Dr. Zuzanna Govednik Kraskova: Na poti (k boljšemu življenju)

Na poti (k boljšemu življenju)

Prispevek začenjam z metuljem, tistim bitjem, ki se iz ruševin z lahkoto dvigne in (od)leti. Tako vidimo njegov let. Lahkotnost pa je raje kot ne,  le navidezna. Vedno vseprisotno navidezno je tudi temeljni pristop vseh psihoterapevtskih metod. Alegorija pometanja pod preprogo  K. G. Junga  namreč opozarja  ravno na prisotnost navideznega, ki nosi bremena posameznika, skrita v globini njegove duševnosti, na tistih krajih osebnosti, kjer  se dogaja nekaj povsem drugega; psihična zmeda; strahovi, stiske, travme izhajajoče iz frustracij, ki so se zgodile neznano kdaj in neznano kje, neodvisno od človekove volje, ki bi se rad na hitro in za zmeraj izvil iz njihovega usodnega primeža.
Namen zajeziti, omilit in, ozavestiti duševne, kakor tudi psihosocialne stiske stanovalcev azilnega doma v Ljubljani (v nad. AD), se je l. 2016 zgodil na pobudo Dr. Dimitra Anakieva, in glede na uspeli poskus omenjene pomoči se je izkazalo, da je bila zamisel odlična.
Nudenje psihosocialne pomoči in psihoterapije je bil sicer zastavljen za širši nabor stanovalcev, takorekoč za vse, ki bi jih tovrstna pomoč pritegnila, vendar večje zanimanje za program, sodelovanja in nenazadnje učinek pomoči, se je izkazal pri ženski populaciji AD. Zamisel o debatnih delavnicah, ki so bile lahko  tudi krožki, krožki pa so bili tematski je rezultirala lep nabor žensk; mater, samskih deklet, deklic. Vzrok za uspeh projekta je bilo pripisati filistejsko in široko zastavljenemu programu, ki je vseboval tematike sestavljene iz tradicionalnih in kulturnih razlik ter kulture in običajev iz dežel prihajajočih žensk; na področju kulinarike, mode, ročnih spretnosti, tradicionalnih obredov, vzgoje, umetnosti itn. Drugi pol projekta pa je vseboval  približke kulturnih razlik in značilnosti narodov zahodne družbe, kulture, katere del si želijo biti.
Iz vidika podpore je projekt vseboval socialno in psihološko svetovanje, ki  se je izvajal običajno med delom v krožkih,  psihološko svetovanje pa je potekalo individualno.
 Program je bil  zasnovan tudi na  nevsiljivi, predvsem pa prostovoljni psihoterapevtski obravnavi. Za izjemno uspešno smo ocenili obravnave s pristopom art/kreativne  terapije. Kar je razumljivo, kajti kreativnost je vedno in povsod kreativnost, raven, drug svet, ki prekriva tega našega …
Empirične izkušnje iz vidika psihološkega svetovanja lahko opišem kot na novo doživeto lekcijo iz praktičnih psiholoških vaj med študijem. In nikakor ne tistih lahkih. Kajti klientke niso vedno kos položaju, v katerem so se one in njihove družine znašli,  zato  svoje psihične stiske izražajo izjemno težko, ker se jih bojijo in jih odklanjajo kot neresnične. AD jim ne nudi doma, je začasno prebivališče, kar se je zarisalo v njihov  psihični zemljevid, ki čaka novo, bolj svetlo risbo, morda novi dom.
Pri psihoterapevtskih obravnavah pa  empirična kognicija postaja še širša, globlja. Ne morem se upreti misli, čeprav je jasno, da je vse pogojeno s kulturnimi vidiki matične države, da te matere in dekleta, ki si takoj, ko je to biološko omogočeno, želijo postati matere. Strastno  stremijo k temu prvinskemu instinktivnemu cilju, kajti verjamejo, da je to njihovo edino poslanstvo. Hkrati pa status matere predstavlja miren zaliv zavetja, kajti materinstvo jih ustanavlja, ščiti, jim da kredibilnost. In v še nekaj, trdno verjamejo, da jim materinstvo nudi družbeno pravico sploh – biti.  In živeti. Na psihoterapevtskih obravnavah sem imela možnost svojim klientkam, posebno tistim, ki ne morejo imeti (več) otrok ali težko zanosijo, ponuditi različna izhodišča (izobraževanje, kreativne vidike, ustvarjanje, raziskovanje ipd.), kar jim zahodna družba , nenazadnje že AD omogoča. Terapije so v večji meri obrodile sadove, kajti kreativna terapija ponuja globlje dojemanje svojih talentov -  lahko so v obliki izjemnih ročnih spretnostih, likovnih kreacijah (nekaj od teh kreacij imam na delovni mizi in jih bom hranila za vedno). Postale so del mene. Psihološka svetovanja in psihoterapije iz tega projekta pa tudi. Na primer, tiste težke in na videz brezupne obravnave, za katere se zdi, da - ne da le ne nudijo rešitve, ampak glede na tradicijo, način življenja in kulturne vidike, so po zapovedi del osebnosti teh ljudi oz. v tem primeru žensk. Toda krivice, poniževanje, ortodoksni, fundamentalni, sekularni pristopi  pojmovanja žensk in ljudi nasploh nikakor ne morejo biti naravna izbira, saj se človek rodi svoboden in ni v njegovi naravi (nekaj kot sprejemljiv) aspekt ujetosti, suženjstva in poniževanja. Če je, ga je trpljenje naredilo takega – kar je bilo  pri nekaterih klientkah zaznati. Čeprav le zaradi njihovega družbenega položaja v državi iz katere izhajajo. A to se bo z novim načinom življenja v EU vsaj v zanje sprejemljivem kontekstu, to upanje  v sebi nosijo vse. Kajti te dame imajo močan občutek za pravičnost in verjamejo v dobro, ki ga svetu z rojstvom prinese vsak posameznik, svet pa mu vrne tako, da ga naredi zlega.  Naj torej tudi sklenem z G. K. Jungom -  Zdravi ne mučijo ljudi, mučeni postanejo mučitelji …

