Sebastião da Gama Castanheira Martins is 25 years old. He is a doctor. Last June he ended year 6 of the IMM in Medicine.

What made us talk to Sebastião was the medical volunteering he did at Medical Volunteers International in Greece, between Lesbos and Thessaloniki. For 2 months, he worked with 4 other doctors and provided medical services to those who need them the most, the refugees who come to Europe every day looking for a better future….

The Sebastião I met on 26 September tells me that he is not the same Sebastião who left for Greece on 14 July. He agreed to talk to News@FMUL because he thought it was very important to talk about it and share what was going on.

“It is true that in 2015 6,000 people arrived in Lesbos per day” while today “around 300 arrive, but it is not because there are 300 that we should stop talking about it”. It is essential to keep the current topic at the UN, the European Union and in Portugal. “We need to rethink strategies.” He believes that the refugee reception policies in Portugal require much improvement. “There is a lot of bureaucracy, a lot of delay,” he says.

 

What were these 2 months like?

Sebastião: They were very intense months, we worked about 8 hours a day at the clinic. They were especially intense emotionally, not so much due to the workload itself. It is very hard to hear their life stories, to be aware that they are looking for a better place and bump into a place and a Europe that closes its eyes and doors a little. They could often spend two or three years in a refugee camp waiting for asylum before they could leave and rebuild their lives. I would say I have a very dual feeling…. It was an extremely enriching experience, I learned a lot from the medical point of view but especially from the human point of view of how to deal with vulnerable people. As much as we learn here at the Faculty, only when you are there do you realize how to deal with such situations. And even when you're there, sometimes we don't know very well what to do. We try using common sense and talking to volunteers who have been there for a long time. At the same time, however, it is difficult to cope with the frustration of knowing that no matter how much we do, at the end of the day those people return to the refugee camp, which has absolutely deplorable conditions. Unacceptable conditions anywhere in the world but mainly in the European Union. And feeling that we are in Europe frustrates us even more.
I also realized that people who go to doctors in these situations often do not even have major physical conditions and come to feel that there is someone who is looking after them...

 

For the emotional support?

Sebastião: Yes, for the emotional and psychological support. 

Was it just between Lesbos and Thessaloniki?

Sebastião: I spent three weeks in Thessaloniki in northern Greece, and then I spent the remaining five weeks in Lesbos...

Are there similarities between the camps?

Sebastião: They are very different places, in terms of the number and type of people they receive. In Thessaloniki there are the people who come by land, those who cross northern Turkey to reach Thessaloniki. Those who take this path, which can last from 3 weeks to 2 months, are usually middle-aged men with some physical strength that allows them to cross over. On the other hand, Lesbos is reached by sea, crossing the Aegean Sea, and there are many families, many women and children. For these reasons, the type of population is completely different.

How did you feel when you came across the reality of refugee camps?

Sebastião: When it comes to different realities, the impressions we have are also very different. In Lesbos, refugees arrive and are required to apply for asylum. They stay on the island for 2 or 3 years - there are a few exceptions - but most of the time it's 2 or 3 years.
In Thessaloniki, it takes 2 to 3 weeks before they start making their way through Macedonia to go up to central Europe. Although this happens in the same country, the realities are quite different.

Do you remember the first idea that came to mind?

Sebastião: Above all the despair... Trying to imagine the situations that these people went through, which motivates them to make a crossing like this with nothing, only with the clothes they are wearing. They often bring family photographs or some money, leaving everything behind.
They have no home... They come looking for a new home and stay for too long without a home, without a place to call their own. And that is very hard.
It's hard to talk about an idea or a feeling ... Because there are so many. 

Did you feel culture shock? 

Sebastião: Not really. In spite of everything we are in Greece, we do feel culture shock when we talk to people. The shock is not there as soon as we land there, the shock exists when we begin to meet people and talk to them, when we begin to realize their stories.

Did you work outside the camp?

Sebastião: Yes, we worked at a clinic on the outskirts of the camp. There are 2 organizations that work in the camp.

 

Did you ever get inside the camp? 

Sebastião: No, I never got in, because I thought I would only go there if I had some work to do, just to see it made no sense. But I saw the peripheries and heard the stories of the people... 

And it was enough to get the picture…

Sebastião: Yes, it was enough to get a very reliable picture of the reality of those people and then yes, there is a tremendous shock. It is very complicated to conceive the possibility that such realities exist today and so close to us, and with this difficulty comes a tremendous sense of helplessness.
We do what we can…
The Moria camp now has 12 000 people*, when it has capacity for 3 000. There is worse, Samos camp, which is another Greek island, with capacity for 600, now has 5 500 people... They are very overcrowded and unable to receive so many people...

