Medical Case


A 44 year old man came to our clinic today with a description of chest pain, mostly on the left side. He says it’s been ongoing for about 4 months.

He arrived in Athens about two weeks ago, with plans to head to Germany in another week. He was seen last week at a Doctors of the World clinic in town for the same problem.

He says they gave him the above EKG, told him he was having a heart attack, and sent him out the door with 10 pills of Prilosec and instructions to go to “the hospital.”

Due to money restrictions, lack of transportation, minimal confidence in, and maximal confusion from, his interaction with his Greek-speaking doctor, he did not go to the hospital. He instead came to our clinic 4 days later, worried he was dying from a heart attack.

How would you handle this?

My Take On The Politics

There certainly isn’t universal agreement on the refugee crisis. In fact to some, the term “crisis” is itself questionable. Many have described this as an outright “Muslim Invasion” of Europe.

As I attend a Calvary Chapel, where simplicity of thought reigns supreme, here is my super-simple take on the political side of this, using a bit of alphabet soup.

I recognize points in the following argument that lack nuance; I do not purport to know answers to this crisis. I can only say that the below line of thinking is viable enough to justify, to myself, the work we are doing here:

Say you come across a guy who has been walking, hiking, crawling from point A for the past year. He has lost half of his family and most of his money on the journey.

His intention is to reach point Z. But you meet him at point T. He is cold, wet, hungry, possibly sick and terrified especially of what awaits him should he return to points A-P(ish).

Given his determination to reach point Z, do you REALLY think ignoring him at point T will discourage him from reaching his goal? Furthermore, those of us comfortably sitting at point Z, do we want to receive multitudes of people who were ignored, possibly abused, at all points along the way?

Most of our larger endeavors in life are gambles. There is no way to know the outcome of our actions until we look back later and see how things turned out. We can’t know how the Western world will change as a result of these things happening today.

And so in this, one the greatest crises ever seen by the combined Western and Eastern worlds, bets need to be made.

As such I bet on love and kindness. Rarely, if ever, do these things result in loss.

FILE - In this Wednesday, Oct. 3, 2013 file photo, a Syrian man cries while holding the body of his son, killed by the Syrian Army, near Dar El Shifa hospital in Aleppo, Syria. Almost a quarter-century ago, a young American political scientist achieved global academic celebrity by proclaiming that the collapse of communism had ended the discussion on how to run societies, leaving "Western liberal democracy as the final form of human government." In Egypt and around the Middle East, after a summer of violence and upheaval, the discussion, however, is still going strong. And almost three years into the Arab Spring revolts, profound uncertainties remain. (AP Photo/Manu Brabo, File)

Lentils or Needles, Your Choice

The Church (not abandoned, as I first thought) were our clinic is located.

We saw around 15 patients on our first day. If I this was a video game (maybe all of life is?), by the end of the day my strength bars would have been around 2/5.

Today we have nearly 30 people on the schedule, plus a smattering of missionaries who seem to filter in with loooong lists of medical questions.

The missionaries are amazing. Most consider themselves to be “married” to the mission field, and are here by themselves, living on donations. And not just for a week. For years.

If you’re looking for “underserved” medical communities, no matter your own personal faith persuasion, here’s one. Most Christian missionaries donated their health and bodies to their work long ago. They see a doctor when they can (read: every 5 years on average), but it’s never a regular thing for them.

One question from a missionary yesterday, “We’re so excited. We’ve been given permission to use an old elementary school from the Greek government. People have been defecating and doing drugs in there for the past 5 years. All we have to do is clean it out, and it’s ours! Do I need Hep B vaccination? I think I had one of those shots. What about that HiB thing? Oh, and what about tetanus. Can’t remember when I last did one of those. And should I wear gloves? Maybe a face mask?”

