MEDICAL MATTERS Robert Marsh: The influx of refugees and asylum seekers to our shores over the past number of years has been well documented and publicised in the media.
A sharp contrast to this is the lack of attention given to the increased workload of GPs who care for this segment of our society receiving little acknowledgement for their often monumental efforts which go unrecognised and poorly rewarded.
As a final year medical student I visited a number of practices in the Galway, Mayo and Roscommon area who had in excess of 50 asylum seekers on their medical card list. The data compiled revealed some startling results.
I recently completed a three-month locum at one of these practices which happens to be in close proximity to a refugee hostel. I experienced first hand all of my research findings from two years prior, the situation had only become worse.
The greatest problem encountered is the language and communication barrier. Many asylum-seekers have limited English and rarely have medical records to hand, and if records do accompany them it is very difficult to obtain an accurate translation.
While the Rotext translation service exists to alleviate this difficulty the sole GP in Clifden or Strokestown does not have the time to await a callback from a translator.
The asylum seeker's initial visit to a GP is generally time consuming as it is very important to elicit an accurate medical history. This also raises the crucial medico-legal issue of who is responsible if an important piece of information is overlooked.
All the doctors I interviewed spoke about the amount of time they spent in the role of social worker.
The GP is often the first point of contact when any kind of problem arises, particularly in the accommodation hostel, one of the most common problems is boredom and occasionally an entire family may occupy only one room. This invariably leads to tension and some GPs have found themselves having to intervene in non-medical situations, effectively being pressed into the role of advocate.
The number of asylum seekers in the practice that employed me consisted of less than 0.5 per cent of the total GMS list but many days represented 5 per cent to 10 per cent of consultations and some days reached 20 per cent to 30 per cent making them by far the most frequent attenders which reflects the level of care they often require.
Some refugees from the Balkans and Congo have suffered horrific torture and abuse which requires intense follow up.
However, this often results in the inevitable disruption of surgery appointments to the local community which has the potential to create resentment towards an already vulnerable group.
Part of the reason for this frequent attendance I believe is rooted in the new policy of "fast tracking" asylum seekers. Some families are split up for the duration of the application process which typically lasts up to four months. This results in the mother and children living in a direct provision hostel while the father may be accommodated in another part of the State. Many of my consultations with asylum seekers over the three-month period involved separation anxiety and invariably the depression that follows as well as the stress of an impending status hearing that for many results in deportation.
It is generally acknowledged that the asylum process required reformation and streamlining. However, the knock-on effect of this has placed a greater burden on GPs caring for refugees. There is a constant flow of new refugees through certain practices despite the fact that the number of applications overall is declining. The principal of the practice that employed me has had to employ an assistant at his own expense to deal with this extra workload for the past number of years with little or no assistance from the Health Service Executive for doing so.
The experience in the UK is considerably different. Designated clinics exist to care for new asylum seekers. They are staffed by specially trained personnel, and interpreters are usually available on site to help overcome any communication difficulties. They operate alongside NHS-funded primary care services and clearly acknowledge that the health requirements of new refugees are often initially intense.
It is fortunate for everybody involved that this service is provided and displays a considerable degree of foresight on the part of the British government.
It is most unfortunate that this wisdom has not yet crossed the Irish sea.
It is simply no longer acceptable that in our new found national prosperity where tax revenue has never been higher nor the population as diverse that the Government can implement a policy of effectively dumping a complex group of patients on a local GP and walk away without providing the necessary resources for him/her to deliver the greatest level of care to both our new arrivals and existing patients.
Robert Marsh is a first year trainee on the Health Services Executive western area GP training scheme.