Friday, November 17, 2017

Greece - Week One

"So how would you describe your time so far?"


Like a long game of charades.


One of the most important skills here is the ability to translate. As we are told in the medical world, with a good history you have a diagnosis but when you are unable to communicate with the patients it makes this very difficult. My rudimentary Urdu is getting me surprisingly far (and advancing rapidly) and the smiles on their faces when I say “App khessay hain?” (How are you?”) brightens both my day and theirs. However, without the help of refugees who can speak multiple languages we'd be lost. Frustratingly for us we are unable to provide them with monetary compensation for their time due to their legal status in the country but it seems that they genuinely want to help and be useful. Additionally, technology has made our lives either both with obvious outlets with Google Translate but also numerous WhatsApp groups filled with ad-hoc translators available 24/7. One day we had an elderly man desperately pointing at his finger and jabbing it but none of us could figure it out and our translator didn't know the English for what he wanted. It was only after looking at his finger and asking about splinters and mosquito bites that we eventually concluded that he wanted blood sugar lancelets as he was diabetic and had run out. Then when he finally came to clinic it was actually the measure strips he wanted. Additionally the questions I have to ask have to include a different level of empathy; I quickly learnt that asking “How did this happen?” is often followed by “bomb blast.” My first patient on the first day reacted in this way but also told me how they’d lost their family too. Another Syrian man was barely able to get onto our ambulance (we aren’t blessed with a ramp/lift) because a bomb blast near his home 6 years ago has left him in too much pain to walk without medication and physical therapy - or so that’s what we gathered from our translation from Turkish to Farsi then to English.

Most of my pictures are of food as I can't really post photos of refugees and where they live due to their status in the country and many are arrested due to lack of papers. 





Therefore it’s not only difficult to ascertain what has actually happened to the patients it’s also very hard to find the correct care. Other than our wonderful doctors in the ambulance and our stock we are limited. We have one clinic from Medicins de Monde we can refer patients too but like our man with back pain, the physiotherapy he requires will be hard to obtain due to his status as a refugee. Many clinics and hospitals don’t take patients until they have a certain level of registration in Greece - which often requires a proof of address which many of our patient’s don’t have. Therefore our clinic can fill this gap but we are still limited in what we can offer - long term mental and physical therapy is somewhat outwith our control. However we do provide a holistic approach to care where we provide them with some social interaction and food- I think my homemade barfi(Asian sweet) went down well!


The style of practice has also needed a lot of adaption. I’m used to working in an emergency setting and this is much more of an urgent care setting. The majority of my work has been urgent care and specifically in wound management. These are relatively small issues but due to the fact most of our patients are homeless they can grow to be debilitating unless cleaned and dressed regularly. There has been the odd chest pain case but this is often related to indigestion triggered by the recent stress -however we don’t have an ECG to confirm this. The clinics we run are generally based in a car park next to an abandoned building. Absolutely nothing glamorous about it, in fact the ground is strewn with condoms as it’s at the epicentre of Thessaloniki’s red light district. Another site is ironically named “The mansion” and is several derelict warehouses which is home to several Pakistani men as well as homeless Greek families. The majority of refugees left are male as women and children are more likely to obtain housing. The patients we see are mainly homeless who sleep in shelters or abandoned buildings, however one morning we arrived to find that 50 men had been arrested following an evening meal distribution because they were sleeping in a building that was privately owned.



Other than my Urdu, my driving skills have been profoundly useful. I am the first person in a long time to be so equipped to drive a Mercedes Sprinter Ambulance with the gear traction of the finest Iveco in the fleet. Despite the fact it is both a left hand drive and manual ambulance, the amount of pot holes in the road here make me feel somewhat like I’m driving back in Oxford. Despite the fact that driving is one my most anxiety inducing parts of my job back in the UK I feel surprisingly relaxed here - something about having laxity on driving rules means I don’t feel like I am breaking them. Additionally the ambulance already has numerous scratches so they aren’t as concerned if I add to them! However, on day 5 we got in the ambulance to start our clinic and the thing wouldn’t start. There had been some beeping over the last few days that I’d put down to a low battery despite keeping it running (work has taught me something!), it got too low and the ignition broke as well. As we all sat in the rain with the hood open, crossed arms and puzzled looks on our faces we were blessed to be greeted by Jonny, our local Greek hero mechanic who happened to be driving past. He tried to jump start the truck and failing that called his friend over with his “tractor” (see below) to tow us to his garage and then he drove us to clinic. A perfect example of Greece hospitality. We had to run clinic that day out of the back of a Citreon Berlingo on one of the wettest days so far. Thankfully we should have the ambulance back tomorrow!






