Inside Geneva’s final summer profile: ICRC physiotherapist Rieke Hayes

This week, in the final episode of our Summer Profiles series on the Inside Geneva podcast, host Imogen Foulkes talks to Irish physiotherapist Rieke Hayes, who now works in Gaza for the International Committee of the Red Cross (ICRC).

“I think I went into physio with the classic idea – I’d have a little clinic, do outpatients, you know, back pain, neck pain. Turns out I really, really didn’t enjoy that setting at all once I was in it,” says Hayes.

Her first posting was unexpected.

“I got this email: would you be willing to go to the Democratic People’s Republic of Korea (DPRK) in two weeks’ time? I didn’t know what DPRK was, so, yes, North Korea, and I went, of course, yes.” 

Now, she works in Gaza, treating patients with spinal injuries. 

“It’s very complicated for someone with a spinal injury to get off the ground and to mobilise with a walking frame – if they had one. But you don’t have a walking frame, you don’t have a wheelchair and you don’t have a raised bed. You’re in a tent and you might be sharing it with 20 relatives.” 

Can her patients recover, given the situation in Gaza?

“Many patients leave our hospital and I say: we did a good job, we’ve done the best we can. I don’t know if they’re still alive or if they’re still walking, but we do what we can. But yes, they’re very dependent on friends and family – if they have any left, of course.” 

Join host Imogen Foulkes on our Inside Geneva podcast for the full interview.

Get in touch!

• Email us at insidegeneva@swissinfo.ch
• Twitter: @ImogenFoulkes and @swissinfo_en

Thank you for listening! If you like what we do, please leave a review or subscribe to our newsletter.

For more stories on the international Geneva please visit www.swissinfo.ch/

Host: Imogen Foulkes
Production assitant: Claire-Marie Germain
Distribution: Sara Pasino
Marketing: Xin Zhang

Chapters

• 0:07 Introduction to Inside Geneva
• 2:06 Rika Hayes: From Astronaut to Physiotherapist
• 5:30 Humanitarian Physiotherapy as a Career
• 9:16 Working in North Korea
• 12:40 Experience in Gaza under Bombardment
• 16:47 Mass Casualties and Frontline Care
• 21:58 Walking Wounded and Limited Resources
• 24:37 Resilience of Palestinian Healthcare Workers

Transcript

SPEAKER_05: 0:07

This is Inside Geneva. I'm your host, Imogen Folkes, and this is a production from SwissInfo, the international public media company of Switzerland. In today's programme.

SPEAKER_04: 0:21

When I first went to Bangladesh, first of all I was weeping because I'd gone from Scottish climate to 30 degrees, Bangladesh, 100% humidity, and I just remember crying under the shower at 3 a.m. because I couldn't sleep. And I had frogs in my room. And I got this email of would you be willing to go to DPRK in two weeks' time? I didn't know what DPRK was. So yes, North Korea. And I went, of course, yes. I'm very curious about this life. The first time I went into Gaza was last year, and it was just a few weeks after the Rafa border had been shut. So at that stage, Rafa was still relatively intact, but now it's completely flat, it's complete rubble. We've got three basic walkers in the whole hospital for at that time 60 beds, and now we've 120 patients, so even harder to share any walking aids. So it's very, very complicated for someone with a spinal injury to get off the ground and mobilizing with a walking frame if they had one. But you don't have a walking frame, you don't have a wheelchair, and you don't have a raised bed. You're in a tent and you might be sharing it with 20 relatives.

SPEAKER_05: 1:41

And in today's programme, I know summer is really well and truly over for most of us. But we are going to tweak to a final summer profile. Our guest today has been very busy doing a very challenging job over the summer months. But I really wanted to get her on our podcast. So I caught up with her at last and joined a well-earned break at this week.

SPEAKER_04: 2:06

My name is Rika Hayes. I'm from Ireland, and I'm a physiotherapist. I've been working for six years now with the International Committee of the Red Cross.

SPEAKER_05: 2:14

So you're a physiotherapist. I always ask people this, and it's a bit it's sometimes it's a bit formulaic, but when you were growing up, is that always what you wanted to be? No, I wanted to be an astronaut first.

