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Women & Children

Mother & Baby Housing Project

Originally posted on April 5, 2016

Rita has just returned from visiting the border of Greece and Macedonia where she was able to see first hand the situation of the refugees. As a result of her visit, SCM will be redirecting some of our efforts from coordinating medical missions to providing temporary housing for pregnant women and their new babies.

One thing many people find incredible about the refugee experience is how many women are making the journey while very pregnant. We have heard stories of the women arriving on Lesbos either about to give birth or they do give birth almost on arrival. Women walking for miles and miles while 8.5 months along. Women at the border camp giving birth in a small tent then having to wash the baby over a puddle outside with bottled (not warm!) water. So many women have risked EVERYTHING to find safety for themselves and their families and are giving birth in deplorable conditions.

To help alleviate this crisis, SCM has worked with local officials to find several condo units that we can rent for a nominal cost to house the women and their immediate family while they give birth and then give them some recuperation time before they have to leave. They will be visited by doctors and nurses on a regular basis.

Currently the rate we have been given is 300 Euro per month for each unit, and we may have access to 12 in total. We will also provide the funds for electricity and any medications the mothers will need. If you can help us provide a safe and clean place for women to give birth, please donate to our Greece Fund by clicking here or go to our Donation page and click the link there for our Greece Fund.

More information will be coming as we make progress on this program, with photos and stories about the women who have been moved into the housing. Check back for updates!


Balancing our Souls, Somewhere between our Hearts and our Brains

Originally posted April 4, 2016

EKO Gas Station Refugee Camp, Highway 75 near Polykastro, Greece
By Dr. Bill Dienst

“If you are in your twenties and you aren’t a bit of a revolutionary, you have no heart; but if you are in your 50’s and do not have some conservative tendencies, you have no brain.”
(paraphrasing Winston Churchill)

Our makeshift town of refugee tents cluttered around the EKO gas station is on the highway, two kilometers South of the exit to Polykastro, Greece. It has mostly Syrian refugees who speak Arabic and Kurdish. The current estimated population here is about 2200 people. Last Monday, our coalition of small NGO’s inherited a small plywood building, which serves as a primary care clinic from Medecins Sans Frontieres. MSF wanted to consolidate their operations among the much larger refugee populations in Idomeni, which are located 20 km to the North, immediately adjacent to the Macedonian border. People have been stranded there for over a month, trying to take the Balkan route to Northern Europe.

Our refugees at EKO are stranded too. For this small town family/ER doctor and my committed colleagues of doctors, Family Nurse Practitioners, Nurses, Emergency Medical Technicians and other humanitarians, it has been an intense labor of love this past week getting this clinic stocked with medications, bandages, tools and other supplies. We even bought a refrigerator so we could handle perishables, including vaccinations, which we hope may be coming to us through MSF in the near future. Immediately we began staffing the clinic 13 hours per day with 3 shifts of intake people, doctors, nurses and translators. Things were going well, and every day, the chaos was slowly and surely becoming more manageable.

Previously, we were providing primary health care out of the back end of mobile health vans. But in these settings, it was impossible to do much about chronic conditions like hypertension, diabetes, epilepsy and the like. Now for the first time, we were beginning to make progress in managing these chronic conditions. We were also beginning to make inroads and relationships with Greek doctors at the Polykastro Health Center, so we can line up lab, X-ray and dental services. The Greek doctors and us all realize that we must all be allies in health care. They need us to take the pressure of them with the overwhelming medical needs that this refugee crisis has created. And we need them to help us with ER, lab, X ray and dental services that we are yet unable to provide. We had accomplished a lot in just one short week. Then on Friday and Saturday, the bottom dropped out.

It all started when Greek government official showed up Friday morning asking for credentials for our doctors and nurses; this is problematic, since our medical staff is comprised of volunteer health professionals from all over Europe, North America, and Asia. Many of our health staff arrive, work intensely for 1 or 2 weeks and then return to jobs in their host countries.

