Transcript Mangere Refugee Resettlement Centre

Mangere Refugee
Resettlement Centre
Dr Martin Reeve, Medical Officer,
What is it?
• A) Multifunction reception centre for quota
refugees
• B) Low level (very) detention centre for a
small number of asylum seekers
Where is it
Near the airport and Middlemore hospital
Probably unique in the world –
why?
• Reception centre for quota refugees –
hundreds of reception centres in the world,
but for asylum seekers, eg Norway 120
reception centres
• One stop shop – all necessary agencies
on the one site
Most countries put asylum seekers into
centres, and quota refugees into community
– NZ does the reverse
Most countries have immigration detention
centres as well as reception centres.
Eg Metsala centre in Helsinki, Finland, is
both. Staff move between reception and
detention sections. Note reflection room
Asylum reception centre
Geneva
Satakieli, unaccompanied
childrens’ centre Finland
Cathedral of the Northern Light, Alta
Midnight sun,
Olderdalen
What are the agencies?
• New Zealand Immigration Service, part of
MBIE, select refugees, own and run
MRRC
• Auckland University of Technology School
of Refugee Studies – education for all
ages, including Early Childhood Education
Centre
• Refugees as Survivors – Counselling
service
• Red Cross – arranges all social services,
including housing, income support. Has a
volunteer support service throughout New
Zealand.
• Medical clinic. Part of Communicable
Disease Control, Auckland Regional
Public Health Service, Auckland District
Health Board
Medical Clinic
• Screening Team – one female doctor, one
male doctor, one nurse
• Nursing team – Head nurse, liaison nurse,
Nurse practitioner trainee (part of
screening team as well)
• Admin team – Programme supervisor,
administrator
• GP
• Health promoter
• Dentist (from ADHB) and dental assistant
(from Middlemore)
• Supplemented when needed by other
doctors, nurses and admin staff from
ARPHS
• Many visitors - phlebotomists, translators,
midwives, dental therapists
Dental team
What do we do?
Provide medical screening and care for onsite quota refugees and asylum seekers
“Gateway clinic” concept
Prepares the refugee/asylum
seeker/protected person for life in new
country by:
• Medical assessment
• Handover to primary care
• Use of ancillary services such as
counselling
• Provision of expert advice
Gateway clinics
Quite widely found, eg Companion House,
Canberra, Finnish clinics
Why screen?
• Two D’s – detection and doing
Forced Migrant Screening
• The prevention of the spread of infectious
diseases from the refugee to the population of
the resettlement country
• The prevention of the spread of infectious
diseases from the resettlement country to the
refugee.
• The exclusion of certain categories of health
problem from resettlement countries
• The assessment of the refugee, physically,
emotionally, psychologically and socially.
• The management of any problems found from
above
continued
• Completion of health documentation needed by
immigration services
• The prevention of future health problems in
refugees.
• Collection of data
• Assessment of, and planning for, the impact of
refugee health on the resettlement country.
WHO screening criteria
mnemonic
• I Understand SCREEN
• Important – the disease should be
important
• Understanding of the natural history of the
disease is essential
• Sensitive, specific test
• Common condition that can lead to serious
morbidity/mortality
• Risks outweighed by benefits
• Early stage of identification – i.e. the test
cannot only detect those with advanced
disease
• Expenses low (inExpensive)
• Non-invasive and acceptable test
How do we do it?
• Structured clinical interview
• Battery of tests – Core (everyone),
conditional (age/sex), secondary(follow up
test, or one requested following interview)
• Core: FBC, Haemoglobinopathy, iron
studies, lft; serology for HBV, HCV
antibodies, HIV, syphilis,schisto; three
stool specimens for parasites only
• Conditional: Age: >11, CXR, <16, mantoux
>15, creatinine and electrolytes
Sex: male, urine for Gc, Chlamydia and
trichomonas. Female, Cx smear, STI check.
• Age and sex: male, >35, lipids, Hba1c;
female >45,lipids Hba1C
• Secondary eg B12/folate, H.pylori antigen
What happens overseas?
Usually similar process. Some tests we don’t
do which others do routinely
• Malaria
• Lead
• Pregnancy
• Quantiferon
• Strongyloides, Chaga’s disease
Finland modifies the tests done according to
the person’s origin.
