The best cure?

Greece is a country rich in coastline and mountains, with a Mediterranean climate and an incredible variety of vegetation. In the coastal and more low-lying areas olives and citrus fruits are cultivated, and vines extend to higher elevations, especially on the sunny slopes. The roadside stalls and the street markets attest to the wide range of seasonal fruit and vegetables produced in different regions, but the most striking feature of the countryside are the wooded areas and the scrub-covered grazing lands. Some of the mountains boast oak or beech woods and black pine, and in the higher ranges, below the barer alpine zone, there are forests of fir, but the tree that epitomises the Greek coastal landscape is the Aleppo pine, Pinus halepensis. The brilliant green of the Aleppo pine and its contrast with the blue of the Greek summer sky and the turquoise of the sea linger in the memory and the photographs of the traveller as “Greece”.

The forests of Aleppo pine provide protection from erosion on the slopes. The wood of the Aleppo pine is not highly valued, but the mature trees in some areas continue to be a source of resin, of which the island of Evia produces up to 90% of the Greek crop. The “retsinades” (resin-men) patrol their allotted trees throughout the summer, slashing the bark to open a strip that bleeds the resin into plastic bags skillfully stapled to the trunk to catch every drop, and replacing the full bags which are emptied into the nearest resin tank. The technology may have changed a bit – 50 years ago the resin was collected in little tin cups – but the process remains labour-intensive, hot and sticky, and mules are still the best way of reaching some of the stands of pine. Beekeepers also erect their hives in the clearings.

Every summer there are hundreds of forest fires in Greece. It is estimated that about 50,000 hectares of forest are burned each year. The Aleppo pines, with their high resin content, burn particularly well, and the explosion of the burning cones spreads sparks far and wide, igniting other trees in a wide circle, often giving rise to elaborate conspiracy theories of multiple arson. The pattern is as often as not a natural one, even if the first spark is ignited by human action.

When a major forest fire gets under way, a predictable series of events is put into motion. The fire service responds to the call and the appropriate dousing measures are activated. The media appear soon after, eager to fill their airtime in the quiet summer months (I mean, inform the public). The videos accompanying the first breathless TV descriptions usually have a faint “archive footage” watermark in one corner, as one shot of an ageing yellow Canadair dropping water on flaming Aleppo pines is much like another. A Government Minister cuts short his vacation and is rushed to the scene to “coordinate the operation” (I say “his” because it always seems to be a male minister on such occasions, and he makes sure that the TV cameras are rolling to capture his arrival). The same, or another, minister and the local MP are subsequently filmed looking serious, meeting with the representatives of local groups whose property or livelihood have been affected, and making concerned statements. Soon after this, an opposition leader and/or local MP visits to be filmed expressing outrage at the tardiness and incompetence of the government efforts and the lack of sensitivity to the interests of the local population. Occasionally, things turn ugly.

“Quick, look concerned!”: Environment Minister Yiannis Tsironis on the site of the Limni forest fire.

Meanwhile the TV, radio and newspaper coverage consists of a recombination of stock phrases: “πύρινη λαίλαπα” (pyrini lailapa, fiery whirlwind), “δύσβατη περιοχή” (dysvati periochi, difficult-to-reach spot), “θυελλώδεις άνεμοι” (thyellodeis anemoi, gusty winds) the last two used as explanations for why the fire engines and planes/helicopters, respectively, have not yet extinguished the fire. The firefighters are making “υπεράνθρωπες προσπάθειες” (yperanthropes prospatheies, superhuman efforts) and the pilots are all heroes. There is the inevitable “vox pop” with a distraught homeowner clad in baggy shorts and flip-flops wielding a small hose or broom. “Where is the State?” they cry, as they try to protect the house they were happy for the State to ignore when they erected it illegally on forest land (a common land-use pattern already noted by the archaeologist of the future).

When the wind drops and the flames are replaced by charred stumps, comes the announcement of the vast area of forest and scrub that was burnt, along with the beehives and sometimes olive and fruit trees or flocks of sheep or goats “but fortunately there was no loss of life, and no homes were damaged”. There are promises of compensation for the local communities, and an opportunity for a demonstration of largesse by those in control of the funds or enforcement mechanisms, with the implied expectation of deferred political reciprocity somewhere down the line. The next event, sometimes avoided, takes place when the first torrential rains arrive and wash down the hillsides unimpeded, denuding them of soil, and carrying rocks, rubble and mud down to block the roads and flood the fields and villages, and the drama resumes.

This series of events was re-enacted this summer, when fire broke out on 30 July near a village in central Evia and in high winds spread rapidly through the magnificent Aleppo pine forests that the area is famed for. There had been a similar fire in the same area in 1977, and the forest was just regaining its former splendour; Aleppo pine regenerates naturally when protected from humans and goats. Within hours the flames had crested the hills to the west and were threatening the attractive coastal town of Limni and a well-known neighbouring seaside monastery. The nuns were evacuated along with holiday-makers camping by the sea. The town was saved and the politicians duly arrived, in this case the local MP and (coincidentally) Minster for Agricultural Development, Vangelis Apostolou, who wrote an account praising the efforts of the responders and promising special easements to those affected. The Environment Minister Yiannis Tsironis, also paid a visit, during which he promised the retsinades compensation and gave the rights for retrieving firewood from the burnt areas to a local cooperative. The Forestry Service was charged with organising anti-flooding measures on the burned hillsides. Opposition leader Kyriakos Mitsotakis put in the obligatory appearance and inspected the area in a freshly pressed smart-casual shirt and suspiciously clean tennis shoes.

