Refugee medicine; the difficulties.

All medical jobs are on a gradation of difficult. The are moments when working in British emergency departments seems an impossible task, however, there are several things working in Moria refugee camp in Lesvos, Greece particularly difficult.

The language

Most of our patients are Farsi speaking, originating from Afghanistan, with a few Arabic speakers from Syria and a smattering of french speaking Africans. Unfortunately my Farsi doesn’t extend much beyond “loftan bishi” (sit please) and “salam, esmam “( hello my name is ) therefore we rely on our volunteer translators, who are refugees as well as complete legends, giving up their time for entirely altruistic reasons.

Getting across some subtle nuisances of a history is a challenge; (dizziness is particularly difficult) but also in controlling the flow of a conversations. The patients are often so keen to get a story across they talk for a long time about several problems; trying to lock down why they have come today and what we can actually help with is the goal. In addition, our most common emergency is panic attacks/dissociative seizures. The calming language that is normal effective in these types of situations is somewhat diluted via a third person.

The culture

Medical expectations in the middle east are very different from what I am used to in England. Every fever is a problem that requires a solution. Every illness requires antibiotics and every injury requires a bandage. A common story is that have had this problem before back home and the doctor gave them an injection and it got better. It is difficult to overcome this preconceptions (especially with the language barrier) and many of our patients leave unhappy with the treatment (or lack of treatment) that they have received.

The Volume

The Boats keep coming. This leads to a high population in the camp (approximately 10 000 currently) which leads to high demand. Adequately seeing the high percentage of refugee who desire medical input is impossible. Therefore we have the screen at the door, attempting to re-direct those with only sore throats or with chronic problems. The consistent new arrivals also means that it is difficult to educate regarding which services are appropriate for which population.

The poverty

The refugees are a diverse mix. With some having resources for private healthcare and just needs referrals for medication which they can purchase themselves. However, others have arrived to the clinic having travelled from Turkey in a dingy several hours previously, owning only the clothes on their back. It is difficult for this latter group to provide any sort of self care and sometimes all they want is a few paracetamol for fever or for pain. If they have more acute health needs and require the hospital, they are often left with no means of returning to the camp or any money to pay for the prescriptions that were suggested. We help as best we can.

Mental Health

Much like back home, mental health is given less priority than physical health. The problems are frequent and severe. Harrowing stories leading to self harm, attempted suicide, panic attacks, spousal abuse, depression, anxiety, flashbacks, nightmares and hallucinations. We have a few services to refer to but these are overwhelmed. We talk and see what we can do to help. As a collection of generalists with limited time I hope the short conversations we have and the referrals we make are of some benefit.

Our own health

Listening to these stories of rape and torture takes it’s toll. Being shouted at by understandably unsatisfied patients is wearing. Being unable to provide the care that we know these people need is demoralising. This is difficult to deal with.

However, this is the best team environment I have worked in.
Everyone we work with is an enthusiastic and caring volunteer, with a diverse skill set from many countries. We informally debrief after ever shift. So we have a beer and we laugh. And then we go back and do it all again the next day.