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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 Wales3 show that there is a high rate of diseases of personal and public health significance in a sample of 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 nonimmune, 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 and syphilis tests if ≥ 15 years of age
hepatitis B test if pregnant or an unaccompanied minor
malaria-rapid antigen test, tuberculosis (mantoux or interferon gamma)
tests for intestinal helminths (worms)
MMR immunisation ≤ 30 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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Good communication with refugees 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 and the national Translating and Interpreting Service provides GPs with a free phone interpreter in many circumstances. It is important to emphasise that confidentiality will be respected. Non-verbal communication is obviously an important strategy and includes empathetic nodding, ...