Health Care For Migrants Research Articles

Reluctance to Do Blood Testing Limits HIV Diagnosis and Appropriate Health Care of Sub-Saharan African Migrants Living in Spain

This study investigates the reasons why sub-Saharan African migrants (SSAM) living in Spain may be unwilling to have their blood tested. A qualitative study was developed for 3 years (2006-2009) with the participation of 1338 SSAM. Cultural differences along with lack of information about Spanish health care system and health-related rights produced a feeling of mistrust towards medical staff. Reluctance to do blood testing may prevent SSAM from having a prompt HIV diagnosis and an appropriate health care. Linguistically and culturally adapted information is essential to overcome these barriers and achieve an equal access to health care services and HIV testing.

Healthcare for Migrants in Urban China: A New Frontier

ABSTRACT: How can healthcare access for Chinese migrants be improved?(1) Migrant workers face two types of healthcare-access exclusion in the workplace: one is financial (because of their income) and the other is social (because of the lack of social networks in the city). We use 2006 data from a survey of rural migrant workers conducted in five of the most economically-advanced cities. The empirical findings support the hypothesis of a return to the hometown for migrant workers with poor health. Apart from residency permits and income, the social integration of migrant workers is also found to be a decisive factor in healthcare access.

A vision and compass for healthcare leadership: Lessons from the migrant nurse resolution for recurrent nursing shortages

A vision and compass for healthcare leadership: Lessons from the migrant nurse resolution for recurrent nursing shortages Deleise S Wilson, Richard W Redman, Kathleen M PotempaSchool of Nursing, University of Michigan, Ann Arbor, MI, USAAbstract: The ways migrant health care workers have been used internationally over the past decades demonstrates, in part, the global factors and effects of institutional leadership decisions. This example is especially illustrative in nursing given decades of the recruitment and exportation of nurses. The lessons for leadership in nursing may inform leaders in other health professions.Keywords: health care leadership, leadership decisions

Migrant Social Networks and Health Care: Exploring the Relationship between Women's Social Networks and Migrant Health Care Access in the United States

The challenges facing today's Mexican migrant population, almost a third of the US migrant population, are formidable. Such high representation offers not only challenges, but also increased political representation and large networks of social support. Complex relationships established through such networks provide Mexican migrants with avenues of access to communities, opportunities and services. Following a working definition of community and the concept of social capital, this paper examines health care availability for Mexican migrants in the United States. Because Mexican women are traditionally responsible for the health of their families, a case study is used to illustrate how knowledge and information gained through women's social networks gives Mexican women in the US critical decision‐making power with regard to health care. Greater acknowledgement of women as the brokers of health‐preserving information networks is key to recognising their significance as stakeholders in community health care. Future policy developers should recognise the importance of understanding such specific contextual issues, because they create a health care system that is responsive to individual and community needs.

Mistakes to avoid in the implementation of community mental health care.

In this issue of the journal, we publish the first WPA guidance produced as part of the WPA Action Plan 2008-2011 1, 2, dealing with steps, obstacles and mistakes to avoid in the implementation of community mental health care. Two further documents are almost ready and will soon appear in the journal: the WPA guidance on how to combat stigmatization of psychiatry and psychiatrists, and the WPA guidance on mental health and mental health care in migrants. The guidance we present in this issue can be regarded as a “second-generation” document in the area of community mental health care, because it takes advantage of the experience of the countries in which the development of community care has been most active, to point out not only what should to be done to implement the process, but also the errors which should not be repeated. In this latter respect, the document contains several important statements, which I will now list and discuss briefly.

Health Care and Health Outcomes of Migrants: Evidence from Portugal

This paper studies the performance of immigrants relative to natives, in terms of their health status, use of health care services, lifestyles, and coverage of health expenditures. We base the analysis on international evidence that identified a healthy immigrant effect, complemented by empirical research on the Portuguese National Health Survey. Furthermore, we assess whether differences in health performance depend on the personal characteristics of the individuals or can be directly associated with their migration experience.

Anal fistula: an unusual presentation of tuberculosis in a migrant health care professional

We present a case of a young health care professional from the Indian subcontinent, who presented with a low anal fistula and underwent exploration, debridement and fistulotomy twice. The initial working diagnosis was Crohn's disease. However, Mycobacterium tuberculosis, fully sensitive to all first-line drugs was cultured from the specimens sent from the second surgical procedure. On initiation of anti-tubercular therapy the symptoms improved within 5 weeks. The origin of the patient, high index of suspicion for non-infectious reactivation of tuberculosis in migrant health care workers, importance of a proper history taking including previous exposure and diagnostic workup is stressed.