Dr. Zuzanna Govednik Kraskova, mag. psih.soc.pom.

MASTER OF SCIENCE (complementary sciences, clinical psychology, clinical psychology approaches/ali/approaches to clinical psychology (izberi kar se ti bolje sliši, oboje je prav), psychosocial approach: (University of Ljubljana: Faculty of Medicine, University of Ljubljana: Faculty of Arts; School of Advanced Social Studies)
DOCTOR OF SCIENCE (social psychology; University of Ljubljana: Faculty of Medicine, School of Advanced Social Studies)

 

ALI "NIJZ: ZAVAJA JAVNOST?

ALI "NIJZ" ZAVAJA JAVNOST? Inštitucija znana po političnem dojemanju medicinske stroke, ki je ob razglasitvi pandemije COVID 19 podala v javnosti "strokovno mnenje", da zaščitne maske niso potrebne - in s tem ogrozila predvsem medicinske delavce -izkazala se je včeraj v Delu z zelo dvomljivo interpretacijo grafikona pandemije (rdeča črta na spodnjem grafikonu) iz katere izhaja da bo epidemije konec sredi aprila. V resnici, če bi sledila predstavljenim podatkom, bi rdeča črta morala imeti valovito obliko iz katere bi bilo razvidno, da bodo prišli še drugi valovi. Zdravniki v službi politike? Slovenska posebnost.

Dimitar Anakiev, dr. med

CRIME AND PUNISHMENT

 Photo: Dirk Planert


How can it be that it is a crime to help people?

We connect feet, we clean wounds, clarify about basic hygiene, prescribe paracetamol to fever patients, and much more - just for the reason because no one else does. Neither the red cross in Bosnia, neither the local hospital, nor any international aid organisations.

What are we supposed to do?

Should we just turn around and let these people screw up and melt? That is literally what happens in vucjak if we do not intervene. And now we're not allowed to intervene anymore. We were kicked out of camp and even had to pay a fine for doing the work that we do the work, Bosnia, Bosnia and the European Union. We have even done this job voluntarily and voluntarily.

Are you kidding us?

In a camp like vucjak, even a small cut wound is a serious injury. It is not helped people when a few times a week the doctors and sisters show up and treat only the emergencies. Because a small cut wound develops, under the crappy conditions in vucjak, within days, in an icy wound, which takes a whole limb. And something like this must be prevented by daily, Multi-hour medical care. In fact, these people are simply helped when you clean the wound and change the bandage or even protect the wound with a bandage.
Yesterday I was at camp and I had to say to the people repeatedly: No, I must not treat you. No, I'm not looking at your wounds. No, I can't help you. No, I was banned. It was the most difficult thing I've had to do in a long time. How can i deny these people basic help, if I can actually help them, should, will and even have to? In Germany you can be charged with failed assistance!
It's puking! We're puking. Bosnia is puking me. The EU is puking on me. This is a daily violation of the convention on human rights, for which the EU has even received a peace prize. A convention on human rights, which has also signed Bosnia. Every person has a right to medical care!

Refugees too!