SPEAKER_04: 2:27

Um I got to in Ireland we've got six years in secondary school, and the fourth year isn't compulsory. So it's a year when the focus is on more non-academic skills. And during that time I did work experience in a centre for young adults with learning and physical disabilities, and I was very surprised that I enjoyed it. I purely had gone there because a friend at a range had had an ant connection. So and I found I was just working as a care assistant more or less. Um, but I found the conditions really interesting. I'd learned about spina bifida, the staff they would let me read about it, and I could see it and I could see the symptoms of it, and then working alongside the clients as well and just helping them with day-to-day care. And I was just surprised how much I enjoyed working with people.

SPEAKER_05: 3:15

And so did you work in in the health service in Ireland first, or did you immediately think I want to take these skills abroad?

SPEAKER_04: 3:22

Or uh no, I started off I did a I did a degree in in physiology, actually, and then I did the conversion course masters in Scotland. I think I went into physiothinking, the classic, I would have a little clinic, do outpatients, you know, back pain, neck pain. Turns out I really, really did not enjoy that setting at all once I was in it, and again surprised myself by finding that I was very geared towards intensive care, trauma orthopedics, and from there on I kind of geared my career towards the humanitarian sector. Because I thought it was only volunteering at first. I didn't know I could get a career in it. So I did the training for the UK emergency medical team. It was a training specifically for occupation therapists and physiotherapists, so that we could be part of a medical team that gets deployed uh by the government in response to, say, an earthquake. So, of course, we had a lot of speakers who were specialists in burns, in trauma orthopedics, and amputations. And that's the first time I twigged that you could have a full-time career as a humanitarian physiotherapist. So that was when, after about five, six years in the NHS, I just handed in my notice and uh decided to go to Bangladesh for six months, uh, working at Spinal Cords Rehab Center and do I helped out in university with teaching, but I I also got some clinical work experience, even at the Red Cross. That's how I got my CV in. And I also worked in Nepal for three months again with spinal cord injuries. So it's a good way to explore whether you would like that work. It's a good kind of testing round because if if it doesn't work out, you can just go back home, essentially, you know, pick up your job again in the NHS and and continue on and go, okay, that was nice. But no, I I loved it.

SPEAKER_05: 5:04

You've worked in a a number of places, and I know you've worked in North Korea, which I want to ask you about for a moment. But I'm always curious. I mean, lots of people who have medical training think, uh, I'd like to take this abroad. But a lot of them, excellent health professionals, but a lot of them have told me that when they first arrive in a place which is not Western high-tech medicine, there's a lot of make-do and mend work that they hadn't quite expected.

SPEAKER_04: 5:33

Well, I think when I first went to Bangladesh, first of all, I was weeping because I'd gone from Scottish climate to 30 degrees, Bangladesh, 100% humidity, and I just remember frying under the shower at 3 a.m. because I couldn't sleep because I was actively sweating and had frogs in my room and uh ants and whatnot. But so at first, yes, I was a bit taken aback and going, oh my God, this isn't the standard I would expect. But actually now, after a few years of experience, actually, when I look back and that that center of rehabilitation of the paralyzed in Bangladesh, it was phenomenal actually that they were set up. I would argue they might actually do better in terms that you have your whatever three-month stay there with spinal cord injuries, and they have a little village built on the ground as well, so that when it comes closer discharge, you and your family can have a practice run of uh living independently of the hospital. But during the day you can feed back saying, Oh, we really struggled with toileting or with with getting into and out of bed, and then they do practice sessions to help them adapt and then get them out. Whereas I I think in many ways you're just kind of one bam, sorry, send you home, quick adaptation.

SPEAKER_05: 6:40

Yeah, yeah, yeah.

SPEAKER_04: 6:41

So and they had a lot more adaptation. It was amazing actually the rehab they could provide in that environment.

SPEAKER_05: 6:47

And so you you joined the ICRC, you had a stint in North Korea. I don't know that many people who've been to North Korea. Tell me about that. What did you what did you do? What was it like?

