Background
The United Nations estimate that 3 percent of the world’s population (213 million by 2010) live outside their country of origin (UN 2009). Globally, doctors are confronted with growing populations of vulnerable migrants and travellers with health problems, diverse epidemiological profiles and needs, and some with diseases specific to their areas of origin. Most migrants move from and to
other Low- and Middle-Income Countries. Many have left their country for economic reasons or to join family. Some stay for the rest of their lives in the new country, others (like migrant workers in South Africa) travel to and fro. Some move to escape persecution: The UNHR considers that there are approximately 44 million forcibly displaced people worldwide. The health status of asylum seekers and refugees is often problematic. Exposure to organized violence, forced migration, family rupture and bereavement cause ill health. The length of the asylum processes and uncertainty during this time often generates psychosocial distress. Especially vulnerable are undocumented (“irregular” or “illegal”) immigrants (without permission to stay). Estimates suggest that there may be 30 million undocumented migrants worldwide. It is estimated that they make up 4 percent of the population of the USA, and 1 to 2% of the total population in Europe. In most countries their living and working conditions are harsh, with a negative impact on health. However, they often have no or limited access to free public health care, due to restricted insurance conditions. Delivering primary care to these groups requires specific skills, especially in dealing with complexity. Family doctors can feel helpless when faced with vulnerable migrant patients, due to a lack of knowledge and cultural competences. Aside from language and cultural barriers, the mixed somatic and psychosocial presentation of symptoms, the administrative burden and financial constraints, migrants can also have different cultural health beliefs and practices to their host countries. Whilst they are not generally vectors of communicable diseases like tuberculosis, HIV and tropical diseases, migrants coming from countries of high prevalence may require some screening. Alongside the issues of forced migrant populations, there is some overlap with Travel Medicine. Challenging adventures in foreign countries bring the dangers of injury and contracting exotic infectious diseases for which they have no natural immunity. Transport of cargo introduces bacterial and other flora to new countries, overcrowding at airports and asymptomatic carriage of infectious disease can be problematic. Some travellers seek advice from their Family Doctor in preparation or, should they fall ill, on return. Others may attend Travel Clinics, some of which have financial motivation above necessary treatments and ethical practices. Support for families may also be needed when a worker is deployed overseas without them for long periods, placing relationships in jeopardy. SIG formation
Formed in Istanbul at WONCA Europe 2008, the Special Interest Group (SIG) in Migrant care, International health and Travel Medicine within WONCA aims to exchange knowledge, resources and experiences between Family Doctors from different countries and backgrounds. Problems faced by Family Doctors during medical encounters with migrant patients were inventoried by using the Nominal group technique. Despite local differences in healthcare systems, it became clear that GP’s all over the world experienced the same problems and needs, e.g. cultural competence, communication skills, communicable diseases, ethnic and cultural differences. Core members of the SIG have a range of interests including international research, undergraduate and postgraduate medical education, and delivering primary care to refugees, undocumented and other migrants and travellers. The outcomes have included the Dutch WONCA member organisation (Dutch college of General Practitioners) developing a special program to integrate ethnic diversity into guidelines and post graduate training. Vision
Good access and quality of primary care for all displaced people and travellers worldwide
Mission
To improve the knowledge and skills of Family Doctors, and advocating for the organisational and financial conditions, to deliver culturally competent, good quality of primary care to migrants of all kinds: travellers, economic migrants, refugees and the undocumented. Terms of reference and aims
To enhance the exchange of knowledge, best practice, education and international research on migrant care and travel medicine in Primary Care through:
1. Knowledge and best practice
= promoting access to and exchange of (web-based) information to support GP’s in daily practice on all aspects of migrant care, international health and travel medicine such as: mental health related to displacement and migration; high prevalence conditions including communicable and non-communicable conditions; communication tools; ethnic and cultural differences in illness, health beliefs and expectations
= Exchange of good practice by international exchange practice visits
2. Education in migrant care, cultural competence and travel medicine:
= Exchange of policies and materials for medical school, vocational training and post graduate education programs by establishing an internet forum for GP’s involved in teaching
3. Research on migrant care, cultural competence and travel medicine:
= Exchange of existing and initiating new local and international research projects
4. Networking:
= Organising workshops and / or pre-conferences at WONCA Europe, other regional WONCA conferences and WONCA World.
= Joint publishing of practice experiences and research results.
