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PubMed2003

Nutritional risk factors for older refugees.

This study describes risk factors for poor nutrition among older Rwandan refugees. The most important areas of nutritional risk for older refugees are: physical ability and mobility; income and access to land; access to appropriate food rations; meeting basic needs such as water, fuel, shelter; equal access to essential services (food distribution, health services, mills, feeding programmes); and psycho-social trauma. Women and older elderly (> 70 years) are significantly more often in disadvantaged positions, such as having poor socio-economic status, poor health, poor mobility, lower food intake, diminished social status, respect and social network. Older refugees are at higher risk than younger refugees and at higher risk than older people in stable situations. They should remain in good nutritional and general health for their own well-being and that of their dependants. In addition to an adequate diet, a support network seems to be an important preventive aspect.

Aged↗
PubMed2003

Quality design: a planning methodology for the integration of refugee and local health services, West Nile, Uganda.

In an emergency, the international community responds to the immediate health needs of refugees through the establishment of action-oriented, life-saving services. Healthcare delivery is often managed with limited, if any, coordination with local health management structures. In situations where refugees remain in the host country for many years, sustainability issues inevitably arise. Refugee-hosting governments may ultimately be called upon to assume the management and funding of refugee services. Planning for service integration, while protecting against declines in service quality, is a challenge in the typically resource-poor host environments. This paper discusses these issues by presenting the experience of the West Nile districts in northern Uganda, and describes quality design as a relevant planning methodology. Quality design is a systematic planning approach that documents and directly incorporates the service users' self-defined expectations and needs.

Community Health Services↗
PubMed2005

Emergency mental health nursing for self-harming refugees and asylum seekers.

This article describes the structure and function of emergency mental health nursing practice for self-harming refugees and asylum seekers on Temporary Protection Visas. Emergency nurses working in accident and emergency departments or as part of crisis intervention teams will see self-harming refugees and asylum seekers at the very point of their distress. This clinical paper is intended to support nurses in their practice should they encounter an adult asylum seeker needing emergency mental health care. Practical strategies are highlighted to help mental health nurses assess, care, and comfort refugees and asylum seekers in this predicament. Mental health nurses should, where possible, work closely with asylum seekers, their support workers, and accredited interpreters and translators to ensure the appropriate use of language when dealing with mental and emotional health issues without further isolating the asylum seeker from appropriate services. To help strengthen continuity and integration of mental health supports for refugees and asylum seekers, well-resourced care must be experienced as coherent and connected. A coherent, interdisciplinary and team-orientated approach will synthesize different viewpoints to shape clinical practice and create workable solutions in local situations.

Acute Disease↗
PubMedDate not supplied

Comprehensive health assessment for newly arrived refugee children in Australia.

Providing appropriate and responsive care to refugees from diverse backgrounds and with unique health needs is challenging. Refugee children may present with a wide range of conditions, which may be unfamiliar to health professionals in developed countries. Additionally, refugees may experience unfamiliarity with the Australian health system and distrust of authority figures and/or medical practitioners. This article provides an overview of the priority areas in health and health management for paediatric refugee patients for paediatricians as well as other relevant health care providers caring for this group. Specific issues covered include general health assessment, infectious diseases, immunization, growth and nutrition, oral health, development and disability, mental health and child protection. Comprehensive health assessment can assist in identifying children at risk of poor health and to provide them with timely and effective care, advocacy and appropriate referral.

Australia↗
PubMedDate not supplied

An issue of access: delivering equitable health care for newly arrived refugee children in Australia.

