nedelja, 30. december 2018

IN-FIELD TRAINING AND EDUCATION FOR PARAMEDICS IN HUMANITARIAN SITUATION (CASE of VELIKA KLADUŠA, B&H), Part Three


This type of skin condition (the so-called "military foot") is often seen in persons who spend a lot of time in the same socks and shoes (usually sneakers or boots). As a result of moisture, the skin begins to wrinkle and take mycotic deposits (fungi) on it. The help in these cases should follow the opposite direction to the vector of action: the wet conditions should be replaced with dry, that is the basic measure (i,e. dry, clean socks and shoe change) and the mycotic changes should be treated with anti-mycotic, most commonly by the cream or gel Canesten. In such cases iodine tincture (Betadine, Povidone iodine, etc.) is not a method of choice except in the prevention of secondary infections, and they occur if skin lesions are observed in the skin (open wounds). These wounds can be treated with iodine as well as any other skin lesions, however, in the case of wrinkled skin, Canesten treatment (or some other anti-mycotics) is sufficient. Canesten lubrication should be repeated several times during the following days to monitor the development of skin changes and at the same time control the conditions of the foot (clean and dry clothing and footwear).
Fungal changes can also be seen on other parts of the skin in poor hygienic conditions (breast, armpit, pubic region, vaginal changes ...) wherever the ambient is closed, not-winded, and moist without adequate hygiene and replacement of socks and laundry. For vaginal mycososes, there are Canesten vaginal tablets and cream.


Dimitar Anakie dr. med

torek, 18. december 2018

GENERAL MEDICAL INFORMATION ON REFUGEES AND MIGRANTS IN BOSNIAN AND HERZEGOVINA BRING CLOSER TO LOCAL PEOPLE

GENERAL MEDICAL INFORMATION ON REFUGEES AND MIGRANTS IN BOSNIAN AND HERZEGOVINA BRING CLOSER TO LOCAL PEOPLE
Until June 2018 refugees and migrants solved their health problems in local healthcare institutions of Bosnia and Herzegovina. At that time the heads of local healthcare institutions normally and democratic informed local media about the health situation of this specific vulnerable population. For example, in Velika Kladuše, from dr. Okanović, the director of local health center, reporting to local media, we knew frequency of migrants visit to health center in Kladuša at that time and morbidity they had from visits. Everything in detail, very professionally. Dr. Senad Okanović also commented to media other things related to healthcare of migrants, for example: preventive measures, cost of healthcare of the refugees and migrants and donations they received. Everything was open and democratic. 
    After MSF ostensibly* took over the healthcare of the migrants and refugees 
in Bosnia and Herzegovina the reporting medical information to the public of Bosnia 
and Herzegovina stopped i.e. local community was excluded from the information. 
MSF was reporting only to UN agencies and they republished it in own circles in very 
general, abstract and often beautified manner. Nowadays we have cases like death of 
a minor in the camp for migrants and no one can get any reliable  information  because 
all medical services in primary health care are alienated of democratic mechanism by 
which medicine regularly function. Professional medical standards are simply abolished 
but they must be restored again.
 
Dimitar Anakiev, dr. med 
*Until November 2008 MSF had no permission to work in Bosnia and Herzegovina and their acting in the filed of healthcare from June to November is unclear.

nedelja, 16. december 2018

MSF IN BOSNIA: HOW TO KEEP GOOD NAME WITHOUT GOOD WORK? A FACEBOOK CONVERSATION WITH MSF OFFICIAL STEPHANE MOISSAING

Dr. Anakiev: Eating beans soup in my improvised clinic in camp Trnovi, Velika Kladuša, BiH but MSF failed to see me. It is interesting that MSF doctors never crossed the line of camp, I suppose for security reasons. Their vehicle was always parked by police vehicle on the other side of the river. But how you can practice medicine if you are afraid of your patients?
 
MSF IN BOSNIA: HOW TO KEEP GOOD NAME WITHOUT GOOD WORK? A FACEBOOK CONVERSATION WITH MSF OFFICIAL STEPHANE MOISSAING

 
Following talk took part on the FB wall of S.O.S, Krajina volunteer Adis Imamamović Pixi in the evening of 15th, December and continued in the morning December 16th, Then the whole discussion by some miracle disappeared after my last comment. It is of professional interest because it shows the character of relationships in the field of humanitarian medicine. Perhaps it shows some other things too. That is why I documented it. As a tool of education. (For the sake of authenticity I did not correct English mistakes).






