Contents
Introduction
Managing the health of refugees and migrants can be complex. Many refugees have little experience of organised healthcare, and may have come from places of extreme poverty and danger and may have suffered physical and mental traumas. This can mean that refugees find themselves overwhelmed when faced with a developed medical system.
There are thought to be over 65 million refugees worldwide.
- The UK accepts around 15,000 refugees each year
- Australia accepts about 13,000 refugees per year
Diseases that are rare in developed countries may affect refugee populations, and are frequently missed as they may be asymptomatic or dismissed as being of little significance by sufferers or their families. They can be missed without appropriate screening. As well as infectious disease, nutritious disorders and chronic disease are common. Patients may never have been exposed to screening (e.g. cervical smears) or vaccination programs, and thus may be relatively “behind” compared to local populations. Mental health issues secondary to trauma are extremely common.
One study of refugee children in Australia found:
- 25% had anaemia
- 25% had serology positive for schistomiasis
- 70% were not immune to hepatitis B
- 25% had positive TB skin test
- 20% had low vitamin D
Don’t forget than in addition to this, refugees will also suffer from all the usual developed country health issues that you see ind ay to day practice! nHowever, these more familiar issues are often exacerbated by communication and language difficulties.
History
When meeting a new arrival for the first time, taking a detailed history is important. Ask about:
- The presenting problem
- Reasons for migration
- Exposure to physical violence or torture
- Psychological trauma
- Family history – including haemoglobinopathy
- PMHx – including tropical diseases and chronic diseases
- Immunisation
- Developmental history (in children)
- Diet
- Drug addiction history – particularly IV drugs
- Smoking
- Mental health history
- Particularly suicide risk
- Oral Health
- Women’s health including contraception and pap smear
Examination
- General examination
- Weight
- Height
- Growth charts (in children)
- BMI
- Skin
- Rashes
- BCG scar
- Jaundice
- Pallor
- Dental health
- Hearing
- Visual acuity
- Cardiovascular examination
- Respiratory examination
- Lymphadenopathy
- Hepatosplenomegaly
- Urinalysis
- Genital health – consider female genital mutilation
Screening investigations for new arrivals
Consider:
- Blood
- FBC
- UEC
- ESR
- U+E
- LFT
- Vitamin D levels
- Vitamin B12 levels
- Iron studies
- TB investigations
- CXR
- Mantoux test
- interferon gamma release assay
- Malaria investigations
- Thick and thin films
- Plasmodium rapid antigen test
- Blood borne virus screen
- HIV serology
- Hepatitis B serology
- Hepatitis C serology
- STI screen
- Syphilis serology
- PCR for chlamydia and gonorrhoea
- Parasites
- Schistosomiasis serology
- Strongyloides serology
- Microsocopy of faeces
- Consider referral to specialist refugee clinics and refugee services
References
- Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
- Refugee Health – RACGP