Blog

Measles and MMR vaccination

vaccinateFollowing a national teleconference this morning we would like to raise awareness regarding the importance of ensuring that the migrant and traveller populations are protected against measles by receiving the MMR vaccination.

There have been several outbreaks of measles in the UK recently which have included traveller and Romanian communities. Therefore we would like ask your colleagues to encourage individuals who have not been vaccinated within these communities to register and attend the GP practice for MMR vaccination.

It is particularly important that those who are travelling to countries such as Romania, where there are a high number of measles cases, are vaccinated with MMR prior to travelling.

Individuals should also be aware that if they are unwell and concerned that they may have symptoms of measles such as high fever, runny nose, cough, red and watery eyes and spots inside the mouth (small red spots with bluish-white centres), that they should first call the GP practice prior to attending to avoid contact with other individuals in waiting rooms etc.

Please see link below with posters and leaflets to support these discussions:

For more information. please contact: Lisa Pledger, Screening and Immunisation Coordinator, NHS England (South East).

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Outreach support for UASC in West Kent

shutterstock_452938996The health assessment process for Unaccompanied Asylum Seekers (UASC LAC) looks at the general health of this group.  Young people in this group can have complex health needs, resulting from the experiences in their home country and their ‘journey’ to the UK.

We looked at the pathway for supporting the needs of UASC in terms of sexual health. Screening for blood-borne infections and sexually transmitted infections would ideally be offered as part of the LAC process for USAC arriving in Kent.  Sexual health questions would also be asked as part of the IHA. Local pathways should be followed for referrals into appropriate local Sexual Health Services.

As Sexual Health Outreach Nurses, we had been asked to support the UASC with Sexual Health provision in West Kent.  During the process, we realised that the young people had specific  learning needs which had to be addressed before any basic sexual health discussion could take place. We identified a lack of knowledge and understanding of the UK social and cultural norms by the young men. This was supported by further research into asylum seekers’ experiences in other parts of the country. There have also been reported incidences of inappropriate behaviour in the UK and other parts of Europe involving young asylum seeker males. The FPA document ‘Supporting Asylum Seekers’ identifies that the young people need ‘an opportunity to learn about the law and common cultural practices including behaviour towards women’. Our sessions are to help raise awareness and to give insight into how behaviours, such as whistling at women or following women could have a negative impact on relationships. These behaviours may be acceptable in their home country, but are not in the UK and can even result in a criminal offence.

Our aim was to provide information about cultural norms around relationships, behaviour towards girls and women and to look at the issue of consent and the law (on a basic level).

We provided a group-based discussion, with support from our Reception Centre colleagues, including up to five different interpreters. We gave the interpreters an introductory letter to explain our goals for the session (template available on UASC website), as they would play an integral part in the discussion.

A series of drawn and photographic scenarios were shown to the groups, which we used to facilitate a discussion with the young people. We initially made this in the format of a Powerpoint presentation, however the use of individual packs of scenarios was found to be more effective in the smaller group discussions.  Each small group was supported by an appropriate interpreter.

The images that we used included:

  • Picture of a lone woman walking at night
  • Picture of young people drinking alcohol having fun with friends
  • Young people in a public swimming pool (wearing bathing suits)

We were very keen to explore the young mens’ views and thoughts on the images and reassured them that there were no right or wrong answers.  We believe that this approach facilitated a more productive learning experience. It helped to challenge their preconceptions in an informal way and it also enabled us to gain a better understanding of their perspective. A good example of this was when a group was shown a photo of a solitary young woman walking along a dimly-lit street. A discussion ensued and concerns were raised for the young woman by the young men as they felt the woman should have been with a male family member to ‘look after her’. However, we told them that the young woman could just be going home from college or work and that her family would more than likely be aware of where she was. This we feel, gave the young men a different perspective. The group discussion enabled us to see that the young men’s experience of ‘chaperoning’ women, in their view is a loving and protective thing to do for a member of the family. Showing concern for a lone woman by trying to befriend her or escort her safely could be intimidating to the woman.

Demonstration of mutual respect in these discussions is, we believe, paramount to the work being of value.

Our session only lasts for an hour; the content is not exhaustive and is only meant to provide a starting point, to open the conversation and to provide a foundation to further learning opportunities.

Our vision would be that further sessions would include:

  • Consent and the Law
  • Healthy Relationships
  • Sexually Transmitted Infections
  • Contraception
  • Internet safety
  • FGM-attitudes and myths

Unaccompanied asylum seeker children have a right to access information about sexual health and the services that are available in the UK and this will provide the building blocks for them to be able to have positive and healthy relationships in the future.

