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Introduction

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A refugee is a person who owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion is outside the country of his nationality and is unable or owing to such fear is unwilling to avail himself of the protection of that country.

The United Nations Conference of Plenipotentiaries on the status of Refugees and Stateless Persons 19511

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The health of refugees is a special challenge for GPs, who are in an ideal opportunistic position to treat these disadvantaged people with their many mental and physical health problems.2 About 13 000 refugees settle in Australia each year with the majority from Southern and South-East Asia, the Middle East and Saharan Africa. Refugees, especially refugee children, arrive with a variety of medical problems that may escape detection unless appropriate screening is undertaken. Many problems are asymptomatic, latent or occult and may be considered inconsequential by the affected person or guardian. Studies conducted in New South Wales in Australia3 show that that there is a high detection rate for diseases of personal and public health significance in a sample of such children from refugee specific clinics. Most of the children in the study had disorders that were asymptomatic. The study identified 25% with anaemia, 27% serology positive for schistosomiasis, and 16% with current or recent malaria, while 69% were hepatitis B non-immune, 25% were tuberculin skin test positive and 20% had low vitamin D levels.3

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Predeparture screening4

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Refugees, like other migrants, have to meet predetermined health criteria to be granted a permanent visa. The basic medical requirements are:

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  • history and examination

  • chest X-ray if ≥ 11 years of age

  • HIV test if ≥ 15 years of age

  • hepatitis B test if pregnant or an unaccompanied minor

  • malaria-rapid antigen test

  • tests for intestinal helminths (worms)

  • MMR immunisation ≤30 years

  • syphilis test if ≥ 15 years

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Applicants are offered treatment for most disorders. However, active TB precludes the granting of a visa. An additional ‘fitness to fly’ predeparture assessment is usually performed prior to travel. However, because of the high prevalence of both acute and chronic infective diseases and the inconsistencies of screening results, it is likely that many illnesses remain undiagnosed or untreated upon arrival in their new country.

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Communication issues

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Good communication with the refugee and their families is fundamental to good outcomes. This involves appropriate rapport, understanding of and interest in their problems. A professional interpreter is the best tool available when dealing with a patient whose language is unfamiliar.4 It is important to emphasise that confidentiality will be respected. Non-verbal communication is obviously an important strategy and includes empathetic nodding, listening and friendliness. It is most appropriate to be aware of the ...

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