Refugees Health, 2024 Resource PDF

REFUGEE HEALTH Dr Margaret Kay AM MBBS(Hons) PhD FRACGP DipRACOG GAICD Senior Lecturer, Faculty of Medicine, UQ 1 OUTLINE  Global perspective  Case study – from general practice  Patient journey  Complexity of issues  Cross-cultural consultatio...

REFUGEE HEALTH Dr Margaret Kay AM MBBS(Hons) PhD FRACGP DipRACOG GAICD Senior Lecturer, Faculty of Medicine, UQ 1 OUTLINE  Global perspective  Case study – from general practice  Patient journey  Complexity of issues  Cross-cultural consultation  Why it is important  A couple of exemplar cases  Refugee Health Assessment  What you need to know  Working with an Interpreter 2 UNHCR GLOBAL TRENDS - (END 2022)  117.3 M forcibly displaced  40% children  37.6M Refugees  68.3M Internally displaced in own country  4.4 (up to10) M stateless https://www.unhcr.org/refugee-statistics/ 3 UNHCR GLOBAL TRENDS - (END 2022)  117.3 M forcibly displaced  40% children  37.6M Refugees  68.3M Internally displaced Solutions: Repatriation  4.4 (up to10) M stateless Local integration Resettlement e.g. to another country https://www.unhcr.org/refugee-statistics/ 4 UNHCR GLOBAL TRENDS - (END 2023) 73% came from 5 countries  Afghanistan  Syrian Arab Republic  Venezuela  Ukraine  South Sudan 38% are hosted in just 5 countries including Iran, Turkiye Colombia, Germany, Pakistan https://www.unhcr.org/refugee-statistics/ 5 UNHCR GLOBAL TRENDS  It is not illegal to seek asylum  75% refugees live in low-middle income countries  11 yrs vaccination  Some children aged 2-11 years from a higher risk country for TB have a tuberculin skin test or interferon- gamma release assay. IFN-g  HIV (>15 years)  Perhaps Syphilis (>15 years)  Other check as indicated e.g. Hepatitis B 13 BEFORE ARRIVAL  Departure Health Check  Physical examination (including legs)  CXR- if needed treatment/old Xray acute malaria  Malaria test (RDT) – treat as needed  Vaccination – MMR, ?ADT, ?Polio  Treatment - Albendazole 400mg > 1 yr  ? Pregnancy test 15-55yrs 14 AFTER ARRIVAL  Permanent resident  Usual rights of permanent residents  Medicare card – green  HCC  Social security – child immunisation  English lessons  Assistance with housing  Connection with GP encourage access to GP  Case Manager 15 ASYLUM SEEKER w/o paperwork  Blue Medicare Care  No Health Care Card  Limited Social Security  May have work rights  Minimal support 16 HEALTH ASSESSMENT  No formal medical health assessment arranged for refugees after arrival in Qld  Health undertaking Many refugees in  Health alert Qld have never had a health assessment  Health manifest 17 HEALTH ASSESSMENT  Not just the blood tests  Good History need full history  Allergies, PMH PSH POH  Listen to the story – journey  Presenting complaint / expectation 18 MEDICAL ISSUES TO CONSIDER  Nutritional problems  Acute health problems unable to access good nutrition  Infectious Disease  Public health issues  Genetic Predisposition  Chronic Disease thalassaemia  Cultural Beliefs - FGM  Preventive health issues  Dental Health Issues  Mental Health Issues common 19 HEALTH ASSESSMENT  Social Health  Immunisation  Pregnancy 20 SOCIAL ISSUES Whole-Person Care  Be aware of Housing- temporary, often mobile  Education  Social security –vaccination proof to get payments  Shopping children vaccinated 21 CONSULTATION  Good History  Medications  Genogram  Systematic review  Diet  Mental health ask if sleeping and eating well 22 CONSULTATION  Good examination  All systems  Nutrition  Ears/eyes/teeth  Pregnancy  Developmental issues  STDs 23 CONSULTATION  Appropriate tests modify for person  Immunisation  Follow up  Referral  Specialist with interpreter  Allied health  Medication know priorities what is the most important issue 24 MENTAL HEALTH Acculturation QPASTT Transcultural Mental Health physical and trauma trauma service to support language and cultural difficulties 25 PATHOLOGY TESTS  FBE  Syphilis Ab  U & E, LFT  HIV Ab  Hepatitis B sAg & sAb  Varicella IgG (if >14 years) (both are needed) – just vaccinate if