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17 Aug 2018

BY PROFESSOR  STEPHEN  LEEDER, EMERITUS  PROFESSOR, PUBLIC HEALTH, UNIVERSITY OF SYDNEY

 

Imagine. You have been asked to organise health care for a population of 70 million people. They are not well off – in fact, most are poor.  Many different nationalities and ages are represented and they are to be found in well over 20 countries scattered across the face of the earth. Where would you begin?

The population I have in mind for you to care for comprises all the displaced persons in the world at present. So, at first blush, my request to you is ridiculous.

There are many demands. The Rohingya mother with a child with diarrhoea in the Kutupalong refugee settlement in Bangladesh will require entirely different care to the 55 year old man with pneumonia in one of the boats smuggling refugees from Somalia to Yemen. But the provision of basic medical care remains a possibility for more of these displaced people than we think.

The 70 million displaced persons in the world comprise such a vast geopolitical problem I find it easy to think – in my despair that there is nothing that can be done. But the Rohingya refugee, Nur Jahan, I referred to was able to take three year- old-daughter Amina to a primary health clinic (pictured) in the refugee settlement in southeast Bangladesh for immediate treatment.The facility is operated by the UNHCR and is open 24 hours a day.  And it is one among hundreds serving refugees.

Well over 90 per cent of consultations are for acute infections. The range of services offered through primary care in dozens of countries are comprehensive, ranging in focus from HIV through child survival to food security.

The power of primary care to manage potentially lethal illness, especially in children, should reinforce our view of the importance of primary care in Australia.  Immunisations and basic public health measures can be provided through primary care with great benefit in even the most difficult circumstances.

The 2017 progress report and public health overview from UNHCR – the office of the United Nations High Commissioner for Refugees states that primary care-based efforts have been successfully directed to the treatment and immunisation against diphtheria.

“…in the densely populated refugee settlements in south- eastern Bangladesh where refugees live in tightly packed bamboo-framed shacks — as well as typhoid in Rwanda and monkey pox in the Democratic Republic of the Congo.”

It is not commonly known that great progress has been made since 2000 in child survival. This is worldwide and immunisation has been a central plank in this achievement. UNHCR has been making a contribution. The mortality rate for under-fives has been steadily declining worldwide at 0.4 deaths per 1,000.  (The fourth Millennium Development Goal – reduce child mortality – was met.  The web site reports that:

  • Between 1990 and 2015, the global under-five mortality rate has declined by more than half, dropping from 90 to 43 deaths per 1000 live births.
  • Between 1990 and 2015, the number of deaths in children under five worldwide declined from 12.7 million in 1990 to almost 6 million in 2015.)

Mental health care for refugees remains rudimentary and is directed principally to the major psychoses and epilepsy, despite the potential for preventive work among those traumatised by their experience of disruption and displacement.

All of which is definitely a feather in the cap of primary care.

There is a growing appreciation worldwide of the value of effective primary health care whether through supplicated, principally medically staffed services in economically advanced communities, or the use of health workers with elementary skills in less economically privileged nations or in regions where doctors and nurses are unavailable. It is a great tribute to agencies such as UNHCR and similar organisations, many dependent on volunteers and donor support, that the misfortune of 70 million displaced people can be so often relieved through primary care.


Published: 17 Aug 2018