NASA Was Right; Re-entry is Hard

We left early this morning (yesterday?) for home, and I was so excited to see my family. It was going to be a long trip, with three separate flights, but I tried only to focus on the outcome - their smiling faces and hugs. I didn't have much time to focus on anything else. We got to the airport, through security, to the gate, and on the plane without a hitch. Take off was smooth, and then...I started to cry.

I don't know what tipped me over the edge, but it started with thinking of my husband, and my kids and how great it would be to see them again. That led me to think about one of the women I cared for at the camp. She had 6 kids, and only 4 were here with her. Her husband was "missing" (presumed to have died escaping from Syria but she hasn't lost hope). The other two had made it through the border at Idomeni, Greece before the Balkan route was shut down. They were only several hours ahead of her, as Mom was slow with the younger kids. Her son was 20. Her daughter? 12. I felt incredibly guilty crying that I had missed my kids for the last 12 days, but I knew when and where I would see them again. I would see them grow, marry, procreate, and mature without having to apply for family reunification. I don't know if my patient would. I would see my husband again, and would grow old with him; she wouldn't have that luxury. The tears fell silently.

This happened multiple times, completely unprovoked, during the day. The sadness of the conditions in which the refugees lived was painful, yet they did the best they could to make it feel like a home. Should I have done something more? Should I have shooed away the rats I saw, the rats no one seemed to notice but were in plain sight? Should I have advocated for toilet seats in the porta potties since it was so hard to potty train your child on them, or take care of female business without being able sit? The rampant constipation I saw - who can have a bowel movement standing up? More tears.

Should I have bought cough syrup secretly for the hundreds of people who have respiratory symptoms due to the cold temperatures and sick contacts? In Syria pharmacists may dispense almost any medication - for illnesses from the simplest to the most complex, Syrians have historically trusted their druggist to give them something for any complaint. We volunteers are all trained differently, treating with evidence rather than empathy; should we have found more common ground, if only to establish trust while the refugees were adapting to a new way of life? Did I explain my reasoning for denying antibiotics well enough, or do they think I want them to suffer because they are Muslim? "No," I told myself, "if nothing else, you did a good job of this. You took the time to show them you care." But self doubt is a powerful weapon, and again I wept.

Coming back to my other life - re-entry as some call it - has been hard. Although I landed only two-and-a-half hours ago, I still can't shut off my brain and I know it will take some time to stop feeling like I've abandoned these lovely people. I am blessed beyond belief to have a supportive, amazing family to come home to, all in one place, and safe. I know it's only a matter of time before I go back, so now my tears have lessened some. 

I highly recommend the documentary, Salam Neighbor, to anyone who has found these posts from my medical mission trip interesting. Although the camp discussed is in Jordan and is much larger, the people and stories within have so many similarities it is uncanny. It is available on Netflix and is 1 hour, 15 minutes long. My husband has used it for his sociology classes and my kids have watched and enjoyed it. You won't be disappointed and you will learn so much about the beauty of the Syrian people and the importance of maintaining their dignity during such turmoil.

Salam alaikum (peace be upon you in Arabic).

Thumbnail for the movie, Salam Neighbor. It's also available for purchase in the iTunes Store

Me on a cold day figuring out how the Greek referral system (doesn't) works for refugees

Remembering the gift of sweet, Arabic tea

 

Goodbyes Are Never Easy

I spent my last day at the same camp today. I had mixed emotions driving there, since I was happy to be returning home to see my family but sad to leave my Syrian friends behind. They have to stay in these extremely tough conditions, but I get to fly away to comfort, warmth, and acceptance.

I was happy the cloudy day forecasted instead turned warm and bright; days like this bring out the best in the camp's residents. I was also happy to share my day with a pediatrician and an Ob/Gyn. This meant the sick 1-month-olds had an expert to evaluate them, and the possible endometritis patients had a physician with an ultrasound machine and years of experience to make sure they were OK. I felt we were at the top of our game, practicing medicine almost like at home. Although I am sure I had done a good job treating the children when they came in sick, I knew I wasn't trained the same way pediatricians were and it had made me feel guilty.

One of the patients who had been moved to housing last week stopped in to the camp today, and I was surprised. "Why are you here?" I asked. "Didn't you get moved to an apartment?" She looked beautiful. Her curly hair was clean and styled, her makeup was perfect, and her clothes were fashionable. She smelled better too! She acknowledged she had moved out, but her 4-year-old son was very depressed and wanted to move back. All his friends were at camp and nobody spoke his language "outside." He did not remember a life other than this. She brought him back to play with his friends, and she felt guilty being here, like she was rubbing her friends' faces in it. She gave me a hug and said it would be OK soon. My heart ached for her. 