“What’s the damage?”: opposition leader Kyriakos Mitsotakis visiting the scene of the Limni forest fire.

The fire at Limni was by no means exceptional; large fires in Greece this summer destroyed large parts of the islands of Chios and Thasos, including extensive cultivated areas. An article about forest protection entitled “Bitter Lessons” written by the then head of the firefighting department of the Forestry Department was republished to mark the occasion – as relevant today as it had been at its original publication in 2008, and a reminder that the lessons haven’t in fact been learned.

It is no exaggeration to say that the elaborate ritual of fire response described above actively discourages the learning of any lessons. The clamour of the fire engines and the human drama of evacuations serve as a noisy distraction from a series of crucial policy failures around forest management that have unfolded in Greece over recent decades. The formulaic language used gives us some clues. The lens through which the media and political culture present forest fires almost seems designed to sensationalise the event itself, and invoke an emotional reflex rather than a reasoned response – to render the audience helpless so as to capture its eyeballs and votes. The fire is a “natural disaster” and the appropriate response is first heroism, followed by sympathy, and eventually a handout. This tweet by a governing party MEP in the aftermath of this summer’s fires exemplifies the genre:

"Solidarity fund should be immediately activated to address natural disaster caused by floods and fires in Greece" pic.twitter.com/yGvHfXCJ7T

— Dim. Papadimoulis (@papadimoulis) September 15, 2016

We know what he is getting at, of course; this is a clearly styled and branded political message to the EU, aimed at unlocking a particular line item in the aid budget. But the clichés in which it is cloaked, and which are routinely trotted out on such occasions across the political spectrum, are not merely tokens of sloppy thinking but are actively harmful. At best, they encourage unquestioning passivity and the shrugging off of responsibility; at worst they fuel destruction in exchange for financial compensation and political patronage. Indeed, recent research has shown a link between the severity of forest fires and election cycles (areas burned in election years have been 2.5 times the area burned in non-election years) that suggests anything but a natural cycle. We would be well advised to heed the well-publicised verdict on a major disaster in another part of the world, Hurricane Katrina, that “there’s no such thing as a natural disaster”, and ask the tough questions about the human factor in such events, the extent to which our individual and collective choices, economic, social and political, have shaped the catastrophic outcome:

If a tree falls in a forest – to make illegal firewood or build a holiday home – and no one is around to hear it – for their own reasons, perhaps a backhander, a vote, or simply the desire for “a quiet life” – does it still make a sound? We should really be considering the impact it has on everyone’s pocket and quality of life. When an individual choses to put themselves and their property in harm’s way by illegally encroaching on a high risk zone – where they also consequently increase the risk of fire – can they truly be considered victims of a “natural disaster”? Or are they in fact passing on the risk and cost of their actions to the rest of society? When a local official or national politician turns a blind eye to encroachment or tacitly rewards its outcomes, is that just a cheap inconsequential favour, or is it in fact a very costly one for those not directly involved in the transaction? And what do we prioritise through our democratic processes? Are we allocating our dwindling national resources in the wisest way? It should quickly become apparent that you don’t have to be a card-carrying tree-hugger to care.

The overwhelming emphasis on safeguarding life and property, which is also made to seem “natural” in the context of fire reporting (because what kind of misanthrope wouldn’t be concerned about casualties?), has its own policy and political hinterland. Before 1998 the responsibility for extinguishing forest fires in Greece was shared by three independent agencies: the bulk of the responsibility lay with the Forestry Department of the Ministry of Agriculture, which complemented this activity with extensive prevention and protection measures; the aerial means, which came under the authority of the Air Force (Ministry of Defence), but was coordinated by the forestry service; and the Fire Department (Ministry of Public Order) which was responsible for residential areas, and whose vehicles were restricted to paved roads, and which being a uniformed service did not take orders from others outside their hierarchy. The army could also be called in to help on the ground.

Legislation passed in 1998 by the Simitis government under the direction of the EU separated the responsibility for the extinguishing of forest fires from that of prevention, and allocated it exclusively to the Fire Department, ostensibly in the interests of conforming with the practice in most of the other member states (N.2612/1998). The Fire Department was also allocated generous funding for equipment and training of staff. The accumulated experience of several generations of foresters in controlling fires in the forests and their knowledge of the local terrain and network of forest roads, were lost overnight. The younger foresters were probably relieved to be spared the extra firefighting duties, which typically involved shift work over the holiday period. The Fire Department, accustomed to easy access to flaming buildings took a long time to adjust to the very different circumstances of wildfire in the forest, and have never really appeared to relinquish their original priorities – hence their much repeated statement that “there has been no loss of lives or property”, and their apparent reluctance to leave the paved roads. The efforts to control fires in the forest now rely heavily on the aerial means and become concerted on the ground only when a village becomes threatened. The division of funding – 35% for protection and 65% for fighting fires – has curtailed the Forestry Service’s ability to apply effective protection measures.

