WONCA Special Interest Group: Migrant Care, Int Health & Travel Medicine

Dr Rebecca Farrington (UK)

email convenor

Dr Rebecca Farrington graduated from the University of Dundee as a doctor in 1990 and undertook a Diploma in Tropical Medicine and Hygiene in Liverpool in 1995. Subsequently she worked as a field doctor for Medicins sans Frontières in Afghanistan, South Sudan, Liberia, and on the Thai-Burmese border. This sparked a career long interest in refugees and displaced people.

She is currently based in Manchester (UK) with three roles: 
• GPwSI in asylum seeker health for Greater Manchester Mental Health Foundation Trust 
• Senior clinical lecturer in Community Based Medical Education for the University of Manchester medical school 
• GP in South Manchester  

Past convenor: Dr Maria van den Muijsenbergh (Netherlands)

M.vandenMuijsenbergh@elg.umcn.nl

Dr Maria van den Muijsenbergh, is a general practitioner in a population with many vulnerable migrants such as refugees, undocumented and homeless people. She is a senior researcher and teacher in the Department of Primary and Community Care at Radboud University Nijmegen Medical Centre, in Nijmegen, the Netherlands. Her research and education focus is on immigrant health and healthcare for refugees and undocumented people (eg the EU-funded Restore-project). She is a senior researcher and adviser to Pharos, Dutch knowledge centre on migrants, refugees and healthcare, in Utrecht.

• Dr Marius Besson (Switzerland)
• Dr Guus Busser (The Netherlands)
• Dr Garth Brink (South Africa)
• Dr Bill Cayley, Jr, (USA)
• Prof Christopher Dowrick (UK)
• Prof Christos Lionis (Greece)
• Dr Yves Jackson (Switzerland)

Vision

Good access and quality of primary care for all displaced people and travellers worldwide.

Mision

To improve the knowledge and skills of Family Doctors in advocating for the organisational and financial conditions to deliver culturally competent, good quality of primary care to migrants of all kinds: travellers, economic migrants, refugees and the undocumented.  

Terms of Reference and Aims

To enhance the exchange of knowledge, best practice, education and international research on migrant care and travel medicine in Primary Care by:

1. Knowledge and best practice 

= promoting access to and exchange of (web-based) information to support GP’s in daily practice on all aspects of migrant care, international health and travel medicine such as:  infectious disease and high prevalence conditions; mental health related to displacement and migration; communication tools; ethnic and cultural differences in illness, health beliefs and expectations 
= Exchange of good practice by international exchange practice visits 

2. Education in migrant care, cultural competence and travel medicine:
= Exchange of policies and materials for medical school, vocational training and post graduate education programs by establishing an internet forum for GP’s involved in teaching

3. Research on migrant care, cultural competence and travel medicine:
= Exchange of existing and initiating new local and international research projects

4. Networking:
= Organising workshops and / or pre-conferences at WONCA Europe, other regional WONCA conferences and WONCA World.
= Joint publishing of practice experiences and research results.

1. Exchange of information
2. Exchange of useful tools and initiatives.
3. Personal exchange visits.
   In May 2011, a first exchange visit took place between Switzerland and the Netherlands, with the Swiss member visiting different Dutch family medicine practices and initiatives to improve healthcare for undocumented migrants. In 2012 some Dutch members visited practices in Japan. In July 2012, practice visits are planned during the WONCA Europe in Vienna.
4. Joint research projects.
   As the European FP7 Restore (http://www.fp7restore.eu/) illustrates, there are possibilities for collaboration in research projects. It gives the opportunity to include larger study populations, and to look into the effects of different healthcare systems on health and access to health. This is also of interest for colleagues who are not connected to an university, but in this way will be able to participate in research projects. The strength of the SIG in this is practice-based research.
   A very interesting and promising field of research is brought up by colleague Yves Jackson, in Geneva: the role of migration related social problems and chronic stress to the rapid development of metabolic diseases as hypertension, obesity and diabetes, in migrants. There is some evidence for this from studies in the USA, but little research has been done until now in Europe.
5. Publications.
   Publications in journals for GPs would offer the opportunity to leave a footprint of the SIG and attract attention of other GPs as well as of policymakers etc.
6. WONCA conference presence.
   The SIG will continue submitting abstracts for workshops with topics relevant to a broader group of GPs, and start to organise symposia or pre-conferences. During WONCA Asia Pacific 2011 regional conference Evelyn van Weel-Baumgarten, Ryuki Kassai, Maria Fidelis Manalo held a workshop on cultural differences in communication on terminal diseases.
   During WONCA Europe 2011 regional conference Eldine Oosterberg, Christos Lionis and Maria van den Muijsenbergh organised a workshop on migrant care and good practices to overcome language and cultural barriers in which some 70 GP’s from 13 different countries participated. Oosterberg and van den Muijsenbergh also organised a workshop on low health literacy, a common problem amongst migrants.
   For WONCA Europe Vienna 2012 and WONCA Africa Zimbabwe 2012, oral presentations and workshop formats are planned

Documents

Anderson B, Blinder S. 2011 Who Counts as a Migrant? Definitions and their Consequences. The Migration Observatory, University of Oxford

Betancourt et al. Defining cultural competence: a practical framework for addressing racial / ethnic disparities in health and health care . Public Health Reports 2003;118:293-302. whitepaper. 2011 Language Line Services USA.