Not only were the residents very active today, but I was happy to see many other NGOs at the camp.  A Greek Department of Education representative was there making sure children were vaccinated so they could soon start school. Joy! The UNHRC was also there for interviews, but what really made me happy was CLOTHES!!!!! AND SHOES!!!!! All day an NGO was present near the military offices with shiny new clothes and shoes for the refugees - people - to take. I didn't see coats but I was told they were there. Seeing warm garments for my friends made me almost as happy as seeing them head off on a bus to semi-permanent housing; now we just need heaters for the warehouse so my friends won't die of the cold.

I was hoping to see my special friend and a few others before I left - I knew some of them were aware it was my last day. As physicians we are not supposed to go into the warehouse and tents unless we were with a translator on official doctor business, so I couldn't go seek them out. While I was quite busy in the afternoon seeing lots of muscle spasms and headaches and dental problems,  I did notice that my special friend stayed to the periphery, shoulders down. She seemed sad, and wouldn't look me in the eye. Her mom came to say goodbye, but she would not; she was too sad I would not be there to see her everyday and make her feel special. My heart ached a little more. 

Lastly, my friend who had said goodbye to her neighbor yesterday stopped to give me lots of hugs. She saw my Miraculous Medal of Mary necklace (thank you, Dorothy), my purple beaded cross bracelet (thank you, Carrie) and my worry ring (thank you, Erin). She said she would miss me and tried to give me her ring, which appeared to be her only piece of jewelry. I was so touched and we both teared up.  I told her she would always be in my heart, and she hugged me again and again, saying thank you for coming all this way to take care of us, to see us and to know our life is real. After looking at my jewelry she seemed happy I  believed in God, and told me when she had lived in Lebanon for 7 years she had lived in peace with her Christian, Muslim and Jewish neighbors. She knew we all believed in the same God, and told me she would pray for me. I couldn't believe that this woman, a refugee awaiting asylum, was going to pray for me. It's the things like this that have touched me so much, these unselfish, loving people who have lost so much but give so freely.

I told her I would pray for her too, and that I knew our God would keep her safe as he had on her long journey thus far. Then we embraced one last time, my heart aching some more, and I said goodbye.

For now.

Our SAMS team on my last day, 22-Nov-2016

 

My friend and her ring. Such a generous soul

The SAMS logo on the vest I wore on my medical mission. I was proud to be an ambassador for this amazing NGO

It Doesn't Get Any Easier

Today was my 9th day working in a Syrian refugee camp near Thessaloniki, Greece. I have 1 day left; we leave Wednesday morning for home. It has been an emotional roller coaster for me, meeting amazing refugees for whom I can only show love in many cases. They need it; it has been a long and painful journey, and it's not over yet.

A bunch of new volunteers arrived this weekend and started yesterday, with today their first full day. I am amazed at all I've learned over the last 9 days that I can share with them. Today I worked with Fionn (short for Fionnghaile*; she's a pediatrician/ER doc from Ireland) and David (pediatrician from Indiana-soon-to-be-Boston). Holly was our team leader, and she's a nurse from England. Our female interpreter was Shayma, a chemist from NJ, and our translators are from Syria, awaiting their final legal papers. "Sul" was a professional soccer player, and "Mo" was an engineer. We were a smart, international team, ready for anything. To me our diversity was so important to show the refugees how the world is working together to help them.

Many people have asked me what the refugees get to eat. Well, I can only answer for my camp, but it boils down to take out. Yes, take out. Because there's basically no electricity, and the tents are inside so there cannot be any fires, the people here cannot cook their own food to their own tastes...yet another liberty taken away. Instead, the Greek government has a catering company visit the camp twice a day (lunch and dinner; dinner includes breakfast for the next day) and the UNHCR (United Nations Refugee Agency) documentation dictates how much they get (based on family size). The camp residents came to the truck and pick up their bags, then go to their tents to eat. An inhabitant has told me a new company has started in the last few days, and meals consist of a selection which could include rice, pasta, chicken, chick peas, and lentils; the morning meal is croissants and juice. The military office keeps a stock of flat bread which appears to be given out fairly freely, and water appears to be plentiful. But spices, fresh fruits and vegetables, and sweets are in short supply. Several times per week an "older" couple parks a truck outside the camp to sell fresh produce, and a decent number of inhabitants seem to buy a few things to add to their meals. It still seems woefully limited, and although I have no idea how much food is supplied in each meal, there are no grossly overweight people in the camp and the children are pretty small.

We weren't too busy in the clinic today - we are using a new program to help take better care of patients and it has been a bit of a struggle - so the slow pace was needed. It gave me more time to really talk to my patients, many of whom I've seen before. I saw one woman to check on her acute paronychia and to evaluate her stomach pain. She was feeling better, and we added what we could to her regimen. She discovered I would be leaving after tomorrow and gave me a giant hug. "What time will you go?" she asked in Arabic. "I need to come say goodbye." She was thankful I, with the other doctors on the team, had helped make her feel better and had treated her with respect. So many people consider refugees invisible, when all they want is to get on with their lives. She left with a smile on both our faces. I was so touched when she returned a half-hour later with a tray of tea for the team, a bowl of sugar on the side to make it as sweet as we liked. Again, like yesterday, she was so proud to see us drink her gift with great enjoyment - these chilly mornings in a tin-can container are nowhere near as cold as in the warehouse, but cold nonetheless. Hot tea is a great gift, especially when it comes from the heart.