But we will do our best to comply with these new onerous requirements. We sent a team Friday night an hour South to the city of Thessaloniki to meet with government officials. When our team returned, we thought we had a workable plan to assemble credentials within the following few days to keep our clinic operational. Mairi, our Scottish logistics coordinator worked feverishly through the night putting dossiers together for each of our providers, even those scheduled to leave in just a few days.

Then on Saturday morning, 3 more government officials arrived, demanding our paperwork immediately. They seemed irritated and left. Then they returned an hour later with police. Under duress, we were forced to shut our clinic down in the middle of a very busy Saturday. The refugees protested by blocking the highway with their tents; passenger vehicles were allowed to pass, but all commercial trucking was blocked. The situation became more volatile and more police reinforcements arrived.

This was a heart wrenching experience for both our Syrian patients and us providers. We have quickly grown quite close each other in our makeshift small town. We are starting to know the peoples’ names, and their families; and they are starting to know us.

What each of us thinks should be done about this mess varies depending on who we are, how old we are and how long we are volunteering with refugee health care. I feel that I must pace myself and pick my battles; only the ones I think I have a chance of winning. At age 57, I can no longer be Don Quixote chasing windmills, I simply don’t have the stamina. As medical coordinator, I am trying my best to work smarter, so that someday soon we all will not have to work so hard struggling with the latest crisis of the hour. But that does not mean I don’t care. It is all a matter of tactics.

There are some who think this is all a deliberate attempt by the Greek government to make life in these makeshift camp so miserable, that more refugees will go willingly to the relocation centers based on the military bases, where they will have better conditions and more consistent health care from Greek military doctors and the German Red Cross. Honestly, I feel ambivalent about this whole process. If refugees are all going to be forced into these relocation centers sooner or later, isn’t it better that it happens sooner? There are no easy answers.

But now I sometimes feel that I am at loggerheads with one young EMT with a revolutionary bent who I fear might have intent toward confronting the Greek authorities. We have to keep talking him down. He is in his 20’s, emotionally shattered, and hasn’t had a day off in weeks; he won’t take a day off and he really should. He is showing telltale signs of burning out. I know them well, for I have been there many times in my career myself. It is not whether or not you will burn out doing this kind of humanitarian work: you will. It is whether or not you will recover from your burnout and remain compassionate. His heart tells him that he must act.

I am trying to use my brain while acknowledging to the younger ones in our medical corp to that I too have a heart even if my distancing from every crisis of the hour doesn’t seem so to them; I do still care. I will never resort to pure pragmatic realpolitik and opportunism, like all the bastards and scoundrels that have created this horrific modern day catastrophe in the Middle East: Bush, Netanyahu, Assad, the Saudi regime and many others, including those who have profited from endless wars. For every outrageous actions, there are equally outrageous reactions: so now we have ISIS, among others.

When will it stop? I don’t know. All I can do is to try and help the vulnerable and the meek. I must ask myself, “How can I help?” Easy question, the answers are not always so easy. The corollary to this is: “If you are going to be a rescuer, don’t become a casualty, neither physically or emotionally.” It was bound to happen and one day it did. With all the hundreds of sick people coughing in our faces every day, I and others have picked up the nasty upper respiratory illness going around, compounded by all the dust and smoke in our working environment.

We must work with the Greek authorities and jump through whatever hoops that they ask of us, as best we can. After all, we are in their country and we will never win by provoking them. The predicament that they are in deserves sympathy too.

Our best response is to develop alliances with all the parties. The director of the Polykastro Health Center, Dr. Georgios Perperidis is also a dentist. A very important man to know. He also knows all they local officials in the Greek Ministry of Health and says he will advocate with them on our behalf. On Sunday, we all meet with Dr. Jolene, the medical coordinator with MSF and work out an elaborate plan to keep the Eko Clinic going under an alliance of small NGO’s.