SPEAKER_04: 6:56

Oh, that that one took me by surprise. That was my first mission. So I had just I was told I I could be waiting months before I get my first mission deployment. So I kind of came back to Ireland and signed up for some locum work. And I got this email of would you be willing to go to DPRK in two weeks' time? I didn't know what DPRK was. So yes, North Korea. And I went, of course, yes. I'm very curious about this life. It was quite a fascinating mission. I was there for one year. Most of the work with the ICRC for a physiotherapist is working with prosthetics north subtitles. So we have many centers across the globe, really, that obviously do the pre-prosthetic rehabilitation. And once we fit people with the devices that we help them walk with them and that's so that they're ready for discharge. So that's essentially what we were doing in North Korea. We had two centers, one that was within Pyongyang and one that was outside. And the one outside is more for civilians, per se. The one in Pyongyang with more military in their family. Very interesting. I mean, mostly amputees for sure. They were quite vague about how they got their amputations. They were a little bit evasive, but but more often than not, it was just fractures gone gone wrong, it was infections. One person lost his leg from a shark. Frostbite was a big one because it gets down to minus 30 degrees. I had a pair of twins who had lost both their legs because they got lost uh during the winter and they weren't found for a month. So it's a miracle they survived. But I would say the the North Koreans for sure, very hardy people do not complain. They were just like, Yeah, we're ready to go. Yeah, the device is good. Like, you're bleeding, we need to adjust this. Like you're getting wounds. No, no, no, I'm good to go, I'm good to go. Um, not demanding at all. And and lovely, actually, something really nice. And one one lady was a carer for her granddaughter who'd lost her leg in a burn, and uh, she would then cook us treats, and then I would return the favor by baking them a cake, and then she would return the favor by baking for my whole office. And it just became this little competition, who could give more? They were just really, really generous, really nice. Yeah, I I was very surprised by what I found there.

SPEAKER_05: 9:04

Maybe uh because it's such an unknown land, we have too many preconceptions about what it might be.

SPEAKER_04: 9:09

It is a little bit like the Truman show. I mean, everything is very often they for show. They like things to be look big and grand and they're a bit elusive about any negative things in their in their country for sure. But you know, it was very interesting. They have a Burger Kim.

SPEAKER_05: 9:26

Not Burger King, Burger Kim.

SPEAKER_04: 9:28

Burger Kim. Kim fried chicken. Uh there's all these little things that are slight variations of what you would see in Europe. It was quite a privilege to have gone for a foreigner. I was surprised by how much freedoms I had because I was allowed to walk around the city. In fact, I drove. I I have a I I have a North Korean driver's license. It expired after two years, but I had to do the test with the military, which was very interesting in itself, because they drive for me on the wrong side of the road. And they they failed me on the first attempt because they said I slowed down for pedestrians on the road, which I thought was a bit funny. So it was it was in many regards quite an entertaining mission in terms of what you could see that nobody else could see. But also I really loved my my colleagues, my Korean colleagues were really nice and fun to work with. The patients were really lovely, and that's a side that doesn't really get shown, I think, in the media often enough. Because again, journalists can't really go in and report. But no. Yeah, I I would I would go back for sure.

SPEAKER_05: 10:24

Let's move on to where you've been most recently than another place foreign journalists can't go in and report, and that is Gaza. You've done a number of stints there since October the 7th. I'm just wondering again what your first impressions were compared to perhaps what you were expecting.

SPEAKER_04: 10:44

Uh to be fair, I think what's shown on the media really does prepare you. I mean, it's I don't think it's a secret. I know there aren't journalists, but everyone's posting about it. I mean, my feed is full of it. So actually it just really affirmed what I was seeing online. It's actually true. It's just the fact that things are complete rubble. The first time I went into Gaza, it was it was last year and it was just a a few weeks after the Rafa border had been shut. So at that stage, Rafa was still relatively intact. But I now it's now it's completely flat, it's complete rubble. Uh I was working in Han Unit at the time in European Gaza Hospital, so I actually didn't see much outside of that life, but it was a it was basically an IDP camp. We had thousands of people living on the ground of the hospital because they thought it was the safest place to be. But that meant you had people cooking uh on the wards in the corridors, you were stepping over their families or extended families, trying to get to the patients. So that took me a little bit aback because I I I wasn't realizing how much the IDP camp would affect actually work inside the hospital. Now, I did then return to the the Rafa Field Hospital then in March. And again, it's I have interesting timing. I came just two days after the ceasefire ended rather abruptly. So I've never really seen a ceasefire in Gaz. I've never really experienced any sort of lull. I only know it to a backdrop of explosions and gunfire, and which is pretty much continuous throughout your your days of work. I mean, more bombs than bird song for sure.

