E-newsletter Issue 49 | September 2006
Letter Home, JUSTINE SIMMONS – MOSCOW, RUSSIA – SEPTEMBER 2006
| Justine Simons (30), psychologist, Australia: "My relationship with MSF began in 2001. I graduated from Griffith University as a psychologist and I started working for a private Catholic hospital in Brisbane, in a General Practitioner (GP) education unit for continuing medical education (CME), training doctors in doctor-patient communication. It was a very interesting job, and a very comfortable one, but after two years it became too comfortable and not challenging enough." |
Justine Simons (currently technical advisor to the MSF homeless children and teenagers project, Moscow, Russia)…
…setting off for a "one year adventure"
Initially thinking she would go for one year, Justine worked for four years as project coordinator of an MSF outpatient healthcare centre for the treatment of patients with knife or bullet wounds in Cali, Colombia. She explains, "In Cali, we cared for a lot of fantastically healthy, bright kids in wheel-chairs, quadriplegics and paraplegics who would remain wheel-chair bound for the rest of their life. Some of them couldn't adapt to this prospect and they would purposefully ignore the recommendations we gave them to avoid ulcer development and other complications. They allowed massive ulcers to develop and get infected, and eventually they would die. A sad form of suicide…"
She was working in one of the most violent places in the world, in a place where the primary cause of morbidity and mortality is gunshot wounds; where gangs wage wars against one another; and where young people sometimes shoot their enemies in the spinal column on purpose, because they prefer to incapacitate them for the rest of their lives than to actually kill them.
Justine's role was to consolidate the project. "During the time in Colombia I was getting to know the organisation and building my skills as coordinator and as a psychologist as well, because it was a medico- psycho-social project. I learned a lot from the staff there," she says. She stayed to the project's end, supporting its eventual hand-over to the local government. The project is still running in the hands of the local health department there. It's a real "success story" for MSF - a service that MSF started, and that is now being replicated.
… next stop Moscow
By July 2005 Justine was on another plane, this time with her husband (a Columbian engineer Jairo Cadena Soto) to Moscow, Russia. She was heading to another project that worked with disadvantaged and excluded young people – a street children and teenagers project for the homeless youth of Moscow (SCTP).
In Moscow MSF does not wish to substitute for the state's existing social and healthcare institutions, but instead tries to fill the gap left by the local health structures, and to propose a suitable model of response to the problems faced by the capital's homeless youth, based on the organisation's rich expertise. The SCTP includes outreach work on the city's streets, provision of medical first aid and referrals for specialist medical intervention, but "so much of what MSF does in this project goes beyond harm reduction and immediate curative and preventative healthcare. The focus is to support these kids to make an informed decision to abandon street life and to choose from alternatives that will re-integrate them into society and ultimately benefit their growth from youth into adulthood. A lot of what the team does is motivational and solution-oriented counselling," explains Justine.
Jairo and Justine decided they would come to Moscow for one year. During their time here, Jairo was sent to a three-month MSF mission to Liberia, where he supervised construction of an extension to a hospital. Now he is operations coordinator in the MSF Day Centre for street kids, working side by side with Justine. That one year has turned into two years already, as they will stay until August 2007.
MSF initiated the SCTP project in 2003, after 11 years of working with the adult homeless in Moscow, because of the considerable number of homeless youth, and because young people who are not Moscow residents are denied access to healthcare by Russian law. In addition, the Moscow health care system is routinely used by the coercive state apparatus that aims to remove homeless youth from the streets by force.
"In a country, and particularly in a city where the living standards are high – and Moscow city does offer opportunities and comfort, the same as can be found in any other capital city - the shocking thing is to see how this wealth contrasts with the dire situation of many young and adult homeless", Justine says. "The stereotype of a homeless child sniffing glue is omnipresent here, especially in the winter, when glue-sniffing is more prevalent, since it gives street kids a sense of warmth and banishes their hunger."
At the core of the MSF project is outreach work. Outreach teams visit the streets of Moscow every night to identify new kids, to talk to the kids they know already, to provide them with first aid or referrals, or to suggest that they come to the MSF-run Day Centre, if they want to wash their clothes or have a shower.
Justine says: “I in some way admire these kids, because most of them have come from a family background that is very difficult, they've been abused in one way or another and they've made a very conscious decision to not put up with it anymore and to explore what life on the streets would be like and to see if it offers them any more comfort or if it fulfils more needs that their family life can fulfil. They are tough kids, they've got a strong character. And that's one of the things that you have to admire."
Medical problems that the team meet on a daily basis relate to the harsh conditions of the streets – young homeless people suffer disproportionately from physical trauma, respiratory infections and skin and eye infections. There are also health consequences of unprotected sex, including pregnancy – for obvious reasons problematic for girls living on the street – and sexually transmitted infections. The street kids experience a number of specific health problems related to substance abuse. Inhaling volatile substances – "glue sniffing" – can lead to brain damage or death, and injecting opiates like butaphanol can result in skin infections and transmission of diseases like hepatitis and HIV. Temperature is one of the biggest challenges in Moscow in winter, as the kids live under platforms in train stations, and in basements and attics, where heating is not always available.
… the value of constant reflection
Her creativity has already given birth to a number of bright initiatives. In July Moscow residents were treated to an unusual open air photo-exhibition. It showed pictures taken by street kids of their lives. The exhibition was a result of collaboration between the team of the MSF Day centre and a professional photographer. The idea was to get the homeless kids interested in photographing their lives by giving them disposable cameras. Nobody expected when they started that the initiative would be such a success and the kids would get interested and continue for a month. MSF developed about 200 films and the kids made a selection of their own and Jorge's pictures for the exhibition. For many of the Moscow public that saw the exhibition it was a surprise that these outcast and much feared "would-be criminals" - (a common and damaging stereotype here) - were able to produce such artistic and meaningful photographs.
Justine Simons has once again decided to prolong her mission to see the
project successfully handed over to local organisations and health authorities.
As she says, "So, what, at the beginning I planned to be only
a one year, kind of, adventure, has turned into six!"