We show up Monday morning to finalize the deal only to discover that 2 of the critical NGOs refuse to collaborate with each other, based on bad blood between them in the past. A lot is lost in translation. Dr. Perperidis explains in Greek that all the problems with the Greek Government officials have been resolved adequately. But now it is still a no-go due to what seem to me are petty differences between rival NGO’s. Who are we working for again? The REFUGEES!!! MSF now needs to take the clinic back for the next week or so, even though they don’t want to. Our clinic needs to be disassembled due to competing assets and competing interests. We have wasted a lot of effort trying to build this dream. We can no longer blame it on the Greeks. We seem to be our own worst enemy.

Are you feeling exhausted, humiliated, and sick; a little burned out perhaps? YOU BET I AM!!!

OK, step back, slow down. Take care of yourself. It’s not just a destination, it is an adventure. Go back to running mobile clinics now and see where all this goes.

Women & Children

Baby Box Project Update

Originally posted on March 28, 2016

Today we received the first half of the New Baby Welcome Kit boxes! Our goal is to get 200 total, and we received 100 boxes to get started on. We have partnered with The Baby Box Company that provides the Bed Box, and they have been really great to work with.

You can donate to our CrowdRise campaign here http://www.crowdrise.com/new-baby-welcome-kits-for-refugees-in-jordan


The boxes arrived flat, which will make them easier to get to Jordan. But I had to put one together to show everyone what you are helping us to accomplish.


The boxes provide a safe and secure place for the baby to sleep, and will be stocked with clothes, a blanket, mitts and socks, diapers, and more, for the baby and new mom to help them through the first year.


Thank you!


Strategic Health Planning Amidst Desperation and Uncertainty

By Dr. Bill Dienst

March 25, 2016, Idomeni Greece, just south of the border with Macedonia

We have now been at Idomeni on the Greek side of the Macedonian border for just over a week since leaving Lesbos. The day before we left Lesbos, I attended the Tuesday coordination meeting where we were briefed again by a UNHCR representative. At that point, he predicted that the refugee population on Lesbos would be increasing due to limited accommodations in Athens, Idomeni and other places. He projected that Lesbos would experience a piling up of unregistered refugees. Contingency plans to house expanding numbers of refugees on Lesbos were in the works.

Then three days later, an agreement was signed between the European Union and Turkey. On the fifth day, the entire refugee populations of Moria and Tara Keppe camps on Lesbos were abruptly put on buses, driven to the port, loaded on a giant ferry and sent to internment camps on the Greek mainland, where they await deportation back to Turkey; we think, but we are really not completely sure. It is all speculation. But now there are hardly any refugees left on Lesbos. Elaborate medical and humanitarian operations there that were developed following the boat people crisis thins past fall and winter are now rapidly shutting down.

We really don’t know what in the hell might happen now on the border here at Idomeni, not in the short term; not in the long term either. Will the population at Idomeni a month from now be at 30 thousand, or will it be zero? As medical professionals and humanitarians, we must still do our very best to plan for the future.

DSCN1570The stranded refugee populations here are centered at Idomeni and 3 other smaller camps that have grown up around the local gas stations: Eko, Hara and BP. Some people have given up and are taking buses back to Athens. Other people are still arriving. Campsites are spreading out laterally over wheat fields to reduce clutter and crowding. So it is hard for us to tell right now if the overall population is contracting or expanding. Smoke billows out from continuous campfires, built for both cooking and for keeping people warm. The downside is that we medics are seeing hundreds of people with sore throats, coughs and irritated eyes from chronic smoke exposure. The only respite from this is when it rains, or when the cold winds blow. But then people get muddier and colder.

Our short term purpose is to provide acute and urgent health care through a mobile health van that we have created. We have aligned ourselves with a British group called Off Track Health. They have a Swedish ambulance that is not operating as such, since that would challenge the existing Greek laws about foreigners running an ambulance. So instead, the back end of this ambulance has been outfitted with various medications and other acute care supplies.

