Module 8 – 5 Prevention and health promotion

5 Prevention and health promotion

Health education for refugees might involve common aspects such as vaccination, hypertension, smoking, influenza or pneumonia (see Module 2) ; however, there are other (specific and unspecific) preventive measures that may be self-evident to us but not for the refugee population, because of different legal regulations in their home country, different cultural significance of certain eating or drinking habits, as well as local conditions in the countries of origin in general.

  • using a helmet on a motorcycle,
  • using a seat belt in the car,
  • drinking enough water
  • dental hygiene
  • sugar consumption
  • nutrition in general
  • living conditions
  • alcohol
  • bodily hygiene (different toilets)
  • adequate clothing for every season
  • physical activity (public sports facilities: swimming pools, ball courts, running tracks,…)
  • recreational areas
  • and many more

5.1 Preventive medical check-ups

Every person in Austria who has completed 18 years of age is entitled to a free preventive medical general check-up once a year. This program has positive implications for your patients: early signs of an illness can thereby be recognised and treatment can be started or preventive measures can be taken early on. The medical check-ups are an opportunity to discuss a healthy lifestyle and necessary changes. The refugees are most likely not aware of the possibility for such regular medical check-ups.

For further information please click here. [https://www.wien.gv.at/english/health-socialservices/preventive.html]

5.2 Preventive cervical cancer screening for women

In Austria, every women who has completed 18 years of age is entitled to have a cervical cancer screening once a year free of charge. The screening is conducted via the PAP-smear and usually carried out by a gynaecologist. This screening is a good possibility to discuss a healthy lifestyle and, particularly, issues regarding family planning and women’s rights.

For further information please click here.

[http://www.cervicalcheck.ie/_fileupload/Downloads/IARC%20QA%20guidelines%20(2008).pdf]

 

5.3 Dental health

Preventive dental health care is also an important aspect that you as important focal point may consider. In many countries of origin of the refugees dental care may have been poor, especially in those recent years. The necessity for dental hygiene for children might not be common sense. You may want to check with both adults and children for dental health issues, remind them of oral hygiene, and refer them to a dental clinic if need be. Overall, it will help your patient’s health status if you give them recommendations about dental hygiene and visiting a dentist regularly.

The refugees are often in a very precarious economic position. Therefore, it is very important to let them know that in Austria, the health insurance covers the check-up at the dentist, as well as necessary dental work (basic fillings, root canal, scraping, dental surgery, removal of teeth and roots). Anaesthesia for fillings is not covered. Costs for dental braces for children with severe tooth displacement are also covered by health insurance until their 18th birthday; the claim is dependent on the parents’ income.

For further information on braces please click here.


5.4 Toilet facilities

In most parts of the world the form of toilets found in Central Europe are not very common. More often, people are used to squat toilets rather than Western sit-down toilets. Furthermore, people might be used to wash after their bowel movement rather than using toilet paper.  In addition, in some countries the toilet paper is put into a trash bin near the toilet and not into the toilet. However, others than toilet papers (e.g. napkins) should not be thrown into the toilet. It would be helpful to explain this, most preferable with pictograms, everywhere where refugees and other newly arrived migrants use toilets.

 

5.5 Nutrition and fluid intake

For refugees, nutritional problems often become even more serious after leaving their home countries, as they are confronted with unfamiliar and sometimes unhealthy food choices, and because they have to develop new habits of eating in face of their financial situation. Malnutrition and adiposities can be the consequence. Both children and adults in the refugee population can profit from your guidance and care to remain healthy and well nourished.

[Link to Module 7 Child Health, chapter 8 Nutrition]

In some societies it is not common to drink a lot of fluid. Therefore, people might not drink the recommended amount of liquid. It might help to interview your patients on their drinking habits and the reasons why they do not consume enough water. [Link to Module 4, part 2]

Vitamin supplements, in particular for vitamin D, should be considered both in children and adults. Most of the refugees came from countries with stronger sunlight than in Central Europe. Darker skin and/or clothes covering large parts of the body might lead to vitamin D deficiency. [LINK to Module 7 Child Health, chapter 8 Nutrition]

For further information please consult the National Action Plan Nutrition Austria.

[http://www.bmgf.gv.at/cms/home/attachments/6/5/8/CH1046/CMS1378816554856/nap.e_20130909.pdf]

This sub-section 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.

The MUST tool for malnutrition [http://www.bapen.org.uk/pdfs/must/must_full.pdf] contains a five step screening to identify adults at risk for malnutrition and under nutrition.

Steps:

  1. Measure height and weight to get a BMI score
  2. Note percentage unplanned weight loss
  3. Establish acute disease effect
  4. Add scores obtained from step 1-3 together

 

 Use management guidelines to develop care plan. 

For nutrition and children please see Module 7, Chapter 8 Nutrition. [Link to Module 7, Chapter 8 Nutrition]

5.6 Physical exercise

Many of the refugees are used to doing sports and seek for possibilities to continue their physical exercise independently. For others, sport might not be a normal thing to do or even shameful due to socio-cultural reasons.

In some of the long-term refugee facilities, fitness rooms have been installed. In the camps sometimes only men are offered to do sports. However, refugee women also expressed their wish to be physically active. For Muslim women it might be a problem of decency to be able to engage in physical activities. Some prefer to wear a hijab during sport or have the possibility to have a separate training facility for women.

As a family physician/ general practitioner/ health care worker you can, for instance, inform the refugees of manifold free exercise possibilities in your area:

  • Parks in the cities with fitness training facilities
  • Ball courts
  • Free bycicles (e.g. in Vienna)
  • Running tracks
  • Cheap fitness centers
  • Volkshochschulen/ adult education centres Sportkurse
  • Public pools
  • Hiking
  • Sport associations

For further information consult the Austrian Sports Ministry website.

 [https://www.sportministerium.at/de/themen/nationaler-aktionsplan-bewegung]