With refugees from Syria beginning to enter Canada this month, you should know how to manage patients with this medical history. You may see them in your clinic or in your hospital rotations. As well, immigrant health is one of the CFPC's 99 topics - so it is worth studying for the exam! Be sure to review our previous blog post So your next exam question is about a recent immigrant: 3 things to know.
If you have a patient who is a Syrian refugee:
WHAT TO EXAMINE - Vitals - Visual acuity - Rule out dental disease - Symptom-directed exam
WHAT TO CONSIDER GIVING - Age-appropriate vaccinations for children (MMR, TDaP, HBV, Polio etc) - Varicella vaccine if < 13 yrs old - HBV vaccine if HBsAb below level of immunity - Influenza vaccine
WHAT TO CONSIDER ORDERING - HBV to determine if needs HBV vaccine - HCV screening - Strongyloidiasis serology (just write "Strongyloidiasis serology on the req; see my previous blog post for more info) WHAT ABOUT MENTAL HEALTH SCREENING?
- Do NOT routinely screen for PTSD unless symptomatic (could be harmful) - DO "be alert for" symptoms of mental health disorders - For a more detailed review on mental health of Syrians see the UNHCR's staff manual on this topic
WHAT NOT TO ORDER - Routine TB screening - HIV screening (prevalence in middle east is < 0.1% - Stool O&P in asymptomatic patients
WHAT ABOUT OTHER REFUGEES? Even though Syrian refugees are in the media the most right now, refugees still come to Canada from all over. Recommendations vary based on country of origin. See the CMAJ's guidelines on refugee health from 2011
OTHER HELPFUL RESOURCES The CFPC website has an extensive list of helpful resources on managing refugee patients. These range from mental health to podcasts on refugee health and even a checklist for refugee care.