University of ThessalyDepartment of Architecture

Art and ToposMobile Medical Unit

Maria Papadimitriou

Dimitris Derzekos

Manos Laoutaris

Constantine Papathanakos

Vasia Sereti

Maria Schina

Kaiti Tsiouni

Action 01

Το σχέδιο αυτό χρηματοδοτήθηκε με την υποστήριξη της Ευρωπαϊκής Επιτροπής. Η παρούσα δημοσίευση (ανακοίνωση) δεσμεύει μόνο τον συντάκη της και η Επιτροπή δεν ευθύνεται για τυχόν χρήση των πληροφοριών που περιέχονται σε αυτήν.

This project has been funded with support from the European Commission. This publication [communication] reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

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Mobile Medical Unit

The degree of integration of Gypsies-Roma in the social security system is still very low, and studies indicate that most are unaware of their rights in the field of care.Moreover, their confidence towards the public health system is moving at low levels. Notwithstanding any serious problems occur gradually but positive steps, including:

1.The regular monitoring of vaccinal situation of children from hospitals

2. The familiarity of women doctors in hospitals to the test P.A.P.

3. The use of decentralized health services such as health centres, P.I.K.P.A.

The crucial issue for the better treatment of various diseases, particularly gynecological and psychological as well as virus infection is the prevention. That ‘s why we believe it is necessary to establish a mobile medical unit which will contribute to prevention, awareness, diagnosis and treatment of medical conditions in the camps. Particularly in the region of Thessaly, where the programmes which provided physicians and psychologists in areas of the camps have stopped . The mobile medical wan is proposed to address the needs of the settlements on the periphery of Thessaly. Be based in the city of Volos and visit the prefectures of Thessaly.

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Ο βαθμός ένταξης των τσιγγάνων-Ρομ στο σύστημα κοινωνικής ασφάλισης παραμέ-νει The integration degree of Roma-Gypsies in the social security system is still very low, and studies indicate that most are unaware of their rights in the field of health care.Moreover, their trust in the public health care system is limited.What is worth mentioning is that although females give birth in public hospitals, they are seldom willing to form a steady relation with the hospital personnel after birth giving.As for the pregnancy period, according to the results of research that took place among health professionals at “Efxini Poli”, a small percentage of pregnant gypsies are prompt to subject themselves to prenatal medical check.According to our research, which was entirely based upon interviews with male and female gypsies from different regions, the following conclusions have arisen.To questions asked exclusively to female gypsies, the following answers were given:• 96% stated Hospitals as place of giving birth, while 3.5% stated home.• 46% were under observation by Hospital doctors, 20% by private doctor and 32% were under no observation whatsoever.• 60% are aware of Pap-Test and half of them have had it at least once, while 45% know about mammography and only 10% have had one.

In the research carried out by Information and Support Centre ‘Efxini Poli”, it has been on the whole estimated that the primary reasons why Roma- Gypsies do not visit Hospital clinics are:- ignorance concerning their social rights- a rather unfriendly welcome, prejudice and- their own mistrust in health care services.However, in the above mentioned survey by the Labour Ministry, 70% of people asked answered that they possess a health insurance card, while 77.8% said that their children possess a health insurance card.

A significant problem which obstracts the access of the Rome community members in the national health care system is the lack of medical and pharmaceutical insurance or welfare. The main reason for this is a widely met occurrence, according to which gypsies are neither officially registered nor do they have I.D., which would certify their particulars. Therefore, lacking naturalization, they are exempt from their rights and access to the health care system.In case of urgent visits to hospitals, they tend to use health insurance cards of relatives and generally give false personal information, especially in maternity clinics. For example, an underage mother without ID signs in as her mother or sisters who have ID so as to be discharged along with the baby.

Moreover, the dilemma often met by members of this particular community, concerning tax settlement or car purchase as opposed to health care insurance by welfare, is answered by turning to private health care services.As for the relation of the Rome with the health care services personnel and the medical scientists on the whole, an improvement has been registered concerning the behaviour of hospital personnel towards the Rome, which, however, does not mean that segregation has altogether vanished. One of the parameters complicating the situation is the different communication and civilization perceptions. The medical community regards non-compliance to rules of social conduct towards doctors as lack of respect.