Almost 20 years later there has been no systematic effort to make a proper assessment of the results of the transfer, but the conclusions of the one published attempt are negative, based on numbers of fires, hectares destroyed, means deployed and cost. Every year, an average of €357 million is spent on forest protection, of which €230 million goes purely to extinguishing fires. In addition, the study highlights that the annual cost of fighting forest fires in Greece dwarfs the equivalent expenditure in the US and Canada, countries with a much higher incidence of wildfires per head of population.

It was probably unfortunate that in the first years in which the Fire Department took charge the summers were particularly conducive to forest fires, and some particularly rapidly-spreading fires occurred, including some with loss of life to fire-fighters. Following these events, there seems to be a tacit agreement that the appropriate terms to describe their efforts are heroism and tragedy, rather than inexperience or, dare we say it, lack of competence. And in the apparent gaps left by the official response, some of the volunteers keen to take on the hero’s mantle have less than pure motives – witness the recent appearance of Golden Dawn groups in insignia among the first responders, and their eagerness to publicly mourn those fallen in the line of duty.

But there is an even more fundamental misplacement of priorities behind the vicious cycle of forest fires. Yiayia happened to visit Limni a few weeks after the fire in the company of a friendly expert, who had this to say:

“In the last 30-40 years there have been extensive forest fires, which have destroyed large areas of coniferous trees and shrubs in the Eastern and Western Mediterranean. These fires have sometimes been caused by lightning in summer storms, but are usually anthropogenic. Forest fires are not 100% avoidable, but their incidence can be managed. The opening up of road systems in mountainous areas has allowed easy access of more people to the forest areas (though also facilitating the approach of firefighters). In the critical dry windy summer months when the low vegetation is dry, the danger of fire is greatest and the conditions are ideal for rapid spread and unfavourable for easy control, despite the deployment of large numbers of firefighters and their variety of equipment (fire engines, aeroplanes, helicopters, etc.).

Forest fires of this extent and intensity cause incalculable damage, economic and ecological, to a region. All the resources and the beneficial effects for the people and for the stability of the environment (enrichment of the atmosphere with oxygen, provision of forest products, regulation of the flow of rainwater, protection from erosion, natural conservation of biodiversity, not to mention human enjoyment and recreation) are obliterated in the course of a few hours. It is estimated that the reestablishment of these forests takes 30 to 50 years, depending on the type of trees and their capacity for regeneration, and the soil and climatic conditions in the area. Especially where the area is characterized by steep slopes, when there are heavy rainstorms soon after a fire, there is danger of even greater damage through soil erosion and landslides, and flooding in the land below.

In the management of forests as a national natural resource, we seem to have our priorities wrong, focussing on the emergency response measures of extinguishing forest fires rather than investing in preventive measures. This would be a less expensive approach, resulting in less damage to the environment.

Preventive measures would include: a good network of firebreaks; maintenance of the forest road network for easy access; annual clearing of the dry roadside vegetation; defence measures in the summer months such as forest outlook posts and patrols; enforcement of restrictions of hazardous activities in the summer months (burning of rubbish, campfires, welding, etc.); better public education on the importance of the forest for our health, physical and psychological, and how to avoid hazardous activities; and, long-term, cultivation in schools of love and respect for the forest and the environment in general, by people who themselves know and love the forest. None of this is new of course, but it has never been consistently applied.”

This all agrees nicely with the Yiayia philosophy on preventive medicine, which also takes a back seat in our national allocation of priorities to rampant antibiotic use. Here, too, we need a change in the prevailing wind. For now, let us hope that the anti-flooding measures are in place by the time the autumn rains come to Limni, bringing the first wild cyclamen from the corms that will miraculously have survived the fire.

With contribution from Atlantis Host and a forestry expert who wished to remain anonymous.

Photos from ethnos.gr, ilamia.gr, voriaevia.blogspot.com

Vapour, smoke and mirrors

It is now one year since Yiayia first voiced her concerns on the alarming dimensions of the tobacco epidemic in Greece, and the Sunday edition of Kathimerini thoughtfully reported on the latest figures on smoking and “vaping” (“άτμισμα”, “atmisma”, i.e., electronic smoking) in Greece. This report was also well-timed, because the present Minister of Health, Andreas Xanthou has recently announced the planned introduction of legislation to forbid the use of electronic cigarettes in public places. Meanwhile, his Deputy Minister, Pavlos Polakis, a surgeon by profession, openly flouts the smoking ban in work places by lighting up in the canteen in Parliament and at press conferences in the Ministry – part of a lovingly cultivated “Cretan mountain man” persona which also includes composing threatening verse in the traditional mantináda style directed at his adversaries, and Berlusconi-style rants alleging corruption in the judiciary.

The debate over electronic cigarettes continues, with evidence to show that their use as a source of nicotine helps smokers to quit, and other evidence to suggest that new users will get addicted to nicotine and then graduate to smoking “the real thing”. Nicotine itself is harmful to the blood vessels and other elastic tissues, so “vapes” themselves are not entirely harmless to the user. Regardless of the debate, “vaping” has caught on in Greece, and the sales of electronic cigarette products is one of the few domains that has flourished during the crisis, with 300 registered specialty stores and over 1,000 sales points now operating throughout Greece. Kathemerini quotes current estimates of 200,000 systematic “vapers” among the Greek population.