While triaging patients later in the afternoon today, I noticed one of our translators had disappeared. I wandered around for a bit and he was heading back towards the clinic when I saw him. "I had to translate for the UN" he said, pointing to a large bus. The bus was parked outside the military office, and about 10-12 people were on it, ready to go to a hotel or housing, one step closer in the asylum process to a new life. I walked a bit closer, and saw the woman who had passed out last week. We caught eyes, and she started to gently cry. I waved to her and could not suppress a sob. She looked so happy, relieved already, to be out of the cold and on her way to some amount of freedom. The bus drove across the parking lot to make a U-turn and on the other side was one of my young women patients, one who had a chronic headache from the stress and anxiety. She was so beautiful, even though she told me she felt ugly and rejected. Her children were always clean and well-behaved...and they were all on the bus. All of them. On a bus to warmth and some independence. She saw me waving at the bus as it departed and stood up from her seat, crying, and blew me a kiss. "Thank you," she mouthed, "thank you." My heart grew some more.

I turned around to go back to the clinic and another frequent patient, the one I had called "old" in my head who was only several years older than me, was behind me, sobbing. She fell into my arms. "Why not me?" She was devastated; her best friend, her long-time tent neighbor, was on that bus. And she wasn't. I had no words, consoling her only with my touch. Shayma, our NJ translator, tried to console her too, but really, what can you say? What? It just really sucked, and there was nothing we could do about it. 

Today's tea delivery

Me and Fionn in the clinic container today

Child's drawing, borrowed from www.sams-USA.net/2016/08/23-days-1-2-of-SAMS-global-response-by-Mark-boothroyd/

*Fionnghaile is pronounced "Finn-oo-lah;" Coolest name ever.

Day of the Child

November 20th is Universal Children's Day and I didn't even know it until the day was done here. I randomly saw a hashtag on Facebook and decided to look it up. It was established in 1954 by the UN, with additions in 1959 and 1989. Its initial sole purpose was to "promote international togetherness among children worldwide, improving child welfare." Since then, a "declaration" (1959) and a "convention" (1989) have advocated for children everywhere. Here's some important points I discovered:

...in particular in the spirit of peace, dignity, tolerance, freedom, equality and solidarity

And the European Commission signed the following in effect TODAY:

Education?

These documents shocked and saddened me as I prepared for this post. Dignity? Really? Is it dignified to have children live in tents surrounded by 600-1200 other people who have suffered or witnessed horrific atrocities? To watch your children fight for food, or be so frightened they won't even eat? How about bathing your children with cold water when it's cold outside? And if you decide not to bathe your child for those reasons, your tent is located in a cold, uninsulated warehouse with no heat. Is that dignified?

Currently 25% of refugees are children. I easily see that in our camps here in Greece. It breaks my heart to see them with the most minimum of basic necessities to survive. I see many of them, when these chilly days get warmer as the sun rises, running and playing like kids do. I don't see temper tantrums. I don't see crybabies. I also don't see children in school. Every day moms or dads bring their kids to have us make sure they don't have lice or scabies, asking for treatment to "keep it away." I told one mom today that treating her kids with lice shampoo now, when they don't have lice, doesn't prevent them from getting it. Her shoulders sagged and she started to cry, "I just don't want them to be filled with bugs." This, on Universal Children's Day.

The European Union signed a Joint Statement today which commented on "an explicit commitment to ensure all children are receiving education within a few months of arrival." What kind of education do they mean? How committed are they? There are 3 new brightly colored containers in my camp, in a recently cleared area which has been covered with a nice layer of pea gravel. There's a fence around it and compared to the rest of the camp, it's quite lovely (as my British and Australian co-volunteers would say). It's the "school." I say "school" because I've never seen a kid in any of the three "classrooms." I've seen some random children playing in the gravel yard, but over the last 8 days there's never been anyone resembling a teacher in that area. I learned that although classes are offered, the kids just choose not to attend. However, here's the catch: the only classes currently offered consist of 30 minutes a day of Greek and English. That's it. 150 children in this camp, and 30 minutes of instruction in how to speak 2 new languages is the only "education" offered. No wonder kids fight over bananas. Not only have they been traumatized by the life they knew in Syria and the journey out, but now by a lack of dignity, tolerance, and absolute BOREDOM. How on Earth can we celebrate Universal Children's Day when these refugee children are virtually invisible?!?!?