European Migration Network (2011) Key EU MigratoryStatistics, July 2011

European Union Fundamental Rights Agency (2011) Migrants in an irregular situation: access to healthcare in 10 European Union Member States, Luxembourg

Eurostat (2011a) online data code migr_asyctzandmigr_asyappctza

Eurostat (2011b) online data code - Asylum and new asylum applicants by citizenship, age and sex: annual aggregated data (migr_asyappctza)

Eurostat (2011b) online data code - Asylum applicants considered to be unaccompanied minors by citizenship, age and sex: Annual data (migr_asyunaa)

Gushulak, B Pace P and Weekers J (2010) Migration and health of migrants In Koller, T (ed) Poverty and Social Exclusion in the WHO European Region: Health Systems Respond, Copenhagen: WHO Regional Office for Europe

Articles

Farrington R. Consternation and complexity: learning from people who seek asylum. Educ Prim Care. 2020; 
 
Farrington R, Bailey A. The Health and Wellbeing of Asylum Seekers and New Refugees. In: Matheson J, Patterson J, Nilsom L, editors. Tackling the causes and consequences of health inequalities A practical guide. First. Boca Raton : CRC Press, [2020]: Taylor & Francis; 2020. p. 250–9. 
 
Farrington R. Migration and mental health. In: Kumar B, Diaz E, editors. Migrant Health A Primary Care Perspective. First. Boca Raton: CRC Press; 2019. p. 195–206.  
 
Tomkow L, Kang C, Farrington R. Healthcare access for asylum seekers and refugees in England: A mixed methods study exploring service users’ and health care professionals’ awareness. Eur J Public Health. 2019;  
 
Kang C, Tomkow L, Farrington R. Access to primary health care for asylum seekers and refugees: a qualitative study of service user experiences in the UK. Br J Gen Pract. 2019 Feb 12;bjgp19X701309.  
 
Farrington R, Saleh S, Campbell S, Jundi A, Worthington E, Nyiri J, et al. Impact of proposal to extend charging for NHS in England. Lancet. 2016 Jul  
 
Farrington R. Health care for refugees: time to get our act together. Br J Gen Pract. 2016 Mar;66(644):148–148.  

Papic O, Malak Z, Rosenberg E. Survey of family physicians’ perspectives on management of recent immigrant patients: attitudes, barriers, strategies, and training needs. Patient Educ Couns 2012; 86:205–9.

Vandenheede H, Deboosere P, Stirbu I, Agyemang C et al 2009): Migrant mortality from diabetes mellitus across Europe. European Journal of Epidemiology 2012; 27(2): 109-117

Priebe S, Sandhu S, Dias S, Gaddini A, et al. Good practice in health care for migrants: views and experiences of care professionals in 16 European countries. BMC Public Health 2011, 11:187.

Nielsen SS, Krasnik A. Poorer self-perceived health among migrants and ethnic minorities versus the majority population in Europe: a systematic review. Int J Public Health: 2010;55: 357 -371.

Pyykkönen AJ, Räikkönen K, Tuomi T, Eriksson JG, et al. Stressful Life Events and the Metabolic Syndrome. The Prevalence, Prediction and Prevention of Diabetes (PPP)- Botnia Study Diabetes Care February 2010; 33(2): 378-384

Bodenmann P, Vaucher P, Wolff H, Favrat B, et al. Screening for latent tuberculosis infection among undocumented immigrants in Swiss healthcare centres; a descriptive exploratory study. BMC Infect Dis 2009; 9:34.

Uiters E, Devillé W, Foets M, Spreeuwenberg P, Groenewegen PP. Differences between immigrant and non-immigrant groups in the use of primary medical care; a systematic review. BMC Health Serv Res. 2009; May 11, 9:76.

Schoevers MA, van den Muijsenbergh METC and Lagro-Janssen ALM: Self-reported health problems of female undocumented immigrants. Top of the iceberg. Self-rated health and health problems of undocumented immigrant women in the Netherlands, a descriptive study. Journal of Public Health Policy 2009:30,4: 409-22.

Lanting LC, Joung IM, Vogel I, Bootsma AH, et al. Ethnic differences in outcomes of diabetes care and the role of self-management behavior. Patient.Educ.Couns. 2008a, vol 72:1, 146-154

Schulz AJ, House JS, Israel BA, Mentz G, et al. Relational pathways between socioeconomic position and cardiovascular risk in a multi-ethnic urban sample: complexities and their implications for improving health in economically disadvantaged populations. J Epidemiol Community Health 2008;62:638-646 doi:10.1136/jech.2007.063222

Harmsen JAC, Bernsen RMD.,Bruijnzeels MA, Meeuwesen L. Patients’ evaluation of quality of care in general practice: What are the cultural and linguistic barriers? Patient Education and Counseling 2008; 72:155–162

Andrulis DP, Brach C. Integrating literacy, culture and language to improve health care quality for diverse populations. Am J Health Behav 2007;31;Suppl.1: S122-S133

French CE, Antoine D, Gelb D, Jones JA, et al. Tuberculosis in non-UK-born persons, England and Wales, 2001-2003. Int J Tuberc Lung Dis 2007; 11(5):577-584.

Beach MC et al. Improving health care quality for racial / ethnic minorities: systemic review of the best evidence regarding provider and organization interventions. BMC Public Health 2006;6:104.

Scheppers E, van Dongen E, Dekker J, Geertzen J, Dekker J. Potential barriers to the use of health services among ethnic minorities: a review. Family Practice 2006; 23(3):325-348.

Campbell JL, Ramsay J, Green J. Age, gender, socioeconomic, and ethnic differences in patients' assessments of primary health care. Qual Health Care 2001;10:90-95.

Links to relevant national initiatives

www.huisarts-migrant.nl
The Dutch website for GP’s with information on ethnic and cultural aspects of diseases and illness, and with patient education materials:

www.Mighealth.net

http://www.hpa.org.uk/migranthealthguide
UK site with information on ethnic and cultural aspects of diseases and illness

www.fp7restore.eu
Site of the European research project Restore, on bridging language and cultural barriers in primary care.