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MIGRATION AND HEALTH

MIGRATION AND HEALTH. The experience of a refugee clinic in Montreal Dr Pierre Dongier Clinique Sante-Accueil CLSC Cote des Neiges. CLINIQUE SANTE ACCUEIL. Medical clinic for refugee claimants in Montreal Created in 1984, based in CLSC Cote des Neiges since 1996 Main objectives :

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MIGRATION AND HEALTH

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  1. MIGRATION AND HEALTH The experience of a refugee clinic in Montreal Dr Pierre Dongier Clinique Sante-Accueil CLSC Cote des Neiges

  2. CLINIQUE SANTE ACCUEIL • Medical clinic for refugee claimants in Montreal • Created in 1984, based in CLSC Cote des Neiges since 1996 • Main objectives : 1. provide access to primary health care for refugees 2. Assess the health status of newly arrived refugee claimants

  3. CLINIQUE SANTE ACCUEIL Demographic characteristics: Age: 90% under 45 Sex: 60% men Education level : mean schooling =12 years Country of origin : 45% Asia 45% Africa 10% Latin America

  4. REFUGEE CLAIM PROCESS • Legal procedures (access to legal aid) • Immigration medical exam • Medical care through FIHP • Access to work permit and social welfare • IRB hearing for status determination

  5. Federal Interim Health Program • Urgent and essential care • Medical consultation, selected medications, laboratory and radiology investigations • Authorisation required for physiotherapy and psychotherapy,and other unusual treatments • Urgent dental care and contribution for glasses

  6. Resuts of studies conducted at Clinique Sante Accueil

  7. Health status screening study • Done between october 2000 and may 2002 • 161 files reviewed • Anamnesis and physical examination • Laboratory tests: -CBC -Serology for strongyloides -Hep B+C filariasis -HIV schistosomia -Stool analysis for O+P

  8. Results of screening study • Anemia 19.3% • Eosinophilia 6.8% • Active Hep B 3.9% • Active Hep C 4.3% • PPD+ 45% • HIV+ 2.4% • VDRL+ 9.7%

  9. Parasites • Intestinal parasites 7% (mainly giardia,amoebas,ringworm and trichuris) • Serology Strongyloides 16% Filaria 7.6% Schistosomas 3.1%

  10. Psychiatric questionnaire • When discussed: 55% normal 45% psychiatric diagnosis: PTSD 46% Adaptation disorder 30% Mood disorder 20% Anxiety 15%

  11. Conclusions of screening study • Health status of refugee claimants generally good • Pertinence of screening beyond the immigration medical examination • Infectious diseases screening according to region of origin

  12. Main reasons for consultation • Common health problems: acute (URIs, gastroenteritis) or chronic (hypertension, diabetes) • Pregnancy • Infectious diseases • Mental health

  13. Access to health care system • Difficulties related to the FIHP: some institutions refuse to give services • Language barrier: unequal access to interpreters • Cultural barrier: understanding health messages, compliance with treatment, punctuality

  14. Conclusions • Need to facilitate access to health services and sensitize health care providers • Approach based on health promotion rather than health protection • Special attention to certain problems: infectious diseases, mental health problems

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