migrant-health

My family is not one to talk about our feelings or problems, let alone trauma. We haven’t sat around the family dinner table unpacking the emotional weight of seeing everyone you love die and your surroundings entirely collapse before your eyes. How do you even begin to heal when you’re thrust onto a plane to Europe, America, or Australia only to find yourself dealing with anti-blackness from the state?
"Do or die" for migrant health

There’s a prominent and growing gap in access to affordable, quality, and culturally relevant healthcare for migrants and refugees in Australia. Because of this, they hold off on seeking help until it’s too late, resulting in higher costs for everyone involved. This quickly escalates into a lose-lose situation; the migrants are extremely sick and are therefore an even larger burden on the public healthcare system. 

World Wellness Group is a not for profit started by a group of professional healthcare practitioners striving to address health inequality in Brisbane. Last year, they launched the World Wellness Clinic, a makeshift operation that they set up with no financial support at the Brisbane Multicultural Centre. They have been operating there in two rooms rent free for the past year, but they have quickly outgrown their capacity and need to set up something larger and more permanent. 

World Wellness Group has tapped into an unmet need, but this means the demand is now exceeding their available resources. Just $60,000 will secure them rent for an entire year, in addition to allowing them to set up the administrative services necessary to support a much larger clinic. This will help accommodate the growing list of healthcare practitioners who want to join the center in providing services to migrant patients in need of support. It’s “do or die time” for the clinic and your help will mean contributing to the health of countless migrants in need.

_________________________________________________________

What good do you want to create? Visit StartSomeGood today to learn about how to start your own campaign.

straight.com
Fraser Valley hospitals revise policies to stop patient referrals to immigration police
Fraser Health Authority has said an article published by the Georgia Straight prompted the agency to instruct staff to stop referring immigration cases to border police.

One of the region’s largest health-care providers wants undocumented immigrants to know they can visit its hospitals and clinics without fear of deportation.

The issue became a concern for some people living in the Fraser Valley over the course of 2015. An increasing number of anecdotal reports suggested staff at Fraser Health Authority’s 12 hospitals, which include facilities in Burnaby, Surrey, New Westminster, Coquitlam, and Langley, were referring patients to Canada Border Services Agency (CBSA).

Then, as the Straight reported last December, information obtained via a freedom-of-information request confirmed that over roughly the preceding two years, Fraser Health had referred approximately 500 patients to CBSA, resulting in an unknown number of immigration investigations and deportations.

Interviewed for that article, Fraser Health spokesperson Tasleem Juma acknowledged patients’ concerns but maintained Fraser Health sometimes has to contact CBSA for billing purposes. She explained that nonresidents of Canada are charged different rates from residents, and sometimes a call to CBSA is required to confirm a patient’s status.

Now, Fraser Health has said it has revised its policies on CBSA referrals and has instructed staff to stop contacting immigration police unless they have a patient’s explicit consent.

The news came somewhat quietly, via a March 15 comment posted by the health authority’s official Facebook account.

“Since mid-January 2016, our staff have not contacted CBSA without the consent of the patients involved,” it reads. “Patient care is our first priority. The ability for a patient to pay does not delay care when they arrive at our Emergency departments.”

The comment goes on to give credit to the Georgia Straight for prompting reforms.

“Following the article in the Georgia Straight, we have reviewed and changed our processes,” it reads.

A subsequent comment attributed to Fraser Health CEO Michael Marchbank(confirmed by the Straight as authentic) provides further details.

“Since mid-January, we have instituted a process whereby our staff will not contact CBSA without the consent of the patient involved,” it reads. “We have informed all relevant staff to follow this process, and we are further communicating this to all of our acute care facilities.

“We understand how difficult it can be for individuals without health insurance to pay for the care they receive at our hospitals,” Marchbank’s comment continues. “Patient care is always of paramount importance to us. The ability for a patient to pay does not delay care when they present at our Emergency departments.”

The messages from Fraser Health officials were posted on Facebook in response to the announcement of a protest against Fraser Health’s old policies that was planned for March 21.

Byron Cruz is an immigration activist with Sanctuary Health, the group that organized that event (which is still on and scheduled to discuss a number of related issues such aspolice and RCMP relations with CBSA). In a telephone interview, Cruz called the Fraser Health announcement “great news”, but also noted it appears to pertain to process, as opposed to policies.

“We really appreciate that they are doing this,” he continued. “We still need to sit and discuss changes in policy….But it’s great news.”