Greece itself has been a bit of a surprise, being relatively unprepared I was unsure what to expect. It has a flare of Portugal to it, linked by the fact they have both been affected by the financial crisis. There is a element of chaos to them with manic drivers (including myself), rabid dogs, toilet pipes that are too narrow for paper, smog, shops that only sells manikins next to a specialist trolley wheel shop and old men sitting inside bars smoking cigarettes. The language is like Spanish or Portuguese initially but then Russian is lurking in there too due to Greek’s similarity to the cyrillic alphabet. A rare case for me but I’ve barely stumbled beyond my “parakahlos” and “efcharistoes”.




I’m staying in an apartment that is shared by other Docmobile volunteers but also volunteers from other charities including food distribution(Soul Food Kitchen, Food Kind) and construction teams(Get Shit Done). There are numerous nationalities and I am once again feeling the English native guilt whenever I walk in the room and they change from their native tongue to English even though native english speakers make up the minority. The apartment itself is very basic with no central heating and no mod cons but I think staying in lavish accommodation would make our conscience loom over our daytime activities. There is a fantastic local market on Wednesdays which rids the need for an alarm clock as sellers compete with each other to sell the rest of their pick and mix sardines.






Despite reports that there were no mosquitos in Greece in November, the chief of the mosquito brigade had been on the phone to his troops and my face and arms were massacred by the best mosquito response team. The weather in general has been cold and rainy but on my first day I had time and the sun was out so  I had a chance to explore the city of Thessaloniki. The city is a bit rough round the edges but the waterfront and central strip are relatively well developed. We are staying in a suburb called Diavata and the road into the city is lined by seemingly hundreds of service stations and abandoned buildings. With pain comes reward and the old town sits atop a large hill and the winding streets and sunset views from the castle are wonderful. Also watching Greek students climb along the crumbling castle wall to get a better view filled my somewhat safety conscious side with the envy of a Health and Safety inspector who is desperate for a greasy doner from Hussain’s Kebab.


Tomorrow we have a clinic in towns outside of thessaloniki which are closer to areas where Syrians have been housed so will include more women and paediatric cases. Additionally one of my colleagues has arranged a football match with teams made up of volunteers and refugees. There will be some changes in the team members and changes to patients and dynamics so I should have plenty for the next update :)

Saturday, November 11, 2017

Pre-Departure Preparations- Greece

That's me on the bus to Gatwick after a hectic few days; I worked almost solidly before I left but had to take yesterday off due being both physically exhausted and I received some news that knocked me a bit sideways. Regardless I'm still heading out on my way and in honest I couldn't be f****** off at a better time. I'm really looking forward to a change of pace and scenery even if it will be difficult and intense at times.

Many of you saw the article about my trip in the Oxford Mail and SCAS Staff matters and in all honesty I didn't really want to shout about my trip, numerous others have gone out to Greece with little song and dance (Plus I hate being in front of the camera - it is not my natural environment!). Regardless, it allowed me to reach a wider audience for donations and has resulted in two massive 100L suitcases stuffed full of medical gear. I've sent photos to my colleagues from DocMobile and they are overwhelmed by all the generosity. The bulk of the donations came from SCAS's HART team and St David's Barracks in Bicester so special thanks to them. Additionally a cheeky Facebook post to EasyJet has landed me free additional hold luggage (although I am yet to actually check in so let's see if that actually went through!). Just wish me luck for navigating my way into central Thessaloniki with two huge suitcases and a 60L rucksack!