Fatal disseminated toxoplasmosis with congenital transmission in an African migrant

Migrants from HIV-endemic areas may be newly diagnosed with HIV in Western countries. A 27-year-old pregnant woman from sub-Saharan Africa presented with disseminated fatal toxoplasmosis and congenitally transmitted the parasite. Despite medical care maternal infection was only diagnosed postmortem and diagnosis in the newborn was delayed. Problematic aspects of medical care in migrants in Western countries are discussed. (excerpt)

Reason for Visit: Is Migrant Health Care That Different?

The purpose of this pilot study was to determine the reasons for which migrant agricultural workers in Pennsylvania seek health care. Participants were individuals 14 years of age and over, actively involved in agricultural labor and presenting for medical care at 6 migrant health care centers. Bilingual health care providers randomly selected and interviewed the participants. The most commonly reported reason for visiting the health care provider was for physical examination. The most frequent acute problems were related to the musculoskeletal and integumentary systems. Frequently cited problems in the medical history were hypertension, musculoskeletal/back pain, and gastrointestinal conditions. Most medications being taken were for cardiovascular or pain-related problems. These results suggest that migrant workers present with medical problems that are similar to those of the general primary care population. Many problems were recurrent and represented common chronic medical conditions.

Gesundheitsprobleme und Gesundheitsversorgung von Menschen in der aufenthaltsrechtlichen Illegalität: Deutschland und Italien im Vergleich

Public health aspects concerning health and health-care of unregistered migrants have been rarely investigated. This article aims at providing some empirical data which are derived from the documentation and annual reports of two health-care institutions specialised in health-care for unregistered migrants in Germany and Italy taking into account the different legal regulations between Germany and Italy for the health-care of irregular migrants. The data show that the patients in both institutions are rather young and immigrated often from East Europe and the former Soviet Union. Their main diseases did not differ much from the average spectrum except for showing a higher prevalence of "poverty-related illnesses" like infectious and skin diseases.

Impact on and use of an inner-city London Infectious Diseases Department by international migrants: a questionnaire survey

BackgroundThe UK has witnessed a considerable increase in immigration in the past decade. Migrant may face barriers to accessing appropriate health care on arrival and the current focus on screening certain migrants for tuberculosis on arrival is considered inadequate. We assessed the implications for an inner-city London Infectious Diseases Department in a high migrant area.MethodsWe administered an anonymous 20-point questionnaire survey to all admitted patients during a 6 week period. Questions related to sociodemographic characteristics and clinical presentation. Analysis was by migration status (UK born vs overseas born).Results111 of 133 patients completed the survey (response rate 83.4%). 58 (52.2%) were born in the UK; 53 (47.7%) of the cohort were overseas born. Overseas-born were over-represented in comparison to Census data for this survey site (47.7% vs 33.6%; proportional difference 0.142 [95% CI 0.049–0.235]; p = 0.002): overseas born reported 33 different countries of birth, most (73.6%) of whom arrived in the UK pre-1975 and self-reported their nationality as British. A smaller number (26.4%) were new migrants to the UK (≤10 years), mostly refugees/asylum seekers. Overseas-born patients presented with a broad range and more severe spectrum of infections, differing from the UK-born population, resulting in two deaths in this group only. Presentation with a primary infection was associated with refugee/asylum status (n = 8; OR 6.35 [95% CI 1.28–31.50]; p = 0.023), being a new migrant (12; 10.62 [2.24–50.23]; p = 0.003), and being overseas born (31; 3.69 [1.67–8.18]; p = 0.001). Not having registered with a primary-care physician was associated with being overseas born, being a refugee/asylum seeker, being a new migrant, not having English as a first language, and being in the UK for ≤5 years. No significant differences were found between groups in terms of duration of illness prior to presentation or duration of hospitalisation (mean 11.74 days [SD 12.69]).ConclusionMigrants presented with a range of more severe infections, which suggests they face barriers to accessing appropriate health care and screening both on arrival and once settled through primary care services. A more organised and holistic approach to migrant health care is required.

Gesundheit und gesundheitliche Versorgung von Migranten unter besonderer Berücksichtigung von Sucht

Adequate knowledge about the target group is essential for user-focused health care. Little differentiated information on the health and health care of migrants is available in Germany, and focused research on migrant groups hardly exists. The burden of the migration itself, the change in the socioeconomic status (compared to the home country) and - compared with the locals - a more restricted access to the health care system affect the health of migrants. A major health problem with this group is addiction. Characteristics of health and health behaviour of Turkish- and Russian-speaking migrants in Germany are examined by a study supported by the German Federal Ministry of Education and Research.

