The health of forced migrantsBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4200 (Published 24 October 2018) Cite this as: BMJ 2018;363:k4200
All rapid responses
I welcome, very much, the powerful review on the health of forced migrants by Burnett and Ndovi . I wish I had had this knowledge available to me when I provided spinal pain clinics in Harrow between 2000-2009.
Systematic audits at Northwick Park Hospital during the 1990s did not report any refugees. We first reported refugees in our clinic in 2002 . A further audit from 2000-2006 revealed 64 refugees from Iraq, Somalia and Afghanistan and 7 other counties mostly from the Middle East or North Africa . Three quarters were diagnosed as having anxiety, depression or symptoms of post-traumatic stress disorder. This latter diagnosis had been frequently missed by the primary care team but was really important to diagnose as therapy can be effective – even small doses of amitriptyline assisting sleep and suppressing nightmares. Comorbidities included gastrointestinal symptoms in 41% and metabolic bone disease in 38% – a common problem for those with dark skins in North London.
Other issues I learned from these patients included:-
1. Those who denied abuse sometimes admitted to nightmares (elicited from the sleep history) which gave clues to previous abuse.
2. Particularly in the early stages, traditional physiotherapy with active exercise programmes may be positively unhelpful whilst passive programmes of massage, a peaceful calming environment possibly with relaxing odours may be what is needed.
3. Referral to the charitable/voluntary sector e.g. Freedom from Torture, where available, can be really valuable – noted in the extended on-line edition but not stressed in the paper edition of the BMJ.
4. Letters of support regarding social/immigration issues can be really effective – physical issues seldom resolve whilst psychological issues persist ; and psychological issues may not resolve whilst social issues dominate patient’s thinking.
(1) Burnett A, Ndovi T. The health of forced migrants. BMJ (Clinical research ed ) 2018; 363:k4200.
(2) McCarthy J, Frank A. Post-traumatic psychological distress may present in rheumatology clinics (letter). BMJ 2002; 325(27 July):221.
(3) Frank AO, Williams A C de C. Retrospective study of refugees presenting to a rheumatological service with spinal pain: psychosocial issues (abstract) . Clin Rehabil 2010; 24: 946-947.
(4) Frank AO. Chronic pain: refugees presenting to a rheumatological service with spinal pain - medical and psychosocial implications. Paper read to the international conference 'rehabilitating torture survivors', Copenhagen, 2008. http://www.ingentaconnect.com/content/mjl/sreh/2009/00000041/00000009/ar...
Competing interests: No competing interests