Afghan migrants arrives on the shores of the Greek island of Lesbos after crossing the Aegean sea from Turkey on a inflatable dinghy, Thursday, Sept. 24, 2015. More than 260,000 asylum-seekers have arrived in Greece so far this year, most reaching the country's eastern islands on flimsy rafts or boats from the nearby Turkish coast.(AP Photo/Petros Giannakouris)
Afghan migrants arrives on the shores of the Greek island of Lesbos after crossing the Aegean sea from Turkey on a inflatable dinghy, Thursday, Sept. 24, 2015. More than 260,000 asylum-seekers have arrived in Greece so far this year, most reaching the country’s eastern islands on flimsy rafts or boats from the nearby Turkish coast.(AP Photo/Petros Giannakouris)

Another story: 12 year old girl with dizzyness. She left with her parents from Afghanastan over 6 months ago, running from the Taliban. The family took a number of cars overland from there to Tehran for around 20 hours. They then hiked from Tehran to somewhere in Turkey for days, eventually finding their way to a huge refugee camp there.

Then the family found a smuggler who, for most of their remaining money, agreed to put them in an inflatable raft for a trip to the island of Lesbos, which is officially “Greece,” and would allow them to begin the process of obtaining refugee status.

They were required to get from the refugee camp to the coast on their own. Upon finding the launch site a few days later, according to the mother, they found that the raft was about 8 feet long, and she counted nearly 30 people in it.

They were turned back by the Turkish coast guard 5 times before they succeeded. Each time they were turned away, they were “towed” back to the Turkish coast, which effectively half-sunk their raft because the front end kept getting pulled under the water. Although some had life vests, many did not, and nobody knew how to swim, so the affair was terrifying.

This young patient started her period 8 months ago. She has had to learn how to be hygenic in refugee camp conditions. She can’t understand why she feels so weak and tired all the time. I asked her how and what she eats.

“We got cookies on the road from Tehran to Turkey. They were good.”

“Do you eat the food in the camps.”

“Ew. It’s always bean soup, and they never cook the beans.”

I smile and look at the mother, she is looking at me, rolling her eyes. “Lentils, usually,” She says through my translator Sahar (and Superwoman). “But I can’t get her to eat anything. She’s my pickiest kid.”

Here I am, a billion miles from my homeland, from any Caucasian, from my life, and this mother is dealing with a UNIVERSAL problem of parenthood.

“I have the same problem in my house,” I say smiling. The mom laughs.

I then look at the daughter, “You are probably dizzy because you are losing lots of blood every month. It makes people feel weak, tired, cold and dizzy. The best way to take care of it is to eat. Cookies are not food.”

I look at the mom, smiling again, but shrewdly. “But I don’t know for sure if this is the problem. I need a,” (imagine the audio slowing down here for emphasis), “BLOOOOD TESST.”

The girl’s eyes widen. “Uh huh,” I confirm. “With a NEEEDLE.”

Cute, 12-year old crestfallen face. “So I’ll make you a deal,” I continue. “Lentils or needles, your choice.” Mom laughs again, getting it.

The daughter, I hope, got it too. The mother and I were able to make light of this, but it could get serious. The girl’s arms at the biceps are thinner than my wrists.

There are more stories from only this first day. To depict them is like trying to pour the entire Mediterranean Sea into a rain drop. It just can’t be done.

This world, these sorrows, these tragedies…they can only be know by walking, even for a moment, with those that are living them.

Tomorrow We Leave

We leave for the refugee clinic in Athens tomorrow.

I intended to blog the step-by-step story for how we arrived at this point. But THAT didn’t happen.

Here are some specifics:

wpid-wp-1443899443776.jpeg-We intend to see approximately 30 patients per day for a week, working half-days on Monday and Friday. I suspect we’ll end up seeing many more than this.
-We will be working in an abandoned church in downtown Athens. We’re staying in a Youth Hostel a short distance away.
-We have access to labs, Xray (maybe?) and some medications but I’m not sure which ones.
-I’ll be using an antique oto/opthalmoscope manufactured by the Riester Company, which was based in, you guessed it, Germany.
-We plan to see Afghan, Iranian, Iraqi and Syrian refugees. There could be many others.
-On the last day we will likely go into a refugee tent camp and set up our medical clinic there.
-Donations continue to roll in, to date over $6000.
-I’m not without a sense of concern. It isn’t lost on me that Americans aren’t the most popular people in the world today, especially in the lands where these people are coming from. On this, the night before our departure, I’m keenly aware of all that I leave behind, and all I hope to see again soon.