Yiayia, being suspicious of what she reads in the newspapers (ever since being misquoted by the local rag at the tender age of 10), resorted to the primary source, in this case the Hellenic Statistical Authority ELSTAT, which publishes information on all aspects of life and death in Greece (no wisecracks about “Greek statistics” please; no doubt there is the inevitable conspiracy angle here too if you go looking for it, but in my professional experience I always found them reliable, professional and cooperative where population and health data were concerned). Every 5 years a Health Interview Survey (HIS) is conducted, and the findings of the most recent survey in 2014 were published this year (in English). The report shows that the percentage of regular smokers in Greece has fallen from 32% in 2009 to 27.3% in 2014, continuing a welcome trend that we noted in an earlier post. Is it possible that the Ministry of Health warnings on cigarette packets, the health education activities, the anti-smoking campaigns and the restriction on smoking in public places are actually producing results? Perhaps it is also the decreased spending power of smokers in the crisis. Although these findings are encouraging, the idea that more than one quarter of the population are still putting themselves, and the rest of us, at risk, is still alarming and is rightfully described as one of the biggest public health problems facing Greece today.

The rationale for restricting vaping is not clear. Second hand vape may be annoying to those at the next table, in the way that taking selfies or dowsing oneself in Poison are, but at least it is not loaded with the carcinogens of exhaled cigarette smoke. And arguably the government’s efforts would be better directed at enforcing existing laws, starting in their own back yard, rather than issuing new edicts. Although the existing smoking ban is largely observed in public offices and banks, it is acknowledged that its enforcement in bars, coffee shops and eating places has met with spectacular failure. This failure is confirmed by the report cited above, whose figures show that of the people who chose to eat or drink out, nine in ten had recently experienced passive smoking in coffee shops/bars, and eight in ten in restaurants/tavernas. If these numbers are anything to go by, the “vapers” have no more to fear than the traditional Greek smokers from the introduction of legislation to restrict their habit…

Image via kathimerini.gr

The “Greek Tobacco Epidemic” – there’s good news and there’s bad news

“The Greek Tobacco Epidemic” is the very apt title of a 162 page report prepared by the Faculty of the Harvard School of Public Health in collaboration with the Hellenic Ministries of Health and Education and the Hellenic Anti-Cancer Society and published in December 2011. It was funded by the George D Behrakis Foundation as part of the “Hellenic Action through research against Tobacco” (HEART) Project. I cite it in defence of what some followers thought were over-gloomy pronouncements in my earlier post on smoking.

Among the multiplicity of data presented in that report are the following numbers: Diseases caused by tobacco accounted for 14.4% of the total Greek health budget, with 53 deaths a day in Greece related to smoking. Bad News indeed. However there was also some Good News: Between 2006 and 2010 the prevalence of smoking dropped by 12% in the 18-24 year age-group. The Good News was confirmed in the European Journal of Public Health in October 2012 in a paper with a less catchy title, “Prevalence and determinants of tobacco use among adults in Greece: 4-year trends”. Based on the Hellas Health III survey in 2010 it was estimated that overall 41% of Greeks (45% of men and 38% of women) were smokers. Comparing the findings with the Hellas Health I survey in 2006, in the “young adult” group there was a fall from 48% in 2006 to 35% in 2010, with “a substantial reduction in the number of cigarettes smoked in all groups”.

Approaching the situation from the economic angle, a very recent publication in the British Medical Journal with another unsexy title, “Estimates of price and income elasticity in Greece. Greek debt crisis transforming cigarettes into a luxury good: an economic approach”, aimed to assess smokers’ sensitivity to cigarette price and consumer income changes, and to project health benefits of an additional tax increase. Using a statistical model the authors estimated that depending on the level of tax increase, revenue could rise while smoking could be reduced and smoking related deaths averted. Also Good News, if somewhat hypothetical. Along with increased taxation, the authors recommend that now is the time for “focused antismoking campaigns, law reinforcement (to ensure compliance with smoking bans)” but also “intensive control for smuggling”, thus keeping a one foot on either side of the fence.

Concerning focused antismoking campaigns, the HEART project, introduced above, remains ever active. It is sponsoring the 6th Three-day Conference “Education for a World without Smoking”, with scientific coverage of such topics as quitting smoking, passive smoking, the electronic cigarette and contraband tobacco. It was opened on 9th December with an event for schoolchildren at the Hellenic Ministry of Education, Research and Religion by the President of Greece Prokopis Pavlopoulos, who tossed back his white mane and presented awards to the children with winning entries in the contest “I learn not to smoke”, confessing that he himself started smoking at their age and has regretted it ever since. He was recently caught on camera cadging a light off the Mayor of Thessaloniki at an official event (above). The Minister of Education, Nikos Filis, looked on with a somewhat sheepish expression, as well he might, when his colleagues in the Ministries of Economy, Development and Tourism, Citizen Protection and Mercantile Marine and Island Policy were publicly supporting the other “Stop Smoking” movement – NO to contraband cigarettes (www.oxistaparanomatsigara.gr).