Vancouver Coastal Health, which operates Vancouver General Hospital and many facilities outside the Fraser Valley, implemented similar reforms in August 2015. Since then, its staff also require a patient’s permission before placing a call to CBSA.

If a patient refuses to give permission, and residency status cannot be confirmed for billing purposes, the patient will be charged the higher rates of a non-Canadian resident.

i did poorly on all my homework

but i persevered and finished it. 

now, its Delores Huerta day. 

if anyone has any burning questions related to community health, migrant health, social movements and Delores Huerta, i’ll be happy to pass them on. 

it doesn’t seem fair. this school is so elitist they better be paying her a lot. my mentor told me to think of it that way, because i was like its not fair. i invited some community clinic people. i’m going to be working in a clinic soon, a community sponsored migrant health clinic. its grant funded from the university and other places i guess, so we won’t be needing ID’s or insurance or anything, which is sweeeet. but i guess we’ll only be running it once a month. blagh. that means the waiting list will be huge and affects minimal. but i’m excited to be back on the clinic scene, i’m tired of watching people on campus walk around like they’re special. 

off to use the free printing that they only have on my (new) part of campus, seriously  the sciences and medical schools are so privileged. my broke ass women and gender study majoring undergraduate ass could of used some free printing. damn. 

Victor Vinnetou has been held by Canada Border Services Agency for 11 years. The detainee is believed to be the missing South African anti-apartheid icon Mbuyisa Makhubu. Canadian authorities cannot positively identify him.

  • Canada regularly breaches international human rights obligations by routinely detaining migrants with mental health issues in maximum-security jails — sometimes for years, says a hard-hitting new study.
  • Calling the country’s immigration detention system “a legal black hole,” University of Toronto law school researchers said there are no established criteria in law to determine when a detainee can or should be transferred from an immigration holding centre to a provincial jail.
  • “Canada’s detention review regime creates an effective presumption against release, while judicial review of detention decisions is largely ineffectual,” said the study by the law school’s International Human Rights Program, to be released Thursday.
  • “In some cases, the end result is long-term detention that is, in practice, preventative and indefinite.”
  • The 129-page report was the result of 10 months of field work and research that included dozens of interviews with lawyers, correctional staff, a former border agency director, doctors, mental health experts, former and current detainees as well as data obtained under government access to information requests.
  • Its release comes just a week after an “agitated” 39-year-old immigration detainee was restrained and died in a Peterborough hospital after he was transferred from the Central East Correctional Centre in Lindsay.
  • It also followed the high-profile death of Mexican detainee Lucia Vega Jimenez, who committed suicide while in detention in Vancouver.
  • According to the U of T study, more than 7,300 migrants — 60 per cent of them in Ontario — were detained by Canada Border Service Agency in 2013, the latest statistics available; nearly one-third of them were held in provincial prisons intended for the criminal population.
  • The rest were detained at dedicated immigration holding centres in Toronto (195 beds), Montreal (150 beds) and Vancouver (24 beds for short stays of less than 72 hours).
  • “Some detainees have no past criminal record, but are detained on the basis that they are a flight risk, or because their identity cannot be confirmed … Some spend more time in jail on account of their immigration status than the underlying criminal conviction,” said the study authored by researchers, Hanna Gros and Paloma van Groll.
  • “Counsel and jail staff we spoke to noted that migrants are often held in provincial jails on the basis of pre-existing mental health issues (including suicidal ideation), medical issues or because they are deemed ‘problematic’ or unco-operative by CBSA.”
  • Gros and van Groll cited a 2013 study by McGill University psychologist Janet Cleveland, who found a third of immigration detainees had clinical post-traumatic-stress disorder after an average 31 days in detention; two-thirds were clinically anxious and more than 75 per cent were depressed.“Once a detainee finds him or herself in provincial jail, they fall into a legal black hole where neither CBSA nor the provincial jail has clear authority over their conditions of confinement. This is especially problematic since in Ontario at least, there is no regular, independent monitoring of provincial jails,” said the U of T study.“Detention in a provincial jail, even for a short period, exacerbated their mental health issues, or created new ones.”The study also argued the arbitrariness of the Immigration and Refugee Board’s decision to release or detain an individual, citing the wide range of the rate of release across Canada. In Ontario, for example, the release rate was only 10 per cent in 2013, compared to 38 per cent in the western region that covers British Columbia.

