(DRAFT Feb 28, 2016 ) Student Handout

Ottawa Summer Institute on Refugee Health 2016

presented by:
the WHO Collaborating Centre on Technology Assessment and Health Equity
and the Canadian Collaboration for Immigrant and Refugee Health
and Bruyere Research Institute, University of Ottawa

Institute Syllabus

This document outlines the core competencies and leadership skills that you will gain over the course of the Summer Institute on Refugee Health, as well as additional resources to supplement your learning throughout the week. Keep these objectives in mind as you progress in your learning – these competencies are applicable only to refugee health but also to global health and beyond.

Prerequisite: Refugees and Global Health e-Learning

All delegates are required to complete Refugees and Global Health e-Learning Program and Quiz as necessary preparation for the Institute. These modules, modeled on the CanMeds roles, present competencies, values, and principles that are essential to practitioners in global health and will provide important background essential for delegates. Delegates must bring their Certificates to the Institute.

The e-Learning program and Quiz can be accessed here: ccirhken.ca/eLearning/

Professionalism

“Professionalism is important to enable trustworthy and sustainable relationships, especially when working with vulnerable populations such as refugees.”

Learning Objectives

A woman in a marketplace.

  • Enhance understanding of professionalism
  • Appreciate the role of reflection and ethical debate in maintaining ‘professionalism’ in humanitarian and resource-limited settings
  • Be introduced to the role of medical ambassador and its importance in community engagement.

Key Points

  • The road to ‘professionalism’ takes place through a series of small steps
  • Resource limited settings may expand students’ roles, but safety and professionalism is paramount
  • Professionals learn to maintain healthy boundaries to keep both themselves and their patients safe.
  • With skills and experience, maintaining professionalism even in the most foreign of settings will be possible
  • Consider yourself an ‘ambassador’ when working with vulnerable patients

Resources / Key Readings

Resources: Ethics Focus

Resources: Guidelines

  • Interested in Pre-Departure Training?…Canadian Federation of Medical Students Pre-departure Training Document
  • Including Cultural Issues in Health Care is Imperative – Check Out What the Australian Government Plans on Doing…Cultural Competency in Health: A guide for policy, partnerships and participation (Australian Government-National Health and Medical Research Council)
  • Learn More About Current Global Health Networks… Student volunteers in Africa development residents mentoring Asia health network working Pocket Guide Action Global Health Network, McCarthy A (Ed) Office of Global Health (2010) University of Ottawa.

Resources: Professionalism In Depth

Advocate

“Health advocacy is an important skill to increase health equity–especially when working with vulnerable populations such as refugees.”

Learning Objectives

Three girls standing together and smiling.

  • Understand the importance of health advocacy to promote health and well-being of refugees and other vulnerable populations
  • Identify skills and challenges of the ‘health advocate’ both at home and abroad
  • Appreciate the challenges and rewards of building a career in Global Health

Key Points

  • Health advocacy skills play a critical role in working with vulnerable populations and one must learn to listen to one’s inner advocate
  • A health advocate will requires skills to enable reaching out, to support inclusiveness and to ensure flexibility
  • There are many different levels of engagement when working with marginalized populations, and much can be done by speaking out without necessarily physically treating patients
  • One of the best ways of preventing burnout is to develop and maintain networks with other social activists, as well as marginalized patients across work settings
  • Being a health advocate means treating your patient in their own particular context, without dismissing their cultural concerns
  • Practical methods to dispel health inequities include: learning to work with interpreters, recruiting and retaining of minority staff, culturally sensitive training and health promotion, including family and/or community members in health care decisions

Resources / Key Readings

Resources: Organizations with Equity Focus

Resources: Specific Examples of Advocacy

Collaborator

“Chronic diseases, both physical and emotional, require new approaches to improve the delivery of primary care. Collaboration is at the centre of these new approaches.”

Learning Objectives

A girl carrying a large jug of water.