Dimitar Anakiev Thanks Nina Peschi and Moissaing Stephane for you readiness to discuss important issues. But let me step a little bit aside - I think it is wrong to understand Adis Imamovic Pixi comment personally, as an insult. It is a kind of emotional screaming because from June to December nothing is done to improve the situation in Kladuša...We all see that and the question is what we did to change the situation? So what can we discuss without screaming if we are humans and not only professionals? That is the question of personal sensibility too. It seems that only screaming can attract some attention (and make people thinking a bit) sometimes on the base of personal resentment. Pixi spent days and days with refugees in the field living in very similar conditions as refugees and migrants. So there is no other way for him to express his feelings but screaming - refugees and migrants speak through his emotions. That is important to understand. It will be terribly wrong to suppress Pixi's screaming. That is my opinion.



Moissaing Stephane Dimitar Anakiev i do not take it personally. I am not screaming neither. We paid a part of the items he distributed in VK. Good Job. We paid a part of the needed answers that he and Dilan made in the barracks in Belgrade. Pixi supported us when we needed. I was in Sarajevo street last winter too.
I do not take things personally.
I just find unjustified getting angry and getting in crusade against every one by frustrations. Their are quite a number of organisations doing what they can and NGOs based on volunteering that kill themself at work who could get frustrated too.





Dimitar Anakiev My I ask you something like a professional Moissaing Stephane? Also all others who are interested in the discussion of NGO role in humanitarian crisis. Until June 2018 the refugees and migrants had healthcare solved in local Health Centers of BiH. The healthcare law in FBIH explicitly allows access to both refugees and migrants to local healthcare system. Why then MSF came to BiH? Let me remind you that humanitarian standards explicitly ban complicity. What way you see the situation?





Moissaing Stephane Dimitar Anakiev yes exactly; i red your blog full of non-based evidence information and had try to contact you for many months now; please check your inbox. Like the information you give above; not based evidence.
They rules of laws take in consideration emergencies and migrants who are registered. Nonetheless the practice after the ministry of security indicated was that outside of the camps people will not be entitled and no refund will be done. Therefore MSF came to support as plenty of cases where not any more supported. At first we did pay the drugs at pharmacy level, then when no health care where given anymore (first in Bihac) we came.
Now the EU del gave some money and we will leave fast as we are not for duplicates.
The lobby is that somewhat an universal access to health be given and accepted by donors and state.
I think you confuse MSF to do a business, MSF is trying to exit any crisis as fast of possible in terms of not removing the states and donors liability.
MSF is independent and does not receive institutional money. MSF will keep neutrality and invest where their are gaps and aim for fast phase out.



Dimitar Anakiev Moissaing Stephane DfA blog (Doctoctors for Asylees), where I published "non-based evidence" is PUBLIC and connected with FB page and other different pages, so anyone who want to comment can do it PUBLICLY and offer evidence if missing or better evidence if my evidence is not correct... So sending private messages to one who offers public communication about public and professional things do not seem to me really professional approach. Even more incorrect is publishing instead in communication on FB - without any proofs- opinion that my blog is "full of non-based evidence". That is classical labeling, which is tool of disqualification of interlocutor. A political tool. All this is not picture of professionalism... I do not want to comment other of your statements because FB is not the place to do it but just short thanks for introducing the MSF. What I was able to see in Bosnia is that level of your work is not very high but I suppose that is because of circumstances and not because of corruption. BTW: corruption is not related only to the money and sources of money. Very often corruption can be accepting some politics and similar moods.



Moissaing Stephane Dimitar Anakiev clearly not based evidenced. We can discuss it privately, this is an invitation. (Not the first invitation but this one cannot be ignored)
And invitation to discuss is not disqualifying is just to understand other perspectives. Regarding qualities and neutrality we are not afraid to be challenged since challenges open rooms for improvements.



Moissaing Stephane Dimitar Anakiev public debates should not be done while non-based evidence and assumptions goes to allegations. Discussions and understanding of everyone limits should be favoured. For 21 years of field work (among it volunteering too) it is the first time i comment publicly... you guys are going a bit far in alleged short-cut. And that brings not thoughtful insights in mobing.

Moissaing Stephane Dimitar Anakiev next time accept my phone call and answer messages. I am always happy to learn.

