Interview with Christa Hook

Interview with Christa Hook, doctor, 56, Edinburgh (UK), 5th mission with MSF.

Just being out in the field today I found it most interesting that we are able to start a special clinic for chronic diseases. In this particular camp situation there is really a large number of elderly people who have all sorts of chronic diseases which have been under ongoing treatment in Kosovo.

When they were displaced, this treatment was stopped and they are now having a lot of problems with their diseases getting out of control, like high blood pressure, chronic lung disease, chronic heart disease. There are people who had  had major heart surgery and had their follow-up drugs stopped suddenly. Other sorts of problems are those of people who have had drugs for schizophrenia and who, without their treatment, find themselves in a very difficult situation. They just can't cope anymore.  

So, for me, it is very important that we have finally started with this program to take care of all these elderly, frail and unsupported people - to make sure that they get the right sort of help.

I work in Brazda camp which is known to the outside world as Stankovic  I. It is a big camp with more than 25,000 refugees. My first impression was that it was a very large, flat and uninteresting area. Very uniform - rows of tents very close together, no privacy, no place to go. Fact is, it is a prison camp because people are not allowed to leave. A lot of people gather near the gates and around the fences. People from Skopje come to see whether their relatives are there. People inside the camp are just looking out because there is nothing to see inside the camps except from tents. The camp is actually set in a beautiful area. Several kilometres away there are mountains still covered with snow and when it is bright and sunny, it is really very very beautiful.  

Day and night the police come and go, the army comes and goes, everybody comes and goes, but the refugees have to stay there all the time. It must have been a haven of safety on first arrival but the longer they stay inside the camp the more difficult it gets for them.

The people here have suffered a lot. They have escaped from a terrible situation and suddenly find themselves here in the camp, which is like a prison. The only way out for a lot of people is the hope to get on a plane to a third country. But this other country is far away from their home in a totally different environment which is unknown to them. It also remains to be seen whether they can be integrated into the population of that country. They will probably come into another camp or camp type situation.

I think one of the most heartbreaking things is when families were split up and suddenly get reunited after contacting someone outside the camp by radio or phone. In the tents next to our OPD, they look after vulnerable people - very often elderly without family support. They also have two young men who are severely mentally handicapped. They can hardly say their own name and cannot even manage their own personal care. And there was no way of knowing where  there families were. And then, one day, out of the blue, the brother of  one of them turned up. That was just overwhelming.

MSF is doing basic primary health care, both physical and psychological. First thing was that we set up tents where we could treat people when they arrived from the border. Then we started to look into the more chronic diseases. And now we have moved on to help women during their pregnancy, providing them with proper care during their pregnancy.  

But at the same time part of the team is working on a system of psychological support, especially in the emergency phase when people arrive after a very difficult and tiring journey, very  shocked. They are sometimes not able to cope with it. So it is  emergency psychological support through local volunteers and with some  backup from expats.

There is obviously ongoing need for physical support. The camp is very cold at night with the temperatures going  down to just above zero. People are lying on the ground. They often do not have anything waterproof, so they are lying just on the ground. Today it rained a lot and it got very muddy. Inevitably, a lot of  people have acute respiratory tract infections, particularly in children. These have to be treated carefully. In this situation they have not got the same possibilities: a good, warm bed, nice nursing care, nourishing food. The food is all standard - handouts, which are not particularly right for children or pregnant women. So medical care sometimes has to make up for deficiencies in proper family care with in proper homes and proper food.  

Initially we started with very basic equipment. One of the great things while working with MSF is that when you move into an area with a huge number of people and a lot of health needs you just say: 'I  want a basic kit'. It contains all the stuff which will keep people alive until you get yourself sorted out and you can look into more specific needs. What you get first is basic life saving drugs and supplies needed to dress wounds. Then you can refine the needs. You look at a particular population. In this case the population had had a fairly developed lifestyle and access to developed health care so their chronic  health needs were being met. And this stopped abruptly. Anybody who has been involved in health care knows that if you suddenly stop people's treatment for diabetes or for high blood pressure, then the  disease will soon get out of control and can lead to complications. We had people arriving who had missed their chronic disease control for days, if not weeks, and the situation was rapidly becoming very serious indeed. So there was the unusual situation of bringing in drugs which we normally do not think of in an acute emergency situation. A variety of drugs, such as for high blood pressure, chronic heart disease or for diabetes or other fairly sophisticated drugs for people with rather rare diseases.

Between us and the hospital on the site we are now  able to meet most needs. But there are some very difficult problems. It seemed like a hospital had been cleared out and at one point  three patients on regular hem-dialysis arrived at the  border having just abruptly been thrown out of the hospital. These patients' lives will obviously be very short indeed if they do not restart their treatment. That is the only thing which is keeping them alive. This is not something which we can do in a camp situation. But we can make links and find out what  the local situation is so that these people get some help within the Macedonian structure.  

Up to now this has been successful, although it puts a huge strain on the Macedonian resources. This is something that the International Community needs to address. The Macedonian health service has done a great deal to support people in the camps and  itself is not able to stretch its limited resources to cover this huge  influx.

At home in Scotland, I work as a locum GP. Obviously it is very different. One of the big differences is that I can not communicate directly with my patients in this situation because I don't speak the local language. Although it is possible to work through a translator, it is one of the things you miss very much. You don't have the same cultural background and some of the concerns and priorities are not always easy to understand. There is one woman who will stick in my memory for the rest of my life. She arrived from one of the buses one night when a lot of people came in from the border. A young woman - her husband was with her. They had walked through the mountains and through the snow for about ten days before arriving at the border. They were carrying their two months old twins.  

These babies were wrapped up in many layers of blankets and I unwrapped these little bundles. And then there were these two  beautiful little babies, smiling perfectly content. She had kept these babies alive. Not only alive but healthy in the most difficult circumstances. She came running into the health centre, first thing off the busses, because her first concern was that someone should look at these babies. They were all right, they were beautiful and it was  lovely to see her relief and her smile when I told her that her babies were doing well. That lady I will remember forever.

My greatest concern? Look at this dreary camp in the rain and the cold and I wonder how long people can stand this. For a short time one can cope with the dirt, the fact that you can't wash, the fact that your latrines are filthy and that you have no privacy. And you have to cope with it day after day. But when it is raining and muddy on top of everything else and there is no end to it, I just wonder how long people can go on.