GYPSIES AND HEALTH CARE TODAY

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Furthermore, according to hospital regulation, during duty calls, only one person is allowed to accompany the patient inside the examination room. Security guards who execute their duty in order to implement the hospital regulations on the one hand, and Rome families who insist on having more than one members, such as parents and grandparents, accompany the patient on the other hand, embark in situations of conflict and strong dispute.

However, preventive medicine has become quite significant for the Rome community through a diversity of programs and information acts that are initiated by state and social services throughout Greece. However, since portions of the population frequently move - not to mention legal impediments, a low level in education etc - serious delays are observed between the manifestation of a disease and seeking medical aid for it. Another reason why visits to hospitals are delayed is the issue of distance, as only 25% call for an ambulance when lacking their own means of transport, while 50% seek for help from a private practitioner, near their settlement. Notwithstanding serious problems, positive steps are gradually taken, including:

1. The regular monitoring of children vaccination by hospitals 2. The familiarisation of women with hospital doctors concerning the Pap- test 3. The use of decentralized health services such as health centres or P.I.K.P.A (the Greek Patriot Institution for Social Care and Welfare)

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A record of the commonest medical conditions met in the gypsy community

1. Psychological problems

- A great number of people suffer from depression (50-70%)- This number is bigger amongst women.Causes of psychological problems – depression:- They get married at a very early age, 12 years old.- They are forced to adulthood at the age of 12-13 years old.- Women are obliged to take care of their children, husband and all his family.- They constantly repeat the same routine.As a result of the above, gypsy women easily take ant depressive medication, which is handed to them by a friend or relative.This results in high blood pressure and strokes, both very serious consequences.If they actually seek for help concerning their depression and other psychological problems, they do so addressing psychiatrists rather than psychologists.

2. Gynecological problems

- Women marry at 12 years of age and are ignorant of gynecological issues.- They are inadequately informed on the seriousness of the PAP test, although there has recently been a turnover in persuading them to visit the hospital to that purpose.- The PAP test is better accepted among younger women, since older women claim more experience due to multiple child births.- They feel more comfortable and trust women gynecologists, avoiding to be tested by male doctors.

3. Inadequate vaccination

- At the beginning they were hardly receptive to vaccination.- In the passing of time they have been convinced on the necessity of certain vaccines, such as the hepatitis vaccine, the vaccine for measles, the ant tuberculosis vaccine.- Nowadays, children are led to hospital to be vaccinated before they begin school.

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Interview to a group of gypsies

Interview to a group of women

We would like to ask you how often you go to the hospital.We go to the hospital very often these days

Does this happen because of little children illnesses?Yes!

Who visits most often the doctors?I bring my child, who’s 10 months old, every night.

Why?Because he has fever, cough…

He doesn’t see any improvement in his health from the medicine the doctor’s prescribe? Not at all! For example, I have a son who’s 5 years old who I’ve just taken to the doctor. The last days, every night I take him to the hospital. I have also paid 150 euros to buy medicine from the drugstore for my other son, who is 15 years old. Still I haven’t seen any improvement in his health either.

Do you pay money for the medicines you need? Don’t you have any kind of insurance to provide you free of charge the medicines that you need?No, we don’t have any help of this kind.

How many members does your family have?It has seven members.

What is the average age in your settlement? Which is the age of the oldest people?The oldest is this grandmother, who is 50.

What kind of problems are the most frequent around this settlement?You mean health or economical problems?

Health ones.My son and my grandson have asthma. This is our problem.

In the rest of the families which illnesses occur besides asthma?These days all the babies have this problem.

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Does the doctor make the vaccination to the children when necessary?He used to, but now the doctor has left. We need a doctor.

Yes, we’ve already heard that the doctor has left.He was a very good doctor. He gave us our medicine; he made the vaccinations to us. But, what a pity, he has left.

Besides the little children do you –the grown ups- have any health problems?Yes! I have stress, melancholy, my back aches, my stomach aches, many illnesses.

Have you visited the doctor about these?Yes! I have. And he has given me medicines that cost 70 Euros and I couldn’t afford them because I don’t have any financial help.

