Addressing the issue of mental health and healthcare needs of migrants and refugees required producing changes in the community and in society as a whole through: increased intercultural competencies, bringing evidence into practice, and reducing inequities in healthcare access.
In recent years, Italy has been facing a difficult situation concerning the arrival of a significant number of International Protection Seekers (IPS) and refugees. The theme of migration is very close to our heart as Italians and as Europeans. Millions of Italians emigrated in the last two centuries, mainly to North America, South America, and Northern Europe. Italian workers, in most cases from the very poor Southern regions of Italy, emigrated to Germany and Belgium following the “Coal and Steel agreement” of 1951, which anticipated the European Economic Community established by the Treaties of Rome on 25 March 1957. Last year, Sapienza University celebrated the 60th anniversary of these very important Treaties signed in our city. We remember that even if the number of migrants reaching Europe is very small, compared to that of all forcibly displaced people in the world (over 65 million), the psychological impact has been very high and many people started to be afraid of losing their jobs, security, and cultural identity. However, we know that migrants are a very significant cultural and economic resource for the EU and other areas of the world. Moreover, it is an ethical imperative to help as much as possible other human beings who are fleeing from war, hunger, and dictatorships—as happened to us not so long ago.
Coursework, Direct Experiences, Strategic Partnerships, and Global Outlook
Given the growing refugee and migrant crises globally, we fully recognize the need, for today and in the future, to produce health professionals with high inter-cultural competencies; universities must play a fundamental role in facilitating integration, as well as contributing to create a welcoming society.
Building Migrant Healthcare Awareness in Curriculum
For about a decade, Sapienza has incorporated a series of courses, compulsory or elective, in which the different dimensions between ‘migration’ and ‘health’ are examined. For example, some educators address migrant healthcare and analyze from an epidemiological, social, and public health perspective (e.g., right to health, healthcare needs, health policies, and organization of health services). This curriculum vision is included in the hygiene, epidemiology and public health general course programs.
An important aspect to the coursework is the openness to an interdisciplinary approach. The International Monographic Compulsory Course on ‘Global Health’ is open for students of Medicine (in 2018, the 4th edition); and the Interdisciplinary Optional Course on ‘Global Health and Equity in Health’ is open to students of medicine, psychology, social work, obstetrics, nursery, rehabilitation, and anthropology (in 2018, the 11th edition). The qualitative factor of greatest interest is the possibility of an interdisciplinary training of students. This allows for training for future collaboration as professionals. It should be noted that this vision has faced some obstacles in implementation from an administrative and organizational point of view.
Developing Concrete Solutions to Healthcare Access
Lack of information about health services and the illegal status of immigrants can make it difficult for foreign populations to access primary care, thus leading to misuse of ERs. To assess the extent of these problems, a research group made up of Sapienza professors, researchers, and residents carried out a study, funded by Sapienza University, that brought together various disciplines (hygiene and preventive medicine, emergency medicine, geography, anthropology).
The project was an opportunity to perform research activities on a national health issue and included a training experience for residents and young researchers in the interdisciplinary use of epidemiological methods, territorial analysis, and social studies, with the final goal of influencing local health policies that would focus on the problems of access to care for foreign populations. The study reviewed a fifteen-year period of access to the emergency rooms of five hospitals in Rome. A central challenge was acquiring the collection of patient data that were accurate and comparable.
One result of the study clearly emphasized the need for more complete data on the characteristics of foreign citizens in order to carry out specific analyses of healthcare accessibility for those without a residence permit. This methodology has been expanded to include a proposal within a H2020 European project. This partnership project is aimed at providing scientific evidence on access to care for migrant populations in order to underpin overarching European policies on migrants and deliver solutions for the long-term integration of displaced people in European societies.
Using Direct Experiences to Build Partnerships, Expand Outreach, and Build Trust
With the aim of allowing students (of medicine, but also of other health and social courses) to directly experience the health implications of IPS condition of vulnerability, a project was launched four years ago in collaboration with the Jesuit Refugee Service. This project provides regular meetings of students with refugees living in a reception center in Rome.
The students, under the ‘pretext’ of weekly support in the study of the Italian language, have the chance to establish relationships with the IPS. Their experiences allow them to periodically engage in discussions regarding the motivational, ethical, and social component of their future professions. The most important factor is generated by the ability of students to ‘put themselves in the shoes’ of IPS and, in this way, to become aware of their living conditions. The ability to experience the reality of asylum seekers and refugees has expanded their social awareness of the many healthcare issues that need to be addressed as well as apply their knowledge to potential solutions.
- Positive effects for student participants: awareness; reflection on the reality of refugees; relationships with different realities and people; reflection on the professional role; understanding to take an ethical standpoint.
- Positive effects for asylum seekers and refugees: acceptance, integration, and socialization.
- Although it is not easy to estimate the impact in the medium-long term of the courses on the overall quality of the doctors and other professional figures trained, approval of the courses by the students is stable on a medium-high level.
- The research on the access to care of foreign populations has produced a large number of presentations at conferences and publications carried out by residents in hygiene and preventive medicine and young researchers educated and involved in the project. The methodology set up and the results of this study–together with the participation of the Sapienza research group to an international consortium that includes other European academic and non-academic institutions involved in an H2020 European project–are intended to underpin European policies on migrants.
- Some obstacles to still overcome include administrative and language barriers.
For More Information and Related Materials About These Programs
To discuss the aforementioned issues related to migrants and refugees health, together with others, such as mental health, infectious diseases, and the role of public health systems, we recently (June 2017 and June 2018) organized two high level meetings with the participation of experts from more than 15 countries: http://www.worldhealthsummit.org/m8-alliance/meetings.html
Some of the information reported above was presented by Dr. Luciano Saso at the Global Issues Forum, organized by the Association of Academic Health Centers, in Toronto on April 30–May 1, 2018: http://www.aahcdc.org/Portals/41/Meetings/GIF/2018/2018-GIF-Agenda.pdf