Physical health problems in detainees

Written by Emma Ginn

Physical health problems in detainees and what to look for in the general clinical examination. □    Referral form with some clinical information, so knowmain issue/s □    You are part of a team: advice and support and specialist opinion a)    MJ office b)    visitor and case coordinator c)    GPs, Nurses, Psychologists d)    variety of leading consultants available for advice; e)    solicitor f)    MJ meetings/organisation □    Take doctor’s bag with basic instruments, take own BP, diagnostic set, stethoscope etc.  Take a ruler.  Camera should be available.  Should be scales there, but check. □    Normal consulting room environment, normal History + Examination □    From conflict areas, so very possibly traumatized physically and psychologically □    Injuries – torture, war, harm in IRCs or on removal □    Mental health – NB (depression, self harm, suicidal intent, PTSD, adjustment disorder, SMI, anxiety/panic) □    Torture – were they asked, was it documented/taken forward □    OEM chapter 38.10 – NB exclusions: mentally ill, severe physical illness, pregnant, children, disabled – detained “only in very exceptional circumstances” □    Care equivalent to NHS - assess standard of health care provided to detainee. □    Ask, “Have you seen healthcare doctor and/or nurse” re health problems, what was the response?   □    Medication – previous Rx, on any now, are you getting it, are you taking it? □    TB □    HIV □    Gynae □    Pregnancy □    Rape □    Malaria Px □    Diabetes □    Hypertension □    Hunger strike □    Anything really – usual clinical skills □    Examination – as directed by history, check vital signs and record them.  Measure and document scars. □    Apply not only usual clinical skills but also usual expectations of care required.  Clinically problems are usually clearcut,  - patient significantly ill or not.  Recommend release from detention if they are.  Adequacy of treatment is a major issue and you may need to challenge that.  Remember the word of a doctor is powerful. □    Clinical findings and management plan – write in the IRC notes, make own contemporaneous notes, recommendations re investigation and treatment.  You cannot prescribe to your patient, and you are not responsible for their clinical care, but can have a major influence. □    Ask yourself, (a) Should the patient be released, (b) Are they fit to fly? □    Visiting in the visitors hall – can get a full history, observation only for examination purpposes, but may be enough for a report.

Last Updated ( Sunday, 03 February 2008 )

 

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