A summer less ordinary
Written by Ryan Tewari
Over the summer, 12 Imperial medical and biomedical students took part in the inaugural Sahara Health Initiative (SHI) expedition, working in the Saharawi refugee camps in the Western Algerian desert – the largest and oldest refugee camps in the world.
SHI is an arm of GLAD (Global Action for Development), a charity set up by ex-Imperial student, Saba Shafi. The SHI aims to take medical and bio-medical students to this neglected part of the world each year to aid health workers and witness the Saharawi way of life.
More likely than not, you will not know about the situation in the Western Sahara. The Saharawi are the indigenous people of the Western Sahara, which up until the mid-1970s was a Spanish colony. Following decolonisation by the Spaniards, the territory was occupied by neighbouring Mauritania and Morocco. The former withdrew their occupying forces in 1979 but the latter still occupies approximately three-quarters of the whole territory. In 1991, an UN-brokered ceasefire was declared between Morocco and the Polisario (the Western Saharan government-inexile), and a referendum was to be held to determine the Western Sahara’s fate. To this day, this referendum has not happened and the situation has been swept under the rug and out of the public eye.
According to some sources, up to 165 000 live in the refugee camps outside of Tindouf, Western Algeria, and have existed for over 35 years. The camps are made up of several districts (wilayas), named after cities in the Western Sahara (El-Aaiun, Daklha, Smara) and important dates in the history of the Saharawi people.
We were based at Rabouni camp, accommodated with many other NGO aid workers. We were split into two groups – clinical and public health. I was part of the clinical group, and mainly alternated between the national hospital at Rabouni Camp and the wilaya hospitals.
I found myself surprised and impressed by how well organised the health system was, but it suffered from severe shortages. Firstly, healthcare in the camps is free for all. Each wilaya is made up of smaller villages (dairas), each with their own dispensary clinic run by nurses. These feed into the wilaya hospitals, which themselves vary greatly in facilities and staff. For example, El-Aaiun hospital had a small burns unit, an onsite pharmacy, an optometrist and two doctors. In sharp contrast, Smara hospital had only one live-in doctor who was effectively on-call 24/7. The next level up is the national hospital at Rabouni camp, but even here they were severely understaffed – a gastroenterologist, an urologist, a dentist and a handful of nurses. Often, the hospital administrator would run a lot of the clinics, although he was originally trained as an agricultural engineer. They have been unable to perform any surgeries for over six months because there has been no anaesthetist – all surgical cases had to be sent to the nearest Algerian city, Tindouf.
There are around ten doctors in the entire camp. Ten doctors serving up to 165 000 refugees.
Much like how our clinical attachments back home differ between different placement sites, it did so here. In some hospitals we sat in clinics, ‘urgencias’ and occasionally took the clinics ourselves. In Smara hospital, the lone doctor threw us into the deep end and would only confirm our diagnosis and prescribe medications. The doctors we met were all very willing to teach and, in all honesty, were better teachers than some of the doctors in the UK, despite the language barrier. We were accompanied throughout by excellent translators (including the deputy Saharawi representative to the UK) who were absolutely invaluable. My consultations would not have gone very far without them. My Spanish didn’t go far beyond ‘Quantos anos tienes?’ (‘how old are you?’) and ‘Donde dolor?’ (literally, ‘where pain?’), and my Arabic was even worse.
Overall, I feel that I would have got more out of the clinical work if I were to do this after my first clinical year (so I could consolidate my knowledge) rather than before and have to learn things from scratch. Having said that, the fourth year medical students were excellent teachers themselves, and the experience gave me a running start in my third year.
The public health group were kept very busy over the three weeks. They collected data on health (on behalf of famous eye doctor John Sandford-Smith) and on water storage tanks (the hope is that they will be replaced by plastic tanks, as the metal tanks rust and contaminate the water). Remarkably, they were able to finish this mammoth task ahead of schedule, and had time to teach first aid in the Women’s Institute and work with some of the NGO workers.
We met a lot of important people while we were in the camps, including the UNHCR team in the camps, the leader of the Women’s Institute and the Minister of Health. The Minister was one of the only healthcare professionals in the early camps over 35 years ago. When speaking to some of these individuals, I had a strange sense of guilt because I couldn’t help them more. In response, they would tell us that we did have an important role; we can tell others in the UK of their plight.
Despite these circumstances, the Saharawi people are among the warmest and kindest people I have ever met. A true testament to how solidarity triumphs over such great adversity. They would welcome us into their homes, share their meals and make us Saharawi tea (which tastes incredible). It is such a tragedy that their plight goes unnoticed by the world and their situation is without solution. Simply put, they cannot lay down roots in Algeria and will remain dependent on outside aid.
It wasn’t all just work and tea however! We had plenty of time to explore the camps, visit Saharawi families and enjoy traditional activities, such as camel herding. On one of our last nights, we spent a night under the stars on the sand dunes. My most vivid memory of the camps is waking up at 4am and exploring the virgin sand dunes under the moonlight with nothing for miles and miles around. Truly breath-taking.
Before taking part in this trip, mind-numbingly dull epidemiology lectures had made me think twice about global health as a career. This experience has put it back on the agenda, and I plan to go back next summer with SHI. I would recommend global volunteer work to any medical student who hasn’t tried it yet!
If you want to learn more about the SHI, please contact Ryan Tewari through the Comment Editor.
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