Emory Report

July 26, 1999

 Volume 51, No. 36

Refugee Diary, Part II:

Bigger planeloads of Kosovar refugees make volunteers work even harder

Susan Lomax spent a week in early May at Fort Dix, N.J., where she helped give care to incoming Kosovar refugees. Part I of her diary appeared in the July 9 issue; Part II, chronicling her final days at the refugee village, are below. A fulltime student pursing a master's of science in nursing, Lomax also works full time in the Emergency Department at Scottish Rite Children's Medical Center on a graveyard shift.

Tuesday, May 11

At the morning meeting we are told there will be another plane on Wednesday. There are political problems with the Macedonians, and they are insisting greater numbers of refugees be moved in a shorter time period.

Although the pace is hectic, the day goes well. An old man comes back to us in the late afternoon, carrying a homemade musical instrument. We saw him yesterday for foot problems; now he wants to play us music to thank us for our help. The instrument has a rough lute-like shape, 18 to 20 inches long. There are two wires for strings, and a number of frets inserted up the neck. Both the bridge and the frets appear to be parts of a recycled belt buckle. On the flat face of the instrument he has drawn the Kosovar double-headed eagle.

The translator explains that this is a traditional Kosovar folk instrument. Only one string carries the melod;, the other is a drone. The old man begins to play, and an intricate music with Middle Eastern cadence fills the room. Everything stops; everyone listens. The old man sings and plays three songs for us. After each song he stops, wipes his eyes, and asks the translator to explain the words. These are patriotic Kosovar ballads. Each song is in praise of a hero or heroine who has died in a conflict with the Serbs. The first song is several hundred years old, the second one dates from the early 19th century, the last one celebrates a heroine who fought against the Serbs immediately before the beginning of World War II. Nothing ever changes. We are all in tears by the time he stands, bows and shakes hands with us, walking slowly out the door.

Wednesday, May 12

The dry-mark message board by the clinic back entrance contains schedules, arrival times for the plane, various pieces of information. Along the top some wit has written, "Today is Wednesday, May 12. I am at Fort Dix, N.J." It would be funnier if we weren't all getting a little confused as to day and date.

The acute care area is treating 40 people a day, the pharmacy is filling prescriptions at a rapid clip and the immunizations folks are incredibly quick. The incoming nurses are experienced, and we are getting physician volunteers who are emergency physicians. The wonderful Midwestern DMAT members will stay another week, but most other nurses and doctors are leaving sooner. We are scheduled to leave Friday. I really want to go home. My dogs are getting on their hosts' nerves, I need to get organized before summer semester, I need a little down time to recuperate. But we won't be leaving enough staff in place and there will be back-to-back planes. This operation was set up to deal with two planes a week, a total of at most 800 people. Now they will be sending 747's, carrying 550 people each, on Friday and Saturday. And this is in addition to the two planes we have already received. Those of us who are able begin to rearrange our lives, extending our stay through the weekend. Maybe we can get most of Friday's folks processed through before we fly out on Sunday.

Thursday, May 13

The Kosovar Albanians are an athletic group, and they are rabid soccer players. One of my first patients was a professional soccer player who almost broke his neck playing soccer in flip-flops-he left without his training shoes. We get daily orthopaedic injuries attributable to team sports. The rest of the problems are related to the exodus from Kosovo. One lady walked out with a severed Achilles tendon and has been limping along for more than three weeks. Her son brought her in immediately after arrival, and she will be operated on Friday to repair it. The chronic lack of adequate medical care due to the two-tier system in Kosovo is starting to be an issue. We are seeing a phenomenon where newly arrived refugees show up with a list of physical problems going back months and years.

Late today a woman is brought in by her family. She is a known epileptic and has had a seizure in the dining hall. As our doctor checks her over he finds that her right shoulder is completely dislocated, a very painful injury. He immediately prepares to reduce the dislocation. Oh no, the family said. She seized five years ago and dislocated that shoulder. We couldn't get anyone to treat her so we just left it.

For five years she has lived with an incredibly painful injury. Tomorrow we will try to get her to an orthopaedist. We may not be able to fix the Balkans, but we can arrange to get that shoulder repaired. You do what you can.

Friday, May 14

The phone rings at 5 a.m. The plane has caught tailwinds and is coming in at 7:05 rather than 8 a.m. as planned. I jump up, put my scrub pants on backward in the dark trying not to wake [my roommate], put my pants on right-way-round and head out. It is in the 40s, my hair is wet, the sun isn't up yet.

The medical group meets at the clinic to drink bad coffee, then loads up into vans for the drive to McGuire, where the plane will land.

We are ready to crawl under the nearest bus when word comes that the plane is five minutes out. Suddenly I'm not cold anymore, I'm nervous. There's a quick rehearsal: what we screen for, how we will handle medical emergencies. And then far off to the east we can see the 747, slowly settling down to land. Within moments the plane has taxied to a halt just in front of the buses. We quickly scan the group and the doctors identify two who appear to need more intervention, but most are stable and can go through immigration.

A woman taps me on the shoulder: someone is not well back in the passenger cabin. I turn to follow. On my far right there is a man sitting rigid, expressionless, holding a blue blanket slung between his two outstretched hands. There is something in that blanket, and it isn't moving. My heart stops. I know this has to be a child. I approach him slowly and gently move the fold of the blanket. It is a child, about six months old. I am reaching down to take the baby and run for the doctor at the front of the plane when the baby yawns. He is only sleeping. Dad's frozen face is sheer exhaustion, not grief.

I smile, re-cover the baby, and hope the father can't see that I am crying.

Only then do I look up and see the faces of 550 refugees staring at me. Their eyes are indescribable. They are hopeful, frightened, defensive, worn out, angry, loving, empty, joyous, mourning what they've left and anticipating what they will encounter. I feel as though I am being pushed back by the sheer strength of all that emotion. I will never forget this.

Saturday, May 15

I am aware that this is my last day, I am feeling emotional about too many things. Probably lack of sleep. The new [nurses] are wonderful, skilled and caring.

I have to say goodbye to the translators who have worked so closely with us. Without them, nothing is possible. Both the main translators for the acute care area are doctors, although neither practices here. One is a radiologist, reads all the X-rays, is a wonderful resource. He knows the Albanian formulary, manages the patients with tact and respect, and has taught us much about his country. Meeting and working with him is one of the best parts of this experience, but I can't tell him. It would embarrass him, and I would cry. So I hug him, thank him, don't say enough. I tell another translator goodbye and he thanks me for taking care of "his people." I can barely finish the conversation.

The day ends at 8 p.m. In 12 hours we have seen 54 patients in the acute care area, not bad for a treatment area which didn't exist prior to May 4. The numbers will only get bigger. I am so sorry to go. And I am so glad to go.

A friend offers me a ride back to the motel, but I want to walk, need to walk.

Two middle-aged men are leading soccer drills with a group of 10 to 11-year-old boys and girls; and my early morning jogger is running again, this time with a group of three others. I turn the corner and head down the side of the Village near the swings. A little girl runs over, waving. I recognize her. "Hello, hello," she says. And I say tunjaht-earla. She smiles and runs off. This time I know I have wished her a long life, and I do, I really do.

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