Johanna Thomé, team vucjak

The comment:  The situation shows very well and very openly the character of European Union. Defending rights of refugees & migrants and avoid at the same time direct political action against the EU politics at this address is not possible. It is not possible to avoid giving precise and right political names for the political actors and their servants. It is not possible of defending human rights in abstract way addressing mist and fog instead of real reasons for the humanitarian crisis we face in B&H and around the globe. I must say I am very much ashamed of my colleagues, medical doctors and medical associations, medical chambers etc. (profession and organization with enormous power and influence) for being silent, for being conformists, for pretending that massive human rights violation related to medical care of refugees and migrants is something happening apart from political system they belong acting as ostriches, acting as the violation of human rights related to health care is not part of their regular duties, duties of medical doctors. Reduction of medical profession to being apparatchik is very much shameful for this profession. Very similar can be said for all medical humanitarian organizations... At the same time I want to congratulate common people educated (or not) in hurry to act as paramedics & medics & ... for the purpose of assistance of people in need as volunteers in the field along with some rare professionals enough courageous to voluntarily do their professions against the will of politics with clear advocacy of human rights. Along with shameful politics of EU we face huge erosion of medical profession in context of massive violation of human rights. We are back in 19th century. Welcome to the hell!

Dimitar Anakiev, MD (DfA)

MEASURES TO FIGHT EPIDEMIC OF SCABIES IN CAMP VUČJAK, BIH

MEASURES TO FIGHT EPIDEMIC OF SCABIES IN CAMP VUČJAK, BIH


Dimitar Anakiev, MD
Global Health spec.


According to the last report (yesterday) of our chief medic in camp Vučjak by Bihać, BiH the morbidity from scabies among refugees and migrants is 2-3 times higher than expected in such conditions (10-15% should be the expected percent, instead we have 30%). Scabies is most often spread during a relatively long period of direct skin contact with an infected person (at least 10 minutes) which may occur during sex or living together but spread of infection may also occur during brief contact or by contaminated objects. It typically only occurs in those with a poor immune system (refugees and migrants are typical case). Areas with a lack of access to water also have higher rates of disease but 2-3 times higher rate shows that medical care does not exist at all. That is not acceptable for many reasons. Also, "symptomatic therapy" does not exist. Bad conditions are often taken as an excuse but the measures to fight scabies in such conditions are relatively simple if medical workers in the field are willing to firmly and systematically organize themselves in the very direction of healing so massive infection of people from scabies.

Let us see what is needed:

Causal therapy:

1. BENZYL-BENZOATE (BENZIL BENZOAT in Bosnian). Very effectively heal scabies if used properly and together with measures of hygiene. Proper use means: apply benzyl-benzoate over whole body during three days without taking shower ("luckily" there is no shower in the camp Vučjak). After three days of many times applied benzyl-benzoate in the way that whole body was covered it can be washed out.

Hygiene measures:

2. Usually bedding and clothing used in the last three days should be washed in hot water and dried in a hot dryer. As the mite does not live for more than three days away from human skin, more washing is not needed.  For the case you cannot wash clothes and bedding (your case!) take clothes and bedding into plastic bag (as such for taking trash) hermetically close the bag (tie it) for 3-7 days. Each beg with bedding and clothes taken needs to have name of the patient it belongs.

Organization:

3. Exchange of bedding and clothing is needed. So you need to have warehouse well supplied all the time. You need coordination and collaboration with different organization.

4. You also need budgeting buying benzyl-benzoate approximately 50 EUR for each 10 patients. In Bosnia is benzyl-benzoate much cheaper (2-3 times) than in Western Europe but anyway one dose-container (for 3 days) cost nearly 5 EUR (9,4 KM - see the picture bellow). So to stop epidemic you need approximately 1.500 EUR for 300 patients (30% of 1000 people). So you need to organize campaign for donation.

5. Medics and paramedics must follow patient to their beds and take bedding and clothes and also watch the situation and check nearest neighbours on scabies.

LET US ORGANIZE AND GO TO ACTION STOPPING THE SCABIES EPIDEMIC IN VUČJAK!

OLOMOUC SUMMER SCHOOL IN REFUGEES LAW AND RIGHTS

SHORT DRAFT OF NEEDS ASSESSMENT FOR REFUGEE EMERGENCIES (NARA) IN REFUGEE CAMP VUCJAK, BIH

Photo: Dirk Planert



SHORT DRAFT OF NEEDS ASSESSMENT FOR REFUGEE EMERGENCIES (NARA) IN REFUGEE CAMP VUCJAK, BIH

Erazem Rajnar, chief medic

Vucjak, BIH, 13/8/2019

0. General atmosphere:

The local population is welcoming to the migrants and willing to provide help, but due to their own economic and social standing their patience is nearing its border, which manifest in more and more anti migrant postings on social media and threats to some volunteers. The local health system is severely underfunded and underequipped to handle their own patients, with the migrant situation putting additional stress on the system, adding to the discontent of the local medical workers and the locals with the migrants..