Who should do the screening?
Overseas, often nurse led, but very
specialised, eg Finland
• One general practice in each receiving city
• Specialised Nurse practitioner +
specialised psychiatric nurse + health
worker + one backup GP
Suggested priority list
1. Older women, especially from high
expectation cultures – experienced
female doctor
2. Older men, especially from high
expectation cutures – experienced male
doctor
3. Young children (parents being assessed)
– experienced paediatric nurse
4. Adolescents – nurse or doctor of same
sex
5. Remainder – nurse or doctor
Opportunities for shared care eg male
doctor + female nurse for younger sexually
active women, health assistant (history) +
nurse/doctor (examination), translator
(structured history) + doctor (examination),
separation of screening and treatment.
What instrument (screening
document)?
Wide range from completely unstructured, to
highly structured, eg NZIS document.
Is it worth it? - results
•
•
•
•
Refugees different from 20 years ago
Most not from refugee camps
From different countries
Many have “plastic bag syndrome” of
medicines
• About half are characterised by having
some condition which requires more than
usual follow up
INFECTIOUS DISEASES
2000 (paper)
2012 – 2015
1623 refugees
TB
2%
<<<1%
HIV
SSA – 4%
Not SSA 0.1%
0.4%
Schistosomiasis
22%
0.4%
H Pylori antigen
Test did not exist
Hep B Carriers
4.7%
Audit showed over 90% +ve
of H pylori antigens
requested in those with
dyspepsia, adult prevalence
20% for H pylori
2.3%
HCV active disease
1%
0.5%
Syphilis
4%
2%
Gut Parasites
30%
15%
Burmese refugees 2015
Helminths
From Thailand, From Malaysia,
refugee camps private
acommodation
141 diagnoses 109 diagnoses in
in 409 people = 685 people = ratio
ratio of 35%
of 16%
Micronutrients %
Iron deficiency
2000
2015
22
8.7
Vitamin D deficiency Test not
39
done
B12 deficiency
0.25?
Folic Acid deficiency 0.5?
31 tests, 13 folate
reduced, 5 B12, 3 both
2
0
BLOOD RELATED %
2000
2015
Alpha thalassaemia
8
trait
Beta thalassaemia trait 1.4
2.3
Sickle Cell trait
0.3
0.8
Other, HbC, D, E etc
?
3.8
Total
?
10.0
2.4
CHRONIC ILLNESS %
Diabetes
Hypertension
Dyspepsia
Haemorrhoids
Glucose intolerance
M>35 F>45
Backache
2000
1.4
1.6
2.3
1.1
2015
3
7.6
13
0.7
Not done 8.3
1.1
1.4
Psychosocial
• 30% referred to RAS, rare to refer
children, so rate is higher
• Can also self refer or be referred by other
agencies
What’s the cost?
for last intake of 130 in 6 weeks
• 2889 inbox records
• 375 vaccinations
• 450 prescription items
• 831 appointments
• 1484 outbox records, including
• 214 referrals
Most examiners can manage only two adults
per three hours, I can just manage three, if
they say no to most things
Appointments pattern
Count of APPDATE
NHI
UXV4454
UZN7551
UZN7578
UZN7586
UZN7594
UZN7624
UZN7667
UZQ9687
UZQ9695
UZQ9741
UZQ9776
VBX9476
VBX9492
VBX9522
VBX9859
VBX9883
VBX9891
VBX9930
VBX9948
Scr
Scr Scr
Scr Scr
nse
nse Dr
Dr 1 Dr 2 GP 1 1
Nse 1 GP 2 GP 3 Nse 2 2
3 Grand Total
1
2
1
2
2
9
1
1
1
1
1
1
5
1
1
2 1
1
1
1
1
2
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
2
1
2
1
1
1
1
1
1
3
2
2
1
1
1
1
1
1
1
1
1
1
2
2 2
1
2
1
1
1
1
1
1
1
1
1
1
1
1
2
1
2 1
1
1
2
1
1
3
18
4
11
3
5
2
3
3
5
7
3
10
6
2
8
5
5
11
9
Cutaneous leishmaniasis
Cystercicosis
Loa-loa
Self flagellation
Whipping
Vitiligo in stretch marks
Smallpox scars
Kiitos
(thank you in Finnish)