So, I understand. You do have health problems, you do visit the doctor, but since you do not have any kind of financial help, you cannot take medicine. What about the stress and the melancholy? How do you deal with them? Do you take any kind of medicine? Yes, I do, but not often due to cash shortage.

Do you think that these medicines help your health?Yes, I think they do since, when I take them, I then get to sleep and I forget all my problems.

You, as a woman, do you take the PAP test?I have taken it twice. The first when this medical mobile unit has been around here and the second time when I went to PIKPA.

Do you have to pay for the PAP test?Fortunately not! If I had to pay money for it, I couldn’t afford it.

Is it easy for you to talk to a doctor for any health problem you have?Of course!

Even in the case the doctor is a male and you have a gynecological problem?Of course! We don’t feel ashamed of this, since I have already given birth to children.

Is it easy for you to speak to a psychologist for your problems?Yes. We had a psychologist but she left. Everybody will finally leave us.

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Here, in this settlement, do you follow what the doctors advise or use any practical methods of yours?Like the maiden “doctor”!Yes, like the maiden “doctor”

These practical doctors, provide you medicine or quack remedies?No they don’t prescribe anything. They prevent or take away the bad eye, with some specific words they say…

We would like to ask you what do you think that the settlement needs most, gynecologists, pediatricians… ?Pediatricians in order to do the vaccinations to our children, and dentists.

Do you need oculists?No. we don’t have problems with our eyes. You won’t see any of us wearing any kind of glasses. We are most interested in a pediatrician.

If there was a mobile medical unit to recognize it from far away would you prefer to have some picture with doctors on it or any other signals?A big cross or some kind of drawing would be better.

Are there any colors that you connect them with health? For example, we recognize the hospital being the big white building. Do you have anything equivalent color to health? Or not?No, we don’t.

Do you have any problem with hepatitis?My daughter and my husband suffered from hepatitis. You should see how I treated them. We had to wash their clothes with hot water. We had to iron them and we had to cook them meet to keep my husband and daughter in a healthy condition. We used all kind of practical methods. If we had to visit the doctor we should wait for two years to get over the disease!

Thank you very much for the information.

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Interview to a group of men

What are the health problems that you suffer from more often?Cholesterol, diabetes.

Do you have psychological problems stemming out of stress?Look at him. A psychiatrist takes care of him. We all need a psychiatrist, a pediatrician, a general practitioner to do our check up.

An oculist, a dentist? Do you need them?No, we do not need an oculist.

Do you visit the hospital?Yes, I do. Everybody does. We need to visit the hospital for everything but the oculist.

Do you think that an oculist isn’t necessary to exist in your settlement?No, but we definitely need a pathologist.

In older times, when there was a doctor in the settlement did you visit him often?Yes! And now that he has left it is a great loss for us. This doctor gave us great services especially to the old ladies. For example, my mother who is 70 years old can’t visit the hospital by herself and it’s a pity that the doctor left us. The doctor was a kind of God for us.He covered all the necessary needs for you.My mother can’t take a bus or a taxi and go to the hospital by herself to take her medicine. Even though there was a doctor here, she could hardly manage it. But she made it. I can go to the hospital, but an old man or a child can’t do this. So the doctor was very useful for these people.

Did this doctor have the authority to give you and prescriptions?Yes, he did.

Which was the specialty? He was a pathologist but he covered many needs for the most of us. We don’t need practitioner, but a pediatrician to do the vaccination to our children. Because now you call the hospital for an appointment and they tell you to come after a month! Is this right? The doctor we had in our settlement was like a God

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to us! He was very obliging to us. I don’t know why he left.Maybe his contract was over.Yes, but if you visit the houses of the old people you will see that they don’t have medicine and they can’t go get them at the hospital. We certainly need doctors.

The medicines you need are offered by some kind of a provident society or do you buy them with your own money?The ones who have insurance they take them free. The others of course cannot.

Are there any people that they don’t have any kind of insurance?No, everybody has insurance, an insurance booklet. This moment I don’t feel well. If there were here a doctor now, I would go to him for a check-up to see the level of my blood pressure; to examine everything, you know. But this thing is missing. As an example, this man has sugar in his blood and he does not know which is its level. This man here, is suffering psychologically and is attended by a psychologist. This man is suffering because of various illnesses. He cannot stand upright, his legs are aching. He doesn’t know were to go. But if there were a doctor here, or a bus and a truck with doctors, he could do his best to meet them.The mobile unit proposed by us would visit you, and by the doctors’ supervision would do basic check-ups and inform the sick persons to confront the problem.We need this thing. Yes, we wish these doctors to come. We need them very much.

