Challenges of migrant health explored

As the home of the United Nations and the International Red Cross Committee (ICRC), Geneva was the ideal setting to discuss physical therapists’ involvement with humanitarian causes. The discussion session on Migrant Health welcomed a panel of therapists who had all experienced treating people who had escaped disaster, war, or persecution and the unique set of challenges their situation creates.

Alice Harvey, from the UK, and Barbara Rau, from Switzerland, headed up the panel of five speakers - all with fascinating stories of migrant health. Julie Shottland-Cox shared her experiences of treating people in refugee camps in Greece, Coralie Rey-Mermier had just returned from 18 months working in refugee camps in Syria, Joanne Kibet shared a case study of her work with victims of torture in Nairobi, and Aline Bouffandeau talked about the challenge of providing continuity of care for migrants in Iraq, Libya, and Sudan.

Emer McGowan, from Ireland, shared her work on the Physiotherapy and Refugees Education Project (PREP) to equip physical therapists with some of the key information and points to be aware of when working with migrant populations. An interesting discussion point was to what extent an online resource can capture some of the challenging areas of work such as assisting people who have been traumatised by rape or torture. It was suggested that case studies from other physical therapists learning in the field would be a good way to convey important information.

Watch Emer McGowan talk about her work with PREP

To illustrate this, Julie Shottland-Cox gave the example of a person who had reacted negatively to her touching his forearm during treatment. She gave him advice on exercises to alleviate his pain and asked him to discontinue use of the arm sling but was frustrated that she couldn’t use hands-on therapy to give him relief. After being concerned that she could have done more to help him she was delighted when a month later he returned, keen to have more treatment and without the sling. She had gained his trust and was able to restore movement to his arm. She shared that she had learnt the lesson through this experience on ensuring consent is always sought before touching any part of a person’s body.

A key discussion point was the use of translators to facilitate conversations between physical therapists and the people they are treating. Panel members and delegates shared their own experiences of using translators while treating people. The discussion covered situations where people either declined to talk because they did not want to disclose sensitive information because the translator was a man/woman or issues associated with involving family members in translation. A typical family scenario was not wishing to disclose sensitive information in front of a father or a mother or if questions were too sensitive for the translator (such as a daughter translating for her mother).

One point that sparked debate was to what extent physical therapists should assist with the mental health of migrant patients, particularly when there is no option to refer to psychotherapists or counsellors. It was highlighted that 70% of migrants have some kind of mental disorder and 100% have anxiety disorder so the chances of them needing assistance is very high. The room was divided in opinion, with some believing physical therapists should keep within their scope of practice and could do more harm than good. Others felt it was a duty for a therapist to assist with a person’s emotional state if they were the only health professional the person came into contact with. Some of the delegates had made the effort to expand their competencies to address this with mention of ‘laughter therapy’ and ‘emotional freedom technique’ as additional skills to help patients.

Watch Julie Shottland-Cox talk about her work with refugees in Greece and Lilian talk about working with Syrian refugees in Lebanon

The audience also raised the issue of access to services citing examples where support had been withdrawn following shifts in government policy. The situation in Lebanon was cited as an example of this when a physical therapist from the region said that out of 40,000 migrants, 50% were children who needed continued specialist paediatric assistance but services had been withdrawn.

The panel and audience were united in their shared experiences of trying to alleviate the pain and suffering experienced by migrant populations around the world. Some were working in areas of conflict where emergency camps had been set-up, such as Syria. Others were trying to balance the demands of the existing population in their home country with a significant growth in the migrant population and the demands it places on the healthcare system, such as in Greece.