Intended for healthcare professionals

Careers

Why more GPs should become involved in humanitarian work

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6168 (Published 22 December 2015) Cite this as: BMJ 2015;351:h6168
  1. Hina J Shahid, freelance GP, London
  1. hinajs{at}doctors.org.uk

Abstract

GP Hina J Shahid found that her general practice skills were invaluable when she volunteered to help some of the thousands of refugees arriving in Greece

The refugee crisis engulfing Europe is one of the worst humanitarian catastrophes since the second world war. The stories and images of desperate people crossing dangerous waters and unwelcoming lands, fleeing persecution and conflict, have become all too familiar. Many doctors read and watch helplessly, wishing they could do something.

Medical roles in large humanitarian organisations are often limited to hospital specialists, which is disheartening for general practitioners who wish to help. We were fortunate to find short term work in Lesbos with an international non-governmental organisation (NGO), Salaam Cultural Museum. We applied for this role after a request for trained medical volunteers by the Muslim Doctors Association, a UK based voluntary organisation. Volunteers on our mission came from all cultures, religious and non-religious backgrounds, driven by a common passion for humanity; encouragingly many were GPs.

Clinical cases

Humanitarian crises can affect anyone, and as GPs we are in a unique position to work as generalists on the front line. Our confidence in clinical acumen over precautionary investigations to guide decision making is an asset in resource strapped settings.

We worked in a medical tent on the northern shore, providing primary care to refugees arriving from Turkey in overcrowded flimsy rubber dinghies. Fortunately, most ailments were minor, such as headache, sore throat, cough, and myalgia. Refugees with chronic illnesses had run out of medication, including insulin, warfarin, antihypertensives, antiepileptics, and antidepressants.

We assessed refugees with malnutrition and complications of poorly managed chronic illnesses such as hyperglycaemia, hypertension, and leg ulcers. We also encountered pregnant women who had not received any antenatal care and unvaccinated children.

The emergencies we encountered included pregnancy loss; thromboembolism; infant respiratory distress; fractures; amputations; and acute conditions such as skin infections, burns, dehydration, exhaustion, pneumonia, asthma, gastroenteritis, and rashes. Sadly, one night a nine month old infant died when a boat capsized and resuscitation efforts by the on-call team were unsuccessful. Unfortunately, this scenario is becoming more common, and we have learnt of hundreds of drowned refugees since our return to the United Kingdom; some, albeit a very small number, have been successfully resuscitated. The need for medical care is even greater now, and many of us are planning to go back.

Organisation and management

The rescue efforts along the shores of Lesbos are predominantly led by small NGOs and individuals, with larger NGOs and official authorities concentrated in the main city. Collaboration with other NGOs and individual volunteers, both medical and non-medical, was paramount to coordinate patchy coverage of service, patient transport, and medication and equipment supply. We also joined a social media group for volunteers to communicate with each other. We worked with other NGOs to set up a clinic on the shore using a donated tent and recycled items to create beds, bays, a paediatric and breastfeeding corner, and pharmacy and waiting areas.

We used organisational skills developed in general practice to design protocols and referral pathways for further care. This included a community clinic 30 minutes away and the city hospital 90 minutes away. We also prioritised emergency transport, with two ambulances and volunteer cars. As GPs we are versatile and can task shift: triaging and providing nursing care with wound dressings, administering medication, and performing bedside tests. We managed the drug stock, ensuring adequate supplies by fostering good relations with a local pharmacy. Additionally, we organised the delivery of emergency equipment such as oxygen cylinders and defibrillators, which were not available in the area. We also set up a mobile clinic to deliver urgent care.

Communication and compassion

Good communication skills and compassion are at the heart of primary care, combined with a holistic approach that sees health in the broader context. Although most of the physical ailments we treated were minor, the emotional and mental trauma experienced by refugees was immeasurable. Providing reassurance and support was our main role. A non-judgmental attitude, empathy, and respect for cultural beliefs were important. We reflected regularly on ethics, professionalism, and good practice to guide decisions that were clinically, emotionally, and ethically challenging.

Our experience made us appreciate the immense potential of GPs’ skills and knowledge and their transferability in a range of settings, including humanitarian crises. Of course, the working environment was highly unpredictable and physically and mentally exhausting, and at times it was frustrating because of severe financial, political, bureaucratic, and other structural and functional barriers. However, with patience, perseverance, and a desire to help others in need, it was a worthwhile experience.

Many of us entered medicine wanting to make a difference, but ever increasing demands and bureaucracy coupled with cuts to funding are causing rapidly declining morale among GPs. Medical relief work can help us remember why we went into medicine, appreciate our profession, and provide a sense of meaning. We urge humanitarian organisations, professional bodies, and employers to actively support GPs to undertake humanitarian work.

Organisations that GPs can contact

The BMJ’s Christmas appeal: Doctors of the World

Please help Doctors of the World bring care to the world’s refugees. The charity is well versed in bringing care to the most vulnerable people in developing and developed countries, which is why The BMJ has chosen the charity for its Christmas appeal this year. Please give generously https://www.doctorsoftheworld.org.uk/pages/BMJ

Footnotes

  • Acknowledgments: Sabrina Qadir, who was a volunteer on the same mission, provided valuable input into the content of the article.

  • Competing interests: I have read and understood BMJ’s policy on declaration of interests and declare that I have no relevant interests to declare.