Refugee medicine; suffering and hope.

When I was eighteen, I left home backpacking, as is the norm for many young Britons. I naively proclaimed I was seeking out the best and the worse that this world had to offer. I had forgotten all about this until one of my colleagues said the same phrase to me as we drove home after a typically tough shift in Moria Refugee camp. It is truly the worst and best place I have ever been.

The bad

12 000 people in a camp designed for 3 000. That was bad. Then it started raining. The lucky were in overcrowded boxes, the unlucky were in leaky tents and the rightly completely pissed off were sleeping on the ground in the open air.

The inadequate standard of healthcare was obvious. The patient had to wait a few hours, standing in a hot dusty road. Often to be told that we couldn’t help them; chronic problems, those requiring imaging or blood tests were outside of what we could offer. For those with mental health issues the challenges were even greater; the daytime general practice services did not treat these problems, we would try and do what we could, but the most desperate patients, those without disorder much more serious than I had encountered as the inpatient psychiatric setting in the U.K, would sometimes have to wait weeks or months for specialist input.

The individual images of suffering were great. The Somali man with an obviously invasive throat carcinoma, who we could only give paracetamol, ibuprofen and a couple of tramadol. The west African man, actively psychotic from PTSD, mute except from talking to the voices in his head, kept safe only by the grace of his community. The Afghani lady with severe heart failure as on no medications, arrives wheezing just after we closed the door. Snapshots of a thousand different stories.

The good

The 12 000 odd people in this camp are not existing without help. A myriad of overlapping and interlocking NGO’s provided services that we relied on heavily outside of our drop-in emergency clinic. From the friendly Americans from eurorelief; being consistently kind to the unruly unaccompanied teenagers to MSF; providing antenatal, paediatric and complex psychiatric care. Not forgetting the friendly bunch who provided the GP service in the daytime out of the same clinic we worked in. To name but a few, not forgetting the dentists, optometrists, physios, teachers , the list goes on.

As an emergency doc I feel for the local Greek hospital. Who we could always send our most unwell patients. I cannot imagine what it is like for the staff there. A hospital designed for a population of eighty-five thousand, dealing with an influx of over ten thousand non-Greek speaking potential patients with complex health needs. The two (yes only two) ambulances on the island seemed to be running a shuttle service to the camp on some evenings.

All of the people working for these services had the best interest of the refugees at their core. It meant my patient with neck carcinoma is due a CT scan this week. The west African gentleman with psychosis is now seeing a specialist team of psychologists. The older lady with heart failure was transfer to hospital on oxygen and was feeling well enough 2 days later to return to the clinic to shower kisses on my college who treated her. Suffering gives way to hope.

The Amazing

Every person I worked with was a volunteer. Every one was an inspiration. The retired dutch GP, who saw fifty patients at the front door without stopping, staying patient and kind the whole time. The English paediatric nurse, who could do the same for our paediatric patients, and gave everyone else a quiet compliment when they needed it. The Portuguese medical student, who spent his summer holiday here, becoming an expert on bandages and crowd control. The crazy Russian who didn’t manage to hide his compassion behind his tough doorman persona. The Afghanistan refugee translator, who stayed to the end of every shift, allowing us to see every last patient we could, before returning to his tent in the camp.

These people’s consistent dedication and enthusiasm allowed us to overcome the disorganisation and lack of resources. In the future, when I am feeling tired and thin, when a difficult job is feeling impossible I will remember these people and draw a little strength.

However, like healthcare everywhere. Most of it is not provided by healthcare professionals, it is provided by the patient’s themselves. This is more true in Moria. The community support is genuinely amazing. The fragile mental health patients, who are accompanied everywhere by a community member, often not even a friend, but who still take this heavy responsibility on. The ease of which a person gives out the phone number of their neighbour if they don’t have a working phone, and know the message will get to them. The informal school started in the space of two storage cupboards but is now providing lessons thirteen hours a day to seven hundred students. Snapshots of a thousand different stories

When our patients are angry and dissatisfied it is easy to forget what they have had to endure to get here. The chaotic home countries which was dispensing suffering on an unimaginable level, but they had hope, so they left these places, the camp is a purgatory for this hope. It shimmers under the surface of all the problems here. But as long as it is there, and as long as it is still there, we have a duty to give these incredible people a reason to hold onto it.



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