Moissaing Stephane Dimitar Anakiev and i never seen you in the field. While i am reported rare appearances of yourself in the field but never witnessed it but always missed you when informed. What should it mean; you mostly watch and complain?

Moissaing Stephane Dimitar Anakiev in 2014 and part of 2015 i was calling MDM (for which i worked too) as problems where even bigger than now. Where were you?





Dimitar Anakiev It is very contradictory invitation Moissaing Stephane: at the same time you continue public labeling (even being warned before) and suggest private discussion about public, medical data. As a MD I am obliged to instruct you that medical data are of public interest. I again invite you to correct my evidences at the site where they are published. That is of public interest. It has nothing to do with my private discussions... After such beautiful introduction of yourself I am sure I will next time answer your private phone call... It is not much tragic that you missed to see me in the field, but it is really tragic that you missed to see the situation in the field. You needed not to make private calls to me but official calls to the Mayor (how many calls to Mayor of Kladuša? How many meetings? How many calls to the Chief of Utility? How many calls to the Chief of Water Supply? Etc. Etc. How many written reports of proposals? To whom? How many official complains? To whom? After you did couple of dozen of reports, proposals, meetings etc. you can speak about "21 year of working in the field". If you worked 21 year like you work in Kladuša it is not something that you need to be proud... Sorry. And BTW: I am not playing hide 'n' sick. I do not know who you was able to see in the field. Do not ask me such questions.



Moissaing Stephane Yes public interests, for this reason we report to the health ministries and agencies. And are happy that pubilc health issues are openly on the table.
Never seen you on the field while i have seem every-one else. Sorry for that. It is not hide and seek. It is because you are not there.



Moissaing Stephane Dimitar Anakiev you did some support though. Thanks for it. All should be grateful for it.
Yes; maybe contradicting myself. But direct contact is avoided. Then??? Answers have to be given while people are not willing to discuss individually.



Moissaing Stephane Dimitar Anakiev call me tomorrow and we can have all the times we need to be informed.

Dimitar Anakiev Direct contact is not avoided just I am too busy right now. We can talk when we meet in the field, or somewhere around. I will call you and invite to be my guest. Be sure about that.



Moissaing Stephane Dimitar Anakiev cannot wait after so many months!

Dimitar Anakiev Moissaing Stephane Probably in January if everything is OK. Until then - All the best in New Year!



Moissaing Stephane Yes because you are not there.
Dimitar Anakiev Because you are not my top priority



Moissaing Stephane Dimitar Anakiev yes what I said you are not there.




Moissaing Stephane Dimitar Anakiev easy to be a critics philosophic man when not even able to check in and be there.



Moissaing Stephane Dimitar Anakiev There are few groups in Bosnia that do amazing, they are there from morning to evenings, check on vulnerabilities while delivering services, keeping themselves high in spirits, go through many challenges, and that in Sarajevo and USK. There are groups in Montenegro, Albania, Macedonia, Hungary, Bulgaria who are holding grounds. There are individuals who give their time for better, there are a lot of challenges that normal people would like to resolve. But they are there; I see them. Thanks for all of them, but when I do not see someone who speaks in social media, mhhhh...



Dimitar Anakiev You are just jumping from topic to topic. I have no time to follow all your interests. .. About philosophy: you even do not know that medicine is not philosophy... Simply you are not doing your job well. People suffer because of your comfort. That is not philosophy. You just need to be in the field and see it. And your communication is not on the level we have in medicine. You are a guest in medicine, that is the problem. You communicate like in tavern, without a sense of responsibility. You are far from patients and you cannot build empathy. You do not bring people suffering with you. That is why you are so talkable. Yeah, you do not bring patient suffering with you during the day, during the evening and night, you do not wake up with people's suffering, that is the biggest point... It is too many demerits. Sorry, nothing personal in all this. I just try to help you understanding your job but some things you must feel yourself. Medicine needs specific profile of people. You discuss medicine with the doctor like drinking beer, without any respect to the job. Not good, my friend.



Moissaing Stephane I am in the field. And you fail to be.



Dimitar Anakiev Drink one beer for me, please!



Moissaing Stephane Dimitar Anakiev I am not, sorry to disappoint. Go to the field before the next 15 days, we will be happy to listen to you.





Dimitar Anakiev My field is named medicine. You are not in my field, that is why you cannot see me. What is the name of your field I am not really interested. But the effects of your work in medicine is not really good.

