HPH TF MFH TF MFH Task Force on Migrant-Friendly Hospitals and Health Services REDUCING STRESS THROUGH MIGRANT FRIENDLY HEALTH CARE Antonio Chiarenza Regional HPH Network Emilia-Romagna AUSL di Reggio Emilia 21 st International HPH Conference Gothenburg, 22-24 May 2013 HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 1 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Challenges for the health system TF MFH IMPACT OF NEW MIGRATION ON WELFARE PROVISION HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 2 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Marked rise in migration TF MFH Total number of migrants in Europe, 1960-2010 80 70 Migrant stock (millions) 60 50 40 30 20 10 0 0 5 0 5 0 5 0 5 0 5 0 6 6 7 7 8 8 9 9 0 0 1 9 9 9 9 9 9 9 9 0 0 0 1 1 1 1 1 1 1 1 2 2 2 Year HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 3 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Diversification in countries of origin TF MFH “too many”, “too fast”, “to diverse” 1950-70s Large numbers from a few places to a few places 1980s onward small numbers from many places to many places NEW MIGRANTS ALONGSIDE LONG-STANDING ETHNIC GROUPS (Vertovec, 2012) HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 4 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Reggio Emilia TF MFH 13.6% of the population - non-national residents More than 140 nationalities Morocco; 14,7 Others; 25,2 Albania; 10,7 More than 200 Moldova; 4,2 India; 9,4 languages Tunisia; 4,3 Ghana; 4,3 China; 7,6 Ukrania; 5,7 Pakistan; 7 Romania; 6,9 HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 5 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Diversity and diversification TF MFH � Intra-group diversity : diversity within the same national or ethnic group. � Increased diversity: different ethnicity, migration category, legal status, language, gender, age, social status,..) � Different immigration status and legal status: • Economic migrants • Refugees • Spouses and family • Undocumented migrants • Asylum seekers • Unaccompanied minors • Involuntary migrants • Migrants held in reception • Students and detention centres HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 6 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Differentiation of rights and TF MFH complexity of regualtions Being migrant puts extraordinary stress on individuals and their families also in the health care system HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 7 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Barriers in migrant patient-provider TF MFH interaction produce stress � Language and communication barriers � Patients’ information and health literacy � Specific competence to respond to diversity � Organisation and service delivery barriers HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 8 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Language and communication TF MFH Language barriers have adverse effects on the quality and safety of treatment received and patient outcomes. � Clinical interviews can be misleading and only minimal medical information may be obtained. � Migrant patients may not understand explanations, and adherence to care might not be ensured. � At discharge migrant patient may leave not well informed regarding follow-up treatment and continuity of care Example: Migrants often report they don’t trust providers with their problems because of the difficulties expressing themselves to the medical profession. HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 9 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Interpreting error TF MFH As a result of an interpreting error, Willie’s brain hemorrhage was misdiagnosed and he was left quadriplegic. 18-year-old Willie Ramirez ate a fast food hamburger, he fell down unconscious and his Cuban family thought it was the hamburger that made him sick. They explained to the emergency room doctor that he was “ intoxicado ” which in Cuban Spanish means “ill due to something one ate.” The medical history was provided in a chaotic and confused manner with various family members using limited English to describe what happened. The teenage girlfriend mentioned that she and Willie had been arguing. The ER doctor pieced together a story that was completely wrong. He thought Willie was “intoxicated” – that he had taken an intentional drug overdose because he was upset about the fight with his girlfriend. HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 10 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Interpreting and intercultural mediation TF MFH � Eliciting patients’ information and medical history � Providing for information and explanation on diagnosis and treatment � Obtaining informed consent � Providing discharge information � Informing on health behaviours and life style HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 11 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Patients’ information and health literacy TF MFH Low level of patients’ health literacy has adverse effects on effective patient-provider cooperation; utilisation of information and participation in prevention and health promotion programmes. � Migrants have difficulty in understanding how the system works and in accessing information. � Written material only partially reach migrant patients if it is perceived as insensitive to their culture or literacy needs . � New arrivals have difficulty in locating and making sense of medical information and in navigating the needed services. Example: Migrants from outside the EU struggle to understand the registration process even if explained in their own language HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 12 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Information and Health Literacy interventions TF MFH � Use of Patient Navigators and Community Health Educators � Signage in different languages � Migrant-friendly food menus and spiritual support � Issue-focussed education programmes (e.g. pregnancy, child birth, cancer screening, diabetes,…) � Migrants’ involvement in the production of information material HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 13 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Intercultural competence TF MFH Low levels of intercultural competence have adverse effects on the ability of health staff to negotiate effective and safe treatment with the patient. � Health providers may not be able to effectively elicit patients’ explanation of illness. � Health providers may not be able to identify the patient’s needs according to individual and family characteristics, ideas, and situations. � Health providers may not be able to recognise the patient’s beliefs and behaviours; their own beliefs and behaviours may impact on effective care. Example: asylum seekers who had traumatic experiences say that doctors often don’t understand their explanation of symptoms. HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 14 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Health staff education & training TF MFH � To enable the patient to tell his/her story and explanation on illness. � To work across differences. � To invest in the relationship with the patient � To use the narrative medicine approach (learn from the patient). � To engage the patient in the co- production of the meaning of the illness experience. HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 15 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Organisation and service delivery barriers TF MFH Low level of adaptation to diversity of the health care organisation has adverse effects on effective access and utilisation of services. � Organisational policies and monitoring systems may not address the different needs of the population. � Health care delivery may not be appropriate to effectively respond to diversity. � Service availability and accessibility may not be able to respond to the needs of the most marginalised migrants. Example: Lack of specific services for Asylum Seekers; lack of health care for migrants who are ineligible or without insurance. HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES 16 REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA
Recommend
More recommend