1. Humanitarian context:

The refugees in the Bihac area of Canton Una-Sana, federation of B&H, are divided between three camps, Bira, Boric and Vucjak. The situation is critical everywhere, with the conditions in camp Vucjak being the worst.

2. Shelter

The camp itself opened on June 12th ,on the old landfill near the village of Vucjak, about 10km out from the center of Bihac. Since then, the camp has grown and is currently housing between 600 and 1200 refugees, depending on the flow of migration and police raids. The average number of people in the camp is around 800 at any given time. The camp spans on 0.1 km², far to small for the number of people being held there. The tents built by the local red cross are mostly 10 person cotton tents with polyester floor, but there are not nearly enough and most refugees sleep outside or in the big tents meant for food distribution. While the floor is currently dry, any rain turns the camp into a mud field, with the previous purpose (landfill/dumpyard) of the land still showing and toxins in the ground still active. There are no permanent objects with the exception of one ruin of a house which is at the center of the social life in the camp. While day and night temperature difference in the tents is high, it is not critical yet, however, with the coming of the autumn and winter, the shelters provided will offer little to no protection from the elements. Vector control does not exist. (Lyme boreliosis is endemic to the area). The local red cross is replacing small tents with big tenets and has stockpiled 10 heating cannons for the tents, but they are not in use yet.

3. Water, sanitation and hygiene (WASH)

There is no electricity or running water. While 4 German red cross sanitation containers are installed there, the quantity and quality do not meet Sphere standards for humanitarian situations. The water is brought to the camps 3 times a day with a small truck cistern and frequently runs out. While the quality of water is not in question where the cistern is filled, the quality of water in the camp is questionable due to old/inappropriate water containers being used.

For the current number (around 800) refugees, there should be 40 toilets provided, however, only 8 are there, filling just 20% of the standard. None of the toilets have adequate lighting or are within 50 meters of the living quarters, failing the other major requirements and only providing safety, but not privacy. This is one of the reasons why the refugees choose to do their business in the surrounding Forrest, the other being horrendous sanitary conditions at the provided facilities.

The number of showers is 20, 10 of those outside and 10 in the sanitation containers, however the ones inside are mostly not functional and therefore not usable. Most refugees choose to shower outside or directly from the tap.

4. Health care

Healthcare is provided only by volunteers with various medical experience, so the quality of care varies. Since there is no electricity diagnostic equipement is limited, and most work is done with improvised means. All medical supplies are paid for from private donations collected by Dirk Planert and there is no local medical support. Red cross provides no medical help at all, other than allowing the volunteers to work undisturbed. They do, however, distribute 2 meals every day for the majority of the camp. The clinic is also not housed in a permanent structure, but in a tent, meaning all medical supplies have to be removed from the camp when the clinic closes as the people use it to sleep in it at night. There is no running water and washing hands is impossible for the medical workers. Instead, wet wipes and hand disinfection are used. The local emergency room declines to send ambulances to the camp so all emergencies have to be driven with volunteers private vehicles, but the medical capabilities of the clinic are at least equal or greater to those of the emergency room, so very few migrants are driven there, except for getting a referral to hospital. Daily, around 12-15% of the camp seeks medical attention, along with red cross and police personnel occasionally. Due to the work load and operational pace, medical records are hard to maintain/manage, and only the most severe examples are logged, however this is done in improvised manner potentially incompliant with patient privacy and informational security needed for such an evidence. The private nature of funding enables the health workers to provide care above the local standard, but very few have the knowledge, as most volunteers are either students, ambulance workers or nurses, making the operation heavily dependent on the individuals, rather than establishing a system anyone can take over/work in.

Mortality:

Information is currently not available

Morbidity:

Around 30% of the population has scabies, which are, in these hygienic conditions only able to be treated symptomatically. Infections of abdomen and genitals appear in around 1% of the population and infections of respiratory tract appear in around 20% of the population. There are a few diabetics (type 1 and 2), and around 30 people are have various cardiac illnesses. The mental health of the population is problematic, but most problems can be solved with therapeutic talk and very few need medicine. Mechanical injuries of the musculoskeletal system appear in around 23% of the population, but very few of them are serious or a result of police violence. Most prevalent are soft tissue infections from wounds acquired with walking or from local flora and fauna, which appear in around 60% of the population, and small allergic reactions to local flora which appear in around 30% of the population.

5. Conclusion

While the situation in the camp is manageable right now, with the summer ending and rain season starting, we can expect a lot more illness and infections, as well as cold injuries if the camp will remain open throughout the winter. While the official standing is that the camp will be closed, no one is doing anything concrete, so the local red cross is preparing to dig in for the winter. Medical supplies and donations to keep the clinic running are urgently needed, as preparations for winter need to be made. A permanent structure for the clinic is also needed, as well as raised beds and blankets for the refugees.

Bosnian Refugees' Situation