In Crisis-Plagued Greece, Heroes Treat Scapegoats

By Zachary Siegel 05/22/17

"We used to have a mobile medical unit that would provide services to homeless and drug addicted people...[Now we] don’t have the funds to hire paramedics who can operate the vehicle.”

Man showing badly damaged arm
Greece's drug addicts and homeless in more trouble as nation's brain drain drives health workers out of the country. photo via Author

Healthcare workers are fleeing Greece in droves. Others stay behind to treat the homeless and addicted.

Eight years after the financial crisis hit Greece, doctors and other highly skilled professionals are leaving in record numbers, in search of a living wage.

But a few, like 32-year-old psychologist Eleni Tovontzi, have chosen to stay behind to help the lowest rungs of Greek society: the homeless and addicted.

“We see a lot of the same people come in and it’s hard to watch most of them not get better,” Tovonzti said inside a conference room at OKANA (Organization Against Drugs), Greece’s largest state-funded treatment center that works under the Ministry of Health.

With bright blonde hair and a cross around her neck, Tovonzti used to deliver harm reduction services to drug users on the street in Thessaloniki, a port city on the coast of the Aegean Sea’s Thermaic Gulf.

“That work really burnt me out,” she said, going on to describe the harsh living conditions of homeless Greeks who struggle with addiction, which have been compounded by the country’s seven year-long economic nosedive.

Forty-two year old Nick Sedaris epitomizes the struggle that wore on Tovonzti. He injected heroin and cocaine for many years but now he receives buprenorphine — a medication that stabilizes people with opioid use disorder — from one of OKANA’s 54 treatment centers that deliver the drug.

“I don’t inject drugs anymore,” he said on the steps leading to the imposing Panagia Dexia, an Eastern Orthodox Church near the University of Aristotle, “but I can’t find a job, there’s nothing for me here.”

Nick's arm was severely burned while handling a volatile chemical called freon, required for building refrigerators at his factory job. Both his unemployment and disability benefits have been slashed under austerity measures that have so far been unsuccessful at chipping away at Greece’s enormous debt, ringing in at nearly €300 billion ($319 billion).

photo via Author

To get by, Nick sells candles in front of the church. After showing me his gaunt arm with burn scars from the freon incident, he lifted up his grey sweatpants to show me his leg swollen from a condition called edema, which from Greek translates literally to “swelling.” Nick’s swollen leg looked alien to the rest of his rail thin body. Swollen limbs are a byproduct of life on the street, typically caused by standing all day. “I’ve got nowhere to lie down,” he said.

The “Brain Drain”

Harsh austerity measures affect people from all classes. Distinguished doctors at the peak of their career take in only €800 ($889) in wages a month. Consequently, health care workers are among those leaving Greece in what's been called the worst “brain drain” the modern world has seen.

From 2008 to 2016, nearly 430,000 highly skilled professionals fled Greece because they either lacked employment opportunities or were not earning enough to support their families, according to the Organization for Economic Cooperation and Development (OECD).

Tovonzti is among the group most likely to flee Greece for greener pastures: skilled professionals aged 20 to 39 years old. Young and bright Greek expats now provide the rest of Europe with €12.9 billion ($14.3 billion) in revenue, making human capital Greece’s highest grossing export next to oil, according to Endeavor, a firm that invests in businesses across Europe.

photo via Author

It’s estimated that 50,000 doctors have fled Greece, causing even more strains to Greece’s healthcare system, which has seen a 50 percent cut in federal spending since 2008. Those who do stay behind, treating public health problems exacerbated by the financial crisis, say they do so for their patients, and at times feel like captains going down with the ship.

Anastasia Drimousi, an internist and director at OKANA’s main treatment hub in downtown Athens, feels it’s her duty to stay and help as many of the drug addicted patients who walk through her clinic as she can, which is roughly 11,000 per year.

“We’re short staffed here,” she said, with the help of a translator, while walking through a hallway at OKANA’s bustling medical center. In one room a meth user was getting his teeth examined. An injection drug user in another room was getting blood work done. Several Greeks waited their turn to for medical services in the lobby.