How many members are you in each family?It depends on the family. For example I have five children now. My mother, who is old, lives with us. We are eight members in the home. This man has four children. His mother and father live with him. They are eight in all. Seven, five, four…members and so on.

Could the previous doctor satisfy the needs of all of them?He was able… the man tried as much as he could, he did what he could do. The man was very good. He confronted a lot of incidents.

Why did they dismissed him from his post? Perhaps the program was ended and the money was finished. His contract would be lasted for three years. The psychologist, the teacher, the doctor, the girl who was responsible for vaccination, all of them have left. We should plan another three- year program, so that they send us others. These are not good things, you know. They would spend the money for food. All right, the food is necessary, but it is not

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so necessary as the medicine. When the psychologist was there, I used to go to her to tell her my sufferings. Then she was giving me a medicine and she was attending me. The psychologist knew mw, why they dismissed her? Now, I must go to another psychologist. Before he left, they should bring another one here. The pathologist served us, he had a contract. All right, he was oblidged to leave. But we need a substitute. If one leaves, he must be replaced by someone else, immediately, not after five years.

Do you have problems with the hepatitis?I don’t know this. I have not been vaccinated, but I don’t know where the boundary of the hepatitis is. If the bus came here, I could go for a check up. To see where I am, what happened. Shall I stay home to hear the news, to learn what the hepatitis is and whether I have hepatitis. I could have hepatitis and diabetes now. I could have everything. But as long as I feel my self young and strong at my legs and can walk, I feel well. If I collapse, in the future, I don’t know how I would be, what kind of illness I would have, which medicine to take. Five times my mother went to meet the doctor, to prescribe a medicine for her. Do you know what was the answer? “The doctor has left, they have dismissed him”. But they must put another doctor into his place, so that he serves the people. They ought to examine these matters more seriously. They must bring doctors here immediately. I see my daughter, who is five years old. She walks, she goes into the water. I don’t know where she is.

Don’t you have sewers and a network of pipes carrying water?No, we have nothing. They have made some things, but they have not finished them. They do what their party (political) tells them to do. In their work, they ought to have you and Mrs. Irene as models: you as well as Mrs. Irene have being trying hard for many years. She does her best to serve all of us. No voice is heard. Among ten voices the one is not heard. It tries in vain to be heard.But the mayor has not made sewers for the waste water.The farmers protested, but nobody noticed them. After they blocked the roads with tractors, the authorities made a resolution. The same thing must be done as regards us. We must protest, mustn’t we? What to do? To go out with rifles to ask for a doctor, to force them to decide? No. the authorities ought to act by themselves. When somebody finishes his term of service, he should leave his job. If a doctor finishes his term, he must be replaced by another one. His post must not be empty for two years. We wish this to be done immediately, in one or two months, not in two years. All of us, who are here, follow a program. We are not public servants. We are people who work in the municipality.

Are Mrs. Irene and you working by contract now?We have been working for many years on a “ work contract”. Now, this became an “indefinite time contract”.

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Interview to a woman

Good eveningHi…

We would like to know if you often face health problems.What do you mean? We have a lot…

Psychological, Hepatitis, but generally what kind of doctor do you need?Everybody has one of these. We had doctors, but they’re all gone. Far gone.

Yes. We know.We want doctors. A pediatrician, a dentist… pediatrician, kids are sick, they cough, have fever, to have vaccination…

Do you visit hospitals?Aha, all the time. We take the kid every day, she’s always sick.

What’s wrong with her?Stomachaches.

Did the doctor prescribe medicine?Yeah, but I didn’t buy it all. It costs me 40€, it’s not for free, I buy it myself, how can I find the money…

Do you go to the hospital by yourselves?Yes, sure we all go. If the baby’s in pain, she’s crying, she’s not well, we go every day.

Do you have psychological problems?Sure we do. Me, if I get drugs I’m fine, I sleep, I have no problems. But I don’t get them all the time, ‘cos of the money.

