We gather in the centre of town and wait for our transport. The main road to the Macedonia (FYROM) border is quiet. Approaching the camp the landscape is illuminated by thousands of small flames providing heat and light for 12,000 refugees stationed for the night. We exit the minivan and head through the darkness, stumbling over the international railway line that dissects the camp and towards the glow of the MSF clinic in the distance. The clinic is located near the edge of the natural basin that swallows up the majority of tents haphazardly arranged in this vast terrain. The wind is still and the smoke now provides a blanket of smog which will irritate the lungs of the sleeping children. I anticipate seeing some of them later. The camp during the day time is a frantic, noisy hive of activity – people trading goods while children play and laugh, but all silent now, apart from the sporadic barks of a farmer’s dog in the distance or the shrill cry of a child.
Arriving at the clinic, the team sets itself up. We get the chance to talk through our plan for the night and to make sure we are thinking the same thing about any challenges we may encounter. I work with another doctor, a nurse, watchmen and three MSF’s cultural mediators, who not only translate but also provide cultural context to our patient’s concerns. They are the key link between me and the patient and allow me to provide more comprehensive management. There are four patients in the clinic already, and 10 in the waiting room. We anticipate a busy night.
The door swings open and the waiting room fills quickly. There is no more room, so a queue forms outside. My first patient; a large 24-year-old man is carried in by his friends. He has just had a diagnosis of kidney stones at the local hospital but he is finding it difficult to arrange an operation. We start treatment of his pain. As I give him some further advice I hear a call for help. A father holds in his arms his eight-year -old daughter, Amina who is dressed in pink pyjamas and wrapped in a grey blanket. Dad looks anxious as he attempts to burst through the consultation room door. He has little English except for: “Help. Sick and child”. I glance over her; she is sick. We immediately clear the bed for her and start our assessment. She is breathing fast, has a dry cough and is wheezy. We start treatment. This case will take time and space is limited – the queue will get longer.
Time passes quickly. While waiting to reassess the effect of treatment on Amina, I manage to get a few extra jobs done such as dispensing medications to those with chronic disease and discuss with the triage nurse the current situation in the waiting area. I ask whether there is anyone she is particularly concerned about. She points to five-year-old Sayid whose temperature is 39 degrees. The high temperature sends alarm bells ringing – he is sick – potentially a lot of bacteria in his bloodstream, he needs assessment and management fast.
I am now happy Amina is getting well with her treatment, and so she can continue this in the busy waiting area, while I invite Sayid and mum to take a seat. Questioning mum, following my exam I exclude any serious pathology. His heart is however beating fast and he also looks dehydrated. We test his urine and discover it is infected. We carefully give him something to help lower the temperature, some ‘rehydration solution’ (salty water) and antibiotics. Sayid starts to get better. I have a conversation with mum; she feels happy with the management plan and will take him back for follow up.
Three more children have presented with some form of respiratory distress, but in general the clinic now starts to settle. An Iranian family arrive. Mum, dad and two children who are surprisingly awake. The camp continues to grow and so they have no tent to sleep in tonight. They are hoping to use our waiting area for the next four hours. We duly oblige. Quiet times like this give us a chance to hear some remarkable stories of refugee voyages that I find difficult to imagine. They also give the team time to talk, to relax, and for one or two, the chance to sleep.
The trickle of patients turns to a standstill. The camp is at its most peaceful. Not a sound. We step outside. It is cold and misty. The sun rises in the distance, over the hills along the border. The shade is an exquisite light gold that gives this camp the kiss of life: a new day.
The sparrows sing in unison to wake up the children. The movement of a toddler’s limbs can be seen through the nylon of their tent as they attempt to wake their parents sleeping next door. Eventually, men sluggishly emerge from their slumber to light fires and brew up breakfast tea. One lean and particularly well-kept early riser meanders through the narrow passages between the tents, avoiding the rodent burrows dug in the clay. Dressed in light grey shorts and a wooly jumper, holding a large white bar of soap and a blue towel, he reaches the narrow road and marches in determined fashion toward the water point.
The clinic room starts to fill with the sound of children playing and children crying. One three-year-old screams in pain. She has fallen into a stove used for cooking porridge. She is burnt – but not seriously. We give her pain relief and dress her wound. Another child has had diarrhea throughout the night – more rehydration needed and informing mum on when to return.
We finish. The last patient leaves. We then shake hands and thank each other for the hard work we have given the shift. Between the two doctors, nurse and three cultural mediators we represent six different countries. We are from very different cultures but with one common interest – to serve the people of the camp during their moments of need.
It is this camaraderie that drives us through the difficult times, of which there are many. I go for a run to relax, then retire to my bed in the safe knowledge that I will not be staring at the ceiling of my bedroom tonight.
*Patient names have been changed