In spite of the sadness and frustration I feel at what I've described above, some children today showed me that even when every card in every deck seems to be stacked against them, they can still shine. My "special friend" I've talked about before came to greet us quite early today. As medical volunteers we are pretty much forbidden to give gifts to our patients, for fear there will be perceived favoritism and then persecution by others in the camp. On my day off yesterday, I found a way to get the picture she had requested of the 2 of us together printed. I signed her copy, and she signed mine; now we have the same picture to remember each other by forever. She was very touched and hugged me as tightly as one can hug. She shuffled off, staring at the photo. It was quite moving. Within 15 minutes, my special friend and her disabled sister delivered the clinical team cups of hot tea, served on a trash can lid turned upside down, like a serving tray, lined with a paper towel. You can tell extreme care was taken for both presentation and quality. It was the most delicious tea I have ever tasted, and my special friend was lifted as high as a kite to see us drink the tea she and her family had prepared for us. It was all they had, and we drank from their cups as if it was the finest china. I've never seen children so proud. In this moment we celebrated the Day of the Child - let's work together so the rest of the world can, too.

Reuters picture; children in Aleppo, Syria this week, collecting firewood in the rubble to stay warm.

Time to Think

As you might expect, I've had a lot to think about. Fortunately or unfortunately, I haven't had a lot of time to think. Today was my day off so in addition to a bit of exploring, it also meant time to be a little pensive.

I took the bus into the city of Thessaloniki, the second largest city in Greece. There are about 350,000 inhabitants and apparently it's a more bustling place in the summer due to its proximity to the coast. My goal for the day was to decompress a little, learn a bit about the region, and go to the Museum of Photography to see the current exhibit' "Another Life: Human Flows/Unknown Odysseys. It's an exhibit about the refugee crisis; how fitting. I was hoping it would help me understand the animosity of the Greek people against the refugees. Something just hasn't fit together logically in my experience so far and I was looking for answers instead of questions.

Thessaloniki is a pretty town, but outside the center the crumbling infrastructure is pretty apparent. There are plenty of shops, shoe stores, bars, coffee shops, restaurants and dessert stores. I visited the White Tower, now named because it has been whitewashed but historically called the Red Tower because of the blood shed at the site over the years during the Ottoman Empire. It was originally built in the 12th century, then this building replaced the Byzantine fortification in the 15th century. I saw something interesting in one of the exhibits:

Top left:the White Tower; top right: the title of the exhibit; bottom: an historical emphasis of diversity

Here's a town which has had much bloodshed due to varying empires, with an historical precedent of people relocating here for safety and solace, in a region against the current wave of refugees. Hmmmmm.

I then walked back down to the opposite end of the waterfront to the Museum of Photography. Thank goodness for Google Maps! It is definitely a bit of a challenge getting around because Greek writing uses a completely different alphabet...I can't type in a name on google maps, because I don't have those letters on my phone (Greek language is derived from the Phoenician alphabet, and it is the predecessor of the Latin and Cyrillic alphabets). I found my way in, somehow, and walked up the stairs to the exhibit space. The first thing I noticed was how quiet it was in spite of the people present. Really really quiet. Large pictures lined the walls of the large, open space and after paying I started at the beginning, pausing at each to read every picture's description.

It was sobering. 

Here you can see two fathers trying to keep their children alive after their boat sank (right) and trying to disembark in unsafe conditions (left)

Not everyone made it; dead bodies washing up on Lesvos

Next is a description of two pictures on display; through the words you can see the people:  

God bless Kostas and Sharaf

This exhibit started in May 2016 and was to end this week; due to overwhelming demand, it has been extended through mid-January 2017. As of May 2016, the number of refugees landing on Lesvos alone was 850,000.  The population of Lesvos before the crisis? 8,500. In fact, the little fishing village where many of the refugees have landed has a population of only 100 people. You can easily see how overwhelming this has been for the residents of the island (there are others too, but this is the most dramatic) as well for those trying to escape the horror.

The pictures were heart-wrenching, but learning more about the history of the crisis through Greece's eyes was fascinating. The last section was about Idomeni. Idomeni is a Greek town on the border with Macedonia where the refugees crossed to go through the Balkan route to Europe. There was no refugee camp there, but when the border was abruptly shut due to the EU's bargain with Turkey, the refugees had nowhere else to go. A makeshift settlement sprang up, with attempts to make it more humane, but 13,000 people is a lot of people. This link shows pictures from a BBC article about Idomeni last March. Eventually the camp was razed and people were redistributed to the camps near Thessaloniki where I am volunteering. I swear I saw familiar faces in the exhibit's photos.

