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Briefing: Complex health problems

Briefing with the Head of Department
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Well, I am just coming from seeing a patient. She is an elderly lady from somewhere in West Africa, perhaps Nigeria, we don’t exactly know. And I was treating her for about three to four months. She initially presented herself with headache and some pain which was just wandering around in the body, in the shoulders, in the back. It was quite difficult to really pinpoint any organ or disease. So the description of the pain triggered a lot of examinations. And if you want to be really diligent in your medical work up you have to start with physical examination, laboratory examination, then perhaps a CT scan and so on.
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So, you have a long list of examinations which are needed to work up the case. At the end, it was just an unspecific pain, perhaps a bit of hypertension which is quite common in West Africans but the presentation of her complaints changed from time to time. So at each visit it was somehow different which shows us that there is a lot of suffering on the side of the patient but our medical system doesn’t really fit to the needs. When I dealt for the first time with asylum seekers and migrants, I thought being a tropical doctor and specialist in infectious diseases and in tropical medicine would qualify me for this kind of work.
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I thought coming from the tropics they are prone to have all kinds of parasitic diseases and infectious diseases. But in fact, I was wrong. In reality, the patients are suffering from a wide range of problems and tropical diseases are just a small part. And especially if they are on the way to Europe for a long time, many of the tropical diseases are just no longer there. They get other kinds of illnesses and problems. The main reality in medical work with asylum seekers who stay in this country for a longer time are psychosomatic or psychiatric disorders and post-traumatic stress disorder.
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All the problems they have from the surroundings from the reality of their life and the insecurity of their future, and the worries they have for their family members at home - all this contributes to a long list of somatic problems but the core is somewhere else. And if we want to address these problems by one (technical) examination after the other, we might lose track of the real problem. On the other hand, there are somatic diseases which need to be diagnosed and need to be addressed and so of course proper examination and a proper health care system is urgently needed. But doctors who are treating refugee patients, they need to know their job.
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They need to know the range of differential diagnosis. They need to include exotic diseases on one hand but also all the sequelae of the mental problems and the mental health issues that asylum seekers carry with them. And this makes this kind of work so difficult, there cannot be a single specialist who covers this field of migrant health from one side to the other. So, we have to work as a team. We have to distribute our tasks according to the capacities and specialties of each individual team member. And we have to find ways to communicate best with each other in the team, in order to provide the best kind of health care for the patients.
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And what is happening in Germany with the legislation we have, which is getting sharper and sharper by the day, is that we wait until asylum seekers are really terribly sick, have life threatening conditions and only then we start providing some health care. The contrary should be done; we should have a very low threshold of access to health care in order to avoid any deterioration in the future.

Sarah thinks: “Finally it´s here, my first day in the Refugee health team in the Department of Tropical Medicine, I´m so excited. I´m glad that the Head of Department has a few minutes for me for a briefing after having seen his first patient.”

The Refugee Health team consists of nurses, general practitioners, pediatricians, infectious disease specialists and an obstetrician/gynecologist. Please click on the video above to meet the Head of Department and listen to what he has to say about the complexity of health problems that patients with a refugee and asylum seeker background may suffer from.

In the next step you can find information on the right to health and health care for refugees and asylum seekers.

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