Turf wars, thieves and disaster tourists: Life at a Canadian field clinic on Poland-Ukraine border
Small team of Canadian doctors, nurses and paramedics is helping treat refugees fleeing war in Ukraine
Galina Bunesky sat quietly in a chair as Canadian physician Daniel Kollek listened to her heart. Her daughter and two grandchildren watched anxiously nearby.
"She was feeling sick and dizzy," said Bunesky's daughter, Marina Petrova.
The family had travelled 770 kilometres from Kropyvnytskyi, in central Ukraine, to the Korczowa-Krakovets border crossing between western Ukraine and Poland. It's an 11-hour trip by bus on a good day — and this was hardly a good day.
They waited inside a large, white tent on the Ukrainian side of the border, packed with hundreds of people fleeing the war by bus or car.
Inside was a field clinic staffed by volunteers with Canadian Medical Assistance Teams (CMAT), a disaster relief organization set up in 2005 in the wake of the deadly Indian Ocean earthquake and tsunami that devastated parts of Indonesia, Thailand, Sri Lanka and India.
"She is very tired after such a long way and all these difficulties, and she has very high blood pressure," said Ukrainian-Canadian translator Natalya Halych. "That is why they had to ask for some help."
Bunesky left the clinic soon after with some blood pressure medication and advice to see a doctor once she got to Poland.
"Thank you very much, it was a very nice surprise. I'm touched with the care I received," she said in Ukrainian as she walked away with her family.
'They're all cold, hungry, tired'
CMAT has a roster of 1,000 doctors, nurses, paramedics and psychologists who volunteer their time and pay their own way to help in disaster zones around the world.
This is Kollek's first deployment, but the emergency room physician, who is Jewish, says it's a personal one for him.
"My family fled Europe in World War II, and those who got out, got out — and those who didn't get out, nobody came to help," said Kollek, who is usually based in Burlington, Ont., west of Toronto.
He's part of a 15-person CMAT team deployed to help refugees trying to escape the war in Ukraine. Last Saturday, he was working with paramedic Scott Haig from Vancouver and registered nurse Teresa Berdusco from Edmonton. CBC News spent five days with the group as they got the clinic up and running.
On the first full day, the team saw a steady stream of people looking for help.
"They're all exhausted. They're all cold, hungry, tired," Berdusco said. "Their blood pressure is high. My blood pressure would be raised if I lost my home and had to move to a new country."'
Haig, who has been on almost a dozen humanitarian deployments, said he has never seen anything like this one.
"The volume of people coming through is just incredible," he said. "It's hard to fathom the number of people who are truly coming through ... maybe a thousand a day at this border crossing."
The mobile clinic isn't designed to treat trauma wounds, such as serious bleeding or broken bones. Those patients are sent to nearby hospitals.
Instead, the clinic is there to diagnose problems that, if untreated, could become more serious, such as hypertension, diabetes, coughs and stomach problems. Most can be handled with some medication and reassurance.
"This is stuff that could be seen in a family doctor's office if that office was there," Kollek said.
Fluid situation on the ground
Since 2005, CMAT has carried out close to a dozen deployments in disaster zones, but this is the first in a conflict zone.
Members of the team found out the hard way that offering help in a war is more complicated — a minefield of organizational turf wars, ever-shifting needs, thieves and disaster tourists.
"It's a fluid, fluid situation. Every day, we have 10 plans in place, and 11 get cancelled and then 20 more come up," said CMAT's executive director and co-founder, Valerie Rzepka, who is a primary health care nurse practitioner.
The situation is also very personal for Rzepka, who is Polish Canadian.
"That border ... is only 150 kilometres from where my family is," she said. "If that border shifts, my family could be affected."
Poland has received more than two million refugees since Russia invaded Ukraine on Feb. 24. Local volunteers, businesses and municipalities have stepped in to help — converting school gyms into dormitories and offering food, clothing and support. A new Polish law allows refugees to work and receive health care and social benefits.
Two weeks ago, Rzepka and Brandon Duncan, a registered nurse, visited border crossings between Poland and Ukraine to see where the CMAT clinic would be most needed.
They settled on Hrebenne, a small border point about 350 kilometres southeast of Warsaw. It was staffed with one doctor who needed help trying to care for a growing stream of refugees.
But two weeks later when the CMAT team arrived, the location had grown into a small village.
"Now, there's thousands of people there and tents everywhere and NGOs serving hot meals," Rzepka said. "It's interesting how in the course of two weeks, things have absolutely exploded."
Turf wars, wannabe medics
It raised the question of whether there was still a need for the Canadian clinic. Rzepka and her team tried to make it work but ran into bureaucratic hurdles and local turf wars that made arranging to get even a few tents a struggle.
"It's unfortunate you're kind of fighting people over turf when you should be working together — and ideally, you would be working together, but egos get in the way," she said.
Then five boxes of CMAT medical supplies disappeared from a storage shed at the border.
"Things always go walking," said Duncan, who is on his fourth international deployment.
"I've had things go walking on every single mission that I've been on, and I had a feeling this was going to happen. Everyone wants what you have to make themselves look good and get what they want out of the missions."
At the same time, there were people walking around the Hrebenne border camp in camouflage clothing claiming to have medical experience. Kollek calls them disaster tourists. One man showed up with a duffel bag of medical supplies.
"An odd hodgepodge of stuff in shoeboxes and so on, and then [he] dumped it on the table [and said] 'Can I volunteer? I'm a tactical medic,'" Kollek said. "We've had a lot of people claiming to be tactical medics. One of them told me ... he has good knife skills. It becomes a big problem when they actually get in the way."
'We go where the need is'
It became clear that the team had to look for a new location.
"We go where the need is. So if we don't see the need on the Polish side and there is a very pronounced need on the Ukrainian side, that is what we need to respond to," Rzepka said.
CMAT contacted the Polish Medical Mission, a humanitarian organization operating a clinic in Krakovets, inside Ukraine. Six people had died of heart attacks at that border point recently, and the group desperately needed backup.
Registered nurse Berdusco said it was the right decision to try to help those passing through the transit point.
"It's preventing them from getting sicker 'cause they still have days of a journey ahead of them," she said. "So if we can ... treat their exposure injuries or anything they have now, they don't have to stop until they get to where they want to go."
The first full day that the clinic was in operation, staff saw a steady stream of sick children and exhausted adults. Late in the afternoon, a man rushed into the tent looking for a doctor. His mother was unconscious in a wheelchair in the line of refugees waiting to cross the border.
The team ran out to the elderly woman, who was dehydrated and slipping in and out of consciousness. They gave her intravenous fluids and called an ambulance, which took her across the border to a hospital in Poland.
"Today, I really felt we did meaningful work," Kollek said. "The lady who we evac'd by ambulance to a Polish hospital did well, I heard from the ambulance crew."
CMAT plans to operate the field clinic for at least 90 days and will extend that if the need is there.
The organization hasn't completely given up on the original clinic location in Poland. It plans to set up a small presence there when more volunteers arrive this week from Canada. Four hundred new volunteers have signed up to join CMAT's roster since the war began, it said.
For Kollek, the trip is already a success.
"The number of people who thanked us from all over the place ... that's hugely important because it is a bad feeling to stand alone," he said.
"They see we are here; they come up to us [and ask], 'Are you the Canadians?' I think that is a huge thing."
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