You just told me there are 2 organizations. Two organizations for 12 000 people?

Sebastião: It is clearly insufficient; those medical organizations cannot do everything. They get about 100 patients a day. There are Doctors Without Borders who are also present in Lesbos, with a psychiatric clinic and a paediatric clinic. We had another clinic where we saw 60 to 70 patients a day. Our clinic was in a community centre called One Happy Family, where there was also a women's centre, a gym, a kitchen, a yoga space... That's where we worked, and because it's a quiet, safe place with various activities, the patients often came back and felt good there.

A moment ago you told me that most of the situations were not physical pathologies?
Sebastião: The patients had mostly mental pathologies. Many post-traumatic stress disorders, depressions, psychoses, alcohol and drug addictions. Some of these people find a coping mechanism in drugs... And we can't judge them because they are in really, really complicated situations.

Does it make the experience even more intense?

Sebastião: Yes, it makes the whole experience more intense and harder... Obviously we had a lot of physical pathologies, but I would say that about half of the patients had some psychological disorder.
The kind of treatment we offer these people is very different from what we do here. In the case of mental pathology, the important thing was for people to feel that they were being heard. Many times we didn't even start medication, it was enough, for example, for people to start doing activities, such as taking swimming lessons, or helping them find a space where they felt safe, for them to start improving. This type of occupational therapy was often sufficient. Of course, there were more serious cases and some of them, if they were here, would require hospitalization in the psychiatric service, but there is no such possibility there and it is very difficult to deal with these situations. We had people with very serious psychoses, who would be referred here to the psychiatry service, but there we tried to manage the best way. The biggest problem in these situations was that they returned to the camp to sleep every day, which is a place with many triggers for mental illness. It is a place where nobody is well, much less those who are in a situation of extreme psychological fragility.
People bring with them a a very complicated past and when they get there they come across a place that does not help them feel better or safer, which does not favour their condition. We even had suicide attempts at our clinic.

And there's still the problem of being on an island, such as Lesbos...

Sebastião:, Yes, that makes things worse, because they cannot escape and that is the difference we have seen in relation to Thessaloniki. In Thessaloniki, they knew that any day, if they gathered some money, they could leave. In Lesbos, this is impossible. We had some training with a Médecins Sans Frontières psychiatrist, who had already worked in various locations around the world, and she told us she had never seen a cluster of mental illness as large as there. One of the justifications is precisely because it is an island and people have no possible escape. It is a feeling of hopelessness, of having no future, because they are surrounded by the sea, they have no way out and they know that they have to wait 2 or 3 years for the first asylum interview, which does not even guarantee that they will have it. Many of them may not be granted asylum and, in this case, will be deported to their country of origin, which generates a great feeling of uncertainty, living day to day without knowing what will happen the next day. They sleep in a dangerous place where there are many quarrels and where people die. There is a very high number of suicide attempts in Moria, the food is deplorable, there is one bathroom for every 100 families, the queue for food takes an average of 3 hours. Can you imagine how difficult it is for a fragile person to recover...
We just try to give them a space where they can feel good, a little safer, but it is difficult to find long term solutions for these people. In spite of all this, the fact is that many of these people when they go to mainland Greece or are granted asylum automatically begin to improve. Just the glimmer of hope makes them better. And this is living proof that with some effort it is possible to give them better conditions. If this whole process was faster, people could recover faster, especially from a psychological point of view. Obviously, there are more complicated situations to manage, for example: at this time in Lesbos there between 200 and 300 people are coming a day, about 4,000 people a month - there is no treatment for AIDS, no antiretroviral drugs. It is important for people to know that there is a place in Europe where antiretroviral treatment is not offered, and this is completely absurd and inconceivable. We had people coming from Congo treated, coming with antiretroviral drugs for the trip and then they arrived in Europe and did not have access to treatment.

And how do you manage these situations?

Sebastião: In these cases, people have to be transferred to mainland Greece, but this transfer may take 6 months or 1 year. Therefore, they are people who are left without treatment for a year, which is completely obsolete in a developed country. This is a very clear situation of lack of political will, because it is now very easy to get antiretroviral drugs for very low prices or even offered by various International Foundations and Organizations.

And do you really feel that it is lack of will?