One of the more difficult things to explain to my patients, when they have asked me why no one is helping them, is that Greece is a very poor country. Five years of recession in the setting of government corruption has left the Greek people wary. The infrastructure is infantile, there has been no urban planning, there is no money to pay debts, there is a 24% tax, and I can go on and on. Nowhere in Greece can you put toilet paper in the toilets - used or unused, number one or number two; it's that bad. The Greek government has put many roadblocks in front of NGOs here to help the refugees, mostly to gain economically from it. Want to treat refugees with meds? Buy them in Greece. Want to get food, clothes, toys, etc for refugees? Buy them in Greece. This way the Greek government, and theoretically the Greek people, can benefit too. People all over the world want to send clothes, toys, supplies, etc but it doesn't seem like any of it can be used because it wasn't bought here; how incredibly frustrating. But think about it - Greece has a population of almost 11 million; the refugee crisis has added an instant 10 percent, at least. Who can pay for that?!?! It just doesn't seem fair that one of the poorest countries in the EU has to bear the brunt of this refugee crisis, and the rest of the EU slammed the borders shut. Both the Greek people and the Syrian people are left to suffer. 

So, I learned a lot today on my day off. I had a lot of time to think, and it's still not fair.

A Sense of Normalcy

Again the sky was blue today. I was assigned to the same camp, and I was happy to see familiar faces. When you've spent 6 days in a row at the same camp, the people become friends and it almost seems...normal. You open shop, unlock the med cabinets, get the triage spreadsheet ready, look through the referrals scheduled for the day, and take a deep breath. You temporarily lose track that you're not in your regular practice, that although your patients have a place to stay, they really can't call it home. Instead, there's a weird sense of normalcy that permeates the setting which makes me feel kind of guilty. THIS ISN'T NORMAL. 

Today my special friend came to see me. We had written her a letter, in Arabic, about our hope to have her family granted emergency asylum. She came with her mom, and sat on our examination table. I handed her the envelope, sealed shut. She took it hesitantly, and needed help opening it; she seemed very nervous. When she opened the letter she gave a slight gasp, "Momma, it's addressed to me. That's my name!" She didn't recall the last time she had received mail of her own. We told the two of them we weren't sure how long it would take, but we were hoping that with her serious medical condition and her family's safety concerns it would be enough to sway someone somewhere that she needed to be a priority. My resident, Fadwa, was with me and helped me to reassure them that no one from the camp was aware of this situation. Mom became emotional and told us she wished she could bring us something to thank us for trying to help them, even a cup of tea. We told them hugs are the best gift we could ask for, and got those without question. Then my special friend asked if she could take a picture with me - after she went to her tent and brushed her hair. I hugged her tightly and she shuffled off, returning 15 minutes later with her shoulder length, black wavy hair brushed and neatly pulled back. With her she carried 2 juice boxes. It was her gift to us for being so nice to her and giving her hope. Juice boxes. Beautiful, lovely, orange juice boxes. For us. We took pictures together and I kneeled down and gave her the juice boxes back, telling her they were our gift back to her. She needed to be strong to help her momma. She smiled and gave me another hug. As she shuffled back to her tent I couldn't help but think about this family's generosity in the setting of such fear and sadness. THIS ISN'T NORMAL.

Seeing patients in this setting has been an exciting but weary challenge. People, no matter where they are, all have the same organs and bones and nerves. We all feel the same pain. Diabetes and hypertension are the same in the US, Europe, the Middle East, and China. We all feel pretty crappy when we have a cold. But in most settings when you need cough medicine or Tylenol you go to the pharmacy and buy it yourself. When you live in a refugee camp, you come to the clinic for everything, because you have no other choice. Lips chapped? Come see me and I will scoop a bit of Vaseline into a little plastic cup for you and stick it into a Baggie. Pass out when you're washing the dishes? I will soak a gauze with alcohol to put on the lump on your forehead because we have no ice packs, hoping that the cooling effect of the latent heat of evaporation will help ease the pain while waiting for a taxi to arrive to take you to the hospital. I have learned many things here with the Syrian refugees - people - including how to do what I can with what I have. While I am proud of these skills and proud of the amazing international volunteers here doing the exact same thing, I wish we could give everyone the best of what the medical field could offer. THIS ISN'T NORMAL.

I have heard many stories, and I will hear many more before I leave next week. Stories help us understand, help us empathize. Just remember the little boy who drops in fear at the sound of a balloon, thinking it is gunfire, the next time you pop one. Remember the family who flees to their tent when a helicopter flies overhead, thinking ISIS is hunting them down again. THIS ISN'T NORMAL. Better yet, remember the little boy playing with a moth on the ground, watching its wings flap up and down slowly, like any little boy anywhere. Remember my special friend wanting to brush her hair before taking a picture, like any young woman anywhere. Remember the next time you go out in your car from your house to by your own cold medicine that you have a choice to go wherever and buy whatever you want. All my Syrian friends want is a sense of normalcy, just like you and me.

Remember that 2-year-olds in refugee camps like to take selfies, too.

