Why we need a SIG on Migrant Care, International Health And Travel Medicine

In the era of globalization doctors all around the world are confronted with a growing vulnerable migrant population and their specific health problems and health needs. Immigrants – those who are staying for a longer period as well as travellers - bring with them diverse epidemiological profiles, based on different environments and endemities of disease in their areas of origin. United Nations estimate that three percent of the world’s population (213 million by 2010) live outside their country of origin (UN 2009).

Most immigrants move from developing to developed countries, where immigrants constitute more than 10 percent of the population. Most of them have left their country of origin because of economic reasons, others to join their partner or family. Some stay for the rest of their lives in the new country, others (like migrant workers in South Africa) travel to and fro between their home country and the host country.Also a large group are refugees: UNHR considers that they are approximately 44 million forcibly displaced people worldwide. The health status of asylum seekers and refugees is often problematic. Beside somatic affections like tuberculosis, HIV and tropical diseases, former exposure to organized violence, forced migration, family rupture and bereavement and length of the asylum procedure often generate psychosocial distress.

Especially vulnerable are undocumented (or irregular or illegal) immigrants (foreigners without permission to stay in the country they live in). Estimates suggest that there may be 30 million illegal immigrants worldwide. It is estimated that illegal immigrants make up for percent of the population of the USA, and 1 to 2% of the total population in Europe. In most countries undocumented immigrants’ living and working conditions are harsh, with a negative impact on their health. However, they often have no or few access to free public health care, due to restricted insurance conditions.

Besides different illness patterns, immigrants often have different cultural health beliefs and practices. Due to language and cultural barriers, the mixed somatic and psychosocial presentation of symptoms, the administrative complexity and often financial constraints, delivering primary care to these groups require specific skills. Many family doctors often feel helpless when they are faced with vulnerable migrant patients, due to a lack of knowledge and cultural competences. They miss the contact with colleagues who can advise them on this topic.

Aside from the issues of migrant populations, travel and work abroad is increasing. People are travelling greater distances more frequently. Certain focused groups are tackling challenging adventures in foreign countries with inherent dangers of injury and contracting exotic infectious diseases. Transport of cargo introduces bacterial and other flora into other countries from its country of origin. Aircraft are carrying more and more people and fly quicker – there is overcrowding at airports and conveyance of vectors responsible for disease and infectious diseases before they manifest occurs rapidly and easily, resulting in the introduction and dissemination of these vectors and illnesses into countries which previously were not plagued with them.

Most travellers seek advice from their own family physician / general practitioner. On return from their travels, should they fall ill, their own practitioner is again consulted. Com­panies are sending employees to foreign countries, often the spouse and children remain in their home country. This places a huge burden on all parties and frequently results in breakdown of the marriage and a disgruntled employee whose productivity falls dramatically. It is to the family practitioner that such families turn for help.

The family physician needs to be in a position to provide the appropriate advice for his/her patients on matters of travel medicine. With the rapid spread of disease, being well informed is critical to supplying the correct medication.

Not all general practitioners wish to get involved to the extent of setting up a travel clinic, yet they do wish to be able to function as outlined above. In addition it is evident that many travellers are being subjected to unnecessary and unethical procedures, vaccinations and treatments by unscrupulous and financially motivated practitioners and others.

With this in mind the formation of a Special Interest Group (SIG) in Migrant care , International health and Travel Medicine within WONCA would provide the platform of knowledge and resources that those general practitioners would need in order to deliver cultural competent care to the needs of their migrant patients and to practice appropriately in the realm of travel medicine.

Based on this need for networking and exchange of experiences, GP’s from different countries and background (migrant care in daily practice, research, medical education) joined forces and organised a workshop on primary care for migrants, refugees and undocumented migrants for the first time in 2008, during the regional WONCA Europe conference in Istanbul. Problems faced by general practitioners during medical encounters with migrant patients were inventoried by using the Nominal group technique.

Despite local differences in healthcare systems, it became clear that GP’s all over the world experienced the same problems and needs. Cultural competences, communication skills, better knowledge of tropical diseases, ethnic and cultural differences are some of the topics. Recommendations were formulated to improve care delivering, research and medical education.

Since 2008, a similar workshop on migrant care has been organised during each WONCA Europe conference, increasing the knowledge of the participants by interchanging experiences and research information. In 2009, at WONCA Europe in Basel, the workshop was joined by the already existing WONCA SIG on travel medicine. Since then, plans have been made to form one SIG for travel medicine, cultural competent primary care and the health problems of migrants in general, refugees and undocumented migrants. All core members of the SIG are involved in international research projects, in training medical students as well as trainees and GP’s in cultural competences and / or in delivering primary care to refugees, undocumented and other migrants and travellers. The Dutch WONCA member organisation (the Dutch college of General Practitioners) has recently developed a special program to integrate ethnic diversity into guidelines and post graduate training.

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