Your thoughts and prayers are most appreciated.


Sansum Medical Research Institute

I used to work at a non-profit medical research institute. There, we didn’t “earn” a single dollar. Everything was given to us through some version of a donation. So I suppose I shouldn’t be so amazed and slightly mystified to receive the thousands of dollars sent our way for the relief trip to Athens.

True, our costs are estimated to run in the $6-10,000 range, and we’re still around $3,000. So it would be nice to get closer to our goal. But even if all the money stopped tomorrow, this has been a humbling experience. Things went from what seemed like a good idea that aligned well with my interests and lifelong training, to something more important. Quickly.

I’ll explain:

I spent a loooottttaaa time in that building. Still miss those days!

The medical school I attended is located in Israel. Called the Medical School for International Health, the curriculum strongly emphasizes International and cross-cultural medicine. It’s a small school, but is comprised of people who love, love, global, cross-cultural experiences.  I’m one of them. These are “my” people. Aside from my wife and children, to this day, I love nothing more than being somewhere, far, far from my familiar world, surrounded by languages I don’t understand and histories and stories and traditions and beliefs I have yet to learn. Being at MSIH put me in the lives of people who love the same thing. I’m not sure I ever felt more at “home,” and I was approximately 6,940 miles from the suburbs of Colorado Springs, where I grew up.

A refugee relief clinic in Athens, thus, is a natural thing for me. I’m wired for this. It’s what I’d do full-time if I didn’t have obligations to children and student loans. But, as evidenced by my parents’ one single excursion out of the U.S. to visit me in all the years I’ve lived overseas, this international stuff isn’t for everyone. In fact, especially relief and refugee affairs isn’t really for most of ANYone. It’s a briar patch kind of thing: This is what I do. But I don’t expect it’s what you do.

So I am amazed to see that what started off as something I care about, has become something you care about too. To those of you who have sent money, and prayers, and follow this blog, thank you. It’s humbling, and a little disquieting, to know that the work we’re doing isn’t being met with ambivalence around the world.

Indeed, it has been quite the opposite.

Athens, October 2015

Athens has long been a crossroads for refugees trying to make their way from the Middle East into Europe. So when I traveled there with my church pastor, David, this past February to explore the possibility of starting up a medical clinic, we had no idea what kind of summer was approaching.

At the time, it was clear that activity in Syria/Iraq (ISIS territory spans both) was worsening, so we predicted an influx of migrants seeking refugee status in the EU. We knew the numbers this summer would jump. But we didn’t predict anything to the level of what we’re seeing today.

Be advised that anything you read below this blog is from the days when my blog was largely a chronicle of my time in family medicine residency in Olympia, WA. Some of the posts are fun, some whimsical, some serious, some maybe a little helpful.

After residency I moved to Germany and live here still. I’m a practicing family medicine doctor and have long planned on working in international and relief settings. This is the primary reason for moving away from friends and family, and my decision has positioned me well to help with the current crises in Europe.

Can I, and this little clinic we’re building, do much to address these massive problems? Hardly. I understand that. But if lots of people do lots of little things, it can equal one big thing over time. So I’m starting with this little thing.

As such, from this blog forward, I’ll mostly be talking about the work we’re doing in Athens and the topics that relate to that work. Namely, cross-cultural medicine and global public health. If you care about these things, you may enjoy following along as I navigate through this project.

The media element of this project is just getting started, and it’s been awhile since I flexed my creaky “blingers” (that’d be blog-fingers). So bear with me.

However, already I’ve been met with scenarios for our clinic that I hope to present to you, SW101 nation, for input and ideas. This isn’t an easy challenge, with lots of questions that have no easy answers. So approaching this as a community is, I think, a much better way forward than going it totally alone.

So, if you’re willing to jump in with me, thank you, and welcome!