Mind left behind, among the vines

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Tuesday, January 30, 2018
Mind left behind, among the vines

So I’m back in Sheffield. Studying for an exam that no longer has any meaning for me after the time I spent at the refugee camp. The exam is tomorrow and obviously, I am spending my time blogging instead of cramming.

It seems that what they say about humanitarian workers is true. It’s difficult to readjust to my “normal” life again. I was quite surprised to realise this, actually. I mean, I’ve only been away for one week! And although what I saw at the refugee camps was definitely less than ideal, I had mentally prepared myself for worse. I’m trying to figure out what is going on with me. I wouldn’t say that it is reverse culture shock because I went to the supermarket and ran errands this morning without any sense of unfamiliarity. But it is just so tough to find the motivation for anything much at the moment, or even just to figure out what I need to do with my day. I’m not feeling social at all. And I am eating dolmades (stuffed vine leaves) for dinner. As cliched as it may sound, I am daydreaming about the next mission.

And so now that I’m back, I can tell you a bit more about Lesvos and the work that I had been doing there. I’d like to start with an apology though. You may have noticed that so far, I haven’t been forthcoming with too many details about the whole experience. I’m sorry that I am probably a little bit overzealous in following instructions to watch what I say. As a doctor, I am already in the habit of thinking about confidentiality at all times, and now I’ve been asked to take extra care. The whole refugee situation can be quite politically charged at times, and there have already been controversies with some of the other NGOs in this line of work. I have become quite fond of the organisation that I was working with, and I’d hate it for them to get into trouble because of anything that I say.

Fortunately though, my organisation has recently released a totally public-relations-department-approved video about the main camp that I had worked in. It is narrated by Alexandra Chen, a very experienced psychologist who specialises in this field. I admire her work a lot, but I didn’t have a chance to meet her this time. Because of all of her other roles with various organisations, she is only in Lesvos for a few days each time, and can only see a small number of patients. Which is a shame, given that the waiting list for residents at the camp to access the “regular” psychologist and psychiatrist is about 3 months.

I don’t think you need me to tell you that one of the biggest challenges at the refugee clinic is the critical shortage of resources. Luckily, I had experienced similar situations before, working in Aboriginal communities in central Australia. But the refugee camp is worse. Our clinic doesn’t even have running water (hand sanitiser saves the day each time). As mentioned in the video, the camp was designed only as a transit camp, where refugees stay for a maximum of 72 hours before they move onwards to Athens. These days though, there are people who have lived there for more than a year. The camp is only meant to house 2300 refugees, but currently, about 5500 people live there (the video mentions 7000, which is when crowding was at its worst, before political pressure led to a bit more movement). The numbers place a lot of constraints on what we are able to do. We’ve even had to halve the size of our clinic to make room for refugee accommodation. This means that we are able to give out even fewer appointments per day.

The appointment system at the clinic basically works along the lines of patients queueing up every morning to get an appointment number from us. We give out only 50 numbers per day. Which means that people start lining up in the freezing cold at about 4am. I wish some of my patients in Australia could see that and realise how lucky they are with their waiting times in comparison. Of course, we also squeeze in emergencies. My suturing skills have come in handy with bleeding wounds from self harm.

When it comes to resources, the other challenge is working in an entirely new medical system. Obviously, lungs still sound the same through the stethoscope, but the remit of respiratory physicians in Greece can be different compared to that in Australia. I had to learn, very quickly, what was considered in local terms an appropriate use of resources when it came to ordering tests and making referrals. This is made more difficult by the fact that Lesvos is a small place. It only has a local population of about 90,000. There are no endocrinologists at the “big hospital”, as it is known to the refugees. This can also create problems with expectation management. Sometimes our patients don’t believe us when we tell them that something is unavailable at a “big hospital” in Europe. They think that we are being deliberately obstructive by not referring them there. It’s not a nice feeling when your patient tells you that you are being unhelpful on purpose. And it’s also not a nice feeling that in many situations, the most that we can do is to hand out paracetamol.

Of course, the refugee population also has much higher needs than your average patient. I was informed by several people that within the local healthcare system (and really, just within the community in Lesvos in general), there is increasing hostility towards them. It’s not ideal, but it’s hardly surprising, especially given how the economic crisis had affected Greece. While I was in Lesvos, I also met more than a handful of Greek people who had returned from Athens, because it became just too expensive to live there. All in all, there is quite a significant net flow of people into Lesvos.

The locals seem to be coping with it better than I had imagined, though. I had grown up during an era of anti-Asian sentiment in New Zealand, and I don’t feel that the atmosphere in Lesvos is quite as charged. I guess the locals are used to it after so many centuries of conquest by different groups of foreigners. Here are some photos of the pretty seaside town of Mithymna, which was probably founded before the 7th century BC. In the last 2700 years or so, it had belonged to various classical Greek kingdoms, Romans and the Ottoman Empire, among many others. And that fortress on top of the hill? That’s Genoese. According to Galen, my famous ancient Greek medical colleague, Mithymna had the best grape vines, which was made into both excellent wine and vinegar.