Helsesenteret for papirløse migranter
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Transcript of Helsesenteret for papirløse migranter
No papers, no rights?Undocumented Migrants, Health Problems
and Health Care
- front line experiences from health care provision to undocumented migrants in Oslo
Frode Eick, Health Care Responsible Health Centre for Undocumented Migrants, Oslo
What is meant by undocumented?
Undocumented migrants; people with no legal resident permit
Undocumented doesn’t necessary mean no passport or ID-papers
Our patients: 2/3 previous asylum seekers (with final rejection), the rest never registered, overstayed visum/resident permit
No paper, no rights?
- right to emergency care- right to necessary treatment before and after giving birth,
abortion and treatment/medicines of communicable diseases (tub, hiv)
- and new political expression; ”health care that can not wait” – open to individual interpretations!
- rights do not guarantee access
No paper, no rights?No right to ”fastlege”
Children: right to all types of health care (and primary education) but still no ”fastlege”
For all: the patients have to pay themselves, no financial system, no reimbursement
Social service: no rights
Background
• Aftenposten ran a feature article series in 2007• Oslo City Mission did a needs assessment in 2008• Uncovered great needs especially for health care• No other Norwegian actors were engaged• Started a collaboration with Red Cross Feb. 2009• Clinic opened 27th October 2009
The Health Centre
• Run by Oslo Church City Mission and Oslo Red Cross
• 2.3 paid employees, aproximately 100 volunteers including professional health workers: doctors, nurses, psychologists, physiotherapists, bioengineers, etc.
Objectives• Offer and provide health care to undocumented migrants
• Give health information to undocumented migrants
• Facilitate undocumented migrants access to health care in the ordinary health system
• Convey information, documentation and experiences about the health situation and needs of undocumented migrants to external actors
• Ultimate goal: to become superfluous, close the centre
What do we offer?Opening hours (drop in): Tuesday evening, Thursday daytime
- Primary health care- Consultation (with general practitioner, psychologists, psysioterapists etc)
-10 -12 volunteers- 6 treatment rooms- specialists (gynecologist, neurologist, nephrologist)
- Medicines- Laboratory tests, vaccines- Treatment and follow-up whenever possible (both somatic and mental)- Volunteer and professional translators
What do we offer?
• Referrals to volunteer network (dermatologist, urologist, dentists)
• Cooperation agreement with Diakonhjemmet Sykehus• Cooperation agreement with psychiatric centre• Cooperation with public hospital for postpaid abortions• Cooperation with pharmacy close by and the ordinary health
system
Our patients
• 720 patients (per 1st August 2011)• 60 nationalities • 35 % women• 20-40 pasients every opening day• 2,000 consultations to date; 4/5ths somatic, 1/5th mental
health related
CountriesNasjonalitet
0
20
40
60
80
100
120
Afgha
nista
n
Albania
Algerie
Brasil
Bulgar
ia
Burund
i
ButanChad
Chile
Colombia
Djibout
i
Ecuado
r
Egypt
El Salv
ador
Eritre
a
Etiopia
Gambia
Ghana
GuineaIra
nIra
kIta
lia
Kamer
un
Kenya
DR Kon
goKina
Kirgisi
stan
Kurdist
an
Kviter
ussland
Libano
n
LiberiaLib
ya
Litau
en
Mau
ritan
ia
Mold
ova
Mon
golia
Mar
okko
Nepal
Niger
ia
Pakist
an
Palesti
na
Papua
Ny G
uinea
Polen
Portu
gal
Romania
Russlan
d
Rwanda
Seneg
al
Serbia o
g Mon
tene
gro
Sierra
Leo
ne
Somali
a
Sri La
nka
SudanSyr
ia
Tadjik
istanTog
o
Tunisi
a
Tyrkia
Ukrain
a
Urugu
ayUSA
Usbek
istan
Ukjent
/stat
sløs
Venez
uela
Vietnam
Zambia
Zimba
bwe
Østerik
e
Gender and ageFordeling kjønn
Kvinner
Menn
Alder
0
50
100
150
200
250
300
350
<18 18-29 30-44 >45
Health problems
Top six (from ICPC-2)
-Digestive (Fordøyelsessystemet)-Musculoskeletal (Muskel og skjelett)-Psychological (Psykisk)-Respiratory (Luftveier)-Skin (Hud)-Reproductive/sexual health
Mental health problems
0
5
10
15
20
25
30
Psykiske diagnoser
kvinne
mann
Challenges
• Identifying target group• Confident and consistent IDs • Translation• Referral and follow-up
Challenges
Economy - need for external funding from 2012 or reduced opening hours / less patients - who should pay the medicine / treatment for patients with chronic diseases?
Capacity- increase in patients - limit how many patients can serve/treat/follow-up- operations are based on volunteers
Mental health- patients with severe mental problems- limited possibility for referral- not enough capacity nor continuity to treat all the patients in need
Ethical considerations
• professional ethics vs. the law• uncover undocumented• humanity prolongs suffering?• test but not treat