Healthcare challenges from the developing world: post-immigration refugee medicine

Adams, Kristina M.; Gardiner, Lorin D; Assefi, Nassim

doi:10.1136/bmj.328.7455.1548

Cited by 105 publications

(94 citation statements)

References 22 publications

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“…Consistent with previous recommendations, the value of a specialised refugee health service was identified (Adams et al 2004;Benson and Smith 2007;Johnson et al 2008). However, while current supports are of great value, many providers are not aware of available resources and in some instances the necessary resources simply do not exist.…”

Section: Discussionsupporting

confidence: 61%

Caring for refugees in general practice: perspectives from the coalface

Farley

Askew

Kay

2014

Aust. J. Prim. Health

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Abstract. This qualitative research project explored the experiences of primary health care providers working with newly arrived refugees in Brisbane. Data from 36 participants (20 general practitioners, five practice nurses and 11 administrative staff) involved in five focus groups and four semi-structured interviews were analysed. The results indicated that despite difficulties, providers are committed and enthusiastic about working with refugees. The flexibility of the general practice setting enables innovative approaches. The establishment of a specialised refugee health service in Brisbane has improved providers' capacity to deliver refugee health care. However, most practices continue to feel isolated as they search for solutions, and the need for greater supports and a more coordinated approach to care were emphasised. The themes of communication, knowledge and practice and health care systems encapsulated the factors that influence health care providers' ability to care for refugees and provide a framework for improving available supports. Australian primary health care is currently undergoing great change, which provides an opportunity to make significant gains in the provision of care for refugees and other minority groups within our community. As health care reforms are implemented it is essential that they are responsive to the expressed needs of health care providers working in these areas.

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Section: Discussionsupporting

confidence: 61%

Caring for refugees in general practice: perspectives from the coalface

Farley

Askew

Kay

2014

Aust. J. Prim. Health

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“…The literature confirms 'somatisation' or 'physical complaints without diagnosis' as being an important part of the illness presentation by refugees in different countries and situations [10,11]. Hondius and Van Willigen [12] found a correlation between the number of physical complaints and a history of physical torture.…”

Section: Introductionmentioning

confidence: 85%

Worries are the mother of many diseases: General practitioners and refugees in the Netherlands on stress, being ill and prejudice

Feldmann¹,

Bensing

Ruijter

2007

Patient Education and Counseling

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Objective: To confront the views of refugee patients and general practitioners in the Netherlands, focusing on medically unexplained physical symptoms (MUPS). Methods: The study is based on in depth interviews with refugees from Afghanistan (n = 36) and Somalia (n = 30). Additionally, semistructured interviews were conducted with 24 general practitioners. Text fragments concerning the relationship between mental worries and health or physical ailments were subject of a secondary analysis, the results of which are presented. Results: Medically unexplained physical symptoms were a key issue for both refugees and GPs. The GPs saw MUPS as a significant part of the illness presentation by refugee patients. Refugees felt GPs were often prejudiced, too readily using their difficult background as an explanation for physical symptoms. A 'general narrative' circulating in the refugee communities undermines trust. The GPs applied different strategies in dealing with MUPS presented by their refugee patients. A 'human interest strategy' is distinguished from a 'technical strategy'. The results are discussed in the wider context of the literature on MUPS and patient satisfaction. Conclusion: No fundamental difference in paradigms was found between refugees and GPs as to the negative influence worries and bad experiences can have on health. For a fruitful cooperation to develop, based on trust, GPs need to invest in the relationship with individual refugees, and avoid actions based on prejudice. Practice implications: The importance of (a lack of) trust is underestimated in medical practice. Phenomena undermining trust are often out of sight for practitioners. Critical reflection is needed on the strategies practitioners employ to deal with MUPS. #

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“…8 For some asylum seekers, poverty, unsanitary and crowded living conditions, inadequate nutrition and poor access to healthcare services before coming to Australia may contribute additional health burdens. 9,10 Existing health issues may be further exacerbated by post-migration experiences such as immigration detention before being released in the community, the indeterminate visa status, social isolation, language barriers, financial instability and poor service access. 8,11 In the current political context, with a dramatic increase in the number of people living in the community while seeking asylum in Australia, it is imperative that we have a clear understanding of their health-related needs in order to develop appropriate services.…”

mentioning

confidence: 99%

The physical health status, service utilisation and barriers to accessing care for asylum seekers residing in the community: a systematic review of the literature

Hadgkiss

Renzaho

2014

Aust. Health Review

137

118

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Objective. To document physical health problems that asylum seekers experience on settlement in the community and to assess their utilisation of healthcare services and barriers to care, in an international context. Methods.A systematic review of quantitative and qualitative studies was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. MEDLINE, PsycINFO, Embase and CINAHL databases were searched from 2002 to October 2012, focusing on adult asylum seekers residing in the community in high-income countries.Results. The search yielded 1499 articles, of which 32 studies met the inclusion criteria -23 quantitative and nine qualitative. Asylum seekers had complex health profiles spanning a range of infectious diseases, chronic non-communicable conditions, and reproductive-health issues. They appeared to utilise health services at a higher rate than the host population, yet faced significant barriers to care.Conclusion. The findings of this study highlight the health inequities faced by asylum seekers residing in the communities of host countries, internationally. National data on asylum seekers' health profiles, service utilisation and barriers to care, as well as cross-country policy comparisons, are urgently required for the development of effective Australian health programs and evidence-based policy. What is known about the topic?The clinical and political focus of asylum seekers' health has largely been on the higher incidence of mental disorders and the impact of immigration detention. Since policy changes made in late 2011, an increasing number of asylum seekers have been permitted to live in the community while their claims are processed. There is a paucity of research exploring the physical health needs of asylum seekers residing in the community. What does this paper add? The international literature highlights the complexity of asylum seekers' health profiles. Although they appear to utilise health services at a higher rate than the host population, they continue to face many barriers to care. What are the implications for practitioners? Studies that explore policy options, including cross-country comparisons of health policy and guidelines that improve health outcomes, to foster equity of access and reduce health inequalities between asylum seekers and the host population are urgently required.

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Healthcare challenges from the developing world: post-immigration refugee medicine

Cited by 105 publications

References 22 publications

Caring for refugees in general practice: perspectives from the coalface

Caring for refugees in general practice: perspectives from the coalface

Worries are the mother of many diseases: General practitioners and refugees in the Netherlands on stress, being ill and prejudice

The physical health status, service utilisation and barriers to accessing care for asylum seekers residing in the community: a systematic review of the literature

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