In July 2016 a pilot project in northern Greece opened its doors to demonstrate both how an abandoned factory can be repurposed to provide much-needed housing for refugees and demonstrate the benefits of providing many services under one roof. Residents of this camp have access to English as a second language classes, Arabic language classes, sports and recreational activities, prayer rooms, and a medical clinic, all within the building. Food is provided once weekly to each family and residents are able to use indoor cooking facilities to cook for their individual family unit. Each family has a private room with walls and a door and access to shared bathrooms, recreational areas, classrooms, kitchen, and dining room.
The current population of this camp consists of 35 families comprised of about 175 individuals, with a steady turnover of residents as families are granted asylum while new families are transferred from other camps based on need as soon as a room is vacated. Residents are disproportionately women and children, with the 6-15 and 0-5 year age groups having the highest percentage of residents. Most are Syrian, but a few are Iraqi or Palestinian. Nearly all residents speak Arabic, but Kurdish is the primary language of some families, with Arabic spoken as a second or third language. Most residents have been in Greece for 6 months to 1 year and have been away from home for two years or more on average.
Volunteer medical professionals and supporting members of Team Rubicon are maintaining 27 residents on chronic daily medications, while providing chronic disease management for 64 residents. The camp’s population has other challenging patients such as three pregnant residents, a 14-year-old who recently got a mechanical heart valve, a 20-year-old who had recent surgeries for subaortic stenosis and cardiac tamponade, and a 1-year-old with epilepsy.. The camp Team Rubicon is operating in offers greater access to supportive services and a higher standard of living than any camp in the area, so medically complex refugees are preferentially sent here.
Greek Healthcare System
Refugees in Greece often lack access to healthcare because the Greek universal healthcare system is heavily affected by the economic crisis. Greek citizens frequently wait many months for a specialty consultation, although they are able to acquire some medications and laboratory tests from hospitals free of charge. No new Greek doctors or nurses have been hired for more than three years, and when a healthcare worker retires, the position is left vacant due to lack of funding to maintain the salary. Only one or two of the nearby ten Greek hospitals is fully staffed on a given day, and the emergency rooms are only available on a rotational basis, in order to conserve resources. The hospitals often lack electricity to conduct imaging studies or may not have personnel available required to provide specific services.
Team Rubicon Clinic
The Team Rubicon medical mission is a truly unique venture, one financially supported by American Express. The team has three core functions: provision of primary care and life stabilizing emergency care, coordination of access to specialty care and resident advocacy. The clinic provides primary care for about 175 medically vulnerable refugees, with 20 patient visits conducted daily on average. The clinic is open seven days a week from noon to eight. After clinic hours, two medical staff are on call for emergencies to provide the community with 24/7 access to medical care. TR has created unique medical passports and personalized medical records for every camp resident that is used to track their health over time. The residents own their medical data and it will travel with them as they move through the asylum process. Because the clinic is located in the camp and is open daily, we are able to provide continuity of care and primary care services such as well child check-ups, public health monitoring, and planning to control the spread of infectious diseases within the camp.
In addition to providing clinical care, the TR medical team developed a system to allow access specialty services at the camp. TR’s leadership coordinates service delivery from several health organizations that visit the clinic to augment primary care services on a regular basis. Our partners include:
- HealthPoint providing residents with dental care
- Rowing Together providing prenatal care and gynecology
- Nurture Project International providing breastfeeding assistance and milk distribution to young children
- Terres De Homes providing psychological support for children
- Medicines Du Monde provides psychology and psychiatry services
When patient medical needs exceed the scope of practice provided at the clinic, the team writes referrals to healthcare providers outside the walls of the camp. We have partnered with Medicines Du Monde Polyclinic, which is our referral source for specialist consultation. Through the Polyclinic, residents have access to specialists including cardiology, dermatology, gastroenterology, general surgery, neurology, nutrition, orthopedics, pediatrics, pulmonology, rheumatology, urology, and vascular surgery.
