Das Dilemma medizinischer NGOs: ein Bericht aus Thessaloniki

Note: This is the adapted translation of an article which appeared here in English in June 2022.

Aufgrund der zunehmenden Migration nach Europa im Laufe des letzten Jahrzehnts[1] und der weiterhin unzureichenden gesundheitlichen Versorgung von Geflüchteten durch die Mitgliedsstaaten der Europäischen Union (EU) haben zahlreiche Nichtregierungsorganisationen (NGOs) begonnen, medizinische Nothilfe zu leisten. Meine Partnerin und ich haben kürzlich fünf Monate als Ärzt:innen bei einer deutschen Hilfsorganisation in Thessaloniki verbracht, die mittlerweile multidisziplinäre Teams nach Polen, Serbien, Bosnien-Herzegowina und Griechenland versendet. Der Großteil unserer dortigen Arbeit umfasste ärztliche Sprechstunden in einer eigens von der NGO eingerichteten Praxis und dem am Stadtrand gelegenen Flüchtlingslager. Kurz nach unserer Ankunft übernahmen wir zudem die medizinische Koordination des Projekts, sodass wir uns zusätzlich um die Personalplanung, die Abstimmung bei Notfällen und die Kommunikation mit den verschiedenen Akteur:innen des griechischen Gesundheitswesens kümmerten. Darüber hinaus oblag uns die enge Kooperation mit diversen Partner-Organisationen, welche sich beispielsweise mit der Verteilung von Lebensmitteln und ehrenamtlicher Rechtsberatung beschäftigen.

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The long-term benefits of NGO work

As discussed in previous posts on this platform, my partner and I recently spent five months working for a medical non-governmental organisation (NGO) in Thessaloniki, Greece. After an intense last week, during which we handed over the medical coordination, wrapped up unfinished work and said our goodbyes to new friends and colleagues, we travelled to the island of Skopelos. Holidaying between luscious green forests and sun-flooded beaches, the evenings spent among Greeks at their laid-back and hospitable best, it’s been tempting to be lulled into reconciliation with this beautiful continent. Yet while I’ve immersed myself in the pleasures of island life and caught up some sleep, death and torture on the Evros river, the natural border between Greece and Turkey, continue. As do the mistreatment of refugees in detention centers, illegal pushbacks to Turkey and brutal broom operations in Athens and Thessaloniki,[1] all of which are the deliberate consequences of decisions made by our elected representatives in Brussels and Athens.

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The dilemma of medical NGOs

This January, my partner and I started working for a medical NGO in Thessaloniki, Greece (a detailed description of the project can be found here). A month after our arrival, we were asked to take on the medical coordination. This has meant additional responsibilities such as overseeing medical staff, answering emergency calls and communicating with various actors within the Greek healthcare institutions. An interesting part of the role has also been the collaboration with other NGOs. We cooperate with several partners offering services from the distribution of food and non-food-items to legal support and safe spaces for women. Beyond these, we also maintain close relations with other medical organisations in the area.

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First impressions from Thessaloniki

In the wake of increased migration to Europe over the past decade, and due in no small part to substandard healthcare for refugees, a number of non-governmental organisations (NGOs) have started providing emergency medical care. As fourth-year residents in internal medicine, my partner and I had begun to feel confident that we could make a useful contribution. Several colleagues had already volunteered with a German NGO currently operating in Bosnia, Serbia and Greece and recommended them as an experienced set-up with good connections on the ground. After months of planning, we thus arrived in Thessaloniki at the beginning of 2022 in order to work for the local project. I plan to share my experiences through a series of essays on this platform.

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The forgotten role of lotteries in democracy

What does it mean to live in a democracy? For those of us raised in the West, the response involves the concept of voting; the claim being that we live in a democracy only if we, the people, come together at regular intervals to determine those who will govern us. Yet if we examine the actual meaning of the word, this association is actually rather surprising, with demos translating roughly to ‘the common people’ and kratia to ‘power’ or ‘rule’. A more reasonable definition of democracy would thus entail any system that ensures that we, the people, govern ourselves.