RESOURCES AVAILABLE to download below, and from our Public Health page:

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Challenges in Primary Care

shutterstock_386979349COMMUNICATION – CULTURAL DIFFERENCES

We had many problems relating to not speaking the same language. It was difficult to get access to appropriate interpreters, especially when there was an urgent medical need. Translation is sometimes difficult. There isn’t always a literal translation from English to the child’s native tongue, needing to re-work what we said, and simplify explanations.

We also encountered Religious issues, there was a need for appropriate places for worship. We always had to have respect for their needs related to food and religious festivals.
TRUST

A lot of the children/young people were frightened, hyper-vigilant and suspicious.  Many had been failed or let down by supposed people in authority or ‘professionals’. It took time to build up a rapport and get a complete story. Their trust had to be earned. Sometimes it took more than one or two consultations to be given all of the facts.


CONFIDENTIALITY

The legal aspects of what to share, when, to whom and why. We were often asked by various agencies for information with no signed consent by YP to release it. It’s not an aspect they are familiar with, being asked for their consent – we needed to explain the pros and cons, not to make them feel pressured no matter who is asking.


IDENTIFICATION

Many of the children / young people have very similar names and the same or very similar dates of birth, such as Mohammed, Mohamed, Muhammed, Muhamed.

Documentation must be 100% accurate between staff and agencies, using  a 3rd identifier at least if possible. Name to be full, in the correct order, such as Mohammed Ali or Ali Mohammed a DOB and NHS number as a minimum.  We also got photographic ID for every child. It is important to double check everything to reduce the risk of errors.


SAFETY

We needed to be ensure the health and safety of the children, staff, us, and other residents. There were unknown communicable diseases such as Hepatitis B.
Any challenging behaviours would be dealt with effectively and preventative actions taken.
Protection must be taken including wearing gloves with body fluid spillages. Risk assessments were also completed                                                                                                                                   
EXPECTATIONS

What the child or young person expects, has been told or led to believe the experience in the UK will be. The reality can be very different leading to frustration and anger.


CONTINUITY

When moving from our unit the continuity of care is important, communication between agencies to ensure hospital follow ups, medications and investigations, linking all the correspondence form different departments and agencies to the child’s new place of residence.


ATTITUDES

Attitudes were a big consideration both from the UASC’s and from the staff working with them. The Young people needed to be taught about British Culture, respecting women, and appropriate behaviour towards women and other people.

The staff attitudes were sometimes that of Indifference, lack of understanding, and a lack of sensitivity. Which also needed to be changed just as much as the young people.

by Jacqueline Nudd

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A Practice Nurse’s story

PersonMy name is Jacqueline Nudd. I am a State registered, Sick Children’s and District Nurse. I have worked in Neo-natal intensive Care, Accident and Emergency, School Nursing, Sexual medicine, acute surgical wards and for the past 26 years the only Practice Nurse in a rural 3,500 patient practice also covering two private schools. I specialise in Asthma along with dealing with Travel Health/medicine, child immunisations, chronic disease management, wound care and all other practice nurse tasks. I can safely say I don’t think there is any part of the skills and knowledge I have obtained over my nursing career that hasn’t been tested in this role. It is truly unique.

MY EXPERTISE INVOLVING UASC

Firstly we needed to ensure all of the children in the unit are registered with the GP to get an NHS number and access health care to which they are all fully entitled.

I set up and ran clinics with a GP at the centre, co-ordinating with support workers and appropriate interpreters for each child. We would deal with common conditions seen in the children/young people such as; scabies,  athlete’s foot but also needed to have a heightened sense of awareness of signs and symptoms of conditions not normally seen in UK children, such as Malaria.

I was involved in advising on Issues regarding; control of infection, clinical waste and the use of agencies such as PHE.

Important discussions were had with all staff, both at the unit and within the practice, regarding information sharing, confidentiality, consent & the law, dealing with communication difficulties when no interpreters were available.

Immunisation was a big part of my role, and a big question was “how do we obtain ‘informed consent’?” A consent form was devised to be used specifically for these children. This was created using ‘The Green Book’ and The ‘Guidelines for those of unknown immunisation status’

Another issue we had to deal with was age disputes – there are a lot of documents and papers on age assessment, this is particularly relevant with UASC’s, and a great deal of caution is needed. This area caused us a lot of problems especially with care when the appearance of a child seemed much older than their documented date of birth.

I was responsible for the Education of staff, children and interpreters about the importance of attending appointments, there was a high DNA rate, the implications and impact on the health of the child and the cost to the NHS in wasted appointments and sorting out further follow up appointments.

