'With Woman', and much more, in Dunkirk Refugee Camp.

So, first trip to Dunkirk refugee camp is out of the way. Much learning and processing is still to be done, though. This sprawling of findings feels like I'm sifting through a tin of spaghetti alphabet letters. In order to explain to another, I need a level of understanding myself, and I don't yet have that. But I CAN tell you of the practicalities, and with so many midwives considering getting out there to support the refugees, this is good enough.

The team. A mix of characters, but we worked really well together.
Thank you, Maggie, Verity, and Sharon, for joining me.

Practicalities of the trip

Obviously, up to date passport, E111, travel insurance. A few euros are always handy, too.

Channel tunnel

Cost £154 and shared by the four of us, booked on line (see channel tunnel bookings). Ferry is much cheaper, and takes about 2 hours. Needed to put passport details of fellow travellers online. We got to the tunnel quite early, after leaving plenty of time to travel down to Folkstone, and managed to get on the earlier shuttle. You need to get there 30 minutes before. Actual time in the shuttle was about 35 minutes.

Driving in France.

Verity, amidst all the donated goods.

I checked my car insurance covered my driving in France. In fact, it covered anywhere in Europe for 30 days. I bought a bag full of the necessary car accessories for driving in France (GB sign, headlight diffusers, two breathalyser tests. Spare bulbs, a small first aid kit, a warning triangle, a high visibility tabard....but you now need one for EVERY passenger. Fire extinguisher is advised but not compulsory) by last minute online shopping. I filled my car with fuel when I left home in Oxford, and didn't need to fill up until I got back into UK. So, fuel for the duration of our stay cost us around £70 tops.

The sat nav was so helpful, and I'd already copied out maps of where we needed to go. However, there wasn't very clear info on finding the actual camps. Having three mates in the car who relentlessly shouted 'On The Right' to me, meant we got there and back in one piece. The most challenging times were giving way at roundabouts, and coming off them, flowing onto a dual carriage way (because you can't easily see with a right hand drive car) and moving out of or into junctions. Talking myself through where I planned to drive, while I was doing it, helped all of us stay focussed. I did have to turn around at one point, because I'd missed a turning. When I pulled back out, I was briefly on the WRONG side of the road, and moving towards the right turn that I'd missed. I totally ignored the panicked shouts of 'On The Right'. I thought they were over zealously telling me where I needed to turn. Hairy moment, but the only one. I found I quickly became accustomed to it.

Hotel

We stayed at the Premierre Classe Hotel, Rue de Lac, Armbouts Cappel, about 7-8 minutes drive from the camp at Grande Synthe (look up Boullevarde Pierre mendes). The rooms had a double bed and a single above. The bathroom was small but always had fiercely powerful and hot running water in the showers. The beds were comfy. For the price of £136 for five nights, the rooms were very good value. Breakfast was a pretty basic affair, with bread or cake, yogurt, juice and coffee.

For our evening's meal, we crossed the road to the Quality Hotel. Nice food, and wine. But they don't serve food on fri/sat/sun evenings.

Provision of maternity care in Dunkirk camp.

Medicins sans Frontieres have now been welcomed to provide care in the Dunkirk camp, and are there up to 7 days a week. Medicins du Monde are now there Thursdays and Fridays, and Gynaecologiques sans Frontieres are also there Thursdays and Fridays.

These guys are able to provide first aid maternity care for women who present at their caravans. Beyond this, the women, and anyone else needing further treatment, have to get to the local hospital. There was understandable frustrations within the teams, with the amount of care they were legally able to provide.

Touching base with MSF. Communication is important.

Many women are afraid of venturing out, and there is a level of mistrust towards the NGOs. Several pregnant women are known by MSF and the various voluntary organisations, but there are undoubtedly some that are unknown to the support workers, and of course there will be new pregnancies. Some more vulnerable women are removed from the camp, and placed in hotel settings or 'plasitc' housing. It was never made clear how these women access their maternity care, or who has details of their whereabouts.

Professional regulation

Not quite midwifery, but valuable all the same.

In order to practice full midwifery skills, we are required to have professional indemnity insurance. NHS covers us for our work within shift and trust time only. Royal College of Nursing, and maybe Unison(?) provide cover for some care, but not all, and certainly not intrapartum care. Royal College of Midwives cover for 'Samaritan' care only (see below).

Maggie doing a brilliant job
 in the 'shoe department'.

In order to practice midwifery in France, you also have to be registered with the French Medical Council. They cover slightly different aspects and, understandably, mastery of the French language is a necessity.

The most convenient way of providing midwifery care in the refugee camps, would be to work within an organisation (NGO). However, in order to get insurance cover, training etc, you'd have to commit to maybe three months continuous work with them, and most NHS midwives would actually have to say goodbye to their regular jobs in order to work with the NGOs.

So, what does this mean for me, as a UK registered midwife? I'm not in a position to be able to leave my job and take up a nomadic and uncertain life with the medical NGO's. I'm not either, at this point, prepared to jump through hoops to become a 'French' midwife.....