We have modified our existing van in similar fashion. On Lesbos, our van was outfitted with more emergency supplies for treating hypothermia from pulling people off overcrowded boats and out of the water. There was risk for mass casualty incidents, drownings and near drownings. Here, we are handling problems, most of which are not immediately life threatening, but which are directly related to present living conditions and overcrowding: Upper respiratory infections, mostly viral, but some with bacterial complications. Vomiting, diarrhea and the like. We are also screening for for more serious conditions, and devising elaborate ways to send people needing hospital care 30 minutes away to the local hospital. If necessary, we manage emergent conditions as best that we can and wait for the Greek ambulance to arrive.

Everyday is a new adventure, as we do our very best to make order out of chaos. We start out at the “medical supply warehouse”, which is really a musty basement where we store donations from around the world. A few days ago, we had to sort through piles of boxes and suitcases full of stuff, some things that are useful to us and some things not. But thanks to a group of German medical students who spent 2 whole days building shelves and sorting meds into alphabetical order by drug name and by category, we can now find what we have and need in a fraction of the time.

Our medications are in English, German and in Greek. There are also some differences between the USA and Europe: e.g. Acetaminophen (Tylenol) is Paracetamol here. Even when we can figure out the generic ingredients in German and in Greek, we often discover that our European colleagues use different preparations for cough and cold than we use in the States, some that we have never heard of.

We have different groups of doctors, nurses and other allied health professionals every day, as many of our volunteers stay for a week or so, and then return home to their host countries. During the past week, I have worked shoulder to shoulder with health care providers from the UK, Ireland, Norway, Sweden, Germany, Switzerland, Austria and Catalonia, The cooperation and collegiality that I have experienced working along side these wonderful brothers and sisters has been inspiring and amazing!

We line up our mobile health van on the edge of camp, with special considerations for crowd control. We try our best to get people to cue up in 2 lines, and send people trying to cut the line back to the end. We have an intake person who pairs with a translator (mostly Arabic, but also Kurdish, Urdu and Pashtu). When we are limited by the number of translators, we employ local people to help with translation so that the lines don’t get too long. Then the patient is seen by a doctor working through the translator, who requests medications from a gofer/pharmacy technician who does her very best to keep order in the van. We typically have seen about 100 patients among 3 doctors in a 3 hour period in this way. Our notations are brief: Patient age, sex, assessment and treatment. We try our best to get specific names if we think follow up or specialty care is needed.

Yesterday, I attended a general medical meeting with the medical director of Medecins San Frontieres (Doctors Without Borders) and the heads of some of the 20 plus NGO’s who are providing health care here in Idomeni. The purpose of this weekly meeting is to do strategic planning and coordination of medical services for the long term. In the next article, I will try and explain what some of the longer term goals are. But our targets keep moving and evolving.

Dr. Bill Dienst is a rural family and emergency room physician from North Central Washington. He has extensive experience in medical exchange programs in Veracruz, Mexico and in the West Bank and Gaza Strip. He is currently on assignment with Salaam Cultural Museum, a Seattle based nonprofit organization doing humanitarian and medical relief work in Lesbos and Idomeni, Greece.


In Arabic: Pardon Me Sir, Is this the Boat to Nowhere . . . or Somewhere?

Tuesday, March 16, 2016 by Dr. Bill Dienst

Aboard the Greek ferry Nisos Mykonos, leaving the Island of Lesvos for the Greek MainlandDSCN1770

During the last days we spent on the North shore of Lesvos, we witnessed the arrival of an armada of NATO naval ships from Germany, Canada and other countries passing in front our our seaside hotel through the straits between Greece and Turkey. There are 15 large warships, at least. As far as we can tell, they are probably heading to the South end of the Island. We think the are here to help stanch the flow of boat refugees that have still been crossing across the wider straits directly into Mytilini. During the past month, crossings have been very few in our area of operations in the North. The Turkish Coast Guard, under pressure from the EU, has effectively blocked most of the crossings.

