Saturday, 30 January 2016

Guys to The Jungle : Salman Sheikh, Obaid Khalid, Yousuf Bashir King’s College London Dental Institute: January 30th 2016

In the second weekend of December we, three dental students from King’s College Dental Institute, drove across the channel tunnel to volunteer what services we could to the people stranded in the refugee camps of Calais and Dunkirk. We went with a group called Refugee Crisis Foundation. Set up by a group of young healthcare professionals looking to make a real difference, this group has been recognised by the French Dental Association and is doing some fantastic work and importantly they’re doing it regularly, with the next trip planned for late February.

Day 1: Dunkirk

The first day’s assignment was given to us over a guilty breakfast on the ground floor of our hotel. We were to help the dental team, comprised of three UK based dentists and four of their French colleagues, in the camp at Dunkirk. Dunkirk was the smaller of the two camps with only 2500 people (3000 at the time of writing), housing many new Syrian settlers, mainly women and children. For many of the group this was their first taste of dental aid work in these conditions and we took our lead from our experienced colleagues who filled us in on what to expect; the main message being not to expect anything and to see what we’re working with once we arrive. As you can imagine our minds were a whirlpool of emotion at the time, each surge bringing with it new excitement, fear and nerves. Reminding ourselves of the real objective of this trip, we steeled ourselves for the day ahead.

Salaam. Peace. This is how we were greeted by everyone on the morning of our arrival as our people carrier slowly trudged through the sticky mud at the entrance to the camp. Friendly, smiling yet expectant faces surrounded the car, walking it through the main passage that led to the heart of the small camp; a heart beating with the hope of thousands of people trying to make a safe home for their loved ones. We looked around and saw the muddy, torn, sodden tents pitched on any available patch of earth, lines continuing in every direction. People queued patiently outside vans and trucks desperately waiting for welfare and aid of any kind – food, blankets, tents, clothes. There were piles of superfluous donations ungraciously dumped by volunteers in heaps on the muddied ground. Well intentioned contributions (shorts, t-shirts, hundreds of loaves of bread) doing nothing but rotting and spreading infection.

After helping our medical colleagues set up their station in an unused supply tent we commandeered a vacant MSF container to house our mobile dental clinic. Outside we formed a queuing system and triage area whilst inside we organised the area into a treatment section, consisting of two mobile dental chairs courtesy of DentAid, and a clean and dirty compound. Whilst this was occurring our colleagues helped us spread the word by walking through the camp and informing people that there was an emergency dental clinic running today and tomorrow. Due to the extremely diverse nature of the people in this camp this was no easy task with Arabic, Urdu, Pashtun, Farsi, Kurdish, English and more being spoken throughout. We attempted to implement the few basic phrases we had learnt in Arabic; hopeful it would see us through the day. Fortunately, we had treated a patient who was more than capable in a few languages and as a result our team had gratefully inherited an interpreter.

For the first hour people trickled in slowly allowing us to test our systems and ensure everything was as efficient as possible. There after we were inundated with patients and had a constant queue of at least 5 - 10 people throughout the rest of the day. We saw a variety of patients with a plethora of symptoms and issues, some that were in extreme dental pain for months, many with periapical infections and several with deep carious teeth that had not been looked after for a while. Most patients were relieved to finally see a dentist as they could not eat or sleep due to the pain. Diagnosis and treatment was further complicated, not only by the language barriers and limited resources, but, by the lack of electricity or running water. This of course meant no hand pieces, radiographs and even limited light as the day waned.

There was a vastly different approach to treatment planning with these patients in comparison to dentistry in the UK. Dentists had to be even more efficient, quicker and plan treatment with the knowledge that most of these patients are extremely high caries risk patients, with a number of medical conditions and poor oral hygiene. As a result, 3 main treatments were planned and completed immediately with patient's verbal consent: hand excavation of caries and GIC restorations, simple extractions, and no treatment at all. No treatment was started if it was not urgent and could not be completed in these challenging conditions. Teamwork spans all aspects of healthcare but it was never more evident than here. As students we were mostly triaging and presenting to our qualified colleagues as well as nursing and assisting for them in simple procedures. It was remarkable to see just how educated and well informed many of these patients were, asking us about dentures and implants and requesting toothbrushes and toothpaste to look after their teeth. For us it was invaluable experience of emergency dentistry as well as general aid work within an impoverished community.

On our rounds of the camp we were greeted with the same amiable, thankful, smiling faces as on our way in. Many told us of their plight and the arduous journey that led them here. When invited into one tent we saw a mother caring for three young children, all of whom had progressive chest infections. The sheer resilience on the face of this brave woman was moving in itself but even more so it was the way she rejected the heater we gave her because “there were others more in need”.

That night none of us slept for the storm in our heads and hearts was far too great. Laid up in our comfortable and warm hotel room we couldn’t help think of the thousands of people displaced from good homes who were now shivering under wet blankets on the freezing ground.