SPEAKER_05: 12:14

Tell me a bit about your patients, maybe one or two that stand out to you, because you are you are a physiotherapist and you know, here in a peaceful country like Ireland or or Switzerland, physio we think of as, you know, maybe if you've got a bad back or you've you've had a a broken arm or leg, or these are probably not the kind of injuries you're dealing with.

SPEAKER_04: 12:35

No. If you if you're working in a trauma ortho ward in the UK, for example, you might have someone in a in a traffic accident or someone who's fallen from a height and they might have a fractured arm, maybe a fractured leg with it. But in a conflict zone, the wounds are very, very different. They're mostly open wounds, and by that I mean penetrative injuries. So you're looking at shrapnel or you're looking at a bullet wound. So just through that, you already have a different injury. You've got the fracture, which is much more severe because it's a very high velocity object which has caused it and has splintered the bone. You might also have bone loss, which means you might end up getting your limb shortened. There's actually a higher risk that your limb needs to be amputated because of the open wounds. That means your your vascular system is compromised. If you don't need any of those severe shortenings or removal of your limb, you've got also the issue of infection. So there's just a lot more difficulties surrounding the injury that you have. More often than not, it's not just one limb either. I had one man, Ahmed. I mean, he was a miracle really that he's managed to survive, and he was a phenomenal young man. He was 19. Shrapnel injuries, he had fracture in his left hand, he needed wires put in and a cast. He had fractures under his right forearm, he had such a severe open wound in his right leg, bone loss, his leg had to be shortened by 10 centimeters. He has a external fixator on, his head was fine, and his left leg was fine. Uh, his abdomen had been shredded as well. He's a stoma bag in it, you know, like a 19-year-old who was hoping to be an engineering student, Kyrgyzstan. That was his that was his ambitions. But yeah, just trying to get on top of his rehab medical care and then his rehabilitation care when you've only got one leg to work with. You've got maybe four wheelchairs in the whole hospital so that you can encourage his brother to get him out in the wheelchair so he gets off the bed. He can't really use any of your walking aids because crutches require hands and both of his arms are fractured, his forearms. We would have these devices in the UK that he could use. There'd be like a large frame that you can rest your elbows on. We don't have that. We've we've got three basic walkers in the whole hospital for at that time 60 beds, and and now we've 120 patients, so even harder to share any walking aids.

SPEAKER_05: 14:47

So was the ICRC asking to get more of these mobility aids in?

SPEAKER_04: 14:52

We had an order. Unfortunately, we used to keep a lot of our stock in European Gaza Hospital, but it was evacuated last year, so a lot of our stock was was was looted, wheelchairs and and walking frames. We did have an order in since November 2023, but it never came. It was it was kept in Jordan, to my knowledge. We don't get much information of why it can't come in or if there's a particular item in the lorry that they don't like. You're just not told, you're just told no. And you just know it's sitting there waiting. So we had clutches waiting, we had frames waiting, wheelchairs waiting, but we didn't have them. I mean, we've got shortages everywhere of like medications and surgical implements, everything. But just imagine also what you're discharging them home to. So at least in the UK, you know, you're unlikely to have lost your home, really. You you have a house, you know, you have a bed, you have a bathroom. Maybe you need some adjustments to those items, and you can get occupational therapy, we'll put in bed rails and a special toy. So you know, give you a commode. What we're discharging people to now is tents. They're sleeping on the ground. It's very, very complicated for someone with a spinal injury to get off the ground and mobilizing with a walking frame if they had one. But you don't have a walking frame, you don't have a wheelchair, and you don't have a raised bed. So you're in a tent and you might be sharing it with 20 relatives. You might still have wounds that you need follow-up care for. Good luck trying to keep them clean. Like we've got really high infection rates because people can't wash themselves. Soap is very hard to find. So it's just all around compounding issues. It makes it really difficult for anyone to fully heal from any of their injuries.