Sebastião: We feel that a lot. This is not necessarily a shortage of money, because the European Union, since 2015, has allocated around 3.5 billion euros to support refugees in Greece. In fact, all you need to do is be there for a week in order to ask the question "where does the money go to?".
There is also very little legal support, the conditions in Moria are absolutely inhuman, the health care is very poor… Anyway… There is so much to do! Too much...

Of the patients you saw, and of their stories, is there anyone in particular that has touched you the most? 

Sebastião: Yes... The patients who mark us the most in these situations are those we see more than once. Most of the time we saw a patient who would never come back. The ones we saw most often were those who had psychological disturbances, and who saw our clinic as a safe haven. There was in fact an 18-year-old boy who came from Afghanistan where he saw absolutely horrible and lurid things.

How long ago had he arrived?

Sebastião: He came to our clinic a week after he arrived, so by now he should be there for about 2 months or so. He suffers from very, very serious post-traumatic stress and have had frequent panic attacks... 

Did he go to the clinic many times? 

Sebastião: He came every day, and we spent a lot of time with him. I learned a few Farsi words from him, and he learned English from the volunteers. He even came to dinner with us... We, and I think that in this kind of scenario is essential, try to avoid the doctor's role as an authority: there is authority, in the sense that they respect medical decisions very much, but in a consultation the most traditionalist and conservative barriers have no place here: I've hugged a lot of patients, done very unusual things, but there's no kind of medical paternalism that I think still exists here, with its advantages and disadvantages, of course.
This guy made a big impression on us, because we followed his case well... This was the boy who tried to commit suicide in our clinic. He tried to hang himself, but fortunately we managed to stop him. Obviously this kind of event marks anyone, doctor or not, and I can never forget the image of seeing a person hanging with a rope around his neck. 

Have you heard about his condition now?

Sebastião: I know he's a little better but that boy's life is a doomed. He is 18 years old and has never been to school, cannot read or write. It is very difficult for cases like him to improve on that island. Health care from the mental point of view is very negligent. This boy went to the hospital in Mitilini, which is the capital of Lesbos, was there an hour and was discharged. In cases of attempted suicide, the patient must be at least 24 hours under observation to ensure that he is calmer and there is no risk of suicide.
Often these refugees, after being discharged, had to walk back to Moria, which is a two-hour walk away. We have heard of women who, after a caesarean section, were walking from hospital to camp because they are discharged and no one provides them with transportation.
From this kind of experience, we always bring many stories home. There was a woman I had a very special relationship with: she was depressed and drank a lot, but was getting better. The constant turnover of doctors and the frequent change of volunteers often makes care difficult, because each doctor who leaves is another who has to establish a relationship with the patient again and gain their trust. Right from the start, when we know there's a patient we're going to see more regularly, we have to say we're leaving, and that's what happened to this woman, I told her "look, in 3 weeks from now I'm leaving" ... But still they always leave us with a very particular feeling! I also met many children, children of extraordinary ability, who if in other parts of the world would surely have a bright future. We will see what the future holds for them, but we must believe that it will be better here than it would be in their home countries.

Do you feel it was months of learning for you as a person and as a doctor?

Sebastião: Yes, surely! I feel that where I learned the most was when dealing with the patients, how to deal with someone who tells us she has been raped, how to deal with someone who is pregnant and not sure if the father of the child is the husband or the rapist, how to deal with someone who was tortured for weeks. The way you handle these kinds of situations is what you learn the most there.
And I believe, I have the full conviction, although this is not consensual in the medical community, that this is the most important quality of a doctor. Of course it is important to have scientific knowledge, but a doctor with enormous scientific knowledge in this kind of context either has a great capacity for resilience and extraordinary humanism or is not that valuable, because what he can do here, he cannot do there. I believe that there, the first and best treatment is always Being and Listening. 

Was patient receptivity positive?

Sebastião:, Yes, as a rule it was positive. There were a lot of patients from the Congo and since we didn't have a French translator at all times and I know a little French, I ended up doing a lot of consultations in that language, and the fact that I didn't have a translator helped to establish a closer relationship with the patients.
In the case of Farsi, it was impossible, but in French, towards the end, I could make a consultation and talk to them, which makes it easier. Receptivity is easier when we speak their language. I met people from southern Congo who spoke Portuguese, which was very interesting and fun. I think, overall the receptivity was very good, sometimes they mocked me a little because they said I looked very young….
I remember perfectly well that one of the first gentlemen I treated was a 70-year-old man who had a urinary tract infection. I treated him and he returned a week later. I was afraid he might be worse, but he was fine. He came to the consultation just to give me a peach and to thank me for treating him. And it is these small gestures that we also value with special affection: a simple peach.