Yiayia was initially heartened when she opened the Sunday newspaper one weekend last month to find a full-page advertising spread dominated by a huge 100 euro note mutilated by a charred-edged cigarette burn. “At last” she thought “An antismoking campaign that will hit Greeks where it hurts – their pocket”. But she looked closer and found that the campaign was anti contraband smoking, and the hurting pockets were the state coffers. She looked even closer and found that she was being invited by 4 tobacco companies, 3 ministries, the municipalities of Athens and Thessaloniki, the Consumers’ Institute, and the Greek federations of tobacco processors, kiosk owners and agricultural cooperatives to join them in their fight against contraband cigarettes and loose tobacco. They even, helpfully, provided the telephone number for the hotline of the revenue office and its e-mail (kataggelies@sdoe.gr) for easy “κάρφωμα” (karfoma – nailing, i.e., snitching) of offenders one might happen to meet. So, in effect, the message was “DO smoke legal tobacco products and lower the country’s primary deficit”.

The full extent of import and sale of untaxed tobacco products is not known. A recent government estimate put the potential gains from a crackdown on contraband at €800 million annually.

Meanwhile, many Greeks are turning to alternative smoking experiences. The increase in the numbers of smokers rolling their own cigarettes is obvious to anybody who takes a walk around. One incentive is the price – it works out cheaper – particularly if your source is contraband. Another is the impression that you cut down on consumption, which may be true, as a lot of time is taken up with all the process of opening your kit, shaking out the shreds, licking the paper, etc.; or you cut down on risk, which is not true. Many smokers in Greece who wanted to reduce the risk have switched to “electronic cigarettes” – now one of the few growth sectors in the Greek “high street”. NOBACCO, one of the marketers of e-cigarettes in Greece, with 22 new shops in Athens, 15 throughout the rest of Greece and numerous other outlets, claims in its advertising that the “British Ministry of Health” says that e-cigarettes are 95% safer than cigarettes. Perhaps so – they don’t have the carcinogen content of cigarettes; however, their active ingredient is one of the constituents of cigarettes, nicotine, which contributes to cardiovascular damage. It is difficult to find data on legal sales figures for loose tobacco or e-cigarettes – an internet search just throws up advertising of the products.

It appears, then, that a combination of antismoking legislation, albeit loosely enforced in the case of bars, coffee shops and restaurants, antismoking campaigning and economic pressures, is resulting in a reduction in smoking in Greece, with fewer young people starting and seasoned smokers cutting down, switching to e-cigarettes or rolling their own. Less revenue, but less burden on health and health costs.

What is Good News for some is Bad News for others, and vice versa. Still, on the rare occasion that Yiayia decides to dine al fresco by the sea she inevitably ends up at the next table to the couple who light up between all the many dishes they order.

Photo from newsbeast.gr

Trouble on the production line

Greece is still managing to gain some revenue from its exports. Many of these are its natural products, lovingly cultivated and harvested by generations of Greek families according to traditional methods, and gaining well-deserved appreciation outside its borders. Many such products continue to provide income for the families and for the country. Notable examples are its olive oil, and two of its more exclusive items, mastic from the island of Chios and saffron from the crocus fields of Kozani.

At various points in its history, Greece has been renowned for its export of another natural product, also lovingly cultivated, fitting the description in the opening paragraph, namely its youth. The current crisis has resulted in an upsurge in the exodus of young men and women, many highly educated at great expense to the country and their families (calculated by the OECD at $23,701 per high school graduate, $37,429 per university graduate). It has been estimated that in the last 5 years well over 130,000 Greeks with university degrees have left Greece to work in other countries, and many others have failed to return home after studying abroad for a higher degree. Their talent is exploited, and their taxes are collected by their adoptive countries, and all Greece gains is an occasional accolade as a Greek scientist working abroad receives an award. This trend is likely to continue, but for how long can Greece keep up its production of this sought-after commodity to a sufficient standard?

Primary schooling starts at age six, provided by the state. Traditionally very young children in Greece were brought up at home with a large extended family ensuring that they acquired the skills needed to succeed and prosper. Even when young Greek women started working outside the home there was always a Yiayia, a grandmother, to take over. Then, with the passage of another generation, Yiayia was working, too, or was not geographically available as the wave of internal migration to the cities continued. Alternative forms of child-care had to be found, including baby-minders (native or “xenes” – how many foreign wives in Greece came originally to look after the children of Greek families?) and the “βρεφονηπιακός σταθμός” and the “παιδικός σταθμός” (vrefonipiakós stathmós and paidikós stathmós – literally “infant and child station”, respectively – nursery school), followed by νηπιαγωγείο (nipiagogío, kindergarten). In the beginning these were mostly privately run, although the larger cities had facilities for the children of civil servants, and some of the banks provided similar services for their employees. Eventually the demand was so great that the municipalities started subsidized preschool care, but with specific entry criteria. Kindergarten became part of the compulsory education for children between five and six in 2006.