SPEAKER_05: 16:24

You also you gave an interview actually to the ICRC online website about voices of ICRC workers, where you said you went knowing what what you might expect in Gaza, but you hadn't expected to be working in casualty with people immediately wounded.

SPEAKER_04: 16:41

I think what you were referring to to is the fact that I was stopping bleeding rather than rehabilitating. And that was largely because we had such an influx of mass casualties that we just couldn't cope with the staffing we had. So my initial six weeks, it was fine. We were 60 bed at hospital. We did have mass casualty incidents, but they were usually about 40 people coming in in a short period of time, and and we could absorb that, we were fine. When I came back for the second round of six weeks, this was just as the food distribution centers opened in Rafa. And I can't come to us to who's responsible for all the gunfire, however, people were being shot going to or at or leaving these food distribution centers, and that was sending waves and waves of casualties our way. But like in numbers we never would have anticipated. So we were looking at 180 one day, 60 the next day, 174, 244 was the highest we had. And you just couldn't recover from that. So imagine how you've got the staffing, usual staffing for a 60-bedded field hospital. Imagine now also it's the night shift. So you've got reduced staffing, and obviously there's no surgical team because we at that time we weren't doing surgeries overnight. So the mass casualties in the beginning were because the food distribution centers would open at approximately 7 a.m., the mass casualty incidents would usually start around 4:30, 5.30. So it was right in the middle of the night shift. So honestly, when you've got a hundred people in a very short period of time coming in, you don't have enough staff, and it is really a ha all hands on deck. And that's how I found myself patching up more bleeding than I would have expected and helping out with tourniquets.

SPEAKER_05: 18:20

Do you ever get depressed or angry? I mean, you seem so cheerful and and motivated, but when you see that, you're talking about hundreds of people shot coming in in waves. Do you ever get depressed or or even angry?

SPEAKER_04: 18:32

I don't think depressed and angry would be the right word for it. I um I guess I got my work hat on, so I know I can do something about it. Do you ever have that helplessness when you see someone injured and you don't know what to do? I always admired when there was somebody on the scene who, like a paramedic who knew exactly what to do and knew how to react, knew how to respond, give the best care. But like over the years, I have become that person in terms of physiotherapy, and I've also done a lot of trauma first aid through my work. So I know what to do, and I suppose I'm happy that I I can do something of help. Because you really just want to help all your nursing and doctor colleagues at this stage and all your physio colleagues. You want to be an extra pair of hands, so you don't really have time to be depressed and upset. I had moments, of course, when I would have to take a breather and go in my tent, have to take a deep breath, and then go back at it because what I found very overwhelming was the screaming and the bleeding. It was it's not just the injured, it's all the families that come with them and it's like chaos. People are lying on the ground, I mean, they see you and they think you're a doctor and they're trying to pull you over, they're weeping. You go and check on the on on a person lying on the ground, you realize they're no longer alive. Then you just try and go and treat someone that you you know what you can do with, you know, you've got some chest wounds or you've got some leg wounds. I'm like, okay, I can patch that up. I can help apply a tourniquet for sure. I can try and stabilize this fracture. That's actually the main role I'm supposed to have in the ED department. It's to stabilize fractures. So yeah, I think you don't really have much time to process what is happening other than, oh God, let's just get through this wave and hope it calms down and we can catch our breath and really really try and deliver the best care.

SPEAKER_05: 20:13

And what about when you get home and you've got more time to think about it?

SPEAKER_04: 20:17

Uh I'm I'm okay. I I think I'm my my frustration at home is that I'm not there helping, I think. I I know it continues after I leave. I think that's what I find hardest. It's not reliving the mass casually in a sense, it's it's getting through the border and leaving people behind and I and I'm still in touch with them and I can see the news and I and I then I worry, of course, that things are worse and that I'm not there helping and then I feel guilty. That's what I I wrestle with the most, I think. It's it's not being there. So you'll go back, I guess. Yeah, yeah, yeah. Yeah, yeah. I the organization is aware that I'm I'm I'm ready to go back and when I'm ready to go back, so for sure.

unknown: 20:56

Yeah.

