PRIMARY CARE AND ROMA HEALTH WORKSHOP Istanbul 9/10 September 2013 Danica Rotar Pavlic, MD, PhD, Zsuzsanna Farkas-Pal, MD, Zelko Erika, MD, Msc

European Forum for Primary Care Since 2005 the European Forum for Primary Care (EFPC) developed as a network with the intention to strengthen Primary Care in Europe. Over the years it published a series of Position Papers, including the approach by Primary Care of specific diseases and system and functional characteristics of Primary Care. EFPC now develops a review of Primary Care’s best offer to Roma patients. A specific working party of the EFPC has been set up

Aim of the workshop To clarify the subject (limited access to health care) To summary of principles and practices in Europe Equity, quality and efficiency of care

Structure of the workshop Zsuzsanna Farkas-Pal: Primary care and Roma Health in Romania (15 min) Erika Zelko: Experiences and developments in health needs assessment of Roma (presentation of dictionary in Romani language, educational brochure and website) (15 min) Discussion

Historical background Romany was in fact a sanskrit dialect that originated in the Indus Valley in Northern India in the ninth century. It is thought that a tribe of people left there and travelled through Persia to reach Eastern Europe about 1000 years ago

Historical background Centuries long discrimination and genocide during the 2 nd World War, has left its marks on Roma identity and psychology. It has led to relative isolation and to indifference towards or enmity/resistance to the norms of the gadje – the non-Roma population. Tis feature is important in health care. Romani children at Auschwitz who were part of various medical experiments. United States Holocaust Memorial Museum

Roma were known as healers As early as the Middle Ages, the Roma were known as healers. Miraculous powers were attributed to Roma women: it was said they could heal men and animals, and that they were searching for medicine for this life and the next. There is little data on measures taken by the Roma upon the occurrence of a particular medical problem, such as fever.

Distribution of the Romani people in Europe (2007 Council of Europe "average estimates", totalling 9.8 million)

Roma decade of inclusion Currently we live in the "Roma decade of inclusion", from 2005 to In that context several health studies and projects have been undertaken. The EU has funded and is still funding projects for integration of Roma, of which health is a component.

Primary Care, especially for Roma? How primary care adjusts the care to the composition + needs of the patient population What are specific health issues of Roma population? Generalisation is necessary but risky

Specific features of Roma population Collectivism versus individualism Language and (il)literacy Expectations of the healthcare system Access to the health system Concepts of health and disease Result of exclusion: low trust between Roma and non-Roma health providers Is this correct? Is this complete?

“I asked the lady how come I was first here, and have an appointment at this time, but now she puts me at the end. And she said that I had time. And I said, ‘Lady, then you shouldn’t make appointments at this hour, but two hours later. ’Such small, not big, small conflicts. A lot of work and a lot of nervousness”. Discrimination

How does primary care take these characterirics into account? key competences of primary care provider: to adequately assess their patient’s individual (health) literacy and to establish a relation of trust most important cultural competences of caregivers when dealing with patients from different cultural background are openness and respectfulness and asking questions out of genuine curiosity Agree? Do training and CME address these competences?

Health mediators? Roma health mediator experiences A sustainable model?

Very specific needs mean very specific skills and practice organisation? Examples?

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