All well and good – our budding scientists are headed on their course. The private sector burgeoned to cover the families not eligible for municipal childcare, or wanting something a little more imaginative for their children. The hours of state primary school often did not coincide with Mama’s work schedule, so a private school providing transport and additional “study time” was sometimes a necessity. And looking ahead, many parents started sending their children to language schools (frontistíria) in the afternoon, or arranging private tuition at home. A fragile balance seemed to have been forged, which ensured a steady stream of children to enter the next stage towards the “finished product” – high school – but that is another story.

Then The Wall came down and people from neighbouring countries were able to come to Greece looking for work and bringing their families. The Greek bubble economy of the turn of the century eventually attracted settlers from farther afield too. Their children, many born in Greece, changed the traditional nearly-all-Greek population of the schools and challenged the teachers who were not well equipped for a multi-cultural environment. The educational budget was being stretched. The private sector flourished further.

Come the crisis, and things really began to fall apart. Parents became unemployed. Mothers now find themselves in a Catch-22 situation where to enrol their children in the municipal preschool they need a letter from their employer, while to go looking for a job they need their children to be in preschool. Families whose earnings exceed a certain limit are excluded from municipal nursery schools, so have to spend a substantial proportion of those earnings on a private alternative. Or press Yiayia back into service.

Meanwhile the municipal facilities are in trouble. They are bankrolled largely out of European funds, but the austerity measures have entailed a pruning down of employees, including nursery nurses, preschool teachers, cleaning and security staff. The state kindergartens and primary schools find themselves in a similar situation, and the school year opened in September 2015 with no teachers at all in some kindergartens and schools, too few in others, and no special education specialists.

At the same time the possibility of a 23% VAT on private education brought the threat of transfer of thousands of children from private schools to a state system unable to cope with its present numbers. The government has now been forced to rescind the tax on preschool facilities and to reduce the VAT on other private educational establishments, to, for example, 6% for language schools and 13% for primary schools. So things do not look quite so bad (in a classic application of prospect theory we are so relieved to see our potential loss reduced that we treat it as a gain).

But we are not out of the woods yet. We must never discount the inevitable teachers’ strikes that will close down the whole system for days at a time throwing every family’s carefully juggled schoolday programme into disarray and playing havoc with the learning curve of the young brains.

It appears that the outlook for the continued successful cultivation of our prime national product is not sunny.

Image: Illustration from Greek primary school textbook c.1980.

Leros and the other “asylum” crisis

On the morning of Sunday 13 September 2015 yet another boat packed with refugees, mostly Syrian, entered European waters, battling heavy waves. It overturned near the rocky islet of Farmakonisi (pop. 10). The Greek coastguard rescued 68 from the sea and a further 34 managed to swim to shore, but 34 drowned, including 4 babies and 11 children. The bodies were taken to Rhodes, the administrative capital of the Dodecanese, and the survivors were taken to the island of Leros, where they were housed temporarily, pending identification procedures and issue of the documents required to continue their journey. Many of them will have to go first to Rhodes for their own, heart-rending identification procedures.

They are not the first refugees for whom Leros was the introduction into Europe. When Yiayia visited the island in 2000 there were already a few – including a young African woman whose baby, born in the excellent maternity department of the island’s general hospital, was provided with a full layette by the hospital staff. Although the larger islands, particularly Lesvos and Kos, have received greater numbers since the Syrian hostilities, Leros, with a population of less than 8,000, has been inundated. Like the other islands, it was unprepared for such numbers, and they have been camping in the hospital grounds, and in the surrounds of the island’s other hospital, the Κρατικό Θεραπευτήριο Λέρου (Leros Kratiko Therapeftirio – the Psychiatric Hospital) – in spite of protests by its board and some of the local community.

A bit of background on Leros. Leros is one of the many small beautiful islands in the Aegean, with its ruined temple, in this case dedicated to Artemis, its castle on a hilltop, its row of windmills along a ridge (now converted into studio holiday apartments), its scattered little white churches (perhaps the most picturesque is the Panaghia Kavouradena, in a cleft in the rock just above the sealine, like the crabs it takes its name from). It also has a well-tended British Military Cemetery by the sea – reminder of the World War II Battle of Leros in November 1943, when the German paratroopers took the island from the British, but not before the Aegean had claimed another victim – a downed Junkers was brought up from the bay in 2003.

Leros has all these, and more. It was under Italian administration for over 30 years, from 1912 to 1943, and because of its fine natural harbour at Lakki, extensive facilities were installed for the Italian fleet, including a whole art deco seafront and mass planting of eucalyptus trees. In 1948 Leros was united with Greece, its Italian legacy being a multiplicity of well-constructed buildings, and a scattering of Italian names. The buildings have been put to a variety of uses, including a Queen Frederiki’s craft school after the Greek civil war, and detention of political prisoners during the military Junta years. The general hospital is still housed in one complex, but the best known institution to take over the empty Italian naval buildings was the Leros “Colony of the Mentally Ill”.

