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.