9 Child health
9.1 Cultural influences and health
Sometimes, children or young adults of refugee families suffer from chronic diseases or are physically/mentally disabled. While or after escaping, their medical therapy has often been minimized or got interrupted at all. Sometimes the source of their disease was not cleared in their home country, especially when they flee from countries, where medical supply is not free of charge or where regional medical structures are destroyed. Additionally, important medical documents often got lost or destroyed. Hence it is difficult for the pediatrician or general practitioner/ health care worker to get a clear picture regarding the medical history of the child and its illness.
Severe diseases or disabilities of children are sometimes the main reason for families to leave their country. Because they often have sold their whole property, a way back is nearly impossible. While having high expectations on curing their child, their expectations about westernized medical care are often unrealistic. In their home countries, human smugglers might have promised them, that in rich countries there exist operations and medications that could heal their children completely.
Caring for such children and their family members represents a big challenge for all medical partners. For effective communication interpreters are needed as a main instrument to detect problems and needs. Please, never accept other children as interpreters!
Beside linguistic barriers, different ways of accepting illness, due to different cultural, social, and spiritual experiences, could make medical treatment and supervision quite difficult (Euro Med Info, n.a.). Our health system is based on cooperative collaboration between physician/ health care worker and patient. Not all refugees are used to organize all their medical aspects by themselves. Additionally, they often get confused by administrative barriers, and stop in consequence their efforts for getting therapies.
9.2 Improvement of compliance
Based on this background information, some points should be checked:
- What are their expectations of western medicine?
- What were the explanations of native doctors about the source of disease?
- Is it possible to organize any medical reports?
- Did all family members flee or is somebody (e.g. a brother) left in the home country?
- Which aspect of the disease makes the family most anxious?
- Have there been any complications before, during or after birth?
- Has there been any hospitalization of the child already at the country of origin?
- Did the child have accidents or other injuries?
- Has there been a case of child death in the family during the past?
- Do other family members have any chronic diseases or take medications regularly?
- Did your family already get a “Mutter-Kind-Pass” and are you informed how to use it?
- Are all medications taken as prescribed?
- Did all therapies (e.g. physical therapy) get started and visited regularly?
- What are reasons for failure (e.g. financial)?
- Which structure would help to improve compliance?
- Which partner/organization could help to support such families?
- Any psychological support necessary?
- Is palliative support necessary?
9.3 Daily practices
During daily routine contacts following points should be checked regularly:
- Physical examination: some children are not used or ashamed to dress off completely, Be aware of signs of sexual abuse and mutilation
- Weight and height – use gender specific percentile curves
- Skin: look for signs of self-injuries, signs of infections, scabies or foreign injuries (accident, torture,…). The Violence against Children Report are Istanbul Protocol helpful, [http://www.unicef.org/violencestudy/reports/SG_violencestudy_en.pdf] [http://www.ohchr.org/Documents/Publications/training8Rev1en.pdf]and at the end of this Module 7 you will find links to support offices for children in Austria. [Link to sub-chapter 12 Helpful Links]
- Teeth: Need of dental hygiene is often only poorly known
- ask for pain, problems of sleep (pavor nocturnus,…) or enuresis/enkopresis
- Ask for signs of seizures?
- Which main steps of development are already reached or any loss of skills observed?
- Signs of weakness?
- Are there any changes of mood (e.g. aggressive, depressive behavior, extremely shyness)?
Additional investigations (e.g. ECG or blood count) should be conducted as being indicated for other children.
Be aware that physical and psychical stress of these children might influence their immune system.
Take care about your personal resources!
Medical supervision of refugees, especially with chronic and severe disease is very time consuming and emotionally difficult.
- Look for partners (e.g. red cross organization, children hospital)
- Most organizations supporting refugees are helpful in organization of interpreters
- Contact governmental organizations (e.g. youth welfare services) to support such families
- Look for a charity organization in your region to support families with seriously ill children
You can find helpful links on that issue at the end of the Module 7.