Supporting refugees in need

Diana, my wife, and I went to Thessaloniki in Northern Greece again in November to offer dental treatment to some of the numerous refugees from all over the Middle East and beyond who are in the area either temporarily (waiting to be re-settled) or permanently (having been granted asylum).

This is not the first time that we have done this, being my fifth and Diana’s fourth trip.  Each trip is different and in the 18 months that I have volunteered with Health Point Foundation (HPF) I have seen the situation evolve.

This time I was the only dentist, Diana was assisting me, because HPF had not expected there to be much of a requirement for hands-on dentistry.  I had been warned that I might be spending a lot of my time delivering oral hygiene advice rather than filling, drilling and extracting but this proved not to be the case.

When making an assessment of how many personnel to deploy, HPF had observed the number of new refugees dwindling with the ones who had been in the area for some time, stabilised thanks to all of HPF’s previous work.  The situation changed unexpectedly – too late for HPF to mobilise more volunteers, so I found myself dealing with many patients with an enormous number of dental problems.

I was often in the invidious position of making an examination, seeing that there was far more than I could hope to treat in the circumstances (there would be a long queue of  people waiting outside the door) and having to ask the patient to identify what was causing the most pain which I would then treat.

This happened far too frequently and I must admit to having had a number of sleepless nights – had it really been the correct tooth to treat and what would the patient do afterwards?  Who would be offering further, quite urgent treatment?

On my first trip I’d been working in tents and to a certain extent on subsequent trips, too.  This time we were in a variety of locations – the

offices of Non Governmental Organisations (NGOs) and on a couple of occasions the shipping container at Diavata – the very first place I’d worked in back in July 2016.

The advantage of a tent is that it doesn’t close!  When working in a room made available courtesy of a charity  (one was a Norwegian refugee organisation for example) the disadvantage is that they want to leave the premises at a certain time – 5.00 or 6.00 p.m. and although we’d have been willing to carry on, it wasn’t always an option.

I found that a number of patients had quite unrealistic expectations.  I was often asked for implants and received requests for crowns and bridges.  I had to explain that it wasn’t possible with the equipment available.

A portable dental unit can deliver basic dentistry very effectively and the service that we were offering was pain relief.  I wondered why the patients had expected such advanced treatment and whether the country where they eventually settled would fulfill their expectations.

I was told that a  number of refugees from Iraq and Afghanistan had requested and been granted voluntary repatriation, having decided that life in Greece was not for them and as Greece is desperately poor and run-down, it’s possible that in a material sense they wouldn’t be a great deal better off.

However, Syria is considered to be too dangerous for that option and so anyone wanting to return to Syria would have to organise it for themselves.

As on previous trips the majority of patients were Syrian but there was a mixture of nationalities – Congolese, Sudanese, Palestinian to name a few.

The Sudanese patient had a cousin with her who spoke good English and was able to translate.  She said that they had flown from the Sudan to Turkey and then made the sea crossing to Lesbos.

The Congolese patient only spoke French, he needed an extraction – one that proved to be quite tricky but ultimately successful.   Diana and I had some rusty French, sufficient for the treatment itself, but not up to giving him post extraction instructions.  One of the coordinators had a friend who spoke good French, so she phoned him, I gave him the instructions which he translated and then conveyed to the patient so we got by.

Translation often proved to be a difficulty.  In the past we’d usually had the luxury of a native speaker of Arabic who also spoke excellent English and even Farsi on one occasion.  It was different this time and we were generally without an Arabic speaker to assist.

Our coordinator, Kat, stepped into the breach.  She was an Austrian nurse who spoke German and Russian, the latter because of her Ukranian mother, as well as excellent English.  Her ambition was to work with Medecins Sans Frontieres (MSF) and so she was planning to spend a year working as a coordinator for HPF to gain more experience, before offering her services to MSF.

Before leaving Austria she’d taught herself the Arabic alphabet and numerals and while in Thessaloniki (about 3 months), she’d learnt enough basic dental Arabic to enable us to manage.  Kurdish was the real problem, she didn’t speak this at all and a number of the Kurdish speaking patients spoke no Arabic.

We had to try to find a refugee with the necessary languages who’d be willing to help us out. I was interested to discover that some refugees had been in Greece long enough to have acquired the language and spoke it well.

