The enormous numbers of refugees and other migrants, including many children and adolescents, that entered European nations, are a heterogeneous group of people. Depending on the country of origin, the public health care and its prevention programmes vary. The challenge we face is to treat every migrant individually and according to specific psychosocial and medical needs while still acting in a resourceful way.
Official directives regulate entry examinations and medical care at the borders or in refugee quarters. However, the recommended details of these examinations vary a lot and written documentation is not always available. To ensure further patient-centred care family doctors/ general physicians/ health care workers, paediatricians or clinics need to be involved.
The following recommendations for physicians/ health care workers involved in medical care of refugee children and youths in different settings shall be used as guidance. This module represents the attempt to combine the Austrian Recommendations of the Working Group for Refugee Children (Grois et al. 2016), the Austrian Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis of the Ministry of Health (BMG, 2016), as well as the ECDC Evidence-based clinical guidelines for immigrants and refugees (Pottie et al. 2011). The concept for the early immunization of asylum seekers of the Robert Koch Institute served as a basis for the recommendations for immunizations (Robert Koch-Institut, 2015).
The module at hand is meant to be a useful tool for efficient diagnostics and therapy, the prevention of physical and mental health issues in this vulnerable population as well as the prevention of communicable diseases. The authors do not claim that this module covers every aspect. They, furthermore, acknowledge that the implementation of their recommendations can sometimes be challenging, because of given structural and financial issues, and that it is an on-going process.
Every first contact to a refugee child or teenager should be used to clarify, if an initial examination has been carried out. To establish mutual understanding it is important to work with the patient relatives and with interpreters. Overall, physicians/ health care workers should be aware that in such a case it might take more than one visit to perform anamnesis, physical examination, screening tests and vaccinations.
The medical history must include every individual patient’s age, sex, and country of origin and course of migration. Additionally, the medical history of family members and close contacts of the last weeks must be inquired. Also information about received vaccinations and, if existing, immunization records should be obtained. Medical history sheets in different languages are available at different sites.
[http://www.docs4you.at/Content.Node/Spezialbereiche/uebersicht_-_transkulturelle_paediatrie.php] [http://www.medi-bild.de/hauptseiten/Materialien.html] [http://www.medknowledge.de/migration/tipdoc/anamnesebogen.htm]
Information about immunizations in different languages is available here.
The introduction and use of health records for the documentation of performed examinations, therapies, vaccinations and relevant diagnoses is strongly recommended. This document should be issued to the child’s or teenager’s legal guardians as soon as possible. It provides them with information and is also a communication tool for the attending physician/ general practitioner/ health care worker. Ask the legal guardians to present the document at every doctor’s visit. As long as there is no official health certificate, the communication file of the Working group for refugee children of the Austrian Society for Political Paediatrics can be used (Politische Kinder Medizin, 2016). [http://www.kinderheilkunde.at/de/downloads/get/42/]
Furthermore, the International Organisation of Migration (IOM) will soon present an electronic platform for a Personal Health Record IOM. [http://equi-health.eea.iom.int/index.php/news-events/294-personal-health-record]
The following chapters cover several important fields concerning the health of migrant children and adolescents.