Moissaing Stephane Dimitar Anakiev you talk and you do not come to the field. Please go where migrants are and practice. Or come where migrants are and research in academic manner. You are not where migrants are. You are not in the field. You write things with a big gap with reality. You only visit times to times but too rarely.



Moissaing Stephane Dimitar Anakiev check in first. You like too much the social media but not the cold :-)))



Moissaing Stephane Dimitar Anakiev stop justifying you. When you will come to the field visiting Migrants and us; please give a ring. I guess it will not be really soon since you do prefer the comfort of distance.
Then in term of Medical monitoring and quality of care; y…See More



Dimitar Anakiev Moissaing Stephane your only tool of communication is labeling. My dear, I am a GP with 30 + year of medical practice mostly in field. I am volunteer in SOS Team Kladuša and I do not remember seeing you around. You, a politician, dare to teach me how to practice medicine in cold? Shame of you. You are not worthy of working in humanitarian field. Because of people like you the situation in health care in BiH is such as is-catastrophic. Before all with your style of thinking you are a dilettante. You do not belong to the field of medicine. Probably Adis Imamovic Pixi not failed much in his judgement about a corruption. It is more and more obvious.


15/16 december 2018



sreda, 12. december 2018

VOLUNTEER’S MEDICAL TEAM (VMT) IN VELIKA KLADUŠA TREATED MORE THAN 700 PEOPLE IN ONE MONTH

VOLUNTEER’S MEDICAL TEAM (VMT) IN VELIKA KLADUŠA TREATED MORE THAN 700 PEOPLE IN ONE MONTH
 
From November 13 to December 12 the VMT in Velika Kladuša, B&H, treated more than 700 refugees and migrants from 17 different countries with different illnesses and diseases (587 of them documented). Morbidity shows the following image: the three of the most often medical situation to ask for help were:
 
411 wounds and different skin conditions 
94 flu cases (including respiratory problems) 
 44 toothache
 
The detailed morbidity report is coming soon.
 
Dimitar Anakiev, 
MD GP and Global Health spec.

sobota, 1. december 2018

IN VELIKA KLADUŠA FIRST FROSTBITES AND FIRST SEEKERS OF PSYCHOLOGICAL HELP

IN VELIKA KLADUŠA FIRST FROSTBITES AND FIRST SEEKERS OF PSYCHOLOGICAL HELP
 
Last night temperature in Velika Kladuša officially went down to -6 degrees C. In wetlands by river Kladušnica given by the municipality to refugees and migrants for living it went even to -8. Volunteer Medical Team (VMT) of SOS Team Kladuša report about 50 new patients treated today for different medical cases: most of them (27) because of wounds (88) and different skin conditions (including scabies). Three epidemics are still dancing in nearly same rhythm: 10 new flu cases, one new gastroenteritis, 6 new cases of toothache. The first time VMT treated frostbites. Because of no shelter and also no regular WASH infrastructure in camp Trnovi such wounds are very hard to treat regularly. In a country where UN agencies work in the field more than 20 years we have situation that more than 2/3 of refugees and migrants are facing winter without proper (or any) shelter, without WASH infrastructure and without primary healthcare. What does it it mean? It clearly speaks that political will of responsible politics acts in a direction of massive violation of numerous human rights... I heard today that a group of international lawyers are preparing a lawsuit against those responsible for human rights violations to refugees and migrants in BiH. That means also against many actors of “international community” and EU bureaucrats. I think it is not bad idea. We can learn many interesting things from such lawsuit. For example: is such massive violation of human rights a kind of torture? Then: who suspended Healthcare Law of FBiH allowing explicitly health service to both categories: refugees and migrants? Etc. Etc. ...VMT reports about first cases of refugees and migrants seeking psychological help. People are heavily bitten and then forced to sleep in wetland without shelter and infrastructure. Without healthcare rights it is not easy to support them psychologically apart from help offered by S.O.S. volunteers.
 