Newly arrived refugees and asylum seekers are faced with many difficulties in accessing effective health care when settling in Australia. Cultural, language and financial constraints, lack of awareness of available services, and lack of health provider understanding of the complex health concerns of refugees can all contribute to limiting access to health care. Understanding the complexities of a new health care system under these circumstances and finding a regular health provider may be difficult. In some cases there may be a fundamental distrust of government services. The different levels of health entitlements by visa category and (for some) detention on arrival in Australia may further complicate the provision and use of health services for providers and patients. Children are particularly at risk of suboptimal health care due to the impact of these factors combined with the effect of resettlement stresses on parents' ability to care for their children. Unaccompanied and separated children, and those in detention experience additional challenges in accessing care. This article aims to increase awareness among health professionals caring for refugee children of the challenges faced by this group in accessing and receiving effective health care in Australia. Particular consideration is given to the issues of equity, rights of asylum seekers, communication and cultural sensitivities in health care provision, and addressing barriers to health care. The aim of the paper is to alert practitioners to the complex issues surrounding the delivery of health care to refugee children and provide realistic recommendations to guide practice.

Australia↗
PubMed2005

Nursing research with refugee clients: a call for more qualitative approaches.

BACKGROUND: Nursing research with refugee populations, who lack an understanding of the importance of research, presents unique challenges. These challenges include bureaucratic requirements for gaining permission for research, navigating through camps, identifying potential participants, gaining acceptance, building rapport and trust, maintaining privacy, and respecting participants' status in the camp. Few studies exist regarding Palestinian refugees, with no reported studies that address nursing or healthcare, especially in Jordan. FINDINGS: Quantitative research, which often requires participants who read and write, may be ineffective with long-term refugee populations. Additionally, many research tools are not culturally valid. Consequently, refugees, many of whom are illiterate, are largely unstudied. RECOMMENDATIONS: Qualitative approaches, such as interviewing and observation, allow participants to describe their healthcare concerns, and their management of them. Rapport and trust can then enable the researcher to provide interventions and education.

Adaptation, Psychological↗
PubMed2006

Practitioner review: assessment and treatment of refugee children and adolescents who have experienced war-related trauma.

BACKGROUND: Increasingly clinicians are being asked to assess and treat young refugees, who have experienced traumatic events due to war and organised violence. However, evidence-based guidance remains scarce. METHOD: Published studies on the mental health difficulties of refugee children and adolescents, associated risk and protective factors, as well as effective interventions, particularly those designed to reduce war-related post-traumatic stress disorder (PTSD) symptoms, were identified and reviewed. The findings are summarised. RESULTS: Young refugees are frequently subjected to multiple traumatic events and severe losses, as well as ongoing stressors within the host country. Although young refugees are often resilient, many experience mental health difficulties, including PTSD, depression, anxiety and grief. An awareness of relevant risk and protective factors is important. A phased model of intervention is often useful and the need for a holistic approach crucial. Promising treatments for alleviating symptoms of war-related PTSD include cognitive behavioural treatment (CBT), testimonial psychotherapy, narrative exposure therapy (NET) and eye movement desensitisation and reprocessing (EMDR). Knowledge of the particular needs of unaccompanied asylum-seeking children (UASC), working with interpreters, cross-cultural differences, medico-legal report writing and the importance of clinician self-care is also necessary. CONCLUSION: More research is required in order to expand our limited knowledge base.

Adolescent↗
PubMed2004

Family consequences of refugee trauma.

OBJECTIVE: To construct a model on the consequences of political violence for refugee families based upon a qualitative investigation. METHODS: This study used a grounded-theory approach to analyze qualitative evidence from the CAFES multi-family support and education groups with Bosnian refugee families in Chicago. Textual coding and analysis was conducted using ATLAS/ti for Windows. RESULTS: A grounded-theory model of Family Consequences of Refugee Trauma (FAMCORT) was constructed that describes Displaced Families of War across four realms of family life: (1) changes in family roles and obligations, (2) changes in family memories and communications, (3) changes in family relationships with other family members; and (4) changes in family connections with the ethnic community and nation state. In each realm, the model also specifies family strategies, called Families Rebuilding Lives, for managing those consequences. CONCLUSIONS: Political violence leads to changes in multiple dimensions of family life and also to strategies for managing those changes. Qualitative family research is useful in better understanding refugee families and in helping them through family-oriented mental health services.