SPEAKER_04: 21:00

It it always is, and unfortunately it's always worse. I mean, March was worse than when I was uh there last year in May. June was by far the worst. I had experience with daily mass casualties. Things were a bit safer. I'd say less stray bullets in the hospital now when I was there just last week. But the situation in Gaza has gotten worse now with the evacuation of Gaza City. So that's of course sending more and more people south to Almawassi and and towards Kanunas, really. And that also isn't safe. I mean, people are already struggling for housing there and for clean water and for food. I think now there's an additional 350,000 people who've now evacuated there. It's like where where are they going to stay?

SPEAKER_05: 21:42

But somebody like like your patients, the the young man you've got whose arms have been fractured, his leg has been shortened, and there are many people with these kinds of injuries. How can they even move to a new place like that?

SPEAKER_04: 21:55

They rely wholly on their family members to carry them. And that's the grim reality of it. We don't have wheelchairs to offer. And the few wheelchairs that we do have or did have, I know they were very much reserved for people with complete spinal cord injuries or bilateral lower limb amputations. So yeah, they are fully dependent for a time. I mean, this this fella Ahmed, I I did meet him actually two weeks ago. I was the first time I'd seen him in in months. And yeah, he's walking, he's got his crutches, the crutches that we made out of pallets, of course, or wooden crutches. You can see him limping because he's got the leg length shortening. He got his uh c colonosity reversed, so now he's got his abdomen closed finally. What I was really happy to see was his brother, Mohammed, actually. Mohammed was his care in the in the hospital for many months, and he was also one of the victims in the mass casualties. So the last time I had seen him, he was lying on the floor and he'd been shot in the neck and in the left shoulder. So I didn't know if he'd survived or not. So to see him walking alongside his brother, the two walking wounded, was uh quite a relief, actually. But yeah, they are very dependent on friends, family, if they have any left, of course.

SPEAKER_05: 23:02

One final question then, Rika. You told us how happy you were to see that patient, Ahmed, and that his brother also up on his feet again. Is that the moment moments like that think yeah, I've I've definitely chosen the right job.

SPEAKER_04: 23:17

Yeah, for sure. For sure. Yeah. And and there's many stories like that where you know you've put them on the path to being independent and being more capable of surviving this. But I mean, I don't want to again, I'm going back on a downer, but you're you're also sending them back out and you're hoping they survive the war. So I don't know. I many, many patients uh that leave our hospital that I say, we did a good job, we've done the best we can. I I don't know if they are still alive, if they're still walking, but we do what we can. And and I will say this for the staff in the Rafflefield Hospital, and I'm not just talking about the international staff, I'm talking about the Palestinians. They are incredible. They are really talented, really, really good carers, very passionate. Obviously, it affects them deeply. It's their neighbors, it's their friends and the families, and they just do a phenomenal job. And I honestly I don't know how they have the capacity to do it, because I I do my six weeks and I know I'm gonna leave and I can relax a little bit and sleep. I don't need to worry about my families while I'm working, but they they have their families to be worried about, they are all living in tents, and yet day after day they come into work and they still do an incredible job and they're really motivated. They're just such lovely people to work with and playful and generous. The little food that they have they're sharing with you, and they banter with you. And I'm impressed that they can still have a sense of humor despite everything that goes on. They really are astounding to work with. It's a real privilege.

SPEAKER_05: 24:46

And that brings us to the end of this edition of Inside Geneva. Huge thanks to Rika Hayes for sharing her experiences and her precious free time with us. We hope you enjoyed listening to her. Next time, we're going to hear from fresh writers and journalists, a form of human rights council about the growth council freedom of expression. We refer to your podcast. Or about the impact of the women and girls, of the cats, and humanitarian funding. Don't forget to subscribe to us and review us. We're always pleased to hear your views. Thanks again for listening.