Dimitar Anakiev, MD GP and Global Health spec.

petek, 30. november 2018

THREE ON GOING EPIDEMICS AMONG REFUGEES AND MIGRANTS IN VELIKA KLADUŠA: FLU, ENTEROCOLITIS AND TOOTHACHE

THREE ON GOING EPIDEMICS AMONG REFUGEES AND MIGRANTS IN VELIKA KLADUŠA: FLU, ENTEROCOLITIS AND TOOTHACHE
 
As temperature falls, health problems of refugees and migrants population increase. Our Volunteer Medical Team (VMT) reports about new 56 cases of patients in only few hours that were seeking medical help from VMT today. Thirty of them came because of wounds and different skin conditions (120 wounds were treated today), 15 new flu cases (5 more than yesterday - total number of flu infected patients is close to hundred in one week, that is between 20 to 33% of inhabitants of wild camp Trnovi). Some of flu infected are also with respiratory problems (let me remind you that this year we already had death of refugee because of pneumonia), then 8 patients came because of toothache (yesterday 5 patients had toothache) and additional 3 enterocolitis cases today. Among the wounds, the number of burns increases (yesterday one, today three).
Ones who receive high daily allowances for a year to protect migrants have not been able to date to do the winterization of the camp Trnovi in Velika Kladuša, BiH. We expect further deterioration in the health of the migrant population (defined as specially vulnerable in humanitarian texts) and possibly new fatalities. Every responsible humanitarian worker would immediately declare a state of humanitarian emergency in these conditions. 
 
Dimitar Anakiev, MD GP and Global Health spec.

torek, 27. november 2018

NEW EPIDEMIC AMONG REFUGEES AND MIGRANTS IN VALIKA KLADUŠA: GASTROENTERITIS

NEW EPIDEMIC AMONG REFUGEES AND MIGRANTS IN VALIKA KLADUŠA: GASTROENTERITIS
Along with new ten cases of flu infected refugees and migrants the VMT* of S.O.S Ljuta Krajina report today about five cases of heavy diarrhea with vomiting. We do not know how many cases (if any) are registered by MSF who patrols three times a week by camp Trnovi and we do not know to whom they send reports, probably to UN agencies but nothing of that was publicly announced until now. Five refugees and migrants with diarrhea and vomiting were seeking help from S.O.S. Kladuša medical volunteers. We know that the health situation of people in wild camp Trnovi (not winterized in 6 months) is already dramatic. At the moment two epidemics are ongoing (flu and gastroenteritis). Coming winter with snow and temperatures under zero (often -10 degree C) will be additional challenge to people sleeping on the ground. Government of BiH and UN agencies was not able to hear until now numerous warnings coming from media and civil society about improving living conditions to refugees and migrants in BiH. Official information from UN agencies says they lodged 1/3 of total number of migrants and refugees but some parameters show that only about 1/10 of all refugees and migrants (10%) is accommodated in proper way. Despite what they say and despite the healthcare law of FBiH in one year government of BiH and UN agencies also failed to secure proper health care for the majority of refugees and migrants.
Dimitar Anakiev, MD GP and Global Health spec.
*VMT-voluteer’s medical team

ponedeljek, 26. november 2018

EPIDEMIC OF FLU AMONG REFUGEES AND MIGRANTS IN VELIKA KLADUŠA, BiH

Today, in only couple of hours, 53 refugees and migrants were seeking help from the volunteer’s medical team (VMT) of S.O.S. Ljuta Krajina in Velika Kladuša. Thirty of them needed help for different injuries and skin condition while 23 refugees and migrants came with symptoms of flu. Medical volunteers of S.O.S. started reporting about flu epidemic from the last Friday (23.11.) when first ten refugees and migrants came to them with the symptoms of flu. From Friday each of next days about ten new patients visited our medical volunteer with the flu symptoms but today the number of new flu infected patient increased to 23 on the daily base. No need to say that most of the flu infected patients came from the wild camp Trnovi (not winterized) where they sleep on the ground of wetland covered often only with polyvinyl. Also no need to say that you will not find information on epidemic in the reports about healthcare of refugees and migrants composed by UN agencies. Partly the reason for this silence is in non-existence of proper humanitarian or regular health service for refugees and migrants in BiH (so the documentation and information are generally missing), partly the reason lies in concealing style of reporting practicing by UN agencies in BiH. Until now no one of epidemic that occurred in Velika Kladuša camps were reported in public including very heavy epidemic of gastroenteritis that has arisen this August when 2/3 of the camp Trnovi (approximately about 300 people) were suffering from vomiting and diarrhea (many of them went to toilet more than 20 times per day) but this dramatic medical event did not find its place in any official report. (photography: S.O.S. volunteers in medical action in Telakić street of Velika Kladuša, BiH)