(via Canada’s immigration detention system breaches human rights, U of T study says | Toronto Star)

news.vice.com
The Mental Health Crisis Facing Europe's Refugees

When a young Kurdish man hosted in a temporary reception center in Milan started swiping through some pictures on his phone, one of the center’s staff members was shocked by what he saw. An image of a man hanging by his neck appeared on the screen. “This is my friend,” said the Kurd, with apathy in his voice.

“They hanged him just because he was Kurdish,” recalls Massimo Chiodini, the coordinator of the center’s temporary shelter program. Two days later, the man tried unsuccessfully to take his life, jumping out of the window of his room on the second floor of the center.

He had fled Iraq. But he could not run away from the unbearable burden of the violence he had witnessed.

Be it a treacherous journey through the Mediterranean on flimsy boats or dodging border patrols, teargas canisters and water cannons in a desperate trek across the Balkans, the migrants’ path to Europe is not just a threat to physical integrity. Mental health is at stake too.

At the beginning of September, the German Chamber of Psychotherapists warned authorities that at least half of the refugees arriving in Germany are suffering from trauma-related mental issues, with more than 70 percent of refugees having witnessed violence and around 50 percent having directly experienced it.

Forty per cent of refugee children evaluated in the study had witnessed violence, the chamber’s president Dietrich Munz told a press conference. Around a quarter “had to watch family members being attacked,” he said.

The United Nations High Committee for Refugees (UNHCR) warned in 2013 that 21.6 percent of Syrians in a refugee camp in Jordan were suffering from anxiety disorders, while 8.5 percent had PTSD.

For Munz, all the symptoms of Post-traumatic Stress Disorder (PTSD) are often present in refugees, who suffer nightmares and flashbacks. He called for more efficient treatment of mentally vulnerable people among refugees; a treatment that cannot solely rely on drugs.

At one clinic in Italy, a country at the forefront of Europe’s migrant influx, doctors are doing just that. In Milan, a small psychiatric clinic is providing support to the “psychologically vulnerable individuals” — a bureaucratic umbrella term for traumatized migrants.

“Let me get this straight,” Marzia Marzagalia, a kind, soft-spoken psychiatrist specialized in treating victims of torture, told VICE News. “[The migration crisis] is not an emergency anymore. 130,000 people arriving in Italy over ten months is not an emergency. It is a steady migration phenomenon. [The migrants’ mental health] is another, far more real, emergency we are trying to deal with here.”

The clinic opened in 2003. Then, the majority of the people coming to Italy were economic migrants fleeing African countries and the aftermath of the Balkan war, attracted by the idea of improving their living standards. But migration flows into Europe radically changed over the years. Survival is now the primal urge.

“Since 2011, people have been running for their lives. They flee persecution, rape and torture. They face a deadly journey to Europe as the only alternative,” said Marzagalia.

The blossoming and the withering of the Arab Spring, with Libya and Syria descending into mayhem and the so-called Islamic State taking control of large swathes of Iraq, migrants are at far more risk of PTSD.

“They are extremely exposed to a countless number of traumatic experiences,” she explained. Trauma related symptoms are not hard to spot, said Marzagalia. “We are talking about physical symptoms such as intense stomach-aches, extreme mental and physical fatigue, and insomnia. In more severe cases we also deal with flashbacks, anxiety crises, dissociative episodes and hallucinations.”

The clinic works closely with the reception centers hosting refugees and migrants that have made it to Italy and are aiming to continue their journey towards northern Europe. Social workers at the centers flag concerning behavior to the clinic, if they spot it.

Over the years, Marzagalia has seen many such cases. “This patient from Cameroon had flashbacks. He was basically reliving the moments when he was tortured, over and over again,” she said.

PTSD is typically associated with war veterans, who often have intense flashbacks resulting from prolonged exposure to traumatic experiences on the battlefield. Having a flashback means being thrown back to a specific traumatic moment.

“He had a particularly intense flashback with a violent outburst. He tore his room apart,” Marzagalia remembers. “He thought he was possessed by a demon, when I saw him for the first time.”

Unlike the Kurdish man who tried to take his life, he was taken to the clinic before things could get worse. He started psychotherapy soon after. He managed to control the flashbacks and overcome his trauma.

When talking to Marzagalia about the cases she has seen, it is clear she is withholding most of the details. The intention is protecting her patients, whose recovery is still uncertain. Scars take time to heal.