 

Remember that moving day, when you live in a refugee camp, is exciting and stressful, just like it is for you

 

Remember the best teams are the most diverse ones - meet today's clinical and interpreter teams

 

I'm New at This

I was again hopeful about today. The sun was shining and although it was below freezing, a rare cold for this time of year, I felt promise in the air. We arrived at our camp and prepared for our patients. There was a trickle in the beginning so we assumed the night had been quiet for the residents at the camp. Unfortunately, that had not been the case. Their fear and cold was too great to face the new day.

Eventually the triage was busy and we heard the usual - headaches, sore throat, runny noses. With two women doctors working today, we also saw many women with "female problems;" modesty prevents Muslim women from discussing private concerns with male doctors. They were grateful for our presence.  Who would have thought both of us would be from New Jersey, never having met before we volunteered in a Syrian refugee camp almost 5,000 miles away?

Like everyday, we try to be optimistic so these beautiful people know they have not been forgotten, that somewhere in the world there are people who know they are not terrorists just because they're Muslim. But it's hard, no matter how you try. When I saw a boy who was almost 5-years-old this morning, but looked like he was barely 3, I asked Dad if he was playing normally. Dad merely replied, "he doesn't really like to get out of the tent." I suggested coloring books and crayons but I only got a blank stare - the boy did not even know what a coloring book was. He was my second patient and I was already tearing up. What 5-year-old has not heard of a coloring book?!  

There were several emotional cases today, but one young woman will hold my heart for some time, if not forever. She has a congenital disease with multiple severe comorbidities. I was amazed she hadn't been moved out of the camp sooner, but the family was still there. Among all these concerns, it didn't seem as if she had been previously told exactly how chronic her diseases would be.  I took a deep breath and asked the translator to explain it using some analogies she might find familiar. As she grasped the enormity of it, her shoulders dropped and she leaned backwards, quickly, against me and started to cry. Mom was crying. I was crying.  Even my translator Hisham looked seconds away from lacrimal gland failure. I told her she was so smart, soooo smart, that she needed to focus on her brain and not her other challenges. Then, Hisham did something really spectacular...he told the young woman about Steven Hawking. He told her that even though the man was paralyzed except for his face, he was one of the most brilliant people in the world. As she heard him describe Steven she smiled from ear to ear. "Don't give up on your dreams" was what he told her. If I know her, she won't. I hope we can make her dreams come true.

At one point a familiar patient came in and I noticed right away her necklace: "fearless," the silver disk on her neck read. Right away I became emotional, and she grasped the metal tenderly and smiled. FEARLESS. To leave Syria, these people had to be fearless. They sold everything they owned to make their trek. They had trekked for hours into Turkey, silently, to avoid being caught and/or killed. They took a train across Turkey to Izmir for at least 7 hours, then a boat in The Aegean Sea. Some capsized, and people drowned. Others made it to the island of Lesvos, then a ferry or freighter to Athens. One of our translators said, "We went to Athens instead of to the northern coast of Greece. What did we know? We were new at this." From Athens, they journeyed up towards Macedonia to go through the Balkans en route to stability and hope. But the gates slammed shut, and they were stuck. No one ever thought it would be this long. Fearless. They are fearless to continue to get up each morning and look the volunteers in the eyes. Fearless to be true to their faith when so many hate them for it. Fearless to hope for a better tomorrow. 

They may have been new at this when they escaped...but they are fearless now.   

From Aleppo to Turkey

 

Across Turkey towards Izmir

Through Greece, however one could

 

The Thursday, November 17th Dream Team

 

The Little Things

The last three days here in Greece have been sobering and have filled me with all sorts of emotions. I knew today when I awoke that the day's goal would be to find joy in the little things. Although I have looked at the refugees' current existence as sad and dark, it is all they have for now so looking at them with pity may be filling them with shame. They don't need to feel shameful; they deserve joy too.