So now our NGO, Salaam Cultural Museum is deploying much of our assets to the Greek Mainland in areas of crisis and greater need: specifically to the border village of Idomeni, where thousands of refugees are now stranded up against a barbwire fence set up by authorities of the Former Yugoslav Republic of Macedonia (FYROM). This is not to be confused with Macedonia, the region of Northern Greece where we are now setting up our operations. We packed up a large van with all the humanitarian and medical supplies that we could possibly stuff into it; and then we headed to the South of Lesvos, an hour’s drive over a twisty mountainous road, and into the Port of Mytilini.

The scene at the ferry terminal was poignant: A long cue of Syrian refugees, still with hopes in their hearts for a better future. Finally, they have made it across “the straits of death” at $1000 a piece paid to smugglers to get to Lesvos, and Europe. They spent their time in the transitional camps at Moria or Kara Tepe. Now for about $60 each, they can cross in comfort to Kavala on the Greek mainland: An 8 hour voyage with beautiful scenery, and relatively zero risk of drowning. From there, they will make their way to the North.

DSCN1766A Syrian man tells me confidently and triumphantly during our conversation in pidgin Arabic: “ I am going to Germany!” Knowing what I now know, I have my doubts about his ability to succeed, but I do not have the heart, nor the language skills in Arabic to warn him about the harrowing trail ahead, so I just let it go. We take pictures of ourselves together as habibis (good buddies). Another Syrian man tells me his family will stay with friends in Kavala and only head up to the Idomeni if the border opens again. This seems like a much better informed decision.

The Syrians climb the gangway up to the 6th level and are seated at the stern; they are they lucky ones. They are free to move about most areas of the ship, more or less, though there seems to be a dividing line starboard side aft. Forward from there are the second class passengers, mostly Greeks and other Westerners, including us. First Class passengers who do not want to deal with the refugee crisis are conveniently accommodated in the bow.

On the sixth level portside is a coffee shop, complete with WIFI. Forward from that is a roped off area where we are not allowed to go. But we can see a large contingent of Greek policemen, and what appear to be “prisoners” Some are handcuffed. They are mostly men, but there are a few women too. I suspect these are people, who for one reason or another, were unable to get registered. If these unregistered refugees dare to wander off from the internment camps where they are housed, and they get caught, they risk arrest.

Whether one gets registered or not often has to do with nationality: Syrians and sometimes Iraqis are favored and deemed “war refugees”. Afghans, Pakistanis, Moroccans and others are considered “economic refugees” and are less likely to be able to get registered. Of course, the details of each person’s individual case is much more complicated than that, as UNHCR has argued. Places like Afghanistan are hardly at peace. But the Greek Authorities are doing the best they can, trying to sort things out and restore order in the middle of the chaos of this refugee crisis.

To me, the whole process seems political. The Assad regime and ISIS, though on opposite sides of the spectrum, are American and Western European adversaries. The Shiite dominated Iraqi regime, placed in power after the US invasion and overthrow of Saddam Hussein, are supposedly our friends. But ISIS exists there too, so there are friends and enemies there. Afghanistan has another regime placed in power following an American and NATO invasion. They are also “our friends”, but what about the Taliban? To me all I see in front of me are a lot of worn, tired huddled masses yearning to be free from war and to have a better future for their families. It doesn’t seem to matter much to me beyond that.DSCN1760

Then there is a limitation of incarceration facilities on Lesbos, so I suspect these “prisoners” are headed to more secure facilities on the Greek mainland. There, they will probably face more accelerated deportation procedures that try to send them back from wherever they came, or else Turkey. Then they will be Turkey’s problem, not Europe’s.