Mental health care of migrants

Mental health care of migrants

HIV Health Care Services For Mexican Migrants

This article reviews the literature on HIV/AIDS health care services for Mexican migrants in the United States. Because so little research has been conducted on Mexican migrants per se, we include literature on Latinos/Hispanics in the United States, because some characteristics may be shared. Furthermore, we focus special attention on data from California because it is on the front line of issues regarding health care for Mexican migrants. The types of health care services needed to improve on the quality of care provided to Mexican migrants living with HIV are highlighted, and recommendations are made for future interventions, research, and binational collaborations.

Global Politics and Multinational Health-care Encounters: Assessing the Role of Transnational Competence

This planet’s most likely political/population scenario for the 21st century anticipates more people, more spatial movement, and more transnational interactions. Global health increasingly will be shaped by encounters among clinicians and patients who meet in health-care settings where cultural, ethnic, and national-origin match is not an available option. In multinational clinical consultations, bicultural competence and lists of culture characteristics will not suffice. The article adapts the generic Koehn/Rosenau framework of transnational competence (TC), which encompasses analytic, emotional, creative, communicative, and functional skills, to the global challenge of providing migrant-health care. The focus is on the patient/clinician encounter, where interpersonal interactions carry the potential to reduce or reproduce existing inequities in health care. A structured literature review provides the basis for the adaptation to transnational health encounters presented for the first time here by incorporating recent research findings from more than 80 published studies regarding patient–provider consultations and cultural competence in the medical interview into the TC framework’s empirical foundation in cross-cultural psychology, development studies, intercultural communication, and international management. The application elaborated in this article will enhance the ability of researchers to explore and to assess the role of encounter participants’ TC capabilities and deficiencies in transnational health-care outcomes—including migrant satisfaction/dissatisfaction with provider care, the incorporation of complementary biomedical and ethnocultural health-promotion practices, effective/ineffective migrant-health-promotion behavior in the new environment, and agreement on mental-health needs. The results of conceptually grounded TC research promise to enhance practitioner training and patient education in both North and South.

Economic transition and maternal health care for internal migrants in Shanghai, China.

Economic migration and growth in informal employment in many of the major cities of developing countries, combined with health sector reforms that are increasingly relying on insurance and out-of-pocket payment, are raising concerns about equity and sustainability of economic and social development. In China, the number of internal migrants has dramatically grown since economic transition started in 1980, and maternal health care for these is a pressing issue to be addressed. To provide information for policy-makers and health administrators, a medical records review, a questionnaire survey and qualitative interviews were carried out in Minhang District, Shanghai. This paper describes important inequities in main maternal health outcomes and utilization indicators relating to economic and social transformation of the Chinese society. Analysis of the data collected clarifies that insufficient antenatal care is one of the main determinants for poor maternal health outcomes and that migrants are using antenatal care services significantly less than permanent residents. The data suggest that there is no single explanatory factor, but that migrants are faced with a package of obstacles to accessing health care services, and that health systems may need to rethink and redesign their delivery approaches to specifically target those groups that are faced with such multi-faceted packages of obstacles to service-access. Although the study addresses a specific Chinese phenomenon related to internal migration and registration of residency, parallels can be drawn to other settings where a combination of economic and social transitions of the society and a reform of health care financing are potentially creating the same conditions of significant inequalities.

Linking Cultural Competency and Community Service

The purpose of the migrant health initiative is to give medical students the opportunity to provide clinical services, at appropriate levels of training, to a population that reflects a different ethnic and economic background than medical students typically see in the clinical setting. This initiative integrates concepts of cultural competency with experiential learning. The migrant health initiative provides an infrastructure for a cultural competency educational program in the first two years of medical school within an essentials of clinical medicine course (ECM). The ECM course emphasizes the impacts of family, society, and community on the delivery of patient health care. Experience in the provision of clinical care to migrant workers provides an exceptional opportunity to expose students to a medically underserved, diverse group of people and to provide care to persons with a different language. The program was developed from grass-roots initiatives of students and the region's Area Health Education Center (AHEC). Historically, migrant workers provide the majority of the labor for harvesting onions in southeast Georgia. In April 2000, the regional AHEC organized a one-day clinic for migrant workers, staffed by one local physician and allied health students. Care was provided to over 400 laborers. As a result of the response by the migrant workforce, the AHEC developed a partnership with the local community to expand the health care services to this underserved group. Five medical students, working with the school's associate dean for curriculum and local AHEC, had observed a migrant health clinic organized by the AHEC and were seeking ongoing community service opportunities. Based on the interest and enthusiasm of the students, a faculty-supervised migrant health elective was developed for first- and second-year students. The number of students who wanted to take the elective exceeded the available opportunities. The ECM course will be enhanced with an integrated and longitudinal curriculum that focuses on migrant health care; the revised ECM course will provide students with the knowledge, skills, attitudes, and behaviors to care for individuals from different cultures. First-year students will be able to volunteer to work in the program. Second-year students will participate in at least one migrant health clinic, traveling only three hours but providing a different world with medical care. In addition, the opportunities for medical students to participate in a community health initiative and to work with nursing and allied health students will enhance their public health knowledge and their team and leadership skills. The partnership between students, faculty, and the community provides the mechanism to thoughtfully develop and integrate cultural issues and experiences into the curriculum. Students have recently received a Caring for Community five-year grant from the Association of American Medical Colleges. Program expansions will continue into the third-year medicine clerkship and include a senior elective. The program expansions will result in a migrant health initiative that will be coordinated; comprehensive; and expand student knowledge, skills, and experiences in cultural health care.

Assessment of Two ‘Low-Tech’ Genetic Health Care Procedures Performed by Prenatal Care Providers in Washington State: Implications for Future Policy Development Activities

Equity in health care demands that patients be treated fairly, impartially and with justice. Health care professionals and others have long been aware of the concept of equity, and the many inequities that exist in our health care cystem. As part of our analysis of postpartum data collected between 1993 and 1996 by the Washington Pregnancy Risk Assessment Monitoring System (PRAMS) from self-administered patient surveys, we explored equity as it pertains to two ‘low-tech’ prenatal genetic health care procedures: (1) whether or not prenatal care providers asked their patients about a family history of birth defects/genetic disorders, and (2) whether or not prenatal care providers talked to their patients about prenatal testing for birth defects/genetic disorders. Overall, about 80% of pregnant women reported that they had been asked about their family history of birth defects/genetic disorders, and about 85% said that their prenatal care provider(s) had talked to them about prenatal testing. Maternal characteristics associated with a lower likelihood of receiving these two low-tech genetic health care procedures appeared to be young maternal age, and low education and income levels, regardless of where women with these attributes received their prenatal care (e.g. community, migrant, health department or military health care clinics, private physicians, or health maintenance organizations).

Cross‐cultural health issues in contemporary Australia

In recent decades, Australia has rapidly become one of the more ethnically diverse societies with over 120 different languages groups and 41.9% of the population having at least one parent born overseas. This presents a great challenge for decision‐makers and service providers to plan and provide effective and responsive health services for communities with such diverse languages, cultural backgrounds, migration circumstances and socioeconomic status. In order to offer equitable, culturally sensitive and appropriate health services, there is a pressing need to identify and manage cross‐cultural health issues. This paper will first clarify concepts fundamental to the understanding of cross‐cultural phenomena. It will then discuss several priority migrant health issues including communication breakdown, reproductive health, mental health, workplace health and safety, and doubly disadvantaged groups. Finally, it will recommend measures to address the above issues and to promote equity, access and quality in health care for migrants.

Health, health care utilization and living conditions in foreign-born diabetic patients in southern Sweden.

To compare foreign- and Swedish-born diabetic subjects regarding health care utilization, complications, clinical and socio-economic characteristics. Cross-sectional study. All known diabetic patients living in six defined primary health care districts. Of 1861 identified subjects aged > 25 years 90.1%. 113 foreign- and 1564 Swedish-born subjects participated. Mean time of residence in Sweden was 32 +/- 1.2 years, 93% > 10 years. A standardized interview, a physical examination and an evaluation of medical records. No differences were found regarding living conditions or health care utilization, with the exception of higher use of home-care from public authorities in Swedish-born subjects (P < 0.05) despite no difference in dependency on help according to Katz's ADL index. There were no major differences in objective health (glycaemic control and complications related to diabetes) with the exception of lower frequency of sensory neuropathy (P < 0.01) and peripheral vascular disease (P < 0.05) in foreign-born subjects. The prevalence of diabetes was 2.1% (95% CI 1.7-2.5) in the foreign-born and 2.6% (95% CI 2.5-2.7) in Swedes. Foreign-born individuals were five years younger (P < 0.001), were more often diagnosed > or = 30 years (P < 0.05), had a two years' shorter duration of disease (P < 0.001) and were less often treated with insulin (P < 0.01). Treatment with insulin was related to the duration and presence of complications related to diabetes. There were no major differences in objective health or use of health care in European migrants with diabetes mellitus, mainly Scandinavians, with short cultural distance and long residence in Sweden compared to Swedish-born diabetic patients.