The science behind the comic

The true story behind this episode is the experience of Hajer. Unlike the comic’s fictionalized account, the reason why Hajer was almost forced into a C-section was the fact that she had already had one, in Syria, during the birth of her first child, 11 years before. Yet she delivered her second one, now ten years old, also in Syria, naturally. Hence, she saw no reason for and was opposed to another C-section. Hajer was taken to a major Athens maternity hospital (not the hospital where EU Border Care conducted ethnographic research) by the social worker of the NGO in charge of her accommodation, where she was told that a C-section had been scheduled. The remaining story evolved as it is narrated in the episode. One more thing to note here is that, according to statistics EU Border Care is in the process of compiling, a fetus’ breech position is indeed one of the main reasons why C-sections are performed in Greek hospitals. Indeed, C-sections are endemic in Greek maternity care, particularly in private maternity clinics, where Greeks of higher socio-economic strata give birth. 2014 figures place the percentage of C-sections in the private sector at 59 percent, compared to the public hospitals’ 54 percent.

In reality, Hajer and the NGO social worker in charge of her care were accompanied to the hospital by an interpreter employed by the same NGO in charge of her accommodation and overall care. Yet the character of the friendly, NGO-employed interpreter who volunteered his services to the interactions of medical personnel with patients other than those he was paid to assist draws on the true practices of an interpreter stationed by his NGO at “Alexandra” hospital’; after a year of working there, the medical personnel calls on him to interpret for most Arab-speaking maternity patients. The lack of permanent, in-house interpretation services at “Alexandra” – as in most, if not all, Greek hospitals – constitutes perhaps the strongest difficulty in migrants’ maternity care, and certainly the first one medical personnel will mention, when they are asked about their experience.

Cynthia Malakasis
EU Border Care researcher
http://eubordercare.eu/team/malakasis-cynthia/

The squat’s depiction draws on a squat in the centre of Athens, one in a network of seven squats organized by the same activists. The one depicted in the drawings, where EU Border Care conducted ethnographic research, housed primarily families with pregnant women or recently born infants. Much like it is represented in the comics, the squat often operated like a village, comforting and stifling at the same time. Further, much like in Sham’s story, refugee families often changed several places of accommodation, in a constant search of circumstances at once more comfortable and more amenable to home-making.

Cynthia Malakasis
EU Border Care researcher
http://eubordercare.eu/team/malakasis-cynthia/

In this chapter, the comic provides a strongly faithful representation of the experience of our Syrian research participants, combining elements of the journeys of the five different women who participated in our research and narrated their stories to us. One participant told us about the “fields of walnuts, fields of death,” dubbed thus by refugees because of the dead bodies on which they stumbled as they attempted to cross; bodies whose fate they were afraid they would also meet. The same participant observed, bitterly, that “animals have become more valuable than people,” when cows were smuggled into Turkey before people themselves were allowed to pass. The fact that people were passed from one smuggler to another is also strongly accurate, particularly after they crossed into Turkey en route to Greece. Another participant told us of spending two nights in jail in Turkey, when the police raided their Izmir hotel, where they were waiting for the smuggler that would help them cross the Aegean. Several participants also told us of having to look for the smugglers they had already paid, after the latter went into hiding to avoid police capture. The depiction of the boat journey – with the passengers being forced to drive the dinghies, which would often either break down or run out of fuel – also reflects our participants’ experiences. Our participants were eager to share the details of being piled onto each other in the dinghies, being terrified by the turbulent waters and by the possibility of being captured by the Turkish coastguard before reaching Greek waters, and of being rescued once they reached Greece.

All of our research participants arrived in Greece after the closure of the country’s northern border and of the so-called Balkan route to Northern Europe. The next best thing, so to speak, was the option of applying for relocation to another EU country under the EU Commission’s “Emergency Relocation Scheme,” which allowed arrivals in Greece and Italy to ask to be relocated and apply for asylum in another European country. Germany was by far the preferred destination, given its reputation among Syrian refugees as a country that offered the best living conditions, but also the fact that many of them already had relatives there.

Cynthia Malakasis
EU Border Care researcher
http://eubordercare.eu/team/malakasis-cynthia/