Dimitar Anakiev, MD
GP and Global Health spec.

nedelja, 25. november 2018

DEMAND FOR THE ESTABLISHMENT OF THE STATE OF HUMANITARIAN EMERGENCY IN BOSNIA AND HERZEGOVINA WITH THE AIM OF SAVING HEALTH AND LIVES OF THOUSANDS OF REFUGEES AND MIGRANTS (Short draft)

DEMAND FOR THE ESTABLISHMENT OF THE STATE OF HUMANITARIAN EMERGENCY
IN BOSNIA AND HERZEGOVINA WITH THE AIM OF SAVING HEALTH AND
LIVES OF THOUSANDS OF REFUGEES AND MIGRANTS (Short draft)

Dimitar Anakiev, MD
spec. Global Health

Ongoing humanitarian crisis in Bosnia and Herzegovina has reached a dramatic phase: the winter. It is the last moment to prevent harder consequences by establishing the state of humanitarian crisis. The government of BiH is not capable of solving the refugee & migrant crisis which takes place in its territory. On the other side humanitarian organization IOM, UNHCR, UNICEF etc. which spent most of the money allocated to solve the crisis, haven't done what was necessary. We face misleading reporting about the situation.

1.BOSNIA AND HERZEGOVINA: West Balkans' state Bosnia and Herzegovina (3.5 mil. population) belongs to the category of so called post-traumatic societies. Very often it is referred to as “failed-state”. Its political system does not function properly, official unemployment rate is at 35.33 percent, corruption index 38. Health care system in the country is still in development after wars in the 90'. Conflict of 1991-1995 in the region produced more than 74.000 uprooted civilians (refugees and IDPs). Because of the above mentioned Bosnia and Herzegovina itself is the subject of humanitarian, economical and political help with the High Representative from EU. In the new refugee and migrant crisis (Balkan Route No. 2) it appears that Bosnian government together with humanitarian organizations which are operating in its territory (IOM, UNHCR, UNICEF...) is not able to face a global flux of refugees and migrants on a regular basis: a dangerous humanitarian crisis has been created in BiH in the past year, which has not yet been officially disclosed even though civil society is constantly warning. Less than 10% of the total number of incoming refugees and migrants are properly treated. Reports given by humanitarian actors very often have no informative value or are misleading.

2. REFUGEES AND MIGRANTS IN B&H (POPULATION): The authorities in Bosnia and Herzegovina (BiH) detected the arrival of 21,201 refugees and migrants to the country between 1st of January 2018 and 31st of October 2018. This increase follows a large increase in September, after a relatively stable four-month period between April and August in which an average of 2,329 arrivals were detected each month, with a low of 2,293 and a high of 2,489. It is estimated that between 4,500 and 6,000 refugees and migrants remain in BiH in need of humanitarian assistance at various locations, in particular in Una-Sana Canton (USC).

3. ACCOMODATION/SHELTER: “Establishing sufficient, winterized, safe, and protection
-sensitive accommodation has been and continues to be a key challenge and focus of the response.” (UNCHR). The UNCHR statement from the same report continues: “ While occupancy rates fluctuate on a daily basis, as of 31st of October 2,064 spaces were available across six locations in BiH, not including safe accommodation and hostels made available to a limited number of particularly vulnerable cases.” To this data it has to be added that only 450 spaces of mentioned 2,064 have regular public health control, like the one in Hadžići (Public health control is not carried out in neighboring AC Trnovo, for example). That means that 3/4 of mentioned 2064 spaces are not suitable for accommodation. Therefore the assertion that almost 1/3 of the refugees and migrants are adequately accommodated is misleading. Over the year, the BiH authorities and humanitarian actors have provided accommodation for less than 10% of the refugee and migrant population. Even more confusing is that the UNHCR report does not mention hundreds and hundreds of men, women and children who are facing winter conditions, sleeping in wetlands, on a bare ground, covered only with polyvinyl. In Bosnia -10 degree Celsius is a normal winter temperature. Let's recall: in the humanitarian cluster the task of the UNHCR is precisely to build a shelter. More than 90% refugees and migrants are facing Bosnian winter without a proper shelter, a huge number of them have no shelter at all.

