2 Monitoring of the health status and initial health assessment
2.1 General information about monitoring of the health status
The human mobility crisis facing the European Union (EU) is complex and the governments of the EU are facing challenges in addressing the health needs of the increased number of migrants arriving from various parts of the world. There is currently no standardized approach to assessing the health needs of these migrants, many of whom have spent days or weeks traveling by foot, exposed to the elements and possible traumas and lacking access to adequate food, water, shelter and health services.
In the context of migration, continuity of care refers to the principle of establishing adequate mechanisms for the continuity of healthcare between countries of origin, transit and destination. However, this presents a major challenge across European countries due to different documentation and monitoring systems if at all such systems are in place.
In some EU-countries, there are initial health assessments for newly arrived refugees and other migrants on an obligatory basis, in others not. Furthermore, the contents of these assessments are not harmonized across the EU-countries and not accorded with the regular health care system within one country. Accordingly, e.g. at the first visit of the new patient, the family physician/general practitioner/health care worker has no chance to receive the data of the initial health assessment conducted in the initial reception centre for refugees/asylum seekers.
There are several projects with the aim to harmonize the monitoring process across EU countries and to facilitate continuity of care for refugees and other migrants.
One of these initiatives is the Health Record Book of the International Organization of Migration (IOM), you can access the personal health record for refugees/migrants/asylum seekers. The questions are written in English and Arabic and could be helpful also regarding your first anamnesis with the refugee/migrant/asylum seeker. [http://ec.europa.eu/dgs/health_food-safety/docs/personal_health_record_english.pdf] The handbook for health professionals also includes explanations regarding all sections of the health record. [http://ec.europa.eu/dgs/health_food-safety/docs/personal_health_handbook_en.pdfhttp://ec.europa.eu/dgs/health_food-safety/docs/personal_health_handbook_en.pdf]
The handbook is also available in other languages than English. [http://ec.europa.eu/dgs/health_food-safety/dyna/enews/enews.cfm?al_id=1647]
Recently, the IOM is working on an electronic system to translate the personal health record into an electronic health record (IOM-PHR system). [https://www.google.at/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwiJlLHKtsrNAhXFWRQKHZM7AfYQFggfMAA&url=http%3A%2F%2Fwww.chafea-migrants-health-2016.eu%2Ffiles%2Fpresentations%2FVal%2520Elena_Re%2520Health.pptx&usg=AFQjCNH7LfGL6neUp7wWmNb9Ufd5AgekbQ&sig2=e5Wi-v1vxqJ6lk_bjAxvuw&cad=rja]
2.1.2 General recommendations regarding facilitating continuity of care
This sub-chapter is taken from deliverable 4.2 of the project EUR-HUMAN: Set of guidelines, guidance, training and health promotion materials for primary care for newly arrived migrants including refugees.
- Write health documents in English (not in national language). Refugees often don’t speak the national language. Because refugees are a moving population, it is important that health care providers in other countries can read the documentation as well
- Use universal (international codes) for diseases/medication and vaccination (see also chapter 2.5 on vaccination) should be used
|Issue:||Medication indexed according to name and ATC code|
|Title:||ATC/DDD Index 2016|
|Description||A searchable version of the complete ATC index with DDD. You can find ATC codes and DDDs for substance name and/or ATC levels.|
|Developed by:||WHO collaborating centre for drug statistics and methodology|
In the following we would like to present to you the initial health assessment in Austria to make you aware of what has been already done and where are areas of special interest for you regarding the health assessment if a refugee/asylum seeker visits your practice/community health care centre for the first time.
The initial health assessment takes only place if a refugee/asylum seeker comes into Austria after a flight. It does not take place if the refugee or other migrant already came to the country as e.g. a student or with a tourist visa and, after this visa is running out, applies for asylum.
Up to now, no continuity of care between the initial health assessment and the regular Austrian healthcare system is implemented meaning that the GP e.g. is not able to receive the data and results of the initial health assessment. It would be good to inform the refugees/asylum seekers to ask for a print-out of the initial health assessment documentation and take them to the primary care provider.
2.2 The initial health assessment in Austria
2.2.1 Aims and objectives of the initial health assessment in Austria
This sub-chapter describes the aims and objectives of the initial health assessment in Austria
2.2.2 Is the health assessment obligatory?
This sub-chapter describes if the initial health assessment is obligatory
The Austrian Asylum Law (Asylgesetz) [https://www.ris.bka.gv.at/GeltendeFassung.wxe?Abfrage=Bundesnormen&Gesetzesnummer=20004240]
2.2.3 Description of the initial health assessment in Austria
This sub-chapter describes the initial health assessment procedure in Austria, what is the focus of the initial health assessment in Austria?
Certifiable diseases in Austria
Austrian Law on Epidemics https://www.ris.bka.gv.at/GeltendeFassung.wxe?Abfrage=Bundesnormen&Gesetzesnummer=10010265&ShowPrintPreview=True
2.2.4 Where and how is this initial health assessment taking place?
This sub-chapter describes where the initial health assessment takes place
The asylum seeker arrives at the health assessment site. A cultural mediator explains the procedure and hands out the self-assessment sheet. The cultural mediators help with language and, if necessary, writing. They also provide information about vaccinations.
Together, the doctor and the cultural mediator are exploring the patient’s history with the asylum seeker according to the self-assessment sheet.
This sub-chapter explains the procedure in Austria if it is not documented whether a patient already received a vaccination or not, and which vaccinations are recommended at the initial health assessment
Ministry of Health recommendations for persons with unknown vaccination status according to the Austrian Vaccination plan 2015.
Ministry of Health recommendations for persons with unknown vaccination status in initial refugee camps in Austria
The incidence rates for tuberculosis vary for the respective countries of origins of refugees/migrants/asylum seekers, please find an overview table by the World bank on worldwide incidences of tuberculosis. [http://data.worldbank.org/indicator]
According to the World Health Organization the most frequent health problems of newly arriving refugees and migrants are:
- Accidental injuries
- Burn injuries
- Gastrointestinal illness
- Cardio vascular incidences
- Complications in regards to pregnancy and delivery
- High blood pressure
Therefore it is primarily important to pay attention to chronic diseases, since treatment of these conditions might have been interrupted due to the flight, or these diseases were already insufficiently treated in the country of origin.
Because of the situation of the flight and the new arrival in an unknown country refugees/migrants/ asylum seekers have more frequent health problems or questions in certain areas than other patients.
The following themes should therefore be particularly addressed by the family physician/ general practitioner/ health care worker:
|– Treatment needs for chronic diseases
– Dental health
– Reproductive and sexual health (contraception/ family planning)
– Psychological stress