“Right now we work without a social worker. A lot of us are also feeling burnout,” Dr. Drimousi said. But unlike some of her colleagues across the medical field fleeing for higher wages, “I wouldn’t ever leave.”

Dr. Drimousi has worked at OKANA’s clinic in Athens for 20 years. Since the crisis, services to help people with addiction have taken a hit, she says.

“We used to have a mobile medical unit that would provide services to homeless and drug addicted people by going to where they stay,” she said. Now a large ambulance with an extended trailer sits unused in a garage. “We don’t have the funds to hire paramedics who can operate the vehicle.”

Litsa Lagakos, a harm reduction researcher from Montreal who works at OKANA in Athens, led me down a graffiti covered sidewalk (I lost track trying to count the anarchist As) to OKANA’s drop-in center, where drug users can obtain supplies for safe injecting or simply hang out and chat with counselors. She talked about the brain drain, how Greece has a surplus of doctors and healthcare workers. There are 8 doctors per 1,000 people in Greece. In Austria, for comparison, there are a little over 5 doctors per 1,000.

Lagakos described this imbalance, and said combined with high unemployment, which hovers around 23%, that it makes sense why so many of her colleagues are leaving.

Dr. Elias Grammatikopoulos, a psychiatrist in Thessaloniki who has studied the connection between the financial crisis and suicide (there's a strong one), said he’s desperate to leave Greece. He’s the author of over 100 scientific articles and considered a preeminent scholar in his field.

“I make €800 a month,” he said. “I can go work anywhere in Europe and make over €100,000 a year.”

“The brain drain, for me, is one of the single most important issues facing Greece right now. Our best minds are leaving and they’re not coming back,” Grammatikopoulos said. Yet he stays behind, because he and his wife help provide for their big family.

Austerity and Addiction

While there is a lack of jobs in health care, massive cuts to the system have also led to a shortage of medical supplies. For OKANA, that means a scarcity of alcohol swabs and syringes — vital tools in preventing the spread of HIV and Hepatitis C. OKANA estimates that upwards of 75 percent of their patients have Hepatitis C.

“We give these supplies out for free so people are safe, so they don’t contract any infections,” said Nana Kaguclazi, a sprightly counselor who has worked at OKANA’s drop-in clinic for 17 years.

“People come here off the street when they have nowhere else to go,” she said.

photo via Alan Mittelstaedt

Local Orthodox Churches offer meals, Kaguclazi explained, but the people dropping in to OKANA seek more than food and shelter. Like anyone else, they need a community and a sense of belonging to survive, which is hard to find in a society that rejects them.

“There’s good welfare for drug users and people with HIV in Greece,” Dr. Konstantinos Kokkolis, a psychiatrist and senior director of programming at OKANA, said. “But due to the financial crisis, they’ve become scapegoats—ordinary people do not welcome them into the system.”

Families have begun to abandon their relatives with drug problems and HIV, causing a spike in homelessness. “Homelessness is unusual for Greeks,” Dr. Kokkolis said. Greece’s tight knit family nexus is undergoing what he called a phase of “westernization,” meaning family bonds are not as strong as they once were.

Dr. Kokkolis sees the loss of social and familial cohesion at his work everyday in Athens. “Homelessness has doubled in just four years,” he said. “Families used to take in troubled family members but now they can’t afford to — so they’re on the street.”

On some nights, Athens’s drug users relax on a long couch in the lobby at the drop-in center, where counselors like Kaguclazi host movie nights. Though syringes and supplies for safe injecting are in short supply, down the hall is a kitchen with snacks and a seemingly bottomless pot of coffee.

The staff tries to make everyone feel at home. Past the smoker’s room, a bald man shaves in the center’s large bathroom, which also has private shower stalls for people to wash away signs and smells of the street.

“I’ve been here a long time,” Kaguclazi said. And like her fellow OKANA colleagues, she has no plan to leave Greece—despite the cuts and lack of funding.

A homeless man sipping hot black coffee next to the snack room, who out of “embarrassment” for his situation chose to remain anonymous, said he just arrived in Athens from the island of Crete because he couldn’t get the help he needed there.