When completing new patient health checks it was important to be aware of additional screening where appropriate. Questions such as;

  • Do they look well, thin, pale, anxious, agitated?
  • Look at body language, do they make eye contact,
  • Are there appropriate interactions between us and staff?
  • Ask if they want help with anything?

Be aware of ‘hidden’ conditions, because of cultural beliefs or shame, they may be afraid and give an atypical history or ‘hide’ symptoms and be not sure who to tell what to.
It was like doing a jigsaw to get a complete picture.

My work also involved dealing with their day to day health needs of the young person. We had to explain to UASC’s what is ‘normal’ in this country, advising that ‘everyone here has these injections’, ‘it is normal to do these tests with these symptoms’, and we had to help them to understand ‘why’’

In primary care with dispersal there may be only a scattering of UASC’s in many practices. Some of the facilities and support we had will not be available, but each one of these children will potentially have a number of unique needs and risk factors not common in primary care normally that may need addressing. They may feel isolated within the community, different language and culture, not have contact with familiar friends or family. The media and some people’s attitudes may make them feel frightened, threatened and intimidated.

In primary care we can make a difference a smile may open a door to communication to help them share a health concern or need. Take time – I know it’s difficult, and the pressure we are under in primary care – make their appointments at a time when the surgery is quieter. Use all the resources now available to help you and them do the best you can.

The role is constantly evolving around what has been learnt, about the children’s ‘journey’ and the experience gained in caring for UASC’s.  Models of appropriate care and support are being made, not only for them but also for anyone involved in their care. Only in the long term will we see how successful we have been in managing the health and well-being of these children as they integrate into society, grow up and nurture their own children in the future.

This is a human being just like us, who deserves a chance to be healthy, and fulfil their dreams and aspirations, despite a start in life neither you, or I could imagine.

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Report: An Emotional Health and Wellbeing Specialist Early Intervention Framework

By Dr. Ana Draper

In July 2016, A Parliamentary Select Committee report entitled Children in Crisis: Unaccompanied Migrant Children in the EU makes the statement: ‘All we can know for certainty is that the number of unaccompanied children in the EU runs to many tens of thousands and has grown significantly in recent years’. From this uncertainty a very specific figure of 3,043 asylum applications from unaccompanied minors were made in the UK, an increase of 56% from 2014. Most of these children have arrived in Kent and passed through reception centres in the county before being rapidly dispersed either into foster care or supported living arrangements. It is from the experience of working therapeutically with these children that the recommendations in this paper are being made.

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Migration crisis inquiry

Europe, including the UK, is facing a huge challenge arising from the number of refugees and migrants reaching levels not seen since the Second World War. In addition to people fleeing war and insecurity as refugees, there are large numbers of migrants attempting to come to Europe to seek a better life for themselves and their families.

After a year-long inquiry, the Home Affairs Committee says EU action to address a crisis it should have foreseen has been “too little, too late”, with the EU-Turkey agreement a partial solution at best which raises serious humanitarian, human rights, logistical and legal concerns.

Find out more

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Children in crisis: unaccompanied migrant children in the EU

The current refugee crisis is the greatest humanitarian challenge to have faced the European Union since its foundation.  

Although the outcome of the referendum on 23 June 2016 was that the UK should leave the EU, the UK remains a full member of the EU, with all the responsibilities that entails, until the final withdrawal agreement is ratified. It is vital, both on moral grounds and in order to help maintain good relations with the other 27 Member States, that the UK Government should participate fully in EU action to resolve this humanitarian crisis.

Read the full report

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Unaccompanied child refugees to be dispersed across UK

A national dispersal scheme for unaccompanied child asylum seekers in Britain is to get under way in July as Home Office ministers prepare to announce a new scheme to take Syrian child refugees directly from camps in the Middle East.

The number of unaccompanied child refugees in Britain has reached 4,029, with many concentrated in Kent and Croydon, where they first made their claims for asylum on arrival in Britain.

The immigration minister, James Brokenshire, told MPs it was clear that a national response was needed to help councils such as Kent and Croydon “promote a fair and equitable distribution of cases across the country in a way that protects the best interests of those children”.

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Unaccompanied asylum-seeking children to be resettled from Europe

Unaccompanied asylum-seeking children will be resettled from Greece, Italy and France, in an initiative announced today following discussions between the government and Save the Children.

This initiative builds on last month’s announcement that up to 3,000 vulnerable children and family members will be resettled direct from the Middle East and North Africa.

And it adds to the resettlement of 20,000 people direct from Syrian refugee communities, which has been under way since last year.

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