However, VICE News did learn the story of R., a gay man from Uganda. Last year, he fled the country, where he was being targeted because of his sexuality.

He had been forced to marry a woman and had a child with her. Disowned by his own parents when his wife left him, he was later harassed by the family of the man he’d had a relationship with. He was jailed for the crime of homosexual activities, and was savagely beaten in prison, before managing to escape.

“I can’t sleep at night. I wake up anguished,” he said, describing the nightmares and anxiety resulting from not just the physical but also the psychological violence he had experienced.

He said despite feeling a huge sense of freedom having made it to Italy, happiness was a long way off. “Nobody cares about my sexual choices [here],” he said. “But I keep telling myself I am selfish. I feel incredibly guilty and sad. I left my whole life behind, even my own son.”

Women can be subject to extra, gender-specific forms of trauma. Systematic rape is used in conflicts around the world as a weapon to terrorize civilian populations and destroy social fabrics, with women and girls most often the victims.

In March 2015, a United Nations Security Council report stated that sexual violence had been a characteristic of the Syrian civil war since its inception. According to the UN Population Fund, 38,000 people appealed to the United Nations for help following sexual assault and other gender-based violence in 2013 alone.

The Women Under Siege Project used a crowdsourced map to look at who were the victims and perpetrators of sexual violence during the first two years of the Syrian civil war from 2011 to 2013. Around 80 percent of the cases they documented involved the rape or assault of women and girls, and almost 90 percent of all the attacks were carried out by forces loyal to Bashar Al-Assad’s regime. According to WUSP, women and girls were often raped in front of their relatives.

Rape has also been rampant within the IS regime, whose members have captured and traded women and girls from the Yazidi religious minority, claiming rape of unbelievers is allowed and even encouraged by the Qu'ran.

“An appalling number of women that make it to Europe have suffered sexual violence back in their home countries or during their journey. The babies of those who give birth once en route or inside Europe are often conceived after rape,” said Marzagalia.

“According the Istanbul protocol (UN guidelines on torture), rape is torture. It leaves the same unspeakable traces in someone’s psyche.” The activity of the clinic in cases of sexual violence relies on the experience gained from the Bosnian war, during which an estimated 50,000 women were raped. This knowledge is now being used to treat rape survivors from the Middle East and Africa.

“We had an appalling case of this young African woman who was sold and traded as a sex slave throughout all her journey to Europe,” Marzagalia, cautious of protecting her patients, told VICE News. “She was so traumatized she lost the ability to speak.”

The woman managed to escape her kidnappers. Once she made it to Europe, aid workers flagged her status as “psychologically vulnerable” to the hospital. Many of the women that are being treated in Milan take months, if not years, to tell therapists about their story. According to Marzagalia, all the African woman could hear in her mind were the voices of the men who raped her: her torturers.

“It took months before we could convince her that she was safe here and nobody would have come and taken her away,” she said. Even those not affected by PTSD or other mental health conditions when they first arrive may later be affected by post-settlement trauma, once they are attempting to start a new life.

“What if you risked your life to flee your country to reach Europe and you suddenly found out that Europe was just a huge lie, a mirage?” asked Marzagalia. Sometimes the worst part of the journey is realizing Europe is not the place where dreams come true. “How can you cope with the fact that in Syria you were a well-respected journalist for a national daily and, here, you end up washing dishes for a living because you don’t have the right to work?” said the doctor. “How can you explain to your family back in Uganda that no, you can’t send them money as you are not actually making any?”

This “resettlement crisis” is often made worse by the extremely long procedure to get refugee status. Long waiting lists leave many migrants in a limbo of unemployment and decaying self-esteem that can easily lead to depression and, “if your religion allows it, drug and alcohol abuse,” Marzagalia added.

Treating trauma-related vulnerabilities is gradually being recognized as a part of the action plan to cope with the current refugee crisis. Treating trauma is also a way to look at the migrants’ long-term future, beyond asylum requests.

Short-sighted solutions can be serious obstacles to psychological treatment of refugees. “We think that we should just give them food and a roof over their heads,” said Marzagalia. “But we have to look at the day refugees will go to their homes and start rebuilding, having overcome their traumas”

Aid workers are often not trained to spot PTSD symptoms. That means many traumatized migrants are not treated until something bad happens, said Marzagalia, which could make the problem much worse.  "If PTSD symptoms go unnoticed, a person could be [needlessly] hospitalized for life,“ she said.

