there as well.  She was several months in captivity of ISIS, and didn’t want to elaborate, fact that mentioned was enough.  She wanted topical creams, for local feminine infections. That is easy enough to provide. She knew as well as me she needed counselling. Nevertheless, past history in the 20th century ( WW2)  shows that a victim can recover from unfathomable suffering by social interaction: the only condition for them to open that possibility is that they are looked upon as normal people, making possible  “normal”, trivial, social interaction. 

For Life itself is the Great Healer.

 

And, last but not least, a boy that I could not see myself, despite the repeated demands of his desperate mum.

A woman, from Aleppo, that I met in a camp, asked me to see a friend of hers, in Athens, and her son, paralysed. I knew no more. I made contact via a translator and Whastapp, and propose to met these people when I returned to  Athens, a week later. In the mean time, she e-mail me the medical report and  X rays about her son. These X rays are most alarming: the boy has a large shrapnell lodged in one of his neck ’s vertebras. ( C7) .

I  had suggested to that person ( via translators, and third parties …)  that she came to the place where I was going to have a surgery. That seemed all right, but on that day she could find enough help to have her 12 years old son transported. I  didn’t manage to find precisely the place where she was , so I didn’t see her. But instead, I met a greek doctor , and understood that the boy, indeed tetraplegic ( paralysed, totally) was actually wounded in July 2015 ( yes 2015, ) in Aleppo, was carried by his parent to Turkey, then Turkey to Greece ( imagine the journey) and had been hospitalised from September 2015 to beginning of September 2016 (12  months) in a neuro surgery department in Athens. On September the 2nd., he was discharged, nothing else could be done for him. This is where I say  that  I believe that a significant medical cost rests on the broken Greek system !

 

 

Last story: lets call him Zeus, because truly, he looks like  a greek god ! 

A  25  years old man, looking like a teenager ,tall, athletic.  Jacky met him in a camp in February, and she described me someone 100 %   cheerfull, always smiling,. Absolutely true and he now lives in an apartment paid for by a group of friends in Spain. He is very hopeful about his asylum. Nice looking, intelligent, cultivated, he was studying accountancy, We had a meal and a couple of beers together. ( Well, no I had wine, he and Jacky were on beer). The wounds on his ankles, on both legs are still very visible, for having been so long in Assad’s jail, after the first student demonstration, a couple of years ago, before the war really went the way it is now, when our newspapers were so hopeful about  “the arab spring”). He was tortured. He considers himself lucky, he was not made to ‘ disappear’ . 

He then kept very low profile in Damascus where his family lived.  But he was later enrolled in the army, and deserted at once. Arrived in Greece after a hollywood style journey. We need him here.

 Note: A special thank you to all of our friends who gave money for medicines.  We spent a wonderful total of 1039.2 euros on medicines, small medical items for Oinofyta camp, and a fridge for medicines for Agios Andreas.  Nearly all the money was spent in Greece. If any of our supporters  wants detailed bills, please email and I will be happy to send the information.

 

 

 

 

 

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