Above on the 7th deck, port side forward at midship, there are an overflow of Syrians who are allowed to walk outside on the observation decks. We befriend them, share photo shots, and I do my physical comedy schtick with the children and get them laughing. Behind the Syrians port side aft are another group of people guarded by a smaller contingent of Greek policemen.
They have darker complexions than the Syrians and their manner of dress is different. The police do not allow us to interact with them directly. I think they are Afghans or Pakistanis: those who are probably not registered. Their trips to the bathroom are monitored so they do not try and slip away to mix anonymously with the Syrians. When we reach landfall, they are probably headed to another internment camp on the mainland until their disposition is decided.

We disembark in our huge van after the ferry arrives at Kavala. We see several large prison type buses and a lot more Greek policemen waiting to receive the unregistered passengers and prisoners. We drive onward through the night, arriving on the outskirts of the huge encampment of refugees at Idomeni just before midnight.


Predicaments of the Current Refugee Crisis in Greece

Originally posted March 14, 2016

Lesbos Greece, by Dr. Bill Dienst

After being part of an advance team sent to the Greek-Macedonian border this past week to scope out the situation of 20 thousand refugees stranded at the border, we are back in Lesbos for a few days more. Salaam Cultural Museum is now planning to deploy more of its resources to the border at Idomeni.

The situation here on the North Island of Lesbos has cooled down. The Turkish Coast Guard and NATO Naval forces have effectively cut off refugee boat crossings in Zone 1 on the North end of Lesbos where we are assigned. There are still significant numbers of crossings on the South part of the Island near Mytilini, but they are currently well staffed with medical and humanitarian volunteers there. So we will be moving some of our medical operations to the Greek Mainland, to where we can now be put to better use.DSCN1575

Today, I will take this time to reflect on information we received last week from the UN High Commission on Refugees.

Boat arrivals to Lesbos have been down; on March 8th, 20% down from the daily average of 1500 arrivals per day recorded the previous week. In spite of this, the populations in Moria and Tara Kepe Camps near Mytilini are still growing, mainly due to a slowdown on refugees leaving for Athens. The capacity in these camps is being built up to house a population of 6500, up from the current population of 4000.

Tickets for refugees to get to Athens and beyond are now being rationed. There are reports of tickets being scalped and sold at inflated rates. There are also reports of fraudulent counterfeit tickets being sold which have no value; some claiming direct ferry passage to Idomeni. The only problem is that Idomeni is inland from the sea by more than 50 kilometers and no ferry can get there. But refugees who fall for these fraudulent sales do not know that, and more of their remaining meager funds are being squandered by these ripoffs.

DSCN1598UNHCR believes that if the capacity at Moria Camp exceeds the 6500 currently allocated, more ferry tickets will become available and ferry traffic for refugees will be increased, with ticket sales acting as a “spigot” to allow any overflow in refugee populations to Athens.

Meanwhile there are negotiations and proposals between the EU and Turkey to have refugees sent back to Turkey. An agreement on this is pending in the next few days.

There are multiple social problems affecting the refugees that have now become apparent. First of all, the problem of separated families. In many cases, the father of a household left several months ago, arrived in Northern Europe, became somewhat settled, and then called back home to his host country and invited the rest of his family to come. So the wife, children and sometimes the elders set off and after a long ordeal, make it to Turkey or Greece, only to be stranded halfway between their relatives back home and their husband-breadwinner in Northern Europe. We have heard a few tragic stories of family abandonment by the father in Germany in some of these cases.DSCN1583

Then there is the fact that 40% of the current arrivals are children. For many children, there is an absence of a safety net. The ones who are traveling with both parents, or one parent, are relatively lucky. There are also children who are traveling only with extended relatives: aunts, uncles, etc. Then there are children traveling with no direct relatives at all: perhaps only with neighbors or people who are from their same village. Theses situations are being dubbed, “extended-extended families.”

There are teams of pediatricians and social workers in Greece trying to figure out how to handle children who seem to be on their own. In some cases, children are sent to children’s boarding houses in Athens. But these are “open” facilities; that is, these children are free to leave if they choose to do so. This then puts them at risk for predators: human trafficking, sexual enslavement, etc. Children’s rights organizations and Europol are now getting involved in efforts to handle this.