  • Understand how collaboration between health providers and settlement workers can improve care delivery
  • Explore the process of delivering and tailoring primary health care for a newly arriving refugee family
  • Become familiar with key aspects of a refugee health network

Key Points

  • Healthcare team include families, healthcare professionals, social workers, settlement workers, public health workers, and traditional healers
  • Interdisciplinary teams provide an diverse approach to care which is helpful in chronic disease management
  •  Collaboration required the capacity to adjust with different approaches and skills to work in multi-cultural settings to ensure optimum care of vulnerable populations
  • Skills include assessing problems, identifying key players, listening to team members, and working together in design and implement programs
  • Respect differences and become skillful in managing errors and misunderstandings with others to maintain positive working environments

Resources / Key Readings

Resources: Examples of Local Collaborative Organizations

Resources: International Organizations

Communicator

“Good communication helps create respectful and trustworthy relationships with patients.”

Learning Objectives

Doctors wearing hazmat suits during the ebola outbreak.

  • Understand the importance of assuring optimal communication with refugee patients
  • Enhance your communication skills and learn basic concepts to facilitate working with interpreters
  • Be introduced to helpful resources to assist you during a cross-cultural medical encounter

Key Points

  • Recognize how your own cultural biases, values and belief systems may affect your interaction with patients
  • Refrain from using family and friends as interpreters, and limit the use of ad-hoc interpreters if possible
  • Family members can play important roles, just not that of translator
  • Always assure patient confidentiality
  • Avoid using complicated medical terminology and long sentences when working with an interpreter

Resources / Key Readings

Resources: Film

Resources: Guidelines

Resources: Communication Support Tool

Manager

“Limited resources combined with refugees’ financial hardships, language barriers, and cultural & social differences make ensuring quality of care a unique challenge for global health practitioners.”

Learning Objectives

A group of village women sitting in a circle.

  • Assuring readiness of the health clinic to deal with complex situations
  • Assuring quality services are provided to vulnerable and underserved patients in resource limited settings

Key Points

  • Preparation for emergencies becomes paramount in resource limited settings
  • Preparation includes a having a framework for determining priorities
  • Vulnerable groups include: women and female headed households, children (especially if unaccompanied), disabled persons, and ethnic and religious minorities
  • The position of vulnerable groups should be strengthened (encouraging equal distribution of jobs and opportunities)
  • Uncoordinated referrals may create more harms than good for a vulnerable person
  • Build a diverse network with skilled and supportive health care practitioners

Resources / Key Readings

Resources: Film

  • There is nothing more powerful than a true personal story of survival. This documentary will give you a new understanding of what it’s like to be a refugee in transition…Safe and Sound? An engaging 30-minute documentary film from the University of British Columbia and Bridge Clinic looking at refugees in transition

Resources: Guidelines

  • What happens after a disaster? These guidelines will take you through the steps of disaster response…The Sphere Project is an initiative to define and uphold the standards by which the global community responds to the plight of people affected by disasters, principally through a set of guidelines that are set out in the Humanitarian Charter and Minimum Standards in Disaster Response (commonly referred to as the Sphere Handbook).
  • Check out these evidence based clinical guidelines for immigrants and refugees. It starts here…The Canadian Collaboration for Immigrant and Refugee Health Knowledge Exchange Network (CCIRHKEN) aims to support primary care practitioners, community advocates and program and policy planners with evidence based recommendations, podcasts, decision aids and web-based apps.

Resources: Organizations

  • Who leads mental health services? What do they offer? Find out now…The Multicultural Mental Health Resource Centre (MMHRC) aims to improve the quality and availability of appropriate mental health services for people from diverse cultural and ethnic backgrounds, including immigrants, refugees, and members of established ethnocultural communities.
  • When supporting a victim of torture…Canadian Centre for Victims of Torture aims to support practitioners and patients with counseling programs, support groups, crisis intervention, and legal support

Medical Expert

“The role of Medical Expert in global and refugee health–caring for vulnerable populations in unfamiliar resource-limited settings–encompasses a wide range of skills, knowledge and attitudes.”

Learning Objectives

A tent with mosquito nets.