Day 2: Calais

Galvanized by a fresh speech from team leader Kiran, we attacked our task for the day two with renewed vigour. We were now assigned to ‘The Jungle’ in Calais. Housing between 6000 – 10000 people (the numbers fluctuate) the camp in Calais has received the bulk of the media coverage and has a reputation for frequent violence. On the frosty winter morning we entered the camp next to the Banksy’s statement piece, our breath hanging in the air, we knew immediately that we were being watched very carefully. Firstly by the police outposts dotted at highpoints surrounding the camp, backed up by their vans filled with gendarmes outside, and secondly by the so called ‘mafia’ of the camp who have a full protection racket in operation. Immediately it was evident that we would need to be more careful here and not upset either party.

We knew this camp had been here for a while but we didn’t expect the level of infrastructure that had developed; shops, restaurants, Churches and Mosques (in different areas of the camp) and even a shisha cafe all set up and functioning well. This showed more than just a resilience to their situation but also a resignation to their medium to long term future here. The incredibly diverse community settling here boasted a variety of ethnicities including Sudanese, Syrian, Kurdish, Afghani, Pakistani and many more settling here in Calais. Although for the most part they all lived here in peace it was clear that certain areas of the vast camp were run by certain ethnicities and all boundaries were understood.

The dental unit here was more established and well equipped as we had a specific caravan kitted out with two dental chairs, some rudimentary tools and equipment, our own steam steriliser (a hot plate with a pressure cooker on top) and even an old autoclave, which more or less still worked. We also benefitted from a large area under a makeshift marquee propped up against one of the shacks neighbouring us that we used as a triage area and a covered supply store – something that came in very handy when attempting to protect the supplies we had brought in. After the success of the dental unit yesterday people already knew that a dental team would be attending here today and many had found us before we were even ready to begin. It was clear today would be an intense day.

With a large crowd huddling around our triage area we needed tight crowd control and an extremely efficient system. We were extremely grateful to an American of Syrian descent who provided us with extremely useful translation services from English to Arabic and Farsi also. Sami had travelled with a party from Boston handing out welfare packs and without him we could not have survived in this extremely diverse camp. Luckily our own command of Urdu had been just about adequate enough also.

There were a flood of people coming in all day. The patients presented with similar problems and similar treatments were needed but there were an extra wave who presented with post-extraction complications – persistent bleeding being the most common. Beyond the language barriers we had to deal with sparse resources, most notably instruments and antibiotics. Rationing medication became extremely tricky, not only because our colleagues in the medical caravan had finished their own supplies, but because one patient in particular took exception to this. In a hospital setting or dental clinic in the UK, there is a well thought out procedure and specific guidelines to follow when dealing with complaints. That kind of approach in this case was less successful. What followed was a 30 minute heated discussion, translated from Farsi to Urdu to English, which involved far more commotion than was necessary and attracted the attention of people nearby. We attempted to diffuse the situation and were finally successful in reaching a somewhat amiable solution when we heard of a much larger commotion nearby. A brawl had broken out down the road between some Afghani and Sudanese people. The factional nature of the camp was especially highlighted here and with the waning light we knew it was time to go.

The team, all 30 of us from different disciplines, had all collected together to make a safe exit. However due to the arguments 6 of us had become split from the rest. We made our way to the main exit which had now been completely blocked by ranks of armed unrelenting gendarmes. When we approached as unthreateningly as possible showing our aid worker badges, we finally realised the mentality of the French police towards not only the people here in the camp but also towards those who come to help. We were told that we had made our decision to be here and that we should now deal with it. The next time we would be leave the camp would the next morning and that it was nothing but our own fault. We tried in English, we tried in French but the result was still the same, nothing worked. One of the friends we had made in our time saw us and told us of an alternate exit at the other end of the camp.

With only around 30 minutes of sunlight remaining and a Eurotunnel slot to make we made a precarious move for the other exit, quick enough to get there before they closed that exit too yet slow enough so as to not attract any attention running through the camp. As we made our way through the factional nature of the camp was yet again underlined as we passed through a number of distinct areas and made it out just as the gendarmes were lining up on the road outside. Thankfully all members of the team made it out The Jungle and back home to English soil safely. We never thought we’d be that pleased to see our own boys in blue again.

Overall, this trip was an incredible experience but one that highlighted the desperate conditions of these poor people. Their sheer resilience in spite of all the adversity they have faced and continue to face is genuinely emotional and inspiring. It is made worse with the knowledge that there doesn’t seem to a political solution coming soon to help them. Despite their optimism, despite their faith, despite their goodbye wishes of “I’ll see you in the UK”, it is hard to see a way out of these camps for them. The aid that we provided, little that it may be, was honestly helpful and necessary. However unless their situation changes they will be in need of help in the near future. Everyone in this camp is in a form of welfare cycle where they start by being in need, they are then given help, whether it be medical, dental, tents, blankets etc. There is a period of acquiescence where their situation appears to be better but then they get another infection, the weather ruins more of their tents, their blankets are soaked yet again, they are hungry once more and then they back in need again.

Politically we choose our sides and fight for a way for this to end but no one can ignore the humanitarian aid that these people need just across the border. One weekend of work is not enough. One drop load of welfare is not enough. It is only through the regular and consistent provision of care that their situation will once again become bearable and we can truly help.

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