One patient I saw could have caused a lot of drama but, fortunately, didn’t.  A couple of weeks previously two young dentists had been in Thessaloniki and seen a patient who needed an upper wisdom tooth extracting, which they proceeded to do, but things had not gone according to plan and it had taken over two hours before the procedure was eventually completed – way in excess of what it should have done.

As I wasn’t there I couldn’t say why this happened but when a young woman came along in considerable pain from an upper wisdom tooth and I offered to extract it Kat (the coordinator) became noticeably agitated and did her best to divert me from this course.

I felt fairly certain that it would be straightforward, but as I proceeded (the patient having agreed) , the atmosphere was tense and Kat was clearly anticipating another marathon session.  She was hovering over me urging me to change my mind even while the extraction was going on and when the tooth came out as I’d expected, I can say that the coordinator and dentist were a great deal more relieved than the patient on this occasion.

On our last afternoon in Diavata a patient presented who, I admit, caused me some trepidation. She was a very sweet little girl of 3, her mother brought her along asking me to extract her front tooth.  This was one of the rare instances whereby the treatment was necessary because of trauma (she’d fallen over and broken the tooth) rather than neglect, poor diet and poor oral hygiene.

Now it’s a very rare 3 year old that will let you take a tooth out under local anaesthetic – I have known one or two in my career – and the norm in the UK would be to refer the patient for an extraction under general anaesthetic.  This option was not available to me, though I did ask the mother a couple of times whether she wouldn’t prefer to wait and let the tooth come out naturally.

She was adamant however that an extraction was necessary because the child was in pain and couldn’t eat properly.  In the event, and to my huge and heartfelt relief, this little girl proved to be one of that rare breed.  She allowed me to inject her while being held tightly in her mother’s arms and was distracted by all those around using a variety of tactics,  from waving toys about to singing and pulling faces.  It proved successful and shortly afterwards the tooth was out, she received the toy she’d been promised and we were all happy!

I get asked whether I find the work distressing and stressful.  I do find it difficult to be faced with a patient that I cannot help due to lack of time or equipment.  Another thing to contend with is a patient needing a referral because of a potentially serious condition.

I can fill out a form for the patient but have no idea whether it will result in a timely appointment with a suitably qualified professional able to asses and offer the relevant treatment.  I can but hope.  I have to balance this against the undoubted fact that I have been able to offer treatment, pain relief and advice that will have made a positive difference and left the people in a better situation.

Joking apart, the really difficult thing to contend with in Thessaloniki is the parking.  We would head for the car in the morning, ready to drive out to the camp not knowing if we’d find the car hemmed in by another car parked alongside blocking the exit.

This has happened more than once.  The driver does not leave a helpful little note giving his location, one has to hunt about wishing devoutly that he has not gone out for the whole day.  Then in the evening the search for somewhere to park can be long and arduous.  All the conventions pertaining in the UK are thrown overboard – park on a corner, across a zebra crossing?  No problem – all’s fair in love, war and parking in Thessaloniki!

We discovered that we were the last dental team being sent out to Thessaloniki for the time being, so at the moment there is no dental provision for refugees in Northern Greece.  HPF being a small organisation has had to make some difficult decisions and has come to the conclusion that, bad as things are in Thessaloniki, they are even worse elsewhere.

HPF is thinking along the lines of setting up a permanent dental surgery in Thessaloniki, which would have the advantage of continuity of care and be better equipped than a portable dental unit.

Greek law states that the dentist must be a Greek speaker, the obvious thing to do would be to employ a Greek dentist and the poor state of the economy means that a sum of about 1,200 euros per month would be sufficient.  This would be a change from HPF being entirely volunteer led and staffed as it is now, but I can see that it’s a sensible way forward.

We learnt that the number of refugees making the dangerous crossing from Turkey to Lesbos has now risen considerably and is about 200 per day.  The deal struck between the EU and the Turkish government whereby the flow of migrants almost stopped seems to have broken down.

Conditions in the camp at Lesbos are bad, and the need for pain relief is great and currently not being met, so HPF is negotiating with the relevant authorities to be allowed to offer emergency dentistry to refugees on Lesbos.

Although this should be straightforward and simple it isn’t – frustrating, bureacratic and seemingly pointless obstacles have to be dealt with patiently and tactfully.  As soon as possible in the new year HPF, plans to be offering dental provision on Lesbos, maybe back in tents again.  Will we be there?  Well, I have offered my services so watch this space.

Photos : Kyriacos Hajikakou

Photos : Kyriacos Hajikakou