1. Although it was chilly, the sun was shining!
2. No fights overnight! The mood was so much brighter.
3. The first patient today was a beautiful and feisty 2-year-old. We taught her "hello" and "bye bye" and played peek-a-boo with her. When we snuck her a lollipop she jumped around joyously. Who doesn't love happy children!
4. A 12-year-old boy with strep throat came to see us. He stared at us with his big blue eyes and said thank you for caring.
5. Our translator and triage guy today was a refugee in a neighboring camp. He was a small, quiet and thoughtful man who had been a veterinarian in Syria. I asked him what his favorite animal was - and he said chicken! "Chicken?!?" I asked, to which he replied, "yes, I am a small man, so I picked a small animal to care for." We all had a laugh about that.
6. The Greek midwives NGO came to visit the camp today, and they parked their car in the compound for a bit, blaring pop music - Jo Lo! All the little kids came and danced to the music, heads back, wide smiles, innocent laughter. Just like home. 
7. A German NGO stopped in to play with the children in the camp. They brought new balls! The children ran around playing football (soccer) and chasing each other. Such joy!
8. We placed foil emergency blankets over our window in the medical trailer, and it retained the heat so much better. Our patients would be warmer when we took off their garments to examine them. 
9. The children love to be tickled :)
10. Two little kids were riding a tricycle together, happy as can be. Their eyes were sparkling!
11. My residents (Fadwa and Ahmed today) were learning cost effective care while still trying to practice evidence-based medicine. I am so proud of their performance. 
12. The military officer came and hung out with us for a little bit before we closed shop as we watched the joy outside. He said we were nice for Americans (!) and when we said goodbye he gave me a hug and said thank you. 
13. Wooden pallets were delivered today - everyone cleaned out their tents of their belongings and the pallets were placed under the tents to get them off the freezing, cold concrete. Then all the stuff was brought back inside. The people will be warmer! The children will be off the concrete!
14. At dinner tonight I learned that one of our translators, "Mo" and his family, along with 27 OTHER PEOPLE were moved out of a neighboring camp into housing, on their way to being legal citizens. 27 PEOPLE! Homes! Heat! Bathrooms! Warm water! Pride! I saw the pictures as they were transported out of camp, with the children being lifted into the air and cheered. I'm still crying. Can you just imagine.

There are so many harsh and unfair things here, which makes the joy so easy to see if you really look. What good advice for all of us. 

Ahmed and his 2-year-old peek-boo friend

Fadwa and Ahmed playing with children in the camp

16 volunteers and our field coordinator, Monica, at dinner tonight, finding joy in each others' company

Not This Brave

Today was a long day. Somehow the busiest days go by so quickly but the trauma you witness drains you like a marathon. We were back at it on a windy, dreary and cold day. I was fortunate to have 2 of my residents with me, Fadwa and Omar, and along with Hisham and Sulamone we were a great team. We would need a great team today.

Without the sun, the warehouse campus was empty when we arrived to open clinic. It bordered on surreal, and the tension was palpable. Although we dressed more warmly than before, we were happy when the military granted us access to the electricity and the power kicked on. Heat! Lights! It's amazing the little things which make you jump for joy. We prepped for the morning rush and opened our doors at 0930 and the team was ready...until the news of the overnight events hit us.

As mentioned in earlier posts, this camp is the "roughest" of the 4 in the region, primarily due to the differing cultures who were moved to the site when previously unofficial camps were consolidated . As such, the tensions can get high and it's the children and their parents who suffer. Last night a colicky baby kept some of the less-tolerant single men in neighboring tents from getting sleep and a fracas ensued. The stress was overwhelming for the mother and the mothers of all young children, and our morning consisted of anxious moms begging us for colic medicine and ways to make kids sleep through the night. Meds we don't have. Fadwa was called to do a tent visit of a pregnant woman having a panic attack from the stress to reassure her that she would be OK. Even through this trauma, the young family invited her to share some tea, which is something I've seen time and time again in my few short days; the Syrian people are kind and generous. That, and they like to hug.

The day was filled with a variety of visits - minor trauma, back pain, muscle aches, viral syndromes, all the same stuff you'd see in any population. I received lots of hugs. But the headaches were from the PTSD of the trauma one has witnessed, the dehydration was from the lack of drinking so one wouldn't have to leave the tent at night to pee in dangerous conditions, and many of the congenital issues the children had were likely due to trauma during their fetal development under these circumstances. The children who had previously been well-behaved before escaping Syria were now fighting each other over a banana. A banana. Only the underweight kids were getting a banana. All the kids wanted them, so while the adults were fighting for sleep, the children were fighting for food. Through it all, the parents tried to keep their families together and keep everyone warm.

At one point a dad came to the clinic concerned for his infant child - Fadwa, ever the momma figure, took off with a colleague to make sure the baby was ok since Dad was afraid to take the baby out of the tent due to fear and cold. Baby was fine, parents were relieved and grateful, and even though they had next-to-nothing they offered her the food they had. That is the way of the beautiful Syrian people.

Would I have given my food to a warmly-dressed, well-fed person if I had nothing else and my children were fighting over a banana? Would I have offered warm tea when it took forever to boil water on a hot plate on the days when there was even some electricity near my tent? Would I have hugged someone if I was cold and my prospects for a home of my own had disappeared from my heart? Would I have gotten off my cot in the morning and hugged strangers if I didn't think anyone in the world cared for me or my family's plight and what we had witnessed?

I just don't know if I could ever be this brave.

Hisham, Fadwa, me and Omar 

Fadwa's tent visit to check on the baby (covered to protect anonymity)

The "super moon" tonight over Damascus, Syria. There is hope. (Courtesy of friends of Dr. "Ahmed")

A Mile in Their Shoes

Today was cold. A cold, windy day...and I had a coat. I was assigned to the same camp as yesterday, where I will be for the next few days. We arrived to our trailer, flipped on the power, turned the heater on and waited for the patients to arrive, which they did. Being an internist, I was slightly nervous about seeing kids - but the 3 docs in our little space consulted each other throughout the day, bouncing ideas off each other regularly. It was energizing. Until reality hit. 

