Darragh Bermingham: The life of a doctor without borders

GP Maitiu Ó Tuathail travels across Ireland to be the first point of contact for newly arrived refugees. He hears stories of rape and torture, writes Darragh Bermingham

Darragh Bermingham: The life of a doctor without borders

AN Irish GP has recalled the harrowing stories he has heard from refugees and asylum seekers in Ireland, who have fled horrific situations across the globe.

Dr Maitiu Ó Tuathail works with Safetynet Primary Care, a charity that provides medical treatment to those who cannot access it, to the the most vulnerable and deprived people in society.

“As part of this work, I provide health assessments and GP services to newly arrived refugees and asylum seekers, and this work takes me to the four corners of Ireland,” Dr Ó Tuathail said.

“I have travelled to, and worked in, most counties in Ireland, at this stage, including Cork and Waterford, and have been doing this for the past two years.

“In many cases, I will be the first medical person these people have seen in years, so, at times, they can have complex medical needs that have been neglected for years”

“We can see medical conditions, such as cataracts, at a very advanced stage. We are often, also, the first people whom they interact with in a meaningful way when they arrive to Ireland, which is a hugely privileged position to be in,” said Dr Ó Tuathail.

“I feel it is our duty to ensure they feel welcomed and supported, and are made to feel that we are here to help them. What is challenging is to hear the harrowing stories of the situations they have fled and the experiences that have led them to seek asylum. We hear stories of rape, violence, child death, and torture,” he said.

“I have met parents who have donated their kidneys, so that they could buy their daughter a hearing aid. I’ve met men who have gone blind from being kept in solitary confinement for years. I’ve met men who have acted out the torture that they have been subjected to, over and over again for years, and then witnessed the adverse impact this has had on both their physical and mental health,” Dr Ó Tuathail said.

“I have met women who have been trafficked here to work in the sex industry. In general, it leaves me feeling privileged to have been able to hear their stories, but also incredibly blessed to have been born into a life where I did not have to flee such terrible situations.”

Dr Ó Tuathail has cared for refugees from across the globe.

“I have worked with a lot of newly arrived Syrian refugees, who have come to Ireland via camps in Lebanon and Jordan,” he said.

“They have escaped the war in Syria, where they faced the most challenging situations imaginable. Many have lost family members and loved-ones in the war. Many are left with the physical and psychological harm that war has on one who has been through it, such as severe post traumatic disorder and injuries from battle,” Dr Ó Tuathail said.

“We are also seeing many people escape countries in sub-Saharan Africa, often to evade death. Their decision to leave is generally an easy one, as, if they remain, they will be killed. They are often persecuted for a whole host of reasons, ranging from religion, sexual orientation, and female genital mutilation to tribal conflicts. They are all leaving to seek asylum, as to stay in their country of origin will lead to harm, often death.”

Refugees and asylum seekers arriving in Ireland usually end up in direct provision centres (there are 34 around the country), which have made headlines because of stories about unsuitable conditions.

“The direct provision centres vary hugely, from their size, the facilities available, and the range of refugees or asylum seekers within them,” said Dr Ó Tuathail.

“There is a move towards independent living now, where people in direct provision will be able to cook for themselves. This is a really welcome development, as having people from different cultures from all around the world, under one roof, means it is impossible to respect the cultural difference, in terms of diet, other than allowing them to cook for themselves,” Dr Ó Tuathail said.

However, Dr Ó Tuathail said there are, “without doubt, difficulties” associated with the centres and refugee lifestyles.

“Asylum seekers are paid €38 per week to live, and, in this day and age, it is simply not enough to get by. They are also forbidden from working for the first nine months after their arrival, so boredom and financial difficulties are common-place.

“In many cases, local communities rally around to help asylum seekers and refugees sign up for courses, volunteer in the community, and join local clubs,” he added.

“In these cases, this is where things work really well. Community support means everything to those that come here to seek asylum. Unfortunately, that support varies hugely from location to location,” Dr Ó Tuathail said.

SAFETYNET provides health assessments, sexually transmitted infection screening, and GP services to several dozen patients per week, including many newly arrived refugees, said Dr Ó Tuathail.

“These would be one-off events, and the result of our assessments would be provided to the local GPs, who ultimately care for these patients long-term.

“We provide ongoing GP care in limited situations, where finding a GP is proving impossible for asylum-seekers and refugees,” he said.

Accessing GPs is becoming increasingly difficult for everyone in Ireland, whether you are a refugee or not, said the Connemara Gaeltacht GP.

“Unfortunately, due to the rapidly escalating GP crisis, refugees and asylum seekers are finding it increasingly difficult to find GPs,” he said. “There are, unfortunately, many asylum seekers without a GP at the moment, because of this. This is no different from the rest of Irish society. Safetynet does provide GP services as a gap, when people are trying to find GPs.”

“But, as we are a small team, and asylum seekers and refugees are dispersed throughout the country, it can be very challenging, at times, to continue this.”

As well as access to GPs, Dr Ó Tuathail said that the GP consultations themselves did, at first, present some difficulties.

“We try to use on-site translators as much as possible,” he said. “At first, it’s difficult to get used to doing a GP consultation with another person, often a total stranger, in the room. But you quickly get used to it.

“From my perspective, getting used to all the cultural difference was the most challenging aspect,” Dr Ó Tuathail said.

“You have to respect the fact that, for Muslim women, it is sometimes difficult to discuss medical issues with a male GP. I have found also, that, in general, mental health issues are a huge taboo for those from the Middle East, whereas homosexuality is a huge taboo in sub-Saharan Africa.

“Knowing this, there are certain ways you can explore these issues without causing offence or stress. In time, you understand the nuances and differences between different nationalities, and even different cultures within nationalities,” said Dr Ó Tuathail. “It makes the work very interesting.”

Darragh Bermingham: The life of a doctor without borders

Dr Ó Tuathail also highlighted the need for multi-disciplinary support for refugees to deal with the trauma they have endured.

“There is a huge need for psychological support and access to counselling services,” he said.

“These services are slowly being put in place by the HSE, but there is a huge need, and, currently, a shortage in the HSE’s ability to meet that need.

“There are other voluntary groups who provide support, such as psychological support, to asylum seekers and refugees, such as Spirasi, a charity that provides counselling to victims of torture, or the Rape Crisis Centre, who provide support to victims of rape,” Dr Ó Tuathail said.

“This lack of psychological services, is the same as that being experienced by the indigenous Irish population, and the importance of urgently addressing this deficit is similar.”

When he took on the job with Safetynet, two years ago, Dr Ó Tuathail was unsure what to expect.

“I had always wanted to work for MSF (Medecin sans Frontiere/Doctors Without Borders), a medical charity that provides care to asylum seekers and refugees worldwide, often in camps in war-torn regions,” Dr Ó Tuathail said.

“The work with Safetynet allows me to do similar work, albeit on Irish soil.

“I have several friends from college who work for MSF now, and many of the medical complaints and problems faced by my colleagues in MSF are not too dissimilar to what I see day-to-day. In the end, I expected to see people who were very vulnerable, who were suffering the ill-effects of war, or who did not have access to medical care for some time, and that is what I am seeing,” Dr Ó Tuathail said.

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