Tuesday, November 28, 2017

Greece - Week 2






















I haven’t really had time to update because I have been kinda thrust into the role of co-ordinator in the team here. The two members of the team who had been here the longest left last week leaving me as the longest running member even if only by a few days. The team is now only myself, a nurse and a doctor (all female and max age 27) but to be honest that is more than enough to manage the situation here. Positively speaking, the number of homeless refugees here in Thessaloniki is decreasing - or at least those requiring our services- but there still tends to be some new faces everyday. This also means NGOs are leaving - we had to alter our main clinic time as we coordinated it with breakfast distribution but the charity that provided breakfast for homeless refugees has left due to lack of funding. Our small team is working well as it’s easy to communicate for discussing clinics and patient plans - especially over our homemade alfresco roof lunches.


Only myself and those not in khaki tabards are left!


When I applied to volunteer here I didn’t really consider that the official coordinators might not be here on the ground with us and the volunteers themselves would have to manage the daily running of things. Although, I was initially terrified at this prospect it has actually been quite refreshing. Working for a well established NGO would not give us the same autonomy that working for this grassroots NGO. We get to manage patients, schedule, medication, workload and attend meetings with other NGO representatives that normally a member of management would attend.


After my first week I didn’t feel like I nearly knew the ropes enough to be left somewhat in charge and everything was quite vague before my arrival - for example I didn’t know the address of where I was staying until I’d landed in Thessaloniki. So one of my first jobs I gave myself was to make things a bit clearer. I updated the guidelines and made instruction sheets for how to make referrals to various agencies. My real baby has been making a digital inventory for the ambulance - which was in a a bit of disarray when I arrived.


Glasgow or Greece?











The majority of the patients we see are still very much minor injuries. A lot of the work is also psychosocial and we tend to stay behind after clinic for an hour or so talking to refugees and exchanging cultural videos of Afghani weddings and Riverdance.  The most relevant patient for me medically was actually another NGO’s volunteers who was badly burnt by hot oil - finally my piles of burns dressings came in useful! I have learnt a lot about managing medications that I often only see at patients houses as well as wound management -all of which should help in my future career progression! I’ve also really enjoyed the pace of not being surrounded by so many stressful situations and only working a few hours rather than 12! The most stressful situations actually involves clothes distribution. There is a whole field of shoe politics that I never knew existed. We are a medical service and are only meant to distribute clothes to those who are receiving scabies treatment or have blisters from ill fitted shoes. However, many people ask us for clothes and with the drop in temperature it is tempting to hand out jackets and appropriate shoes. The problem is we don’t have enough for everybody and we had one day where there was nearly a brawl outside the ambulance because someone was given clothes and another wasn’t. As much as I hate seeing people going without I also hate it when things are unfair and because we can’t give everybody clothes we have had to become stricter and now definitively only give clothes to those who have a medical condition that requires new clothes. It’s difficult especially considering even I am going to bed in a fleece, two pairs of socks, a hot water bottle and two blankets. So if you have some old clothes (especially mens shoes which seem to be in very high demand) or want to do an alternative Christmas gift then think about sending something this way(we get our clothing supplies from Help Refugees). Saying that, we do also have some patients who beg us for new clothes and then we give them some and they throw it back at us and walk away because they don’t like the style.

"Banana dog" - the surprisingly tame street dog that loves bananas. (If I had my own house I'd have taken him home but a group of refugees have taken him under their wing).


We also do clinics in community centres in different towns and although most of our patients in Thessaloniki are Pakistani and Afghani these patients are predominantly Syrian. It’s also our chance to see paediatric and female patients of whom we rarely encounter in the homeless clinics. A perk of  being the paramedic is that I tend to get the “triage” role at clinics which really just translates as playing with kids and chatting to patients - which I am perfectly happy with. Once again, the talent that some of the kids have astounds me, their level of English is phenomenal - we have kids of 14, 17 and even 8 translating for us. As amazing as it is for these kids to be translating we have to be careful as the subjects are often beyond their years - despite what they have also been through. Many of our patients have fled bad situations but also within their time in Greece. We have had several safeguarding cases with aspects of threats of physical harm as well as honour related violence which have caused us to consider the correct means of referral in an already foreign and complex system. Overall we have been quite impressed at the standard of the Greek health system. Helping us navigate our way through the health system is a wonderful Palestinan doctor called Dr Rahim who came to Greece from Palestine to study medicine back on the 70s/80s. He is often available at the drop of a hat to translate, provide advice and even see patients in his clinic. He is a very kind and generous man and has had us all at his house for homemade falafels on more than one occasion!


Sundays are generally reserved as our day off and last week one of my colleagues organised a football tournament with volunteers and refugees. It was a fantastic idea and went down an absolute storm with eight 5-a-side teams. One of the refugees of the mansion offered to make food for the event and we offered to help so went along beforehand. This was in the mansion which is an abandoned building so the cooker was simply two open fires. Two enormous steel pots were transformed into vats of delicious smelling spicy rice and aloo gobi almost within the blink of an eye. I’m hoping that I will manage to cook for them in return as it is not the first time they have hosted us at their “mansion”and it’s amazing to see such warmth even in such a cold, derelict building.



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.