Unemployment or flexible, precarious employment and an ensuing generalized anxiety have been the reality of more and more Greeks since the beginning of austerity policies in 2010. In the midwifery sector, our research participants report that their employment opportunities after they acquire their degree are limited. The public sector is saturated, whereas employment in private maternity clinics, doctors’ practices, or Athens’ very few private birthing centres hinge strongly on “whom you know.” The expansion of NGOs’ services in response to the advent of refugees has presented an additional option for several of them, who often started out as volunteers in the early, makeshift refugee camps, and were recruited by NGOs who were also on-site to offer their services.
Further, Matina’s preference for work that allows her to apply the midwifery model of care, which is premised on limited medical intervention throughout pregnancy and labour and assigns a central role to the midwife rather than the doctor reflects the preference of most of our midwife research participants – a preference that is very difficult to realize in Greece’s strongly biomedical maternity culture.
In the public hospital maternity clinic where we conducted research, midwives play a central role in the care of native and migrant women. In the labour ward, trainee and senior midwives stay with and monitor the women until they are ready to deliver. In the delivery room – at least according to our observation – midwives are at least as active agents in the birthing process as the young resident doctors, who perform the delivery as part of their training, under the supervision of a senior obstetrician. Yet midwives will tell you that their contribution goes mostly unacknowledged, particularly by Greek women, who credit their doctors with their successful delivery. The possibility of developing a relationship with refugee women within the context of care – a relationship that might wash away the stereotypes and misunderstandings that fester on both sides – is severely curtailed, once again, by the impossibility of linguistic communication.

Cynthia Malakasis
EU Border Care researcher
http://eubordercare.eu/team/malakasis-cynthia/

Most women came to MeditAction through word of mouth. The birth experience narrated by Narimasse encompasses some of the issues reported by our research participants. Hospital staff remove the headscarf for hygienic reasons, but the argument counter to this is that women should be given surgical caps, as a compromise between their cultural norms and the hospital’s pragmatic concerns. The lack of linguistic interpretation, which largely prohibits any communication between hospital staff and women during labor also constitutes a pressing issue.

Cynthia Malakasis
EU Border Care researcher
http://eubordercare.eu/team/malakasis-cynthia/

Much like this chapter’s opening depicts, the medical personnel in the NGO and the public hospital where we conducted research often performed ultrasounds and other forms of prenatal examinations conversing with each other in Greek, which Syrian and other migrant and refugee women of course did not understand. In the comic, we see Sham and her husband expressing the stress this caused them. Syrian patients’ worries was often noticeable by the distant or preoccupied looks on their faces. As soon as interpretation became available (at the NGO where we conducted research, the interpreter usually participated in the process before the ultrasound examination, during the phase of the initial questions, and then also after the examination, when the doctor and midwife discussed their findings and planned the next steps in the woman’s care; in the public hospital, interpretation was usually not available, unless women came with their own interpreters), the women would become markedly more animated and much more active participants in their care.

Further, much like this chapter narrates, our ethnographic research revealed that Syrian men were in many ways as vulnerable as their pregnant partners. In this chapter, Sham’s husband, Suleiman, faints, because of the combined effects of malnutrition, the traumatic stress of the perilous journey behind him and the strong uncertainty that lies ahead. All of our research participants – who had resided in camps in islands and the mainland, in NGO-run hotels, and in squats – told us repeatedly that the food they were given was inedible and quite often rotten. Further, the vast majority of women whose prenatal consultations we observed came to the maternity clinics without having eaten breakfast. This happened either because the food was inedible, or because they had to get up very early to make the journey from the camps (some of them as far as some 40 kilometers away from the center of Athens) to the maternity clinics. Women would give the doctors and midwives this information when asked, but their consistently low blood pressure was also a testament to this. The creative license this chapter takes to transfer this vulnerability to Sham’s husband offers a glimpse into the fact that men were subject to the same conditions.

Syrian women’s care-giving role persisted even in circumstances, such as their prenatal consultation, where they were supposed to be the receivers of care. Sham narrates the story of her pregnancy to her unborn child, and she chooses to put emphasis on this specific episode of her husband’s collapse. Research participants would often put their own well-being aside in favor of the needs of their husbands or children. Research participants, for example, who had to be hospitalized for serious health issues during their pregnancy would leave the hospital against the doctors’ advice, in order to care for their families who had remained at the camp, often putting their lives in danger.

Cynthia Malakasis
EU Border Care researcher
http://eubordercare.eu/team/malakasis-cynthia/

Much like the comic series depicts, expectant fathers overwhelmingly accompanied their partners to their prenatal consultations.  Also realistic is the fact that migrant women sought care or were directed to more than one medical facilities; it was not unusual to be seen at a medical NGO, such as Médecins du Monde, the MeditAction centre, and the outpatient maternity clinic of a public hospital. 

This fragmented care is embodied in the clear file, containing examination results or prescriptions, referrals, or diagnoses from the various practitioners the woman has seen throughout her pregnancy. It is made of sturdy or flimsy plastic material; it is creased or unfolded, clean or stained by fingerprints and items it touches in the purses or coat pockets where it’s stored. From there, it comes out and onto the health professional’s desk, and reveals its contents: papers of different size; with different print, logos, and stamps. The practitioner sorts through the papers, figures out whether the tests prescribed have indeed been performed, wonders why appointments were missed or exams were not done, and gets less or more sufficient answers through the help of an interpreter.  

