7+-+Refugee+Health+Moncton+Santé+Refugiés

= **Why work with Government-Assisted Refugees?** =

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Why Refugee Health Moncton Santé Refugiés?
In Moncton, MAGMA has had difficulty in finding family physicians willing to accept refugees as patients, resulting in emergency department visits for less urgent health concerns. There are currently only 2 family physicians who regularly accept Government-Assisted Refugees as clients.

In other Canadian cities, a program that provides initial health screening and history-taking, as well as a short introduction to the Canadian healthcare system, has resulted in more family physicians accepting refugees as clients. It has also decreased ER visits and helped refugees become more comfortable with accessing appropriate healthcare resources.

How the program will work:
Once you have completed this module and filled out the quiz and confidentiality agreement, I will keep your name on a list. MAGMA receives about 50-60 Government-Assisted Refugees per year, but they often only hear 2-3 weeks beforehand when they will arrive. Irina Raduly will contact me and I will email the group to ask who is available and what languages (French, English, other) are needed.

All meetings with clients will take place at MAGMA's offices at 150 Queen St, Moncton. If for some reason you have to cancel please call or email me ASAP at the addresses provided in my email to you.

**When you get there on the interview day:**

Find Irina or Joanne and your interviewing partner for the day. Irina or Joanne will provide you with the packages and introduce you to the client(s). The packages consist of:
 * Instructions for you
 * Education sheet
 * Cumulative Patient Profile
 * Questionnaire
 * Prevention Pages for Adults (Male or Female) and Children - take those needed for the individual/family you are interviewing

1. Introduce yourself, explain who you are, the purpose of the meeting, and that you have signed a confidentiality agreement. Explain that this means:
 * Once you are ready to start:**
 * The information they share with you will be recorded and stored in an secure area
 * You will not tell anyone about what is discussed at the visit except as needed to others involved in caring for their health
 * Mention that the information will only be accessible to Irina and to bring when going to the doctor or other health care professional

2. First work through the **Education** sheet:
 * Ask the family how they received needed medication in their home country
 * While going through the sheet take time to assess understanding (see the page on Cross-Cultural Communication for a refresher)
 * Once you have completed the sheet ask if they have any questions

3. Work through the **Cumulative Patient Profile** with each person:
 * Languages – List all other languages and check whether they can speak, write or understand
 * Immunization – Ask whether they have vaccination records with them
 * TB - ask if they have every had tuberculosis or a BCG vaccine
 * Personal History – Get some general details about the circumstances that led to their arrival in Canada. You do not need a very detailed description of this and be aware some may be hesitant to discuss this subject.
 * Past Medical History – ask the individual to recount all the times they have been in the hospital and why, also any major illnesses, injuries or disabilities they have experienced. Completing a thorough review of systems can be helpful for this.
 * Reproductive Health – can be a sensitive subject. Assess how much you can explore this topic (it may depend who the translator is and who you are interviewing together). Ask the women if:
 * They have any concerns or questions
 * <span style="display: block; font-family: Arial,Helvetica,sans-serif;">Previous pregnancies, how their health was during the pregnancies and any problems during delivery
 * <span style="display: block; font-family: Arial,Helvetica,sans-serif;">Previous contraception used, need for any currently
 * <span style="display: block; font-family: Arial,Helvetica,sans-serif;">Experience with Pap smears.
 * <span style="display: block; font-family: Arial,Helvetica,sans-serif;">Note: female circumcision and sexual abuse are seen often but are subjects likely best left for visits with their primary care provider
 * <span style="font-family: Arial,Helvetica,sans-serif;">Past health care system – Ask them to describe the healthcare system in their home country. Ask where they would have gone when they had a health complaint and what treatments they have used in the past (acupuncture, coining, traditional medicines, etc).
 * <span style="font-family: Arial,Helvetica,sans-serif;">Family history - Fairly self-explanatory. You may not be able to get much information for this section.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Nutrition/dietary – Ask if they have any dietary concerns and how they are adjusting to the food in Canada. Advise them that a lot of food in Canada is high in calories and that a healthy diet includes plenty of fruits, vegetables and whole grains.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Emotional – Tell the individuals that many people feel very happy when they first arrive in Canada. Tell them some people may feel sad for many reasons including missing their home country. Tell the families that if they begin to feel sad it is normal and it usually gets better with time. Also encourage them to talk to someone, especially if they are feeling sad for a long period. There are many people to talk and this includes doctors and other healthcare professionals.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Lifestyle - Ask about use and amounts. It may be helpful to ask "how much do you smoke" as opposed to "do you smoke" style questions to reduce any perceived negative connotations of use. Ask what if any type of physical activity they like to engage in.
 * <span style="display: block; font-family: Arial,Helvetica,sans-serif;">Present medications - Ask if they are currently on any medications, what they are used for and how long they have been taking them. If they were on medications ask them if they think they still need it.

<span style="display: block; font-family: Arial,Helvetica,sans-serif;">4. You will also complete a **Questionnaire** for each client: <span style="display: block; font-family: Arial,Helvetica,sans-serif;"> <span style="display: block; font-family: Arial,Helvetica,sans-serif;">The purpose of this is to screen for any acute health conditions that need urgent or semi-urgent medical attention. You may need to explain some of the symptoms listed.

<span style="display: block; font-family: Arial,Helvetica,sans-serif;">* If you do identify something from either the CPP or Questionnaire that you feel needs urgent care, please discuss this with Irina or Joanne and they will get in touch with myself and/or Dr. Adenuga. *

<span style="display: block; font-family: Arial,Helvetica,sans-serif;">5. Once you have completed these forms, remind the family of the purpose of obtaining this information (ie that it will be provided to any health care professional they seen in the future)

<span style="display: block; font-family: Arial,Helvetica,sans-serif;">6. Thank them for their time and provide them with the more detailed information sheets and suggest that they ask someone to help them review these at a later date. <span style="display: block; font-family: Arial,Helvetica,sans-serif;"> <span style="display: block; font-family: Arial,Helvetica,sans-serif;"> <span style="display: block; font-family: Arial,Helvetica,sans-serif;">For your interest here are the information sheets provided: <span style="display: block; font-family: Arial,Helvetica,sans-serif;"> ﻿ <span style="display: block; font-family: Arial,Helvetica,sans-serif;">  <span style="font-family: arial,helvetica,sans-serif;">

<span style="display: block; font-family: Arial,Helvetica,sans-serif;">7. Once you have completed the session, transfer the information to the computer in Irina's office, **saving the file as "Last name First name CPP"** and save it in the folder as shown to you by Irina or Joanne.

<span style="display: block; font-family: Arial,Helvetica,sans-serif;">That's about it!

<span style="display: block; font-family: Arial,Helvetica,sans-serif;">Any questions or feedback along the way, feel free to contact me!