Precautions when treating patients with potentially serious imported contagious diseases

I would like to tell you the story of a patient that arrived from an African country to Germany in order to seek asylum here. And the patient presented with a skin disease that led to sensitivity loss and resulting injuries like burns. He was not diagnosed in Germany and he did not receive any treatment. Because of family and friends in the Netherlands, he went to the Netherlands where he was diagnosed with leprosy and he was started on treatment. Then - because of the Dublin agreement - he was sent back to Germany where he lived in a small town in an asylum seekers camp.

There he went to the authorities in order to continue his treatment, but the people there instead of giving him the treatment and continuing it, they were scared because of the diagnosis of leprosy and started a big isolation and information campaign. They started to call us almost daily here in order to ask whether this patient could have infected the staff or other people in their small town. There was a big stigma attached to the disease. This patient, he was already on treatment for three months so there was no risk of transmission. We also talked to the authorities several times to tell them that there was no risk of infection but they still could not handle the situation.

We then hospitalized the patient here, started treatment again and tried to organize for him to move to a camp near here in Wuerzburg in order to keep him on treatment. That was a very difficult task with a lot of bureaucracy included and at the end we had to discharge him with no solution to this problem. So he went back to his town with his medication and well, now it is on us to call again and to see whether he still receives his medication, whether there is a follow up. And the authorities told us that there was at least no possibility in the next months, to transfer him to live in a camp in Wuerzburg.

And this is also a good example to see how the focus at the moment of health care for asylum seekers in Germany is almost exclusively on preventing transmission to German residents and not on individual health care. It is much more work to achieve equity for asylum seekers and refugees but it is worth it and we should go this extra mile to achieve it and to treat, cure and help them.