This article was originally published in Italian on Univadis Italy
When I got into the car in Milan with a civil protection paramedic and a neurologist from Niguarda Hospital headed for Przemysl (pronounced Pshemishl), a town on the border between Poland and Ukraine, I had no particular expectations other than to fight the sense of helplessness that had seized me while watching the Russian-Ukrainian war from the sofa of my living room.
Our task was to deliver the much needed drugs, donated by the University of Pavia and some private donors, to the Polish town where there was a sorting centre for Ukrainian refugees. Both the task and the destination seemed random; I had contacts with a group that runs a small kindergarten for children inside the refugee centre, which allows mothers - exhausted by days of travel and in need of time to deal with documents and prepare asylum requests - to leave their children in trusted hands for a few hours.
The road from Milan to the Ukrainian border is long: taking about 19 hours, including breaks, through Austria, Hungary, the Czech Republic, and all of Poland.
Neither I, who work as an editor of Univadis Italia and as a University researcher, nor my companions had ever experienced volunteering as medics in the field before, but we had heard that the number of refugees continued to increase and that anyone with any medical expertise was welcome. A free week over the Easter holidays seemed the perfect opportunity to see if we could be useful, even if it just to help distribute clothes and hot food.
The Citadel of Volunteers
It turned out that we didn't have time to register as volunteers at the refugee centre before our local contact called us. A Franco-Israeli NGO, Rescuers Without Borders, which manages the medical tent at the border with Ukraine in the nearby town of Medyca was urgently looking for doctors who could cover some guard duty. We accepted even before understanding exactly what we were getting into. After getting clearance for our professional credentials, we found ourselves in a military tent, set up right next to the gate at the border, on a wooden platform resting in the mud.
Next to it, was a large shelter tent where the NGO manages to give emergency care to women and children who arrived too tired to be able to continue to the refugee centre. The Medyca clinic is part of a sort of 'volunteer citadel', a long line of tents and marquees that line the road along the border. Those arriving from Ukraine on foot with suitcases and animals in tow have no choice but to pass through it.
Even with the sun out, the temperature is still frigid, and those who cross the border often have already spent at least 8 hours in line for border checks in the cold. Amongst the volunteers, there are those who deal with distributing warm clothes, drinks and food, or free sims that the largest European telephone companions have made available to refugees for phone calls.
Women, Children, and the Elderly
On a medical level, those who work on site have a basic pharmacy at their disposal, with products classified according to the United Nations codes for emergency drugs: anti-inflammatory, antihypertensive, insulin, some oral antidiabetic drugs, broad spectrum antibiotics, dermatological ointments, anti-epileptic drugs (essentially phenobarbital and carbamazepine), steroids, and many anxiolytics, as well as paediatric formulations of the most common drugs. Also available is an emergency rescue bag (that fortunately we did not need to use), and a semi-automatic defibrillator.
Above all, women with children (often very young) and the elderly pass the border. Most of the cases we had to treat involved chronic diseases, such as diabetic or hypertensive patients who remained without drugs for the entire duration of the trip and, in some cases, longer if they came from war zones. Anxiety disorders are common, with dyspnoea or real panic attacks.
Many women only fully realise that they have lost their homes when they actually find themselves in a foreign country, having left husbands and companions on the other side of the barrier, blocked in Ukraine by general conscription. However welcoming and equipped the shelter tents are, one sleeps on makeshift cots in beds covered with sheets and blankets previously used by others.
Elderly people, tend to suffer from intense joint and muscle pain, often caused by days or weeks spent sleeping on makeshift beds in cold basements to protect themselves from bombs. They are frequently dehydrated and decompensated. In two cases, we had to deal with war wounds. One woman coming from Kramatorsk station, which was bombed by the Russians during the transport of a convoy of refugees, showed up with a bandage that hid a bluish-red foot, clearly infected and oedematous. It is likely that a fragment of metal or other material had entered her foot, as other fragments had been glued to the plastic of her anorak from the heat of the propulsion. We could not help but give her an intravenous antibiotic and send her to the Polish Red Cross, hoping that at least they could do an X-ray.
A young man presented with a classic explosive oedema, treated by paramedics with compression bandages. You are never ready to treat war wounds, but you are even less ready when you have never received any specific training in the matter.
The doctors who work in these structures temporarily managed by NGOs have different specialties, almost always internists, they come from all over the world (we worked with an Indian doctor, two Americans, two Israelis, and one French medic). They make themselves available for short periods, from 10 days to 3 weeks, and have at their disposal a basic paraphernalia unsuitable for real emergencies.
A widespread problem that we had to face was the lack of needed drugs. The kits recommended by the United Nations comprise basic molecules and do not even remotely cover the broad spectrum of prescriptions our patients came to the clinic with. It is not always possible to replace one drug with another or, at least, it is not possible to do so without an adequate period of observation and overlap that we did not have available to us.
The most complex case we had to deal with was that of a young epileptic woman who had a seizure while queuing at the border. We did not have her prescriptions available and only due to a stroke of luck and the tenacity of some volunteers, who literally went hunting for the right medications in all the local medical centres, we were able to recover some of her missing meds. The woman was traveling with a 10-year-old son in tow and, after a night spent under observation in the medical tent, she resumed her journey to her final destination in Germany.
Often, in choosing a treatment programme, we also had to consider the responsibilities of the patients: in the case of single mothers with one or more children in tow, drugs that alter the state of consciousness or induce drowsiness, such as benzodiazepines, cannot be administered because, unfortunately, there have already been cases of child abuse and there are no staff able to look after the little ones while the parents are resting.
'Niche' drugs are nowhere to be found, even when life-saving. We had to help a myasthenic patient who quickly showed signs of worsening and difficulty swallowing. To avoid having to intubate him in case of compromised respiratory muscles, we sent him to the town hospital hoping that at least they would have physiostigmine available. We do not know what happened to him but the translator who accompanied him told us of a hasty and not very empathetic welcome from the local staff, understandable if you think that the entire Polish health system, in the border towns, is at the point of collapse, with staff burned out. Just in Przemysl, a town of about 60,000 people, an estimated 3000 refugees a day have passed through in just the last month and a half,
COVID: The Ignored Problem
COVID is a health problem that is present but that no one is dealing with. The refugee centre, installed in a large disused shopping centre, hosts about 4000 people, distributed in what were once the various shops, each of which is marked with a flag indicating the country of final destination. There are no windows, no natural light, and, obviously, no efficient ventilation systems. The cots occupy every free space and overflow in the corridors.
Only volunteers are tested with rapid antigen testing at the time of accreditation and then never again. The use of masks is non-existent, and in any case it is almost impossible in such an environment. Almost all the volunteers have been infected or are expecting to be infected soon.
Overall, the experience was stronger and more intense one than I expected. I do not know if we succeeded in our intent to help. What is certain is that the margins for improvement, at least as regards basic medical care, are very wide. Better coordination between NGOs and local health centres and the final destination of refugees is also needed, especially to give the right support to the most complex cases.
The psychological aspect, while essential to avoid the consolidation of post-traumatic stress syndromes, is only handled by volunteer personnel, whose skills are limited. It would also be helpful to better coordinate professional interventions, under the guidance of emergency experts.
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