Have you had contact with a refugee who has been waiting for the asylum interview for a long time? 

Sebastião: I didn't know much about the asylum application process and learned a lot there, obviously.
The first thing that marks the whole process and the future of these people is the country from which they come. For example, people from Syria, as it is a country at war, have the least difficult asylum process. People who come from countries considered "safe", for no apparent reason, have a more difficult asylum process. Namely, Afghanistan, which despite not being officially at war, still suffers from Taliban guerrillas, and is not at all a safe country. The Congo, the same thing. And then there are other countries whose asylum process is very, very slow, as is the case with Iran and Iraq.
In addition to medical volunteering, I also taught violin classes in the morning in another camp, Karetepe, with about 1200 people.
There, I was mostly in touch with children, so I was very close to a family of girls from Iraq. They went to school every day. During the 5 weeks I was there, they always went to classes, and I ended up being very close to them. The family even invited me to dinner in their container, so I went to dinner and dance to Iraqi music.

How long had they been there? 

Sebastião: For two and a half years. They are from Iraq and had no prospect of leaving... There are a number of nuances to bear in mind in such cases. Karetepe is regarded as a worldwide example of what a refugee camp should look like... It is a bit ironic that this camp is located very close to one of the worst refugee camps in the world, which is Moria.

How come? 

Sebastião: When entering this camp, we feel safe. It's a quiet place where everyone has a container, no people sleeping in tents. It is a place where there is a lot of policing, many children and where they are given many possibilities to learn. It was there that I ended up teaching music. In this case, there are people who know that when they leave, they go to a probably worse place. And this family said they didn’t mind being there, because it's a good place indeed. They don't even know if they will be entitled to asylum… 

If they are not granted asylum they will be deported to the destination countries... 

Sebastião: Yes, they are deported. It is painful to think that those 3 girls and their parents may have to go back to Iraq…
I also met a family who was there for two and a half years, went to Germany and then were sent back! They spent all their savings to go to Germany and were sent back, so there's a bit of everything!
But in the midst of all this, there are also beautiful and successful stories. We got to know some people who started their trip, arrived in Germany or France and were able to settle down there. There were also people who settled in Greece and work, for example, as translators in the field. They have their lives there, they are happy and they want to stay. This is to say that there are also good stories and that there are people who have been able to rebuild their lives.

So you met someone with a happy story? 

Sebastião: Yes, I did! A translator we worked with in Thessaloniki. He had tried to go to the UK but failed. After returning, he decided to settle in Thessaloniki and is currently working for an Organization. He has a salary, his home and wants to stay there. There is also the example of another translator we worked with in Lesbos. As the camp was getting too crowded, there were a lot of people moving to mainland Greece, and one of our Farsi into English translators, an amazing person, was also moving to Thessaloniki.

And did she take her family?

Sebastião: Yes, they had an apartment with very good conditions and were very happy. And they believed that there they could rebuild their lives. And this is very good!
There is always some fear, because many of them leave Lesbos and go to another camp in mainland Greece, sometimes in worse conditions, so they always go feeling some fear. In the case of this girl, fortunately, they managed to have their home. And they're fine, they're happy (he says with a grin) and I believe everything is going well for them. 

Now that you're here, do you hear from the people you met? 

Sebastião: Yes, I'm keeping some contact, especially with my Coordinator to know how some of the patients I left there and some of the people are doing. I continue to know some things. A lot of people have been arriving, just yesterday 450 people arrived in Lesbos. A week ago a 10-month-old child died on a half-hour sea crossing. The situation in Moria is becoming more and more degraded… But yes, I keep in touch as much as possible!

You referred to the Karetepe camp as an example. Are there any selection criteria for one family to stay in this camp and others to stay in the other? 

Sebastião: Yes, there is. It has to do with vulnerability, meaning large families usually go to Karetepe, which is the good field, so to speak. Older people, people with serious diseases, single women and some unaccompanied minors also go to Karetepe. But even transferring to the good camp can take time, because there are restrictions on the number of people. That is, only when someone leaves Karetepe can more people enter to avoid overcrowding. Moria was also an acceptable camp at first, but it started to become overcrowded and now has the conditions we know...Therefore, there is not always a place in Karetepe for the most vulnerable people. 

Are there many unaccompanied minor?