I saw an "old" woman who came with joint complaints. Her book (a kind of chart) said she had a history of rheumatoid arthritis, and she came complaining of joint aches. Her book also said she was 4 years older than me, and in my brain I had called her "old." I was embarrassed. We followed the usual protocol for pain management with the resources we had, and I went through a slew of symptom relief instructions to improve her comfort, including "keep warm."

"Keep warm," she admonished me, "keep warm?! I have only the clothes on my back and the scarf on my head, and you want me to keep warm?" I wanted to crawl into a hole and cover myself with a rock. I was ashamed. My translator, who is a volunteer from Canada, and I were silent. I touched her shoulder. I said I was sorry. What else could I say? I'll take you home with me? I'll rescue you? Here, take my sweater? But all I could really do was touch her shoulder and say I was sorry. So sorry.

When our little heater overpowered the weak power grid at the camp, we lost power. No lights and no heat, but I couldn't even think of complaining given that I had warm clothes and someplace, anyplace, warm to go to later. It was cold, but still they came, babies, toddlers, children, moms, dads and "the elderly." We saw them all and did the best we could. I felt less incompetent as I got used to saying more appropriate things for the patients in front of us. Until the shoe incident.

Another woman came to see us, seeming much older than her 54 years. She had diabetes and had foot pain. Ahhhh, this was my comfort zone. Peripheral neuropathy, easy. But how do you treat it when you have no gabapentin and the patient has only flip flops? The thinnest, oldest flip flops you've ever seen? And no socks? No socks. No other shoes. And losing the ability to feel her feet. The sensation was overwhelming. I had no words, and could only touch her shoulder.  And then she thanked me and gave me a hug. A hug. She gave me gift when I could give her nothing. And this happened all day long, with most people thanking us for helping them, when all they wanted was to be, well, wanted. They would rather be wanted by someone, anyone, rather than have a pair of shoes.

I will be looking at shoes in a whole new way from now on.

Mackenzie's bear she asked me to bring to experience this journey with me. 

Four-fifths of today's care team...our American team lead, American volunteer doc (me),  Norwegian volunteer doc, and Canadian volunteer translator (left to right). We were a great team today!

Not Just A Refugee

Today was the first day of my time with SAMS in Greece. SAMS stands for the Syrian-American Medical Society, and I traveled to northern Greece to do medical work for/with SAMS in the Syrian refugee camps near the Macedonia border. I've been wanting to do more meaningful work for a long time, and a variety of signs led me to this experience. Enough thinking about it - it's time to do it.

So, after a long journey we (3 medical residents and I) arrived in a small town between Thessaloniki and the Macedonian border last night and today we got right into the swing of things by having a half-day clinic and then taking stock of supplies. I have been assigned to one of the "rougher" camps for the next few days, but with both the police and military around, did not ever feel unsafe. Instead, I got to see just how rough these people have it.

This camp, like the others, is an abandoned warehouse lined with rows and rows of tents. You'd think they should be actual refuges, given they house refugees. Perhaps when all you have left in this world is inside those canvas walls it is home, but to me it only felt like those of us who have a roof and sturdy walls to protect us have failed these poor people. The UNHCR is the United Nations refugee agency which works to respect refugees' basic human rights while a long-term solution is worked out. The camp where I worked today is also sponsored by a Norwegian relief agency, and I've been blessed to meet several Norwegians in our group.

Today we saw patients at our camp but I was most impacted by one of the doctors with whom we worked. I'll call him Ahmed for his safety. He is a Syrian doctor who is very highly trained and specialized and was seen as a target by ISIS. He was assaulted and incarcerated for a variety of inconsequential things, once for a very long time. I will spare you his personal terror but I can assure you that ISIS treats fellow Muslims as badly as anyone else. Ahmed told us of walking his small children in the town square, when on a good day only 1 or 2 beheaded people were strewn about. As he became increasingly concerned of being targeted, he ultimately fled the country with his immediate family, leaving others behind. He now works for his fellow countrymen in these medical clinics. I just. Can't. Imagine.

I did not take pictures today. I won't make this experience seem like a tourist attraction, because it's not. Maybe I will feel more comfortable in a few days, but the pictures I may include here during my almost 2 week stay may be from other sources (cited when possible). I came to help, and to show these people that there are many in this crazy world do care, but right now the only way we can show that is to minister aid to them in this way. However winter is approaching,  the warehouses aren't heated, and the electrical grid is infantile...and there are so many children. Little, cold, children and their parents. Not just refugees.

Not from the camp where I was today, but the exact same set up. Borrowed from https://mollyvalentineblog.wordpress.com/tag/unhcr/