Dr Sarah Wookey / Retired GP & Humanitarian Medic / UK
At the beginning of this year, Dr Sarah Wookey worked in a Syrian American Medical Society (SAMS) refugee camp on the island of Leros. Sarah was a GP in Oxfordshire for 30 years, following up her retirement by gaining the diploma in tropical medicine, working with MSF for 9 months in Africa, and then spending this 2 month spell as a medical volunteer in Greece. The camp in which she worked was set up in a former psychiatric hospital, run by the Greek authorities. Most of the occupants were from Syria, Iraq and Afghanistan, with multiple other countries represented. All were waiting while their applications for asylum were processed, an operation which could take months. The Greek government had asked for help from NGOs to provide services to the occupants of the camps; they were keen to avoid uncoordinated, fragmented interventions. Anyone interested in doing voluntary work in the camps was strongly recommended to do so under the auspices of a recognised organisation who could then take responsibility for ensuring appropriate standards. In this brief essay, Sarah reflects on a consultation with one of her patients: an example that showcases quite how desperately hard it is to look after the physical and mental health of those who have undergone trauma and geographical displacement.
Yasmin
As I entered the camp I was met with shrieks of merriment. Children tore around the open courtyard giggling and chasing one another. I recognised Yasmin’s* children amongst the crowd.
The courtyard is a slab of concrete surrounded by a 9 foot high fence topped with razor wire. Police are on duty at the gate. The refugees’ dwellings are metal containers. There are no decorations and from a distance the place looks like a container port. On reflection I realise that this is exactly what it is. A people container port.
The facilities here are astonishingly good – by comparison. I saw the makeshift camps where, for a few terrible months in 2015 and 2016, tens of thousands of refugee families were abruptly halted in their flight from home by the decision to close the border leading from northern Greece into the rest of southeastern Europe. They consisted of families living in muddy fields with no facilities or security. An enterprising garage owner offered hot showers – for €15. The lucky ones had a tent or, perhaps, polythene sheeting. Here, in the quaint little island of Leros in the south east of the Aegean, the camp is basic but well ordered. Yasmin and her children are clean, dry, warm, adequately fed and, for the moment, safe. What will happen to her after her asylum application has been processed is unknown.
Later that day Yasmin came to see me in the camp clinic. One of the children had a trivial laceration on his head after tripping and hitting his head on a metal post. He was fine and he and his sisters, bright eyed and inquisitive, behaved the way normal children do in a consultation. That is, after shyly checking that I didn’t look cross, they listened to each others’ chests and tummies with my stethoscope and took my (happily, indestructible) otoscope apart. What was not normal, however, was the way in which they appeared unaffected by their mother’s behaviour. Staring blankly into space, with tears pouring down her cheeks, and twisting her veil over and over in her fingers, she explained that she could not sleep and had pains all over her body.
In my usual practice as a family doctor in Oxfordshire in the UK this would be a red flag the size of Texas. I would tell our receptionist that I was going to be running late and would try to probe further using standard techniques:
“Tell me more”
“You look unhappy”
“What happened?”
Often the most powerful tool of all is saying nothing and just waiting. I’d also be able to see her repeatedly over a period of time and build up a relationship with her.
Here in Leros I’m only here for a few weeks. I’m from a different culture; everything she says has to be painstakingly translated from Arabic to Greek and then from Greek to English, followed by the same in reverse for my replies. Goodness knows what nuances get lost in this process. Our interpreters are very professional, but as there are very few of them and they’re often needed elsewhere in the camp, there are time pressures.
Nearly every woman I see can’t sleep and hurts all over.
There is a psychologist in the camp but she is overwhelmed by the demands and is subject to the same problems with language and culture.
I was very reluctant to give Yasmin sleeping tablets as they’re addictive and can make depression worse. I was also concerned that if I gave her some, everyone else in the camp with the same symptoms would ask for some too. It’s very easy unwittingly to create the basis for a black market if there are known to be sleeping tablets in circulation.
I tried to explain to Yasmin that the symptoms she’s describing are what one might expect following very stressful experiences. She gave me a wry half-smile. We both knew it wasn’t enough.
Links
The Syrian American Medical Society is a non-profit, non-political organisation that aims to offer medical support during humanitarian crises for the people of Syria and the United States.
*Name has been changed for anonymity.