Do you visit a psychologist or a psychiatrist?We went to the doctor who was here, but now he’s gone.

How many are there in your family?I have six kids now, the grandparents… ten.

Is your husband away on business for long?He leaves to go to the villages to sell stuff. He wanders, for a while…fifteen, twenty days…

How do you manage on your own?I manage… what can I do… I stay here in the house with the kids.

What’s your daily routine?Here… I do chores, wash, clean, cook, tidy the house.

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Don’t you get bored in the house all day?What to do? I do chores, tidy. In the morning I sit with my daughter and grandma and talk, then chores… we have to cook for the babies.

Don’t you do anything else but housework?No, what else…come and see how nice the house is. What else to do?

That’s all we wanted to ask you, thank you.

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Prevention and treatment

The crucial element for the better treatment of various diseases is prevention, which is why we believe it to be necessary to establish a mobile medical unit which will contribute to prevention, awareness, diagnosis and, more importantly, treatment of medical conditions in the settlements. This is particularly significant for the region of Thessaly, where the programs which provided physicians and psychologists in the settlement areas have been halted . A mobile medical unit should include:

A general physician or a health visitor, who will give emphasis on:-prevention of various diseases-vaccination of children-informing women on gynaecological conditions and first aid.

A psychologist who will explain that one should not immediately turn to ant depressive pills, which are largely consumed.The unit vehicle driver could be one of the above professionals.The specialists could alternate depending on the needs to be met in each settlement.Members of the gypsy community tend to trust people of the same race more. Therefore, one of the doctors could come from the particular race, so as to facilitate the patients’ need to talk about the symptoms of their conditions.It is proposed that the mobile medical unit should address the needs of settlements in the district of Thessaly. It could be based in the city of Volos and visit the prefectures of Thessaly.

Gypsy settlements in the district of Thessaly

Magnisia county : Aliveri, , Nea Ionia municipality Agia Paraskevi, Volos municipality Dimini municipalityLarisa county : Nea Snirne, Larisa municipality Tirnavos municipalityGiannouli municipalityKarditsa county : Sofades municipality (2 Settlements)Trikala county : Kipaki, Trikala municipality

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Distance in kilometers between settlements in the district of Thessaly

VOLOS – LARISA 63 km.

VOLOS – KARDITSA 116 km

VOLOS – TIRNAVOS 91 km

VOLOS – TRIKALA 121 km

VOLOS – SOFADES 92 km

LARISA – KARDITSA 70 km

LARISA – TIRNAVOS 16 km

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Οδικός χάρτης περιφέρειας Θεσσαλίας

Διαδρομές κινητής ιατρικής μονάδας με αφετηρία το Βόλο

Basic Routes

Basic RoutesSecondary Routes

Mobile medical unit routes from Volos and Larissa

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Equipment to be used in the mobile medical unit

•hem dynamometer•Respirator•Electrocardiograph - Defibrillator with the ability of external pacing• Pulse Oximeter• Scoop-stretcher•stretcher for patients suffering multi injuries• Rescue vest•Air-collars•Head Guardian • Aspiration device (stable and portable) •Ambu mask•Portable stethoscope•Three- blade laryngoscope•Glucotest •Isothermic blanket• Pharmaceutical Equipment

Specialized medical actions to be carried out by mobile medical unit personnel:

•Air tube support by immobilizing the cervical spine. •Breathing sustention and support through oxygen administration, intubation and use of breathing devices.•Basic and specialized KARPA - Defibrillation –Pacing•Control of external bleeding, evaluation of wounds and ability to stitch them. •Circulation sustention through intravenous administration of fluids and medicine •Evaluation and stabilisation of external and internal injuries and fractures in arms and legs, as well as spinal fractures by use of immobilization devices. •Treatment of thermal and chemical burns •Treatment of poisoning and drug- use • Diagnosis and treatment of seizures, hhypoglycaemia, acid pulmonary edema, myocardial infarction and more life threatening conditions•Treatment of emergency obstetric (labour etc), neonate and pediatric cases. •Estimation, evaluation, immobilization and safe transport of multi injured patients. •Pharmaceutical and medical care for children with severe health problems •Providing counseling as well as social services to children and families facing problems. • Vaccination of children - members of a specific population.

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