Sebastião: We didn't deal much with unaccompanied minors, because they are in the care of the Greek Authorities and Doctors Without Borders, who have a paediatric clinic near the camp, but there are some and in quite complicated situations. Children who arrive alone are in a supposedly safer area of the camp where there is a lot of policing and much follow-up. And in this area there was a fight which resulted in the deaths of 2 young people, 14 and 16 years old. This in the zone that was considered the safest. No one took responsibility. Life there is not easy for anyone, even in safe areas.
I have the idea that there are about 2,000 unaccompanied minors, but I they may be more.

It is a very high number...

Sebastião:  It is… I met a guy who said he was 17 years old. When they arrive in Thessaloniki they often have no documents at all, and when asked how old they are, many say they were 17 because being younger has more perks: it is easier to have access to food, to have accommodation...
In the case of this boy he did not look seventeen, but he was alone and completely lost. He had been there for 3 weeks, was not registered anywhere, had no papers, slept in the vicinity of the camp because he was not registered in the camp. He did not know what to do. He had no money and wanted to get out because they often have to pay the police to let them pass, or have to pay for rail or bus travel. And there you hear the most horrible stories: from people who make entire freeways under a truck to cross borders or people hiding in train cars. We were able to refer him to the Association that deals with minors. I remember asking him what his dreams were, what he wanted to do...

What were his dreams?

Sebastião: He said that at that moment, he just wanted to leave. He wished he could go somewhere in Europe, because his mother had sent him so he could settle down, earn money to send home (in Afghanistan), so that he could afford the school of the two younger brothers. His dream was that the brothers could have access to education.
He had been there for 3 weeks and I asked him if he had spoken to the family since his arrival. “Does your family know that you are here, that you are alive?” He said no. I gave him my cell phone and he called his brother. It was the most expensive call of my life but it paid off a lot. I never knew anything about him again. I know he often asked about me...
From time to time I still think about it… I hope he is more settled… 

Will you return, Sebastião? 

Sebastião: I really want to do this more often. I don't know if in Greece or elsewhere. It is curious, but after six years of studying medicine, there I felt extremely useful for the first time... My usefulness as a doctor and the usefulness of medicine, in the way I conceive it and how I believe in it. In human medicine, for the people. That's where I made peace with the medicine that I think should be practiced, and I really want to go back to working in this kind of context, because in fact it takes people to devote some of their time to being there for others, and those people really need help and someone to take care of them.
But I also felt that… Well, the university educated me quite well and I was a reasonable student, but sometimes I felt that I lacked a lot of knowledge, which is normal. I saw a lot of things, like tropical diseases that I had no idea how to treat, diagnose, or what to do. I felt that I lacked a more specialized training, so I want to graduate here in an area… We'll see what it is… In order to do a better job in this kind of contexts.

 

Can this experience have an important weight in choosing a specialty?

Sebastião: Surely it will! We will see what the area will be. It has an important weight in many things, whether in choosing the specialty, what we want to do in future and especially, in the way I will see patients in the future. I am sure that today's Sebastião is a more dedicated Sebastião. 

Sebastião leaves a clear message to our students, “We, as future doctors, have a very important role and we have an extraordinary opportunity to be able to help in a way that, I venture to say, with all due respect for all other professions, is unique and essential. So I think we should, at some point in our life, give these people some of our time! Obviously here in Portugal there are also people who need a lot, but if there is a possibility to do so now, as students, or as specialists, I think it is very important. We always learn a lot of things that you don't learn here, which means that here we have people who do not go through the same traumas”.
He believes that this is an extraordinary school of life and that the reward comes in the simplest things. “It is very worthwhile and I hope there will be more people doing this, even if it eventually implies, as it was my decision, not to take the exam right away,” he says with bright eyes of hope. This Sebastian I know says he is not in the least sorry, and once again I believe him!

“I hope there are more people doing this, this is my main message. We, as doctors, have a really, really important role. May we use this training that is so valuable to help these people.

 

***

I finish transcribing this interview with the news I have just heard: “Fire broke out this Sunday in the overcrowded refugee camp in Lesbos, Greece, confirming the death of one person. Clashes with the police ensued, who threw tear gas at people. The causes of the fire are unknown”.
Thank you, Sebastião!

* At the time of the interview the number was around 12, 000 people. At the time of publication, the official number is about 13,500 people. In the weeks following the interview, there were 3 wrecks of boats trying to reach the Greek islands, accounting for more than 10 deaths, most of them children.