Cynthia Malakasis
EU Border Care researcher
http://eubordercare.eu/team/malakasis-cynthia/

MeditAction is the pseudonym given to a small, independent maternity centre in downtown Athens, which has, since it opened in September 2016, provided prenatal care and breastfeeding consultations to hundreds of migrants and refugees from Syria, Afghanistan, and a number of Middle Eastern and African countries. MeditAction was also a key site of EU Border Care’s ethnographic investigation. Unlike most other sites of prenatal care, the center focused strongly on the midwifery model of care. Its founder and staff first came together in makeshift, provisional camps in 2015 and 2016, where they had gone to volunteer their services to newly arrived refugees, who dwelled there for as little as a few days to as long as several months, before making their way out of the country, or moving or being moved to other facilities.

The comic’s depiction captures the centre’s messy yet affable atmosphere, with its staff striving to maintain an orderly register of, welcome, and serve the constant arrivals. The centre attracted women from as near as the downtown squats and as far as the camp in the city of Malakasa, almost 40 km. away from Athens. Apart from the personalized prenatal consultations each woman received – similar to the care provided in medical NGOs, although in a less bureaucratic, more casual setting, but markedly different from the harried and impersonal atmosphere of public hospitals’ outpatient clinics – the centre provided the opportunity for much-needed sociality. Women often dwelled for hours drinking tea, sitting cross-legged on mattresses in the centre’s living room, chatting, breastfeeding and changing their babies. Meanwhile, their older children played in an adjacent area filled with toys and children’s books.

Its homey atmosphere aside, the centre mirrored many of the impasses faced by Greece’s natives and immigrants alike. The price of petrol made central heating prohibited, as in most block of flats around the country; the staff struggled to heat the different rooms and spaces with small, electrical heaters or an air-conditioning unit. Funding for rent, bills, personnel salaries, and supplies did not come from a central or permanent source, but rather relied on the constant solicitation of multiple and diverse donors, ranging from individuals to charity organizations around the world. Minimum-wage, precarious employment was also the reality of its employees, reflecting the circumstances of the vast majority of Greece’s workforce.

Cynthia Malakasis
EU Border Care researcher
http://eubordercare.eu/team/malakasis-cynthia/

The character whose maternity experience this comic narrates is meant to draw element from the real-life circumstances, trajectories, and experiences of our Syrian research participants in Athens, Greece. Given the project’s objective of in-depth research that would really bring out the perspectives and experiences of our participants, we chose to focus on one national group, Syrians, who constitute the largest national group arriving in Greece since 2015. Sham’s story draws on the accounts given to us by five pregnant Syrian refugees inhabiting different housing structures in the wider Athens area over a period of nine months, and, to a lesser degree, on the observation of hundreds of other Syrian women we encountered at the maternity-care facilities that were the sites of our ethnographic research.

The medical clinic run by Médecins du Monde on Peiraios Street, a satellite clinic funded by the UNHCR and established to cater specifically to beneficiaries enrolled in the EU Emergency Relocation Scheme, was one of the primary sites of the EU Border Care Athens ethnographic research. The relocation scheme was established by the EU Council in September 2015 to relieve pressure on Italy and Greece by transferring asylum seekers to other member-states, where their applications would be then processed. In Greece, Syrian refugees were the primary beneficiaries of this programme, which was not open to the other major national group arriving in the country as refugees, Afghans. This is because the relocation scheme is open to national groups with an EU-average refugee recognition rate of 75 percent and over.

The Syrians’ “privileged” position vis-à-vis Afghans as a group with a much higher refugee recognition rate meant that even those among them living in camps rather than hotels or apartments did so in camps with better facilities and closer to the city center. Given its poetic license, however, and the objective of offering the broader picture, the comic strip positioned its Syrian heroine, Sham, at the abandoned Elliniko airport, a makeshift, unofficial refugee camp inhabited almost exclusively by Afghans. About 10 km. from the city center, Elliniko served as the Athens International Airport for more than 60 years, until 2001. Once Greece’s window to the world and a site of privileged mobility and often historic comings and goings, the old airport and its run-down premises were, since December 2015 and until June 2017, when it was shut down by the authorities, “home” to some 1,200 Afghans, effectively trapped in Greece both physically, after the country’s Balkan borders closed in March 2016, and administratively, given the enormous backlogs of its asylum system.

Although supposedly a tent at Elliniko, Sham and Suleiman’s crowded living quarters – with food, clothes, and bed linen necessarily piled together – are strongly reminiscent of the tiny, two-room container inhabited by a research participant at the “model,” according to authorities, camp of Elaionas, a few minutes’ metro ride and another few minutes’ walk away from the city center.

Lying sleepless on a mattress on the floor of her tent, Sham thinks of Taim Hassan, the Syrian actor-heartthrob whose soap-opera adventures were followed eagerly by research participants with access to satellite TV

Cynthia Malakasis
EU Border Care researcher
http://eubordercare.eu/team/malakasis-cynthia/