I believe many midwives are out there simply 'doing their bit'. They are providing emergency care, midwifery based or not, and are working without the support of their country or union. Yup, dodgy, but definitely raw humanitarian work where and when it is needed most. Bless them, and what a crying shame they're not getting the support they deserve.

Over the next few months, I wouldn't be surprised to see a few more positive statements creep out of the woodwork. Mostly, midwives are caring people. Why wouldn't they want to support this dreadful crisis? Legally, or illegally, they're going to help. It would fill my heart with delight to see the Royal College of Midwives providing some kind of support. Maybe there will be a statement posted soon, on their website explaining their position.

There has been debate over exactly what constitutes emergency or Samaritan care. When pushed, the RCM provided this definition....

'The policy provides for claims arising from a good Samaritan act however it is important to note that a Good Samaritan act is where medical services are provided at a scene of a medical emergency, accident or disaster who is present by chance or in response to a medical call. '

The finer detail of 'present by chance' isn't really fine enough, in my mind. It left me thinking if there did happen to be a maternity emergency, I'd be better off walking in the opposite direction, in case there were repercussions. This is wrong on all levels.

Other tips to share.

There is no legal advisory organisation that I know of, working within the Dunkirk camp. The refugees could REALLY do with this. They need to be supported to move on, and have choices regarding safe transit, asylum, and funding during this process. So many are still in camp because they don't know what to do next. They are sitting ducks for yet more trafficking.

Getting past the police into camp was problematic only on the last day. We were advised we'd have to go to the town hall to request authority for access, but they then 'allowed' us in, after check all or our passports (midwives are such a dodgy gang!).

Our small team of midwives spent much of our time in the Women and Children's Tent. This seemed a pretty sensible place to hang out to get conversation started, support women emotionally, with advice and education about any issues these women had. Sadly, it's probably only the more confident women who were accessing this tent, and until word gets around that midwifery support is here, we'll have limited knowledge and access to the more vulnerable ones. It would be great to have midwifery presence on a regular basis, so that we can venture into the 'woods'.

If you're a midwife planning on going over there, be prepared to support generally. Litter picking, taking people to the hospital, gathering provisions for people, help support the new school. Vaccination programmes for measles may be up and running and you might like to help out with that. HANDS, NGO, seem to be organising this. Stay in contact with MSF etc, as these guys will be in the 'know' of recent events.

Risking life and limb (mostly limb) to get to the Women and Children's Tent.

If you want to support the Women and Children's Tent, there are a few simple ground rules. The aim is to supply women with clothes etc, and for them to collect what is needed in a safe manner. Men in the tent is a 'no-no'. Men hanging around the tent is discouraged. Only three women at a time in the tent (as some more sought after provisions disappear very fast!), children need to be accompanied. Ethos is to take only what is needed (ie, not taking half the shop in order to sell it on..). Put your personal belongings behind the 'no-go' area, or they WILL walk. Remember the guys in charge (currently Adrian and Svenja) are volunteers, too, and you're sharing THEIR space. The door opens at 11am, and closes at dusk, or when quiet.

With Adrian and Svenja, catching up after a lovely
lunch that DIDN'T consist of rice.

There IS a box labelled 'Maternity' at the back of the tent. It has multi vitamins, Iron, UTI treatments, condoms, pregnancy tests inside. We could do with Vitamin D, too. These are all 'off the counter' preps. Any translations/ communication aids can be left here. Over time, it is hoped that women know they can seek the more social/ educational aspects of midwifery support in this tent, and it can also be a base for volunteering midwives.



Cards, with Kurdish writing on the reverse, to help
 educate about pregnancy complications.

There is not enough women's leggings, jogging bottoms, sleeping bags, hair brushes, conditioners, wet wipes, small packs of tissues in the Women's and Children's tent. If you're planning on going, take provisions straight there. Do not pass Calais. Go directly to Dunkirk.

In time, there may well be a new 'Women's Tent' erected near the current tent, where women can go to cook etc. Maybe this will have more space to 'be', as supporters. The idea of a 'knitting tent' has gone. There isn't enough stability, currently, to keep this a 'safe' place.

There are many volunteer groups on Facebook etc. It's a good idea to make yourself known to a team and ensure somebody knows where you are. Loads of support is around at the weekend, and the place feels quite different. Help is best coordinated, and projects, current needs, and concerns (there were shootings in camp on the day we arrived, and demonstrations/ tear gas use on another day) can be passed about very quickly. Every day is different. More hands make less work...only by collaboration and communication.

In limbo...and an awful lot of mud!

I apologise. This is a rather sullen and humourless post. I found nothing to joke or get excited about (Best I don't mention the many firm bums in the blue Gendarme trousers every night at the hotel). The apathy and lawlessness in the camp was a real eye opener, but it was present alongside the many dreadful stories of basic survival of the fittest and the lucky. What some of these people have endured to get to this point beggars belief.

So, this is as much as I can give at the moment. Frustration, anger, disappointment, sadness...doesn't become me. I shall jiggle things and ferment ideas until I can come up with a wholly more positive picture, and update.

An answer to this whole sorry state would be good, but while the world makes noises about getting it's act together, we'll just carry on caring.