The Team philosophy is mission first, patient first. As a result, the Team Rubicon clinic provides a higher level of care than all the other camps in the area. The UNHCR and Greek Ministry of Health were so impressed with the capabilities, that they designated the camp a site for “medically vulnerable and complex” refugees.
Despite being a primary care clinic, the TR model has allowed major life saving and changing successes that would not have been possible at a typical refugee camp where residents have unreliable access to care. For example, Rafa (name changed) is a14-year-old boy had surgery to place a mechanical heart valve. This complex procedure also required complex and regimented post- operative care. He has required daily visits to the clinic to assist with adherence to his medication, developing a pathway to ensure reliable drug level monitoring, and coordination of care with his cardiologist at a local hospital. The continuity of care needed to manage this resident would not have been possible with the level of access to healthcare provided at typical refugee camps. Quite simply, despite the generosity of the Greek cardiac surgeons to perform the procedure, he would have likely died in the camps without Team Rubicon’s commitment, advocacy and professionalism.
The case of Alia (named changed) is another example of how the mission first, patient first mantra has dramatically changed the lives of those we serve. Alia is a 7-year-old girl with cerebral palsy. She had never walked before. Team Rubicon utilized their network to identify a Syrian physical therapist who could work with Alia and train the TR staff to assist with exercises between visits. In early November, using a donated pediatric walker, Alia walked for the first time in her life. Since, she has been working on strengthening exercises every day and is slowly transitioning from the walker to crutches. This process has involved daily hands-on sessions with Team Rubicon volunteers and behavior modification coaching to encourage her parents and other community members to encourage her to keep trying to walk, rather than carrying her to help encourage independence.
In addition to these powerful individual stories, we completed a history and physical exam on every resident of the camp and have gathered vaccination information on each individual. This data was then entered into a medical passport for each resident, so when they go to the emergency room in Greece or when they move on to another country after being granted asylum, they will able to present this easily transportable, concise summary of their medical history to their new primary care provider. This project took several weeks to complete due to the barriers in recreating health records in this population. The process of gathering detailed data on our population of residents also allowed us to determine which individuals are classified as high risk for seasonal influenza based on WHO criteria, and we were able to vaccinate all residents who qualified.
Importantly, the team of medical professionals who are staffing the clinic are helping to provide the residents here with a sense of normalcy that is otherwise difficult to maintain at refugee camps. These residents are from areas of the world where there was adequate access to health care needs, to physicians, and to pharmacies. Since leaving home, they have struggled to maintain access to basic care needs such as cold medicines, well baby checks and fetal monitoring, access to chronic medications, and routine lab monitoring. Having daily access to a medical clinic allows residents independence and a sense of normalcy that is unique to this camp.
There is a steady turnover in our resident population as some families are granted asylum and families are moved in from other camps. A new family often arrives less than 24 hours after a room is vacated, and we often have no medical information other than what the individuals can recall when we take a health history after they arrive. This is especially challenging to provide quality primary care when many of these individuals have recently had surgeries, been hospitalized, or are taking several medications to manage chronic diseases.
Most residents speak Arabic, but some speak Kurdish and are less comfortable conversing in Arabic. Nurses and most other medical personnel aside from doctors only speak Greek. Most Team Rubicon volunteers and camp staff speak English, but not Arabic or Greek. Many healthcare encounters for this population involve three languages, which slows down the provision of care and can lead to communication difficulties.
As the refugee crisis draws on, many NGOs are running out of funding and either scaling back operations or leaving Greece altogether. Because refugees are being barred from receiving an AMKA number which is needed to access the Greek nationalized healthcare system, refugee populations rely on services provided by NGOs to access medical care. The politics surrounding refugee health in Greece are complex and continuously evolving. The barriers our residents face when accessing healthcare are myriad, and most residents of will be staying here for the foreseeable future.