Adult↗
PubMed1998

Trauma exposure, postmigration stressors, and symptoms of anxiety, depression and post-traumatic stress in Tamil asylum-seekers: comparison with refugees and immigrants.

Compared to research on displaced persons whose refugee status has been endorsed prior to arriving in Western countries, there is little systematic information available about levels of past trauma, postmigration living difficulties and psychiatric symptoms amongst asylum-seekers who claim refugee status only after arrival. Asylum-seekers, authorized refugees and immigrants of Tamil background were recruited by personal contact and mail-out in Sydney, Australia. A total of 62 subjects, constituting approximately 60% of the estimated pool of Tamil asylum-seekers, agreed to participate in the study. They returned statistically significantly higher scores than immigrants (n = 104) on measures of past trauma, symptoms of anxiety, depression and post-traumatic stress, and on all dimensions of postmigration difficulties. Asylum-seekers did not differ from refugees (n = 30) on measures of past trauma or psychiatric symptoms, but they scored higher on selective components of postmigration stress relating to difficulties associated with their insecure residency status. Although limited by sampling and diagnostic constraints, the present study suggests that asylum-seekers may be a high-risk group in relation to ongoing stress in the postmigration period.

Acculturation↗
PubMed2005

Mental health needs, service use and costs among Somali refugees in the UK.

OBJECTIVE: To assess the mental health needs and service use of Somali refugees living in London. METHOD: Subjects (n = 143) were sampled from conventional and non-conventional sites. Needs and service use were measured using the Camberwell Assessment of Need and the Client Service Receipt Inventory, respectively. Comparisons between sites were made and cost predictors identified. RESULTS: Basic needs occurred frequently but were often not fully addressed. The mean number of needs was around four out of a possible 22. The most used services were GPs, other clinicians and refugee services. Higher non-inpatient costs were associated with length of stay in the UK and lower costs with being at risk of suicide and having panic disorder or agoraphobia. CONCLUSION: Somali refugees living in London have a relatively high level of need but a low level of service use. Refugee characteristics could only account for a limited amount of cost variation.

Adult↗
PubMed1982

Life-threatening indicators among the Indochinese refugees.

The Indochinese refugees have experienced more devastation than most Americans will know in a lifetime. The tremendous turmoil of war, the risking of one's life, the forced separation of families and relocation into the American culture have drastically changed the lives of every Indochinese individual. Nor do the emotional scars imprinted into the minds of these people disappear upon arrival into a neutral country. Rather, these psychological problems can show themselves as suicidal preoccupation, or attempts. This paper stresses related variables observed in those Indochinese people contemplating suicide. Of 4,192 Indochinese refugees sampled, ten suicidally inclined refugees were identified. Clinical findings revealed that multiple determinants were operating conjointly in creating the high risk of any particular refugee in relation to suicide.

Adolescent↗
PubMed1987

Epidemiological assessment of the health and nutrition of Ethiopian refugees in emergency camps in Sudan, 1985.

The findings from epidemiological data that were collected from emergency camps for Ethiopian refugees during a mass influx of refugees into Eastern Sudan in 1985 are presented. An overall mortality of 8.9 per 10,000 a day was recorded during February 1985, and in children under 5 years of age the rate was 22 per 10,000 a day. The estimated prevalence of malnutrition (calculated as less than 80% of the reference weight for height) ranged from 32% to 52% among children of preschool age. The principal causes of morbidity and mortality were measles, diarrhoea and dysentery, respiratory infections, and malaria. The findings suggest that malnutrition and disease increased in these refugees after they arrived in the camps. Epidemiological assessment is essential to help to maintain the health and nutrition of refugees in emergency camps.

Adolescent↗
PubMed1978

Psychiatric consultation in a Vietnamese refugee camp.

The authors provided psychiatric consultation to medical personnel in charge of a Vietnamese refugee camp in California. Although the emergency measures that supplied clothing, food, shelter, and medical care to nearly 60,000 refugees were immensely successful, consultation was requested to assist with selected mental health problems. The recommendations of the consulting team were related to the stage of camp development: early recommendations concerned easing adaptation to the camp setting; later efforts included creating a psychiatric crisis clinic and carrying out a mental health survey on a random sample of refugees. The results of this survey helped camp directors to understand how refugees responded to the camp experience.

