Monday, May 21, 2018
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Refugee Health

Refugees have unique health needs that are different from the general Canadian population.  They suffer from medical problems that are not found in Canada, such as strongyloides and schistosomiasis.  They have higher rates of certain medical issues, like viral illnesses.  There are more physical disabilities and chronic injuries in this population as a result of violent trauma.  Finally, there are very high rates of mental illness and distress in this population.  The refugee health practitioner must be familiar with the diagnosis and treatment of these issues.


In addition, the administration of refugee health is much more complicated.  Refugees are defined by their need for protection; often, they do not speak English or French when they first arrive.  Because of this, interpreters are retained to assist with communication with the patient.  Further, they don't always receive orientation to our health care system before they arrive, and so effort must be taken to educate them around Canadian health care culture.  Refugees also have a completely separate system of health care administration.  Unlike in general Canadian practice, where Provincial health care coverage is relatively straightforward, there is a complicated and tiered system of health coverage for refugees.  Many physicians and institutions do not understand this complexity, and so it is not uncommon for refugees to be turned away from care that they should be entitled to.


In order to be successful, refugees require an approach that is not as common in general family practice.  Their health provider must seek to understand social, settlement and judicial needs of patients because of their impact on health.  Similarly, in order to go to school, get a job and contribute to society - which is the ultimate goal of the vast majority of refugees - health must be addressed and optimized.  Refugees' health and settlement needs must often be addressed together.  This can be complicated, and requires experience beyond the usual medical model.


Refugee medicine, like geriatrics and sports medicine, is an emerging discipline within family medicine.  Refugee health providers must draw on specialized health knowledge and use skills, like cross-cultural communication techniques, that are used much less frequently in other areas of family medicine.  They must have knowledge of issues specific to refugees, such as their health insurance.  And they must be able to work with others who provide settlement and community integration services.  This work is done best in specialized, multidisciplinary centres.