The Leros Colony of the Mentally Ill opened its doors to its first 400 patients on 2/1/1958 according to Royal Decree 452/1957. Its purpose was to relieve pressure on the urban psychiatric hospitals by housing long-term patients and also to provide employment for the local population. Over the years, to the patients with chronic mental illness were added people with severe mental retardation, including children who grew up within the Colony. By the 1970s the patient population had reached 3,379. The care they received was mainly custodial. They were cut off from their families by the prohibitive cost of travelling from other parts of Greece, but well before tourism found Leros, a small industry had developed around providing for those relatives who persisted in visiting. In 1976, Presidential Decree 133/1976 renamed the institution “Leros Psychiatric Hospital”. The 1980s movement for psychiatric reform, with the EEC Regulation 815/1984, promoted deinstitutionalization of people in long-term mental health facilities. In the case of Leros this was hastened by prominent coverage in the British press and a widely broadcast investigation by Channel 4’s “Cutting Edge” documentary series. 

“Reclassification” of patients was initiated, and funds were found for relocation of some in various forms of sheltered accommodation, preferably closer to their homes, and better care of those who needed continued hospitalization. Around 200 of the more seriously ill patients remain hospitalised in the Leros facility. Although there were many “success stories”, and as in other countries, psychiatric reform may have led to decongestion of the old “asylums” (see note on political correctness below), it has undoubtedly contributed to an increase in the numbers of homeless. The crisis and its paring down of public expenditure have resulted in loss of funding for hostels and care-in-the-community and reduction in the staffing of psychiatric hospitals. At the same time, there is evidence of a marked increase in mental illness in Greece since the beginning of the crisis. Earlier this month, while Syrian families were struggling ashore in eastern Greece, and Afghanis were camping in the parks of Athens, a young patient started a fire in one of the remaining city psychiatric hospitals, which killed three other seriously ill patients. This occurred in a high security ward where the patients were restrained in their beds “to prevent them harming themselves”. The hospital spokesman claimed that they are severely short of staff.

The language of mental illness has never been famed for its political correctness, and perhaps it is a sign of progress that the word “asylum” is now associated with refugees rather than “lunatics”. The word “lunatic” has been replaced by supposedly less stigmatizing alternatives; but no euphemisms can hide the fact that Greece, while being called upon to respond to the waves of refugees being washed up on its shores, is in the midst of its own humanitarian crisis with the collapse of psychiatric reform. It is ironic that the victims of both crises find themselves cohabiting at close quarters on a tiny island out of the stream.

There will always be an unfortunate minority of people, by whatever label, whose mental capacity does not enable them to care for themselves. Many have other serious health problems which preclude care at home. Leros was called upon to provide custodial care to such people in the past, however outdated the conditions seem by today’s standards, and rose to the challenge of adapting this in line with the principles of psychiatric reform. The people of Leros are now responding to needs of its refugees, but where are the resources to support them, on either front?

Image: Alex Majoli, taken shortly after the closure of Wing 16 of the Leros Psychiatric Hospital, from thepressproject.gr. The grafitti reads “We’ve closed it and we’re leaving, 6/5/94, time 10:30, Goodbye.”

Off agenda: Where have all the ashtrays gone?

“From life to death is only the distance of a cigarette”

Some items are somehow always left off the political agenda, even if they are life and death. In the midst of the Greek political and public preoccupation with the “agreement” earlier this summer, the minister of health Panayiotis Kouroumplis generated a minor furore. He proposed compulsory medical checks for detecting four forms of adult cancer in the early stages, as a means of reducing the burden on the health system, even going so far as to suggest that individuals who failed to comply would be expected to contribute towards the cost of their treatment should they later develop cancer. I do not propose to analyse here either the ethical implications of such a programme or whether his proposal meets the well-defined criteria for medical screening (it was hastily retracted). The minister’s concern with the astronomical public expenditure on cancer treatment is justifiable; but how justifiable is his lack of enthusiasm, like that of many of his predecessors, for legislation to curtail exposure to cigarette smoke?

Smoking kills – the startling black words on every cigarette packet tell us so, except that they no longer startle. I shall not provide references, they are far too numerous, but they confirm that exposure to cigarette smoke is statistically associated with cancer of the lung and larynx, chronic obstructive pulmonary disease and other potentially fatal disorders of the lungs, heart and circulation; also with less lethal but nonetheless distressing conditions, such as wrinkling of the skin and erectile dysfunction. Even second-hand smoke is hazardous, particularly to family members, including unborn babies, whose body weight and immune system and even brain development are affected by their mothers’ – and probably even their fathers’ – smoking habit. Yes, smoking creates a burden on public and family expenditure, not only through direct health costs, but also because of loss of work-years to illness and premature death. Add this to the budget balance: Every year some home fires and more than a few forest and wayside fires are caused by unextinguished cigarettes, at inestimable cost to both state and citizens.

