EH 6_2015

EUROPEAN HOSPITAL  Vol 24 Issue 6/15 6 NEWS & MANAGEMENT Refugees keep coming but Munich medics meet demands The major healthcare challenge Anaesthesiologist, intensive care physician and pain expert Bart Morlion MD is president-elect of the European Pain Federation EFIC. He studied at the University of Leuven, Belgium, and completed a specialist residency at the Ruhr University, Bochum, Germany. He returned to Leuven in 1998 to become professor in the Department of Cardiovascular Sciences and head of the multidisciplinary pain centre. From 2006 until 2012 Morlion presided over the Belgian Pain Society and is the principal investigator in 28 national and international multicentre clinical trials (Phases II, III and IV) Report: Anja Behringer The refugee wave rolls on with no ebb in sight. For many, Germany remains their travel destination. In August and September alone, tens of thousands refugees arrived in Munich, presenting the Bavarian capital with a major challenge: How could the city provide initial medi- cal care for everyone? While the German Asylum Procedure Act gov- erns the appropriate procedures, in this unprecedented situation it was necessary for everyone involved to act quickly, efficiently and, most importantly, less bureaucratically. Due to its timely relevance, Dr Werner Schimana of the municipal health department was asked at short notice to speak at European Health Congress in Munich in early October. The paediatrician and ado- lescent medicine specialist reported how medical examinations are per- formed in tents at the central station in the course of registration, even before refugees are allocated to the initial processing facilities in the city and vicinity and then taken to other states. During this initial screening, teams containing two paramedics and a physician examine refugees; two teams can care for approximate- ly 500-600 people within a 24-hour period. Within three days an additional health examination is performed in the initial processing facilities. If need be, the refugees receive medi- cal treatment, which is not always easy. Since both the federal and state authorities want to improve care of refugees, including health- care, the draft Asylum Procedure (Acceleration) Act was adopted by the federal cabinet on 29 September 2015, with a supporting directive. As far as disease prevention is con- cerned, the states can also draw on the Robert Koch Institute and its ‘concept for implementation of early vaccination of asylum-seekers’. Medical care with little bureaucracy To provide non-bureaucratic assis- tance, the paediatrician Dr Mathias Wedeborn founded ‘Refudocs’, a Munich-based association that oper- ates an acute treatment practice for refugees, financed outside the health insurance system. Since January, general practitioners, pae- diatricians, gynaecologists, and psy- chotherapists have been offering consultation five days a week in the initial processing facility at the Bayernkaserne for patients with acute illness, trauma or pregnancy. They work on an hourly basis in addition to their regular work or, if retired, in the spare time. More than 70 physicians are on the association’s roster, which functions as the practice owner. ‘We are not only inexpensive. By virtue of our presence at the scene, we prevent many unnecessary emergency cases and hospitalisations,’ Wedeborn explained. Moreover, examination results are entered in a database so that they can be assigned to the per- son even after the refugee’s transfer. The Oberbayern regional govern- ment, which assumed the start- up financing of this practice, pays Refudocs a contractually agreed, fixed hourly rate for medical service rendered. The association retains a portion to pay technical staff and practice overhead. The rest is paid to the physicians. Immunisation: a first step toward prevention At the beginning of October, the Robert Koch Institute (RKI) report- ed that there is currently only a very low risk of rare infectious diseas- es borne by asylum-seekers being imported into Germany. ‘Analyses of reporting data on infection incidents in the past years show that more than 90% of those who were ill were infected in Germany. That means the asylum-seekers are more of a group at risk than a risk to others.’ The institute also provides a list of infectious diseases uncommon there, which can occur among asylum- seekers – inter alia malaria, typhoid or relapsing fever. At the same time the Institute stresses that an out- break of these diseases among the general population is very unlikely. Rather, many refugees suffer more from scabies incurred during flight, or from being in cramped quarters. According to Schimana, current examinations show that less than 1% of the refugees tested positive for HIV or hepatitis. Approximately 1% has TBC infections, whereby the number of suspected cases is higher, ‘but that corresponds to the incidence among the German pop- ulation and is manageable’. The next step in medical care to be performed is – nevertheless vol- untary –vaccination, in accordance with the recommendations of the Standing Immunisation Commission (STIKO). Anyone who does not have a vaccination card is deemed un- vaccinated. According to the Asylum Procedure Act, the senior state health authority determines the scope of examinations for commu- nicable diseases to be performed on foreigners who have to live in an ini- tial processing facility or communal accommodation. The law prescribes that these people must submit a physician’s certificate that there are no indications of infectious pulmo- nary TB. This certificate must be supported by a lung X-ray for all 15+year-olds (except those who are pregnant). That sums up the legal requirements. However, according to RKI ‘The current high numbers of asylum- seekers presents the states with great challenges, also in organisa- tion of health examinations, inter alia with regard to the required capacity for X-ray examinations. Hence there ought to be a technical reassessment of the procedure for thoracic X-ray exams of people 15 and older.’ Additionally, the Institute fears that a sharper increase in the illness is to be expected. It is estimated that one person suffering open tubercu- losis – half of all new disease inci- dents – infects ten healthy people annually. Another approach would be a triage using infection diagnostics (IGRA/ tuberculin skin tests) and a subsequent X-ray only if the test is positive. However, current test methods do not permit a distinc- tion between active tuberculosis and latent TB infection (LTBI). Moreover, since the tests do not offer 100% sensitivity, a false negative finding is possible, even in a case of active TB. They are unsuitable for predict- ing the progression into a case of active TB. Werner Schimana presented the initial assessment of refugee medical care at the European Health Congress eMotio, the examination couch that reinvents the medical examination Sterile single-use suction range for ear endoscopy The all-electric eMotio couch, the most efficient e x a m i - nation couch ever designed, should become the new assistant for general practitioners and specialists. Promotal carried out the largest study ever conducted in medical furniture, with two hundred doctors from six European countries. The final product, the result of three years develop- ment, allows the doctor to fully concentrate on the diagnosis, while gaining time and space. The patient benefits from increased comfort and lower stress for a more balanced exchange. To optimise a medical examination, the eMotio couch offers numerous possibilities as standard. Gain in time and comfort thanks to: • favourite positions with one press: two 100% configurable exam positions, return to welcome position, couch/ chair positions • Fast, easy surrounding access • Optional gynaecology position, with possibility to raise the pelvis up to 105 cm (41.34 Inch) http://www.promotal.com/en/ Award-winning UK manufacturer of innova- tive and high quality single-use surgical instruments DTR Medical, will showcase their new endo scopic ear range at