4. HEALTHCARE: One of the most dramatic sectors of humanitarian refugee crisis in BiH. Reports written by humanitarian actors are incompetent and misleading. Following their reports one can learn that refugees and migrants are incorporated into primary health care of BIH. The phrase “primary health care” is repeated nearly as many time as phrases like “basic standard” or “kitchen”.
But it must be clearly and loudly stated that refugees and migrants in BiH do not have access to the primary health care. Even more, from June 2018 they have been denied access to the health care system of BiH and pushed into uncertain embrace of humanitarian medicine (the MSF, which took part in separating refugees and migrants from the local healthcare system, was waiting for work permission for more than 10 months). The UNCHR report on healthcare from October 2018 contains exactly 1071 words but among them not even one basic parameter of healthcare can be found: no mortality, no morbidity, neither any other parameter. Total number of medical check-ups (3580) in the entire Bosnia and Hercegovina, that is mentioned in the report, is unrealistic for such a big population with special needs. One small health center alone, like Velika Kladuša, during the period when refugees and migrants were part of BiH health care (until June 2018) had about 1000 check ups per month serving 6 time smaller number of refugees! This indicates, what we all know, that health care of migrants and refugees actually does not exist, especially not primary health care and public health control. As a consequence, we can see volunteer medical staff helping migrants in the middle of the street, in the fields or in the inns. The situation is dramatic. The UNHCR health care report does not mention any epidemic among many we had witnessed. Further more, the UNHCR report does not mention to what extent have he instructions of Institute for Public Health BiH issued in May 2018 been applied until today? How many doctors have been mobilized in and in how many medical teams? How many unemployed and young doctors are among them? How many specialists? We do not know anything about it because not a single step has been is made. Ten days ago we noticed a young refugee in Bihać with a big open wound on his femur after the curettage of phlegmon in a local hospital. He was putting bandages on it in the middle of the street. In Velika Kladuša a team of volunteers cares for about 30 refugees and migrants on a daily basis and offer medical care on the streets. At the very moment they report about flu epidemic among migrants from wild camp Trnovi. What is the medical situation in wild camp Ključ? We do not know. But somehow professional humanitarian actors still fail to recognize the situation.

CONCLUSION: Thousands of refugees and migrants without shelter and health care are facing the Bosnian winter. It is the very last moment to activate humanitarian emergency cluster by establishing the state of humanitarian crisis in Bosnia and Herzegovina.

ponedeljek, 19. november 2018

IN-FIELD TRAINING AND EDUCATION FOR PARAMEDICS IN HUMANITARIAN SITUATION (CASE of VELIKA KLADUŠA, B&H), Part Two

IN-FIELD TRAINING AND EDUCATION FOR PARAMEDICS
IN HUMANITARIAN SITUATION (CASE of VELIKA KLADUŠA, B&H), Part Two

Dimitar Anakiev, dr. med
GP and Global Health spec.



1.BASE OF MEDICINE:



-INFLAMMATION OF DAMAGED TISSUE: Paramedics in the field very often meet inflammation of damaged tissue (skin, for example). Orientation about degree of inflammation is very important for both: triage and treatment. The four cardinal signs of inflammation are: redness (Latin rubor), heat (calor), swelling (tumor), and pain (dolor).



-DEVELOPMENT OF SITUATION: Another important issue to discuss is development of medical situation. Following the development is important to learn more about our treatment

(sufficient or not) and about nature of the illness. That is why we order patient to come again (in three days, for example).



2.HUMANITARIAN MEDICINE:



International humanitarian system, that is today broken, is formed in the end of 1960' during the Biafran secession war (1967-1970). Among many international medical humanitarian organizations in the region of the Balkans we mostly meet Médecins Sans Frontières (MSF) and Médecins du Monde (MdM).Two sister organizations have a different ways of working: while the MSF prefers isolated work of experts („jump and go“ system), the MdM builds its work on the basis of connecting to the society in the way primary health care is usually defined. This is a triad of medical humanitarian activities described by the MdM:



1.Health Care

2.Documentation

3.Advocacy



We will see in continuation how important is documentation. In humanitarian situation many participants simply forgot to document own work. That is the most typical mistake especially among medical crew coming from public sector. Documentation is a tool to control chaos, it is the foundation of medical work and finally a base for advocacy-an obligatory posture of humanitarian medical worker.

