DIFFERENT APPROACH for DIFFERENT PEOPLE. Giorgio Monti Bologna, June

Transcription

1 DIFFERENT APPROACH for DIFFERENT PEOPLE Giorgio Monti Bologna, June

2 Why? Emergency Physician, Internal Medicine Departement of Emergency University Hospital

3 WHO? MIGRANTS

4 Article 25 Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family Paris, December 10, 1948

5 WHO? Migrants seasonal workers, sex workers, migrants on landings, unaccompained minors, people affected by natural disasters, Romani people, people in need REFUGEES, PEOPLE IN REFUGEE-LIKE SITUATIONS, ASYLUMSEEKERS, INTERNALLY DISPLACED, STATELESS Maghreb Sub-Saharan Afghans Chinese Pakistani Syrians east European Iraqis

6 HOW? DIFFICULT CHALLENGE different cultural sensitivity Strange and neglected diseases different needs Language

7 SO?... I do not have great truths to be revealed, but feelings and reflections made on personal experiences

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10 Kenya well organized Country educated population POINT OF ARRIVAL OF MIGRANTS

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16 South Sudan new country long war RETURN POPULATION resumption of fighting POVERTY Reassesment of healthcare system

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21 Founded in Italy in Organization recognized in Italy, UK, USA, Japan and Switzerland. UN partner (DPI / NGO).

22 EMERGENCY / Intervention criteria According to local health authorities, but independent and neutral. Guidelines and standardized protocols for situations with limited resources. Reliable and essential.technologies

23 EMERGENCY / how Assess the health needs Propose an intervention to local communities Design, build and operate in long time Take care of all solely on the basis of needs High standards in the training of local staff

24 BACKGROUND Poverty Civilian war victims Lack of local staff specialized Lack of facilities of high standard and free Lack of effective interventions in the long time

25 BACKGROUND

26 PROJECTS

27 Internal medicine Primary Health Care Obstetrics and Gynecology Paediatrics

28 Surgery Traumatology

29 Infectious D Tropical Medicine

30 Health Promotion programme IDPs Refugees Camps Welfare orientation

31 High standard facilities Design, build and operate in long time

32 EDUCATION S E S R U O C B O J ON

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34 Sudan long war return population resumption of fighting Poverty TRANSIENT POPULATION

35 EMERGENCY IN AFRICA 3 sale operatorie

36 EMERGENCY IN AFRICA terapia intensiva

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39 PAEDIATRIC CENTRE MAYO ANGOLA CAMP inhabitants over half< 14 years 20 tribes

40 PAEDIATRIC CENTRE MAYO LOCALE/INT STAFF 24/1 BEDS 6

41 AFGHANISTAN inhabitants

42 AFGHANISTAN Victims of long war corruption Poverty ongoing attempt to leave the country to reach Europe THE CONDITION OF WOMEN

43 AFGHANISTAN KABUL PANJSHIR LASHKARGAH

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46 EMERGENCY IN AFRICA GRAZIE

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50 Central African Republic coup d'etat THEN religious conflict ongoing attempt to leave the country to reach France

51 Central African Republic inhabitants development Index 180 /186

52 Hospitals

53 Clinique Pédiatrique Bangui CAR march 2009

54 Chambre admissions %<5aa Severe malaria 75% mortality 7%

55 The coup

56 The coup

57 closed hospitals open problems

58 people closed hospitals open problems

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60 Sierra Leone Already long war badly organized nation then EBOLA FEAR Hard to escape to the Europe

61 December 2013: where it all started

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63 HEALTHCARE ABSENT

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66 against EBOLA IDENTIFYING, ISOLATING AND HEAL THE SICK OF EBOLA IT IS THE BEST WAY TO STOP THE SPREAD OF THE VIRUS

67 against EBOLA

68 EMERGENCY - Iraq Since 1995, treated over 500,000

69 IRAQ Already long war then ISIS KURDISTAN Refugees / displaced attempt to reach Europe

70 THE HUMANITARIAN CRISIS 1.8 million internally displaced IDP 1.7 million civilians in areas under control of armed groups 1.5 million of 'host community'

71 KURDISTAN

72 ISIS Summer 2014: ISIS takes Mosul ISIS and new "Sunnistan" between Iraq and Syria Peshmerga and the international coalition

73 more than 2 million IDP and refugees REFUGEES, PEOPLE IN REFUGEE-LIKE SITUATIONS, ASYLUM-SEEKERS, INTERNALLY DISPLACED, STATELESS

74 What we found

75 What we found

76 The clinic in the Arbat Iraqi IDP camp is cofunded by WHO he clinic in the Arbat Syrian refugee camp is cofunded by UNHCR