Why, then, does somebody not do something about it? Well, for one thing, cigarettes are mentally associated with a host of other images, some of them particularly Greek: accompaniment to the first morning καφεδάκι, the little Greek coffee to clear the head – or more recently the φραππέ (frappé), often enjoyed at the wheel of the car or even on the motor cycle on the way to work; as a symbol of “maturity”, “glamour”, “non-conformity” or “virility” (μαγκιά: maggiá), reinforced by the still prevalent advertising; an integral part of the “παρέα” experience (paréa: friendly company), and particularly the night-time and “ξεφάντωμα” (xefántoma: party); for post-coital relaxation; in response to yet another wage-cut, price-rise, political gaffe… the list goes on. In the Greek countryside distances to be traversed between places were measured by the time taken to smoke a cigarette (as in Melina Mercouri’s quote above, amazingly never used in an anti-smoking campaign)

Also, we must remember that Greece has traditionally been a tobacco-producing nation. Although there has been a reduction over the last few years in both numbers of tobacco growers and overall production, there are still 58,697 farmers whose primary crop is tobacco (some in the Muslim minority population in Thrace in NE Greece for whom tobacco is an essential cash crop). In the last 2 years domestic production, at 120,000-125,000 tons, was the second largest in the EU, after Italy. About 25 tobacco processing and trading enterprises are still active in Greece, far less than in the heyday of pre-war domestic cigarette manufacture, which has been eclipsed by the aggressive importing and marketing of the multinational companies. Some of the Greek companies have been taken over, and as recently as 2013 tobacco was being used as in incentive to “invest in Greece” as arrangements were being discussed for the creation of a Philip Morris “Logistics Hub” in Agrinion, the centre of the tobacco growing region in west central Greece. On that occasion the then Prime Minister Antonis Samaras said apparently without irony, “Greece does not stop here. We will develop all our comparative advantages to make our homeland a healthy investment destination with solid new job positions, particularly for our youth”. He is at present searching for his misplaced rose-tinted spectacles.

Cigarette sales represent a large slice of the turnover of the myriad περιπτερα (períptera: kiosks) and ψιλικατζίδικα (psilikantzídika: corner shops selling a bit of everything) that are a feature of every Greek neighbourhood. What is even more relevant here, is that taxation of tobacco sales, whether domestic or imported, has always provided a hefty source of revenue for the state, which at present is desperately in need of it. Increase in the tax on cigarettes has always been a controversial option for replenishing the coffers. Former New Democracy minister Kyriakos Mitsotakis recently suggested increasing the VAT on tobacco rather than private education (on Skai TV, 19^th August 2015). We may never know if he would dare to make a similar proposal while in government; but even so, the success of such a measure cannot be taken for granted. According to Euromonitor International in its most recent report, “tobacco sales recorded negative growth in 2014 for the fifth consecutive year… not a reflection of decline in consumption, but a switch to illicit trade to reduce spending.” As we recently pointed out in this blog, at least €800 million a year is lost due to sale of contraband cigarettes. We are promised that this situation is to be rectified, with new legislation on the illegal import of tobacco.

So with this background it is hardly surprising that the Greek government has dragged its feet over legislation limiting the advertising, sales and consumption of tobacco products. Quite a few laws and ministerial decrees have, in fact, come into effect over the years – 22 to be precise, beginning in 1945 with a law to forbid cigarette sellers to give gifts coupons or lottery tickets. A law was actually passed in 1952 banning smoking in all forms of transport, but obviously was not put into practice at that time. Lack of enforcement of smoking laws is a popular Greek tradition. The first time a minister of health made concerted efforts to reduce exposure to tobacco smoke was during a New Democracy government, when Spyros Doxiadis, a paediatrician in civilian life, succeeded in passing legislation banning smoking in hospitals in 1979 (which was effected, although the doctors’ offices often seemed to be rather fogged up), and in closed public areas in 1980 (which had limited success, despite the ubiquitous appearance of the anti-smoking symbol). Doxiadis also tried to introduce a national health service based on primary health care, but was sabotaged by his own party. His successor, Georgios Gennimatas, riding the triumphant wave of PASOK, succeeded in founding a National Health Service, but failed to follow up on promotion of anti-smoking. He was a heavy smoker himself and died too young of lung cancer. His colleague Melina Mercouri, who became minister of culture after a career in acting characterized by a universally recognizable husky voice, was a legendary smoker who insisted on lighting up in hospital while receiving cancer treatment; she was also a casualty of her smoking habit.

Greece’s entry into the European Community in 1981 sped up legislative activity in line with European directives. This included recommendations on the content and “quality” of cigarettes. Ashtrays disappeared from public buildings and theoretically it is now forbidden to smoke indoors except in private quarters and designated areas. Some of the rules work – cigarette advertising has been restricted in content and venue, and the depiction of smoking in films banned; Greek buses and the enclosed spaces of ferries are smoke-free, and the first journey on a domestic flight without a fug over the back five rows was a red-letter day. Public service buildings and banks are slightly less unhygienic now that cigarettes have to be extinguished outside (though stress levels remain high); but when am I going to be able to enjoy my freddo without inhaling my neighbour’s fumes? The only noticeable effect of the smoking ban in cafes is that the ashtrays are kept under the bar. The French, equally fanatic smokers, have managed to conform, why not the Greeks? Once again, “the crisis” becomes an easy excuse for our perennial policy failures.

As a Yiayia (Γιαγιά, grandmother) my clubbing days are long past, so that is the problem of my children and grandchildren. How I wish that ministerial policy would extend to the enforcement of its own anti-smoking legislation, and to the promotion of health education measures (theoretically an integral part of primary health care) to help Greece’s young people to avoid poisoning themselves and each other.

Image of Melina Merkouri from ladylike.gr