Maria Garcia De Frutos, from Segovia in Spain, has been based in the UK for almost 16 years working for the NHS — first in Bath at the Royal United Hospital, and now in Hackney in London.
But in 2016, at the height of the ongoing refugee crisis, she felt that her skills could be best put to use supporting the pregnant women, new mothers, and newborn babies who were living in the camps.
As the world marks International Midwives' Day, we asked Maria about her experiences volunteering in the camp, and about why midwives and maternal health are so important.
Could you give a description of your medical background, and how it led you into midwifery?
I studied nursing almost 20 years ago, actually not that much, but a long time ago. And I’d been working as a nurse for a few years when I realised that actually I wanted to work only with women.
I had a lot of passion thinking about how wonderful it would be to be part of the birth, and how magical it was. And that got me into midwifery, I just wanted to work with women.
I did feel like creating a new life was something quite special, and I found it crazy — I still find it crazy — that a human being can create another human being. It was like a piece of art; I thought it was a very artistic thing to be able to produce life. Then I got really interested about the whole thing of how this was done and I wanted to be part of that process.
When was the first time you went to volunteer in a refugee camp?
It was the summer of 2016 during the so-called refugee crisis in Europe, when a high number of refugees were crossing the Mediterranean and most were arriving in Greece. So I went over to Greece.
At the beginning of the year 2016, most of the European countries had started to close their borders, so basically loads of people got trapped in northern Greece. So, in northern Greece, that was the border that they were using to come through the Balkan countries.
They had to improvise loads of refugee camps to accommodate all the people that were stranded at the border. And that is when I arrived, in the summer of 2016. I was responsible for two refugee camps on the outskirts of Thessaloniki.
How did you make that happen? With an organisation?
For many years in London I had been volunteering with Médecins du Monde (Doctors of the World), working with undocumented migrants in a clinic that was specifically for undocumented migrants and their babies.
So then they knew of me, then they called me saying they really need a midwife in Greece and they thought that I could go there. So it was a volunteer position not with Médecins du Monde, but with their network.
What made you want to do that?
I had always been drawn to working with migrants, and displaced populations. And maybe it's because I’m a migrant myself and I always thought you go through a lot of struggles when you’re not in your own country surrounded by your family, friends, where you know the system ... [and] how horrible it must be to find yourself in this situation.
And on top of it being pregnant, and on top of that having gone through a long journey to arrive where you are and then realising that actually I thought I was going to be better off here, and actually the challenges don’t stop.
That was the main drive to work, and with refugees it was the same. How hard it must be to make a long journey thinking you’re going to arrive in a place where you’re going to be safe and have an a easier life and then realising the challenges don’t finish ever.
How did you feel arriving for the first time?
The first thing I thought of the refugee camp was … I had been working with migrants for a long time, and I was an experienced midwife and I should know everything about it.
And then I arrived there, and it was like, I could never have imagined that a refugee camp was such a horrible place, and so hostile, and there were actual humans living there with no end date.
They didn’t have a deadline, it was not like, OK, they were going to be there for a week. No, they had been there for weeks and they didn’t know how much longer they would have to be there.
I remember it took me hours walking around the camp, trying to realise what it was, and also I think it was a very unique situation that that was happening in Europe.
So for me the conflict was also that this is Greece. iIt could have been happening on the outskirts of Leeds, you know? It was very difficult. You see refugee camps on the TV but it’s always in conflict areas, or in war-torn areas, but this was happening at home.
That was a very big thing, and for me it was the first shock. My thought was like was how complex the context was, having a refugee camp in Europe.
What was it like, working there?
When I arrived, I was in two camps but most of my days I spent in one of them.
It was located in an old, abandoned factory from the '70s, so this building was completely not fit for living. And it was 1,500 people living there, so it was like a small village.
When I got there people had been living there for three or four months and they had never seen a midwife, or a health professional relating to sexual health. So I was part of a medical team, with a GP, a paediatrician, a nurse, and myself, but we divided up so I was in charge of all that had to do with women’s health.
At the beginning it was a challenge, because we knew that there were pregnant women in the camp, but we didn’t know who they were, where they were, or how many.
I came with my idea of guidelines, protocols, strategies. Then you realise that, no, actually, what they need is to go back to the basics. I had to think to myself you are in a little village, you don’t have any equipment, how do you find out who is pregnant and where they are?
So I did the basics, I went tent by tent, saying, “Hello, I’m a midwife, are you pregnant?” or “Do you know anyone who’s pregnant?”
That helped me a lot to know them and for them to know me. So then we started creating a little relationship which was really nice, because then someone would say, “I know someone on the other side of the camp who’s pregnant, let me take you to her.”
And then there were things like sending people to hospital, like I was used to here.
Someone comes to see you at the clinic with "X" worry and you’ll assess her and then you may send her to hospital for a better check up. But there that wasn’t the case, I had no hospital to send them. So I had to really change my way of thinking and my knowledge of policies to adapt them to them.
And also asking them what their needs were, because who was I to decide what they needed, or what they didn’t need? Their perception could have been very different.