3.MEDICAL PROCEDURES (CONTINUATION ON SKIN SITUATIONS):



More than 70% percents of refugees and migrants in Velika Kladuša suffer from different skin diseases (15% scabies). This the result of substandard hygiene condition. Treatment of these diseases is part of obvious front line duty of paramedics together with injuries (75% of injuries are result of EU police violence). Let us take a look at some of typical skin situations:

-MYSTERIOUS PLANT: Following skin conditions are result of contact with mysterious plant that lives in woods around Velika Kladuša. Typical white foam that goes from the infected parts of the skin speaks that probably plant contains some toxic substance that irritates the skin. Often we also see secondary infection (yellow brown scabs). Infected skin creates berry likes papules that are commonly seen in viral skin infections. We really do not know what is this plant and its toxin.





 
Suggested treatment:

1.washing with water (plus soap)

    2.curettage with gauze and iodine
    3.covering or not
    4.control of development


-BACTERIAL INFECTIONS


They are very widespread with varying degrees of tissue inflammation (redness, heat, swelling, pain!). Cleaning is very important, especially in the case of abscess (purulent collection) - extruding purulent content is necessary if possible. 
  1.  
                                                      case of abscess

                                                                   inflamation (redness, swellin) worthy of Betadine net 
     Suggested terapy: 
1.cleaning

2.curettage with gauze and iodine

3.Betadine cover.



-TREATMENT OF WOUNDS

One of greetings of European democracy:


Clean, not close! Only gentle protection of wound is suggested.

 Photo documentation: Adis Imamović Pixi



To be continued

petek, 16. november 2018

IN-FIELD TRAINING AND EDUCATION FOR PARAMEDICS IN HUMANITARIAN SITUATION (CASE of VELIKA KLADUŠA, B&H)

 
IN-FIELD TRAINING AND EDUCATION FOR PARAMEDICS
IN HUMANITARIAN SITUATION (CASE of VELIKA KLADUŠA, B&H)





Dimitar Anakiev dr. med

GP and Global Health spec.



Humanitarian situation has been present in B&H frontier from June 2018. Since November same year we started organizing In-Field Training and Education with Paramedics of S.O.S. Bosnian Frontier volunteers practicing in field and street medicine. Training and education topics are grouped in three section: base of medicine, humanitarian medicine principles and medical procedures.



1.BASE OF MEDICINE:



Medicine is by nature autonomous work regulated by own rules. That means in no case medicine work cannot by ruled by police. We discussed general medicine principles expressed by proverbs:
Primum non nocere (First, do not harm). That usually means that practitioner uses only procedures that he/she is trained.
Medicus curat, natura sanat (A doctor administers the cure; nature does the healing.) is also discussed.
We discussed also differences in approaches of „clinical medicine“ and „in-field medicine“. Clinical medicine means work in „controlled conditions“ while „in-field medicine“ means opposite: work in uncontrolled condition. That is why sometimes they use different measures. In clinical condition we usually do not put iodine on open wound while in-field we often do so in case of small wounds and skin ulcers. The similar case is use of antibiotic: in bad hygiene conditions prevention of secondary infections is more important than side effects of use of antibiotics etc.



2.HUMANITARIAN MEDICINE


Different from „social medicine“ (medical assistance to poor) which is regular part of the political system and mostly included in different institutions (like churches etc.) humanitarian medicine provides medical care out of the system (mostly „in-field“) and is politically independent – that means: not controlled by government. That is why governments usually hesitate in allowing humanitarian medical work. Four basic principles of humanitarian medicine are:



-Humanity (health & dignity)

-Impartiality

-Political independence

-Neutrality (avoiding risk of complicity)



3.MEDICAL PROCEDURES (CURETTAGE AND LOCATION OF PAIN)



Supervision of work of the team of paramedics of S.O.S. Bosnian Frontier showed that treatment of wounds is not always proper i.e. cleaning of wounds must be better. It is especially important in substandard hygiene condition. That is why I introduced the technique of curettage (Curettage is medical procedure meaning use of a curette /French, meaning scoop/ to remove tissue by scraping or scooping.) and improvisation of curette (A curette is a surgical instrument designed for scraping or debriding biological tissue or debris in a biopsy, excision, or cleaning procedure) by using gauze or bandage as the tool in combination with Povidone-iodine. This simple but efficient improvised medical procedure was very well accepted by our paramedics and soon they changed way of treatment of wounds with superb results.

Also we trained location of pain by palpitation of numerous contusions (result of EU police violence) judging degree of pain, outspread of pain and functionality of injured part of the body.



To be continued...