Politics also plays a key role. The ethnopsychiatric clinic where Marzagalia works is part of one of the most well-known hospitals in Italy. Not naming the hospital in this piece was a condition for gaining access.

That hospital is overseen by the regional council of Lombardy, currently led by Italian right-wing party Northern League, whose anti-immigration stances have escalated in the last few months.

In a political landscape saturated with roaring slogans such as "Italians first,” or “Stop the Invasion,” providing support for migrants can make you unpopular.

While Europe is dealing with the most immediate aspects of the crisis — shelter and food — much more has to be done to support the scores of refugees streaming into Europe. In the words of Marzagalia, echoing Dietrich Munz: “It requires stepping up the game. But Europe is probably not yet ready.”

This past Thursday, on September 15, 2016, my practicum group and I went to Benson Area Medical Clinic to educate migrant workers on various health issues that are extremely prevalent in their population. Every Thursday night, from the months of April to October, physicians at this clinic discontinue seeing patients at 8 PM and begin seeing the migrant workers until all who have been scheduled, are seen. A majority of time, these migrant workers come to this clinic in groups; therefore, they must all leave together. For example, if twenty farmworkers are seen on one Thursday evening, they all come together on a bus and they all must leave together. During the time that each patient is getting seen, multiple workers are sitting in the waiting room. As a part of our public health practicum, we aim to educate these workers in health promotion.

The topics that are most prevalent in the farmworker community are high blood pressure, diabetes, heat stroke, green tobacco sickness, and oral health/hygiene. It was alarming to see that easily preventable diseases, such as gingivitis, were of major concern in these communities. Our practicum group made a poster board on the topic of heat stroke because we thought it was important that the farmworkers should get adequate hydration and layers of clothing in order to prevent fainting, nausea, dizziness, or altered mental state/behavior.

Upon arriving to the clinic, four workers greeted us as well as a few employees of the North Carolina Farmworkers Project, who help assist in transportation. We were made aware that three of the farmworkers that day had fainted due to heat stroke. Two were taken to local hospitals, and one had refused to go. It was shocking to learn that the issue we were going to talk about that evening hit so close to home. Although there was a language barrier in the room for some of our practicum group, there was a sense of comradery between us because we were all trying to accomplish the same goal: health prevention strategies.

Aside from discussing the ramifications of heat stroke, we also discussed the importance of oral health. Knowledge that is so routine to our practicum group, such as brushing your teeth twice a day or when to get a new toothbrush, is not well known among migrant workers. We created an interactive game called “cabbage,” or “repollo” in Spanish, which had different facts about the frequency of brushing teeth, and when to throw your toothbrush away. Our practicum wanted to educate these farmworkers on various ways to maintain optimal health, and the farmworkers were intrigued and involved in what we as students had to say. This made me feel like we were making a difference in our rural community. This direct impact is what I hope achieve as a public health leader and a physician assistant.

This past Sunday, September 18, 2016, our practicum group attended the 26th Annual Festival de los Trabadores del Campo. It was a festival dedicated to bringing farmworkers from various campsites together. There were soccer games between all campsites, delicious food derived from various countries, and different vendors ranging from jewelry makers to local health businesses who wanted to educate these farmworkers. Our practicum group set up a table near the Farmworkers Project tent and educated anyone willing to listen about the dangers of heat strokes. During our free time, we visited the Campbell University School of Medicine tent, where second year medical students were offering skeletal manipulations to alleviate pain and stress from farmworkers. This was a thoughtful idea because these men work incredibly long hours and deserved some rest and relaxation. This was beneficial for both the students and the workers.

After attending the festival, I realized the importance of having these events because they establish a sense of community. These men are away from their families for months at a time, and do not talk to their loved ones every day at times. This festival is so integral in keeping these men connected in order for them to feel at home even though they are not physically in the country they are originally from. Bringing together vendors from the local community for this celebration was amazing to witness.

Prior to my practicum, I had little to no idea that this community of farmworkers existed. I now notice vulnerable populations need to be addressed because the lack the opportunity that most of us are fortunate to have. In future activities for our practicum, we hope to educate more camps about health concerns and how to prevent disease. The necessity to address these health concerns in vulnerable populations is crucial because it will help accomplish the goals of public health: to promote health, to prevent disease and to enhance the quality of life for population health and individual health. #ThisIsCampbellPublicHealth