For the first time in my life I am off to a country and haven't learnt at least a few basic phrases so I'll be using this time on the bus to try an navigate the Greek alphabet. Instead of Greek I've been spending time brushing up on my Urdu(one of my secret talents - only rudimentary levels!) as many of the patients I'll be dealing with are actually Pakistani. However we will also be dealing with some of the Greek homeless population, Syrians and potentially Bengali so I've got more phrasebooks than pairs of socks.



Sunday, July 23, 2017

Orkney's Mental Health Crisis

Orkney came out as the second best place to live in the UK and the best for rural quality of life. But for lots of people it’s the opposite. Yes it is beautiful but for many people it is like a cage. For many it’s a great place to grow up; you can run around on Hoy to your heart's content and you rarely fear crime. However, at a certain point in adolescence you can hit a wall. As a young person it can be a very difficult place to grow up in and find acceptance - we have been reminded of this both often and recently.
Over the last two years of my paramedic training I have seen several suicide victims and countless more who have made attempts. My care has to include both the patient themselves but equally the family and friends they leave behind. I have seen the devastation it leaves in it’s wake and it includes that on the mental health of individuals in the emergency services. However, it’s not my job that initially woke me up to the prevalence of suicide. At least 4 young people I know have taken their own life back in Orkney but there are no doubt more I knew more distantly. This is a figure that shocks my “South” friends and rightly so. The numbers are not only high, but the effect these tragedies have on the community is magnified because of the nature of small, rural communities. Everybody knows them and their family, even if it’s vague, and there is this sense of community grieving. However, this community spirit can work against people too.
There is has always been a stigma around being different or vulnerable in Orkney. Everybody knows your business and you tend to be known for the scandals rather than the good work you’ve done. It is the same in all small communities be it rural, religious or racial communities. The Scottish Suicide Information Database report from 2016 shows what we already know, that Orkney, the Highlands and Shetland in particular have the highest rates outside of Glasgow but most importantly these were considered “preventable”.
Of those I knew who took their own lives, more often than not it was a complete surprise. Nobody expected it. There is this reluctance to ask for help and a large part of it probably stems from a fear of being judged. Often these people have felt like they would never be accepted for example, it’s only in the last few years young people have felt like they can come out as gay and often they have to move south first. Or even just the idea of being depressed is enough to feel shameful and alcoholism often is Orcadians way of showing it. Underage drinking in Orkney is rife and everyone turns a blind eye at Barn Dances. However, this culture can be toxic to those who stay as even when you grow up there can feel like little else to do in Orkney but drink.
I personally had a good upbringing on Orkney but I was very aware of the effect it has on others. It’s still a beautiful place with plenty of good points but both experience and statistics show that there is a problem not just in Orkney, but all small communities. There needs to be a change in attitude and all too often this seems to come over time waiting generations or for the government. Sometimes something needs to be done sooner and young people have to take things into their own hands to prevent another tradgedy. Talk to be people. Break the chain and be vulnerable. Even if you’re not in Orkney please talk. Reach out for help and take time for yourself. You’ll be surprised to find that we’ve all been there.





Monday, August 29, 2016

Pokhara

You can see Pokhara miles before the "Welcome to Pokhara" signs as the mountains that surround it can almost be seen from the Indian border. Pokhara is the tourists gateway to the Himalayas and appears a lot wealthier than other parts of the country because of this. Our faces sat pressed to the windows as we knew that behind the clouds was one of the best backgrounds in the world.

However, despite the majestic backdrop the stage ,Pokhara, itself is quite unimpressive. It is very touristy with hundreds of shops selling the same genuine fake "The North Face" products and new hotels sprouting up like beanstalks. After a brief drop into our hotel we had an orientation walk to the "Lakeside" which was the main tourist stretch. Pokhara was going to be our chance to just be tourists. At the far end we were approached by a old oriental woman who asked us to come to her shop. This is was something we got asked many time before and often ignored however when we saw that her shop was merely the contents of her rucksack we stayed a bit longer. In these parts of the world it's hard to believe stories. We are often brought up to assume street sellers are trying to rip us off. Equally, in this part of the world more people live in poverty and lead lives of extraordinary survival than we are used to back home. It's hard to know what to believe and really you just have to go with your gut. This woman explained that she came from a Tibetian village over the border and sells jewellery that her father had made there and we left with several bracelets each.

