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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.

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