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78 Camp Clinic

79 Camp clinic The illnesses amongst people living there are mainly the consequence of their living conditions

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81 SERBIA The edge of Europe accommodate the shift to reach Europe DIFFERENT KNOWLEDGE SYRIAN AFGHANS

82 Zlatibor Lončar

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87 Outpatient clinics Castel Volturno / Mobile unit Bologna / Mobile unit Palermo Marghera Polistena (Rc) Castel Volturno (Ce) Napoli Sassari Landings Rec. Center Siracusa / Ex Umberto I Augusta / Harbour Agrigento / Villa Sikania Siculiana Catania / Harbour Mobile clinics Polibus Minivan Politruck

88 Article 32 - Constitution of the Italian Republic The Republic safeguards health as a fundamental right of the individual and as a collective interest, and guarantees free medical care to the indigent. [...]

89 Who? Migrants, seasonal workers, sex workers, migrants on landings, unaccompained minors, people affected by natural disasters, Romani people, people in need

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91 YEAR 2015 MAIN COUNTRY OF ORIGIN LANDINGS IN AUGUSTA Data courtesy of Prefecture of Siracusa

92 Where? Outpatient clinics (Project coordinator, cultural mediators, dental assistants Volunteer nurses and doctors. Non medical volunteers) Mobile clinics (Project coordinator, cultural mediators, nurses, doctors Volunteers)

93 Marghera (Ve), Outpatient clinic

94 Puglia, Minivan Seasonal workers

95 Landings

96 Unaccompanied Minor Center

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98 MAIN MEDICAL ACTIVITIES OF PROGRAMMA ITALIA

99 Overall diagnoses PI

100 Good Practices Basic medical services respond to a fundamental right of individuals and reduce the need for referral to secondary care, consequently reducing the costs for the NHS. i.e.: Mobile Clinics Consultation outcomes: 10% of patients sent to second level consultations at NHS 0,7% of patients referred to NHS Emergency Dept 0,1% of patients sent to NHS through the NHS Emergency number Cultural mediators are essential as permanent staff of the NHS to facilitate the access to healthcare services

101 Most of the people arriving in Italy is basically healthy. «HEALTHY MIGRANT EFFECT» a form of self selection based on migration of only those in good health. Health and diseases of migrants. Critical areas and areas of ambiguity. di Aldo Morrone* * Responsible of Service of Preventive Medicine of Migration, Tourism and Tropical Dermatology Scientific Institute San Gallicano (IRCCS) in Rome

102 the "Real health" in supplied to migrants is, more or less, rapidly consumed the average time that elapses from the arrival in Italy to the first visit to a doctor's office - varies on average from 8 to 10 months (Rome) to days (Genoa) RISK FACTORS The lack of work and income Employment in hazardous work and unprotected Degradation living in a context different from the country of origin The absence of family support The climate and the different dietary habits, which often are added to a condition of compromised nutritional status Discrimination in access to health services

103 Migrations routes and death tolls in Mediterranean sea Fonte:

104 6th June 2016 EMERGENCY & MOAS Migrant Offshore Aid Station partner up to provide rescue and medical care to migrants in the Mediterranean A joint operation aboard the Topaz Responder, a search and rescue vessel which will patrol the world's deadliest migrant crossing: the central Mediterranean. MOAS' Responder is 52 metres long, equipped with two highspeed rescue boats, a 20-strong professional crew of seafarers, rescuers, doctors and nurses as well as a fully-stocked clinic to provide emergency search, rescue and medical care.

105 MOBILE UNIT in Bologna for social-medical orientation and counselling Since August 2015 services to people who have difficulties in accessing healthcare. mediator and a nurse to help people access or the National Health Service in the suburbs of the city and near the station. monitor the territory to identify pockets of need or cases in which people's rights are not being enforced, where they intervene and work together with the local institutions and associations. free of charge

106 therefore Healthcare in the age of large migrations. there is no magic bullet, there isn t a safe and easy approach;

107 therefore Healthcare in the age of large migrations. It is a complex process in a continuous becoming we need the support of NGOs the NHS and international organizations that should prompt us to a constant effort to know more and more

108 therefore Healthcare in the age of large migrations. to provide operators with "hands on" cultural and practical tools efficient and effective to ensure that those involved in public health will always consider it a top priority

109 "Our concern is not with philanthropy but right, and in this context the right of an alien not to be treated as an enemy upon arrival in another's country...the right to visit, to associate, belongs to all by virtue of their common ownership of the earth's surface...since the earth is a globe [human beings] cannot scatter themselves infinitely across it, but must, finally tolerate living in close proximity, because originally no-one had a greater right to any region of the earth than any other". Immanuel Kant, Zum ewigen Frieden Perpetual peace (1795)

110 THANK YOU