Kaguclazi nodded her head, affirming the lack of resources on Greek islands.

“I’ve been injecting heroin and cocaine,” the slight man said. “I so badly needed to get to Athens.”

He hopes to enroll in opioid substitution therapy (OST), the same type of program that Nick with the swollen leg is in. The program entails combining either methadone or buprenorphine maintenance with psychosocial services. In America it’s called medication-assisted treatment (MAT).

But there are a few big differences in how the two countries deliver services. In Greece there’s what's called a “low-threshold model” that allows easy access to maintenance drugs, which are paid for by the state, for anyone who needs them. It's essentially state funded harm reduction, with no strings attached. Unlike America, where under brand names like Suboxone, the medication is often priced out of reach, especially for low-income drug users.

And even those who can afford buprenorphine in the U.S. face many barriers, either in the form of stigma from an abstinence-only philosophy of treatment, or in restrictive policies that make it difficult for doctors to prescribe the only FDA-approved drugs (methadone and buprenorphine) that can reduce mortality rates by upwards of 50 percent.

Greece's harm reduction approach is in stark contrast to America's punishing attitude to addiction treatment. Treatment programs in America tend to kick their patients to the curb for using drugs (this happened to me), which is strange considering that drug using is a symptom to the disease supposedly being treated.

Still, Greece has its share of its own problems. One of the biggest challenges OKANA faced was in 2011, when after the financial crisis hit there was a seven-year long waiting list for patients to receive substitution therapy. Since roughly 60 percent of OKANA’s patients are heroin users, and roughly 75 percent of their patients have Hepatitis C, the long wait time proved to be an example of how an economic crisis can cause a health crisis too.

During 2011, for example, HIV among injection drug users in Greece increased 16-fold, according to the Hellenic Center for Disease Control and Prevention. While people had to wait seven years for a treatment that research shows reduces the spread of bloodborne disease, they ran the risk of being infected or fatally overdosing. It’s precisely this reason why these medications are on the World Health Organization’s list of “essential medicines,” and why access to them saves lives.

photo via Author

In the midst of the HIV outbreak, Dr. Kokkolis and his colleagues at OKANA expanded the number of centers where patients could receive medications for opioid use disorder, particularly in Thessaloniki and Athens.

In 2010, when the financial crisis hit, OKANA was treating 5,100 patients with either methadone or buprenorphine. By 2014, the latest year for which their is data, that number soared to 8,426 patients, according to OKANA’s research.

“It used to be a seven year wait and we got it down to three years,” Dr Kokkolis said, adding that that’s still too long. But if patients are either pregnant or have HIV they are triaged to the top of the list. The same goes for America.

Expanding services was a difficult task amid the economic crisis, but treating injection drug use with medicine is an upstream solution that prevents further costs down the road. Still, Kokkolis worries sometimes that more cuts are around the corner. The healthcare system is so stressed, he said, that any more austerity measures could result in yet another public health disaster.

Recent history shows his worries are justified, and may even be coming true. Late on Thursday night, Greece’s Parliament voted to impose yet another round of austerity that will once again slash pensions. It remains unclear whether or not the healthcare system will be bear the brunt of this new round of austerity, which was met with protestors organized by labor unions.

Back at OKANA’s Thessaloniki clinic, Tovontzi, the young psychologist, says some of her colleagues feel despondent and worn out.

Tovontzi earned her masters in psychology at the University of Durham in the United Kingdom. She was born in Athens and moved back to Greece after she graduated and just before the crisis hit. With her education she’d have little trouble finding a higher paying job elsewhere in Europe.

“I have some friends who left,” she said. “There just wasn’t enough work for them here.”

She says what keeps her from leaving Greece is her family, along with her love for the work she does, serving the city’s most struggling residents.

“I can’t leave them, it’s home.”

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Zachary Siegel is a freelance journalist specializing in science, health and drug policy. His reporting has also appeared in Slate, The Daily Beast, Salon, Huffington Post, among others. He writes often about addiction, sometimes drawing from his own experience. You can find out more about Zachary on Linkedin or follow him on Twitter.