Do any specific women stand out in your memory?
I remember on my second day I was there, a newborn arrived to the camp. So I went to see the family, and check the baby, and I was all focussed on breastfeeding, and safe sleeping.
The tent was tiny, and they were sleeping with loads of blankets. And in that bed, there were two adults and three or four kids plus the newborn baby.
I was trying to explain advise for sleeping because of the risks of sudden infant death syndrome. And then the mother said, “OK, can you bring me a cot?”
I said I don’t have a cot, but I’m sure I could make one up, maybe I could bring a cardboard box and we could make a cot out of that.
And then she said to me, “You think it’s safer for my baby to sleep in a box, with a tent that’s open, because I don’t know how to close the door, in a camp where so many things are happening? You think my baby is safer in the cot or in the bed with me?”
And then of course it’s safer in the bed with her, and also she feels safer like that. So there were lots of things like that where I had to change my way of thinking. And yes, we have all this beautiful research, but where do we do the research and who can we apply it to?
There were loads of cases like that where I had to completely change the way I was thinking, and I learned a lot with them. I was asking them, what is it actually that you are worried about and how can I help you? Rather than me going there and telling them what to do.
It was a very particular environment in which to work.
Would you want to volunteer again?
I would love to do it again — the problem is money. You cannot maintain two lives unfortunately.
But it was super positive. Probably it was the first time in years I really felt I was being with women and working like a midwife.
When you work on the NHS or at an institution … you have all this bureaucracy and rules you have to comply with.
Whereas there I really had the time, and quality time that I spent with the women who were pregnant or who had had their babies. Because I could dedicate the whole day to them. It was really beautiful because I was back to basics, which sometimes when we are here we forget.
But actually, them making me learn and changing my ways, it was super positive.
Do you have any thoughts about the global effort to help keep mothers and their babies safe, specifically before, during, and after childbirth?
When we go on these humanitarian missions, we have to really ensure that we are doing more good than harm. Sometimes we come with policies, and if we don’t adapt to local people maybe we’re actually not doing that much good.
It’s great that they are funding abroad, but the funding needs to stay here as well. Sometimes ... people talk about the global need to improve maternal health, absolutely, but global means everywhere. And we see inequality in our developed countries as well.
I think there is no reason why we can’t do both at the same time, and sometimes priorities abroad or the challenges abroad are much higher. The maternal mortality that some countries have, for example, we haven’t seen here in years, so of course we need to tackle that.
But we have to be very mindful of what their actual needs are and how sustainable our interventions are, because it’s about creating something that is sustainable.
From your first-hand perspective, why is this global effort so important?
With maternal health, if you don’t keep mothers healthy, there is no future. You are actually investing in the future, it’s not like you’re investing in something that’s just a moment in time.
Sometimes I think if you don’t care about the mothers, well at least care about the babies because they’re the one thing that’s going to be here tomorrow.
What’s the best thing that’s happened to you while volunteering in the camp?
The first thing that comes to mind: Once we had an old building, in ruins, but we used it as a safe space for women. It was only for women; women could come there and they had different activities, they could do whatever they wanted. So there was knitting, talking, whatever.
I started doing sessions with them, so I asked them what they wanted and the mothers asked me if I could do a session for their older daughters about periods, sex, stuff they wanted them to know but they couldn’t talk about openly with them.
That was quite beautiful because the mothers were listening, too, and giggling about the stuff I was saying to their daughters.
Then they said we also want a session but without our daughters. I asked, what do you want to talk about? They were very relaxed, they were like, oh, we’ll just come and I’m sure we’ll find something to talk about.
The next day, I arrived and it was so beautiful because I remember these women were mainly from Iraq, Afghanistan, and Syria, so they were wearing the most colourful clothes and seeing them all sitting in a circle, I was quite amazed.
I asked what they wanted to talk about. And one of them was like “I want to talk about sex, and how do you manage to have sex in the camp, where there is no privacy?”
It was beautiful because then it was so relaxing for them. They were joking, they were giggling, they were giving each other advice on what things to do. It was a completely different life from the one they were having outside of those walls.
It meant a lot of things for them, and me, that session. It was so liberating for them, and for me. I always have a tiny feeling in my head about that evening, it was really good. It was so powerful as well, all of them joined together. That was one of the highlights.
I had two interpreters with me, and I remember the interpreter saying to me I cannot translate that. And I said, “Well, I want to know”, and they were like, “No, no, it’s too much.” And I was like, no loosen up, translate.
It was like a party, honestly. I felt like I had been invited to a party.
What would you say to other people who are also thinking right now about lending their skills to support global development?
I always say the same: If you want to help and you don’t know what to start from, start from your neighbourhood. I’m sure you can find something, and that will give you the humanity also to go somewhere else.
In terms of skills, just go back to basics. We don’t know better than anyone else. Not because we’ve been trained in a high income country, and we have best outcomes, etc. We don’t save people and we don’t know better.
So it’s like, having a very humble approach and asking people what do they need and how can you help them, rather than guessing.