Adaptation, Psychological↗
PubMed1988

Influences of time, ethnicity, and attachment on depression in Southeast Asian refugees.

The author reports on a study investigating the question of whether certain phases of resettlement are accompanied by an elevated risk for depression in Southeast Asian refugees in Canada. In general, the longer the Southeast Asian refugees remained in Canada, the better their mental health. However, unmarried or otherwise unattached Laotians and Vietnamese refugees experienced high levels of depression 10-12 months after arrival. Two years after the initial investigation, this group, disadvantaged by a lack of social resources, continued to be more depressed than other refugees.

Acculturation↗
PubMed1981

Evaluation and psychotherapy of Indochinese refugee patients.

Based on clinical experience with 70 Indochinese refugees, specific approaches to diagnosis and treatment of these patients were developed. The psychiatrist/patient relationship was supported and improved by well-trained, empathetic interpreters who assisted with the evaluation which stressed thorough history-taking and a mental status exam. Cultural differences and the psychiatrist's attitudes about refugees and the Indochinese war influenced the therapeutic process. Treatment consisted of appropriate medication, involvement with the social agencies when necessary, and the warmth, empathy, and support of the physician. In particular, it was helpful to understand the symptoms as the patient perceived them and to relate them to possible stresses in the past. Problem areas of therapy were the patient's concentration on physical symptoms, the horror stories, and taboo subjects difficult for the refugee to discuss. Case histories point out the conflict of values and cultural attitudes about mental illness among refugees due to their changed environment and life style.

Adult↗
PubMed1987

A review of mental health services for refugees between 1975 and 1985 and a proposal for future services.

A lack of federal planning and foresight and an uneven and poorly coordinated network of state services have resulted in fragmented mental health care for the large number of Southeast Asian and other refugees who have entered the United States since 1975. The author reviews the history of mental health services for refugees between 1975 and 1985 and proposes the development of separate mental health and health services for refugees that are responsive to their political, social, economic, and cultural needs. Ideally the services would be provided within existing medical institutions and staffed by medical, psychiatric, and social services personnel assisted by culturally sensitive translators. The author outlines the role of government and organized psychiatry in shaping new programs for refugees and promoting their mental health.

Asia, Southeastern↗
PubMedDate not supplied

Findings from mental health screening of newly arrived refugees in Colorado.

States are required to provide a public health screening for all newly arrived refugees in the United States. In 1997, a comprehensive program was created to include both a physical examination and a mental health screening. This article provides a complete description of the mental health screening process, including two illustrative cases, and reports information about the refugees who participated in the program. Ten percent of screened refugees were offered mental health referrals; of those, 37% followed up. Refugees who presented for treatment reported a higher number of symptoms upon screening compared with those who were offered referrals but did not follow up. Psychiatric evaluation confirmed that those who screened positive and presented for treatment were experiencing a high level of suffering and qualified for mental health diagnoses. The findings support inclusion of a mental health screening as part of the public health screening.

Adolescent↗
PubMed2000

Issues facing TB control (2.1). Tuberculosis control in refugee populations: a focus on developing countries.

Today's worldwide tuberculosis epidemic and the movement of a growing number of refugees overlap geographically and have made tuberculosis control in refugee populations an issue of increasing importance. However, in developing countries, where both of these problems are concentrated, tuberculosis control in refugee populations remains a largely unmet need. Experience shows that despite difficult field conditions, tuberculosis control programs can be managed successfully in this setting. The analysis of information available from previous experiences served as the basis for formulating the main policies which, if applied consistently, will reduce morbidity, mortality and transmission of tuberculosis among refugee populations living in camps. The recommendations given are in line with those of the guideline recently produced by the World Health Organization.

Communicable Disease Control↗