1. MIGRATION AND HEALTH The experience of a refugee clinic in Montreal Dr Pierre Dongier Clinique Sante-Accueil CLSC Cote des Neiges

2. CLINIQUE SANTE ACCUEIL Medical clinic for refugee claimants in Montreal Created in 1984, based in CLSC Cote des Neiges since 1996 Main objectives : 1. provide access to primary health care for refugees 2. Assess the health status of newly arrived refugee claimants

3. CLINIQUE SANTE ACCUEIL Demographic characteristics: Age: 90% under 45 Sex: 60% men Education level : mean schooling =12 years Country of origin : 45% Asia 45% Africa 10% Latin America

4. REFUGEE CLAIM PROCESS Legal procedures (access to legal aid) Immigration medical exam Medical care through FIHP Access to work permit and social welfare IRB hearing for status determination

5. Federal Interim Health Program Urgent and essential care Medical consultation, selected medications, laboratory and radiology investigations Authorisation required for physiotherapy and psychotherapy,and other unusual treatments Urgent dental care and contribution for glasses

6. Resuts of studies conducted at Clinique Sante Accueil

7. Health status screening study Done between october 2000 and may 2002 161 files reviewed Anamnesis and physical examination Laboratory tests: -CBC -Serology for strongyloides -Hep B+C filariasis -HIV schistosomia -Stool analysis for O+P

8. Results of screening study Anemia 19.3% Eosinophilia 6.8% Active Hep B 3.9% Active Hep C 4.3% PPD+ 45% HIV+ 2.4% VDRL+ 9.7%

9. Parasites Intestinal parasites 7% (mainly giardia,amoebas,ringworm and trichuris) Serology Strongyloides 16% Filaria 7.6% Schistosomas 3.1%

10. Psychiatric questionnaire When discussed: 55% normal 45% psychiatric diagnosis: PTSD 46% Adaptation disorder 30% Mood disorder 20% Anxiety 15%

11. Conclusions of screening study Health status of refugee claimants generally good Pertinence of screening beyond the immigration medical examination Infectious diseases screening according to region of origin

12. Main reasons for consultation Common health problems: acute (URIs, gastroenteritis) or chronic (hypertension, diabetes) Pregnancy Infectious diseases Mental health

13. Access to health care system Difficulties related to the FIHP: some institutions refuse to give services Language barrier: unequal access to interpreters Cultural barrier: understanding health messages, compliance with treatment, punctuality

14. Conclusions Need to facilitate access to health services and sensitize health care providers Approach based on health promotion rather than health protection Special attention to certain problems: infectious diseases, mental health problems