The next day we woke up to complete darkness, both because it was a power cut and we were getting up at 3am to watch the sunrise over the Himalayas. A romantic idea but it was pouring with rain so we weren't too optimistic, but not enough to actually go back to bed because missing it would be worse. Our early departure was due to the fact that traffic up to the view point is normally choc-a-bloc. However, due to the rain most people seemed to have opted for bed.

After parking the truck we went on a blind scramble up to the platform which was surrounded by small tea houses. Most of the tea houses had clicked on to the idea of offering a fee for tourists to go on their roof to get that extra 2m elevation. Just as we were thinking we were going to get to enjoy the free platform to ourselves we heard a bus load of other optimists descend upon us.

When the sun did rise we caught a glimpse of the Himalayas enveloped in clouds which actually made it more special than the perfect shot the brochures advertise. A group of women from Gujarat starting chanting a prayer in an attempt for the sun to come out. Alas, being the first to arrive we were okay with being the first to give up. The plan was to hike down the mountain and for some reason I remember our guide saying it would only take 20 minutes but 2.5 hours later we were at the bottom. Thanks to the cloud cover I didn't realise quite how high we were from the ground and I suddenly regretted by idea to skip breakfast.

The sun didn't appear until later that afternoon when we were due to go paragliding as if there is one place that you should go paragliding - it's the Himalayas. The mini-bus ride up the mountain was an adrenaline ride in itself as we got an idea of what real Nepalese driving was like when tourist comfort isn't priority. Minutes after getting off the bus we were already in the air where the briefing was used literally as we were told "When I say walk, walk. When I say run, run." As it was a tandem ride it really was that easy. The thought of running off a cliff is against all natural instinct you were already in the air before the edge so you couldn't really stop even if you wanted to. There wasn't a big adrenaline rush which I was expecting but in fact it was actually quite pleasant and relaxing - until we decided to do somersaults before landing.

Our last evening was spent drinking on a bar roof enjoying the last sunset in Pokhara before our bellies got talkative. There is a phenomenon when travelling in an unfamiliar country when you start to crave those familiar carbohydrates and bland sauces. So continuing our touristy binge we had dinner at a popular westernised restaurant and were happy to have some pizza and our first 'Everest' beer to wash it down.

Friday, July 22, 2016

Chitwan National Park

Everyone thinks of Nepalese countryside as being dominated by the Himalayas but there is a surprisingly large portion of the country that is covered in wetlands - or should I say sweatlands. Chitwan National Park is one of these wetlands which is a bit like the Asian Serengeti as it's famed for it's elephants, rhinos and even tigers.


The drive from Lumbini to Chitwan took us over a small mountain range where we had a scenic toilet stop at the top and a bite to eat at a roadside shack that seemed to specialise in whisky and whole cooked chickens. Back on flat ground the houses were surprisingly grand and painted in bright colours and surrounded by verandas. The explanation for this was clear as there was a lot of advertisements for companies that supply locals with visas and work abroad. While in India there was a great focus on advertising for education and work within India, it seems in Nepal more young people travel abroad for work and send money home. This is reflected in not only the housing but the more relaxed attitude around westerners.


We arrived at our hotel for the next few days called Sapna Lodge which means "Dream Lodge" which was quite apt. Other than the fact we were sweating from places we'd forgotten existed, the area was beautiful. There were several wooden buildings that looked somewhere between the grand houses we'd driven past and a thatched mud hut. In the distance you could see the Himalayas peak over the clouds and the piece de resistance had to be the fact there was a mum and baby elephant at the bottom of the garden. 


We were given an hour to explore that was easily taken up by rekindling my inner Eliza Thornberry with the tame elephants. The way the baby reacted to attention and it's playful nature and the mother's watchful gaze gave me no doubt these creatures have a bigger emotional capacity than we give them credit for. Chitwan is home to the Thuru people who are indigenous to the foothills of the Himalayas and we went on a visit to one of their villages. On appearance it wasn't that different to other rural villages in the country and considering they are known as people of the forest there was a lack of trees around this one.  We were shown numerous local dances and told about their way of life but it seemed that without visits from tourists these unique aspects of their life could quickly be lost. We ended the day with a lovely dinner at the lodge watching our elephants bathing in the river with a sole keeper rubbing their belly before chatting away under the majestic stage of mountains and stars. 

