Global Health involvement without leaving home:

Transcription

1 Global Health involvement without leaving home: Welcoming Syrian refugees as Family physician. François Couturier MD, MSc, DTMN&H Professor, Family Medicine Janie Giard, Md, MSc Professor, Family medicine Nov Sharbat Gula, June 1984 Photo Steve McCurry 1

2 Objectives Participants will be able to: 1) Demonstrate a better understanding of the global context of the actual refugee crisis 2) Identify and respond to refugee health challenges 3) Provide guidance through health systems. 4) Adjust to trans-cultural communication. 5) Extrapolate from the current crisis, measures for other populations in need in their environment. 2

3 Global context of the actual refugee crisis 1. Refugees in the 21th century 2. War in Syria 3. Impact on populations 4. IDP, refugees, immigrant 5. In Canada 3

4 Refugees in the 20th century Vietnamese refugees in Canada 4

5 Refugees in the 21th century 5

6 Refugees in the 21th century 59.5 million displaced people 19.5 million refugees 38.2 million internally displaced persons (IDP) 1.8 million de of asylum seekers o 3,740 lost lives crossing the Mediterranea in 2016 o One death for every 88 arrivals 2015: crossing and deaths 2016 Oct 25th: crossing and deaths Oct Alan Kurdi 6

7 Refugees in the 21th century Displaced from: Iraq, South Soudan, Syria, Central African Republic, Somalia, Eritrea, Afghanistan, Pakistan, DRC To : Turkey, Lebanon, Jordan, Iraq, Pakistan, Kenya, Europe(Germany) 7

8 2011, Arab Spring Tunisia, (January 2011) Egypt Lybia Yemen Syria 8

9 Syria: Since 2011 Demonstration, repression, uprising, more repression (March 2011) Civil war (2012) (Sunni, Shia, Alawite) Massacres of civilians, bombing and war crimes Nerve gas attacks (August 2013) Rise of ISIS (June 2014) Wars within the war US-led coalition air strikes (2014) Massacres of Yazidis men, slavery for Yazidis women( 2014) Russian bombardments (2015) Refugee crisis in Europe (2015) Siege of Aleppo (2016) Bachar Al Assad still in power More and more refugee 9

10 How many Syrian refugee? affected (pre-war population 22 millions) registrated Syrian refugees o in camp o outside camps UNICEFSyriaCrisisSituationReport_September2016FINAL.pdf 10

11 How many newcomers in Canada? Immigrants : 260,404 in 2014 Economics immigration 66.6% Family reunion % Refugees % Others % 11

12 How many Syrian refugees in Canada? 17,627 gov. assisted refugee 3,445 blend visa office referred refugee 33,723 privately sponsored refugee Total : Syrian refugees [Nov 4, Oct 30, 2016] 12

13 Sponsoring a refugee? The Private Sponsorship of Refugees Program helps thousands of refugees every year. Family, Group of 5, Cultural community Can sponsor refugees who qualify to come to Canada. Sponsor must provide financial and emotional support. This includes help for housing, clothing and food. Most sponsorships last for one year, but some for up to three years. Refugees must qualify for entry under Canada s laws and must pass medical and security checks before they can come to Canada. 13

14 Interim Federal Health Program (IFHP) Programme fédéral de santé intérimaire (PFSI) Basic coverage Similar to health-care coverage from provincial plans In-patient and out-patient hospital Medical doctors, registered nurses and other health-care professionals, including pre- and post-natal care Laboratory, diagnostic and ambulance services 14

15 How many Syrian refugees in? Iraq Jordan Lebanon Turkey Europe

16 Refugee health : Usefull tools

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21 What else? Dental care Contraception Strongyloides stercoralis serology Diabetes High blood pressure Alcool, drugs, anxiety, mood disorder Healthy lifestyle 21

22 Post Traumatic Stress Disorder DSM-5 Exposure to actual or threatened death, serious injury or sexual violation Directly Witnesses Learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental); or Experiences first-hand repeated or extreme exposure to aversive details of the traumatic event Impact: Distress or impairment Re-experiencing, avoidance, negative cognitions and mood, and arousal. Arousal; aggressive, reckless or self-destructive behavior, sleep disturbances, hypervigilance or related problems 22

23 Post Traumatic Stress Disorder Symptoms Dissociation Flashback Anxiety Impact on daily life and family Mood an affect regulator usage: Healthy vs Unhealthy 23

24 Trauma awareness 24

25 Refugees health need Safety Access to health care Housing Jobs Schools Social integration Interdisciplinary team work Trans cultural approach 25

26 Adjust to trans-cultural communication Listen slowly, talk slowlier Listen to body language Work with a language interpreter 26

27 Be a family physician Establish a relationship Allow the patient to help you in the interpretation of symptoms Respected cultural differences Be aware of high possibility of traumatic experiences Be an advocate 27

28 Be a family physician Extrapolate from the current situation, measures for other populations in need in your environment. 28

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