Migration Roundtable, CISTM 2019 Charge to Panelists…. 1) From the perspective of your organization identify the gaps in knowledge/practice/or guidelines in healthcare for migrants that should be priorities for Migration Health Roundtable ISTM and how they can support the WHO GAP. 2) Identify and discuss strategic concrete actions that Lessons Learned and Moving Forward ISTM can do as an organization as well as in partnership with your organization and other key CISTM 2019 migrant health stakeholder organizations to support Washington, DC the implementation of the WHO GAP June 7,2019 •to promote migrant health Patricia Walker, MD, DTM&H, FASTMH •to contribute to the migrant health scientific evidence base. Professor of Medicine, University of Minnesota 1 2 2 perspectives… Priorities of the Global Action Plan Lessons from a US domestic refugee clinic Priority 1. Reduce mortality and morbidity among refugees and • migrants through short- and long-term health interventions Priority 2. Promote continuity and quality of care , while developing, • • HealthPartners reinforcing and implementing occupational health and safety mea sures Center for Priority 3 . Advocate mainstreaming refugee and migrant-sensitive • International Health health policies , legal and social protection , and gender equality , including interventions to protect and improve the health and well- (USA/Minnesota) being of women, children and adolescents living in refugee and migrant settings ; and promote partnership and intersectoral, • Established in 1980 intercountry and interagency coordination and collaboration mechanism in global, regional and country agendas • 39 years of caring for Priority 4 . Enhance the capacity to tackle the social determinants of • health and accelerate progress towards achieving the Sustainable refugees Development Goals , including Universal Health Coverage Priority 5. Support measures to improve communication and domestically…. • counter xenophobia Priority 6 . Strengthen health monitoring and health information • systems 3 4 The “International”ASTMH ASTMH Mission Founded in 1903, ASTMH is “…We accomplish this through generating the largest international and sharing scientific evidence, informing scientific organization of health policies and practices, fostering experts dedicated to career development, recognizing excellence reducing the worldwide and advocating for investment in tropical burden of tropical infectious diseases and improving medicine/global health research.” global health. 5 6 1
Gaps in knowledge/practice/guidelines ISTM could… Partner with other organizations to help: Many receiving countries have international and 1) Raise knowledge about the existence of clinical resources domestic screening guidelines, but ….. 2) Help raise the expectation that providers refer to those These often are applicable to refugees, and may not be resources, or refer migrants to those with expertise in applicable to other migrants or VFR travelers the field (ie – remind PCPs that there is a body of Specific areas need further guidelines, and some knowledge in the field!) countries are in the process of writing them ie US CDC Refugee Centers of Excellence working on: Screening for cancer in migrants Thus supporting the Global Action Plan….. Women’s health guidelines Priority 1. Reduce mortality and morbidity LGBTQI migrant guidelines Priority 2. Promote continuity and quality of care Improved mental health screening guidelines 7 8 Mammogram screening disparity Gaps in practice regarding migrant by US vs foreign born health research in receiving countries HealthPartners • Data gets buried in less than useful race categories 6.5% • Demographic data sets should include country of 10.5% origin 21.4% • Key quality measures should be analyzed by country of origin as well as other usual measures, to create a “health disparities report card” 9 10 Gaps in knowledge regarding health care for ISTM (and others) could… migrants….(receiving countries) Those who perhaps provide the MOST care for migrants Encourage research projects which utilize (primary care providers) have large gaps in their clinical country of origin as one key demographic knowledge; just some examples: measure Lack of knowledge of the existence of guidelines Advocate with your health care system and Lack of knowledge of geography, history, culture and public health agencies to collect country of origin language, and it’s relationship to health routinely (10-15% or less of US health care Late diagnoses of active TB system collect this data routinely, and it takes a Missed opportunities to diagnose and treat strongyloides lot of work to engage an entire care system in Inadequate screening for chronic hepatitis B this system wide change…) Less than high quality care for chronic diseases and mental health issues Thus supporting the Global Action Plan….. Lack of understanding about how to set up a high functioning clinic system for refugee Priority 2. Promote continuity and quality of care 11 12 2
Draft Proposal On line “mini medical school” for the public on ISTM could….. Human Migration and Migration Health Guiding belief: • Partner with other groups to produce and disseminate educational materials for primary The public discourse on migrants does not reflect our care and other providers on migrant health innate human capacity for empathy and compassion. Dispelling myths about migrants and migration health • Partner with other groups to produce a “mini can help tap in to innate human values, and help shape medical school” for the public regarding discourse nationally and internationally. Physicians and migrant health… (“medical school for the other providers in migration medicine should advocate for public” being something which is of great refugees and migrants not just with peers, but also with interest to the general population) the public and politicians. The public is interested in learning more about migration. PFW 13 14 Draft Proposal Draft Proposal On line “mini medical school” for the public on On line “mini medical school” for the public on Human Migration and Migration Health Human Migration and Migration Health Product: On line, open access short course with the following Purpose: Educate the public about human migration and characteristics: migration health, with the following goals: Total length of course: 4 hours, 24 talks 10 minute “TED talk” format Acknowledge human migration as normal, inevitable Each talk must include at some point, the voice(s) of refugees and positive and/or other migrants Lecturers from all over the world Provide a historical and legal perspective on human Capacity to take core curriculum and translate it in to other migration and human rights languages with other speakers Reduce fear of migrants and migration Capacity to tailor and update the course to specific situations Dispel myths about refugees and migrants (selected examples: develop talks on history of the EU refugee Share the evidence basis for healthy migration crisis; situation in Germany, Greece; Italy; Canada; US; DR Offer resources to learn more about human migration Congo, Myanmar/Bangladesh; Syria/Jordan/Lebanon) PFW PFW 15 16 Draft Proposal Draft Proposal On line “mini medical school” for the public on On line “mini medical school” for the public on Human Migration and Migration Health Human Migration and Migration Health Potential topics: Potential topics: Definitions of refugee/asylee/IDPs Responding to refugees – public health perspective from Human migration by the numbers resettlement countries Modern international human rights law and history of the Geneva Responding to refugees – clinical perspective from resettlement Convention of 1951 countries Role of key actors – UN, governments, NGOs, public health Key health issues of migrants, (and how migration health can be authorities in each country, health care delivery system/clinics, examples of best practices):TB,HIV, intestinal parasites, vaccine others preventable diseases, malaria, NCDs, mental health, women’s Myths and realities of refugee situations – (including “camp” vs health urban refugees, long term nature of crises, need for schooling, What migrants bring to their new countries – ( cultural, income strategies, etc.) intellectual, economic and other benefits) Responding to refugees and IDP crises – perspective from the Refugee voices (many potential topics – family, culture, art, UN/IOM/MSF and others literature, economic hopes and successes, etc) Etc! PFW PFW 17 18 3
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