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Modern segregation

I was out with a good friend last year, in search of a late breakfast, when I was once again confronted with the extent of modern segregation. It was a crisp and bright Sunday in late November. We were strolling down Eisenbahnstrasse in the German city of Leipzig which had, until recently, been considered the most dangerous street in the country[1]. But a whirlwind of gentrification had moved through the area, removing all signs of former threats. We’d been out all night and barely slept and I was craving a coffee as we walked past a colourful mixture of cafés, run-down casinos, vintage shops and shisha bars, discussing the night’s events and taking in the Sunday sights. At first glance, the neighbourhood appeared to be a bustling, multicultural hub, with people of a variety of backgrounds going about their day. Yet on closer inspection, the scenes in Leipzig – recently praised by the New York Times as Europe’s new ‘‘cool-kid-town’’[2] – were among the most segregated I’ve ever seen.

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Why the Left needs to get its priorities straight

With the rise of Donald Trump, France’s National Front and Austria’s FPÖ, to name just a few, the question of what has happened to the voice of the political Left has been asked very frequently over the course of the last year. One of their most important problems was highlighted quite accurately by U.S. political commentator Bill Maher in his ‘Real Time’ show in January 2017:

‘‘You know in 2016, conservatives won the White House, both Houses of Congress and almost two-thirds of governorships and state legislatures. Whereas liberals[,] on the other hand, caught Steve Martin calling Carrie Fisher beautiful in a tweet and made him take it down.’’ [1]

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Lessons not learned

Europe over the last decade was confronted with the worrying development of uprisings by young people without any sort of apparent political goal. As we approach the 10-year anniversary of the 2005 Paris riots, we would like to ask whether lessons have been learned from these events. Considering the fast pace of today’s media, which barely allows for the consideration of a problem before covering us with a mountain of ‘newer’ issues, have politicians pushed through those promised measures, with which we were appeased in the immediate aftermath of each period of unrest? Did they tackle the actual causes, which include mostly a lack of opportunities and social inclusion of young disadvantaged people- or was the issue left to fade slowly from our memories? Too often do we forget pressing issues of the more recent past, and therefore fail to ask whether the problems that we were briefly so concerned with have actually been solved.

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An introduction to the defence against neurobiological reductionism

It was whilst studying neuroanatomy during my third semester at medical school that I first came across the problem of neurobiological reductionism. We had three weeks to prepare for this fourth and final part of the cadaver dissection course, and so I delved into the realms of our brain and spinal chord, the ‘central part’ of our nervous system, learning about the various lobes, the basal ganglia, the limbic system, the brain stem and so on. It wasn’t until learning about the frontal lobe, which includes the prefrontal cortex – a structure that’s widely held responsible for many of the characteristics that separate human beings from all other living things- that I began to think about the meaning of such understanding for the concepts about our own actions, and indeed for free will in itself. An often used example when explaining the functions of the prefrontal cortex is the tragic story of the young American railroad construction worker Phineas Gage. He was the head of a small unit of men within the rail company, described by those who knew him as extremely capable; an excellent worker as well as a respected leader. During an accidental explosion in 1848, an iron rod was knocked into Mr. Gage in such a way that it ‘entered on the side of his face, shattering the upper jaw, and passing back of the left eye, and out at the top of the head’1, cutting in its path through the connections between limbic system (held responsible for motivation and human drives) and the prefrontal cortex. It didn’t, however, damage his brain stem, and he was thus left alive. To the general astonishment of medics at the time, Phineas Gage recovered fully from the accident. He was able to see with his other eye, his vital organs worked normally, he was able to walk, talk, eat, drink and appear generally like a well-functioning human being. Yet emotionally, Mr. Gage changed. He became erratic and uninhibited in his behaviour. He lost his job and his friends. His post-accident behaviour was compared to that of a child. Anatomically, everything still worked the way that it should do, except for the damaged connections within his brain. The prefrontal cortex was cut off from the limbic system, and this showed in his behaviour. Interestingly, it has often been claimed that Mr. Gage later managed to relearn some of his social capacity- the changes were apparently not permanent.

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