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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.

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