The next day we woke up before the sun as we were heading on an early morning safari to see what we could spot. We didn't have the best sleep as we were woken up not from the noise of the fan turning on but from drowning in sweat when the fan turned off. We drove out on a jungle beach buggy and headed along the highways "into the jungle" - although with our timescale we didn't have time to delve deep into the jungle! As we were cruising along the Nepalese roads I felt something fly out of my walking trousers and to my horror I saw my phone getting all some close contact with a lorries wheel. After stopping our buggy myself and our guide ran back to the incident site and were surprised to find only the screen was smashed. Well, and it didn't turn on. Regardless, I was impressed it didn't smash to pieces. 

After the excitement of my phone's death the safari didn't conjure up any extremely rare creatures and only a monkey or crocodile or two. I always find jeep safaris a lot less exciting and rewarding than walking safaris. The animals get pretty switched on to running away from the loud regular grumble of the safari trails, the suspense of a walking safari is miles better as anything could be around the corner. We returned to the hotel for breakfast before hopefully getting the chance to wash our hotel's elephants. 


We were disappointed to find out that our elephants were otherwise engaged (the life of a Chitwan elephant is comparable to a London stockbroker). Instead we drove to the nearest village which was the notoriously touristy village in Chitwan and turned into a busy river filled with tourists and two elephants. These elephants weren't looking as happy as ours did yesterday getting his belly rubbed. It felt like a bit of a production line as life jackets were passed from tourist to tourist before an elephant was commanded to lie down in the water by a man with a stick balancing on it's back while another two tourists climbed on it's back. The stick man then "encourages" the elephant to spray tourists with water before they are quickly booted off so they could get another pair on. Although this set up was horrible, it was amazing to sit a top and feel the power of this creature and feel it's tough skin alongside the smooth and refreshing splash of water. However, I'd recommend anyone who wants to do something like this in the future does more research than I did and find a more authentic and genuine experience (which unfortunately is hard to find in these parts of the world especially on a budget).

Our next event took us back to the water as we were canoeing down the river Rapti alongside some crocodiles. The canoes were hollowed out of a single tree and managed to fit six of us even though we did end up a little too close to the water considering the purpose of the trip was to spot crocodiles. Considering our past week the ride was ridiculously peaceful. It was quiet enough to hear the clap of a passing butterflies wings yet in the distance we could hear the roar of thunder. 

Back on dry land we went on a safari on foot and it reminded me how experience should always be regarded miles above qualifications. I have a fancy bit of paper and letters after my name that mean I should know a good bit about the natural world around me but compared to our guide who had left school at 16 to train with guides in the jungle; I knew nothing. We were on the trail of a rhino but only got as far as it's toilet - as rhinos use the same toilet sites for around a fortnight before moving on we could have spotted one had we waited long enough but not this time. It did get me imagining the situation in reverse and rhinos sitting around public toilets waiting to spot us. 

That evening we were treated to a Thuru culture extravaganza beginning with a traditional meal. The starter was an ambiguous soup that tasted like something you don't normally eat, a bit like leather. The rest of the meal was much more palatable and the waiters crowded around asking us about life back home. That evening we were heading to watch some traditional dances and so I thought now was a perfect opportunity to wear my new sari. Big mistake. I was suddenly every male member of staff's favourite guest. We were all expecting to be sitting in a circle watching eccentric dances by the light of a campfire, however we arrived at a purpose built hall that rapidly filled up with Japanese tourists. The show was quite impressive, if bizarre, with lovely costume and rhythmic dancing to make me feel so uncoordinated, especially when they invite you up to join. One of the highlights was when someone came on dressed as a peacock, danced and then handed out individual roses.

We left Chitwan the following morning and paid our bills before bundling back into our air-conned bus and enjoying the sensation of feeling every bead of sweat evapourate. Next stop: The Himalayas.