  • Discover the challenges of treating and preventing disease in resource-limited settings
  • Demonstrate an awareness of how war, conflict, and famine impact the health of individuals
  • Understand barriers refugees face when trying to access health care

Key Points

  • Refugees may present with a wide range of illnesses- a medical expert must be aware of global patterns of burden of disease
  • Experts must develop skills to diagnosing tropical infectious diseases that are rare in Western countries
  • Forced migration exposes refugees to potential trauma, precarious living conditions, and disease.
  • The medical expert needs to be aware of the many barriers to health information and health care that refugees may face
  • In addition, the medical experts must also be aware of health systems and health practitioners-level barriers that also exist
  • Working with refugees often entails working in resource-limited settings; thus, the medical expert needs to be adaptable and develop skills in response to cultural and linguistic diversity. i.e. working with traditional healers to provide the best possible care

Resources / Key Readings

Resources: Guidelines

  • View Evidence Based Clinical Guidelines for Immigrants and Refugees…Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, Narasiah L, Kirmayer L, Ueffing E, MacDonald N, Tugwell P. Evidence based clinical guidelines for immigrants and refugees. (CMAJ 2011
  • Learn about diagnosis, management, and prevention of infection in newly arriving refugees…Australasian Society for Infectious Diseases. Draft guidelines for diagnosis, management and prevention of infection in recently arrived refugees. Sydney (Australia): The Society; 2007.
  • Incorporate Cultural Competency in Health Care…National Health and Research Council AG. Cultural competency in health: a guide for policy, partnerships and participation. Canberra (Australia): The Council; 2005. Resources: Articles with Focus on Immigrant Medicine
  • Which principles and practices are being followed in migrant medicine? Check out…Gushulak BD, MacPherson DW. Migration medicine and health: principles and practice. Hamilton (ON): BC Decker; 2006. Gushulak BD, MacPherson DW. Migration medicine and health: principles and practice. Hamilton (ON): BC Decker; 2006.
  • Learn more about clinical topics relevant to immigrant medicine…Walker PF, Barnett ED, Stauffer WM, editors. Immigrant medicine. Philadelphia (PA): Saunders Elsevier; 2007

Scholar

“Scholarly method or scholarship – is the body of principles and practices used by scholars to make their claims about the world as valid and trustworthy as possible.”

Learning Objectives

A sunrise on the river.

  • Understand the role of scholar in reducing health disparities for refugees and other vulnerable populations
  • Identify the skills and methods of a global health scholar
  • Appreciate the challenges, as well as the many rewards, of emerging global health scholarship

Key Points

  • As Scholars, professionals demonstrate a lifelong commitment to learning, as well as the creation of knowledge
  • Global health includes health equity, population health, immigrant and refugee health, inner city health, indigenous health
  • Practitioners need to master and apply methods that are adapted to the unique needs of the communities with which they work
  • The scientific method refers to investigating phenomena, acquiring new knowledge, or correcting and integrating previous knowledge
  • Logic models, synthesis of evidence, using methods to formulate recommendations and evaluating the effectiveness of guideline are all examples of scholarly work

Resources / Key Readings

Resources: Health Care Database

  • Find systematic review articles with up-to-date evidence and research on effective practice…The Cochrane Collaboration is an international, independent, not-for-profit organisation of over 28,000 contributors from more than 100 countries, dedicated to making up-to-date, accurate information about the effects of health care readily available worldwide.

Resources: Scholarly Organizations

  • Discover new and exciting immigrant and refugee health guidelines and methods…The Canadian Collaboration for Immigrant and Refugee Health is a national collaboration including specialists, primary care practitioners, researchers, policymakers, and immigrant community leaders each dedicated to improving the health of immigrant and refugees. Recent publications include over 500 pages of peer reviewed publications in the Canadian Medical Association Journal and linked podcasts, patient decision aids.
  • Explore preventitive health care…Canadian Task Force on Preventive Health Care develops and disseminates clinical practice guidelines for primary and preventive care, based on systematic analysis of scientific evidence.
  • Additional resources on migrant health…UK Migrant Health