Immigrants' health woes focus of new guide

Canadian doctors now have their largest, most comprehensive reference guide yet to use in treating immigrants and refugees.

Compiled from global data, the 100-page report published Monday by the Canadian Medical Association Journal is the first of its kind and synthesizes results from 150 investigators.

The guidebook highlights medical problems that are common among immigrants and refugees but can easily get overlooked because they're not typical in the wider Canadian population. 

"Immigrants are coming from 150 countries," notes Dr. Kevin Pottie of the University of Ottawa, who co-authored the guidelines. "Some of them come as refugees, some under family class. So, there's a large diversity of needs and potential preventable and treatable illnesses [that] the average family doctor just isn't thinking about."

Pottie hopes to develop an international set of guidelines in terms of treating migrants.

"We need to see health as a human right, and small interventions are all that's needed for all immigrants," Pottie said in an interview with CBC News.

The guide, titled Evidence-based Clinical Guidelines for Immigrants and Refugees, instructs physicians on how to deal with the kind of health risks faced by the 357,000 annual migrants to Canada, including refugees, international students and migrant workers.

It says the post-arrival "healthy immigrant effect" is declining and recommends that doctors get their migrant patients to visit them more than once a year. 

Specifically, certain immigrant groups suffer from higher incidences of some diseases compared with people born in Canada: Southeast Asians from stroke, Caribbeans from diabetes and all immigrant men from liver cancer.

Also, the report says many immigrants are susceptible to diseases that are often preventable through vaccines:

• 30 to 50 per cent are susceptible to tetanus.
• 32 to 54 per cent are susceptible to measles, mumps or rubella.
• A significant number come from countries with chronic hepatitis B infections.

The guidelines recommend that:

• All adults without immunization records be vaccinated against measles, mumps, rubella, diphtheria, whooping cough, tetanus and polio.
• Adults and children from countries with chronic hepatitis B be screened and vaccinated.
• Adolescents and adults from places where HIV is prevalent (i.e. greater than one per cent of the population) should be screened, with informed consent.
• All immigrants greater than 35 years of age from areas of the world at high risk, which includes South Asia, Latin America and Africa, be screened for for Type 2 diabetes
• All women of reproductive age and children aged one to four should be screened for iron-deficiency anemia.
• All migrants should be checked for dental pain.

A time-saver for treatment

Pottie said the guidebook can be an effective tool for time-saving and inexpensive treatment. He cites the presence of intestinal parasites in some migrants. He said most doctors would probably find, on average, 12 parasites, and most doctors wouldn't know which ones to treat.

"We've discovered, through a detailed look at evidence, that virtually all these parasites will go away except for two: strongyloides and schistosoma, which are particular to Asia and Africa. So we're able to refine it to a simple blood test."

Dr. Meb Rashid runs a clinic inside a refugee centre in downtown Toronto, A family physician for 17 years, Rashid has worked mostly with refugees and immigrants for the past eight years. He applauds the guidebook, which will help doctors intervene faster when it comes to possible illnesses in their migrant patients.

"There are physicians in rural Canada who may be just starting to see some of these diseases, and I think these guidelines will be immensely helpful to those people," Rashid told CBC News. "It's well-organized and easy to reference."

Refugees at higher risk

The guidelines say it's important to distinguish whether a person came to Canada through voluntary or forced migration, as those who have been displaced against their will face the most significant health risks.

They say refugees have experienced "past exposure to harmful living conditions, violence and trauma," and note that many experience a rapid decline in health after arriving in Canada and need more care and attention to their medical needs.

Refugees, of which Canada takes in 28,000 a year, are especially vulnerable to depression and other anxiety disorders, the guidelines say. The report recommends physicians use "culture brokers," and not anyone related to the refugee, to help with treatment and to monitor progress and address the social causes of the depression. It proposes "empathy, reassurance and advocacy" and cautions against pushing for "disclosure of traumatic events," which causes more harm than good.

The guidelines include a section on AIDS. It warns that while many HIV-positive migrants may already be aware of their status, they may not be knowledgeable about treatments.

The report warns that migrants may come from countries where there is a strong stigma against HIV-positive people. It counsels health professionals to inform patients of the "risks and benefits of treatment in a culturally and linguistically appropriate manner."

Tread carefully on condom issue: guidelines

On women's health, the guidelines say "culturally sensitive" contraceptive counselling should be offered to women who are or could be sexually active, and they should be given a choice as to what method they want to use. The guidebook underlines that condoms are often taboo in some cultures and seen as an indication of promiscuity, infidelity or having a sexually transmitted infection, so there needs to be careful explanation about their use.

As well, it says that females between ages nine and 26 years should be vaccinated against the human papillomavirus, or HPV.

Migrant and refugee women are also at greater of risk of violence from their husbands and complications connected to their pregnancies, including sexually transmitted infections, chronic pelvic infections, reproductive tract trauma and psychological trauma, the guide says.

It says doctors should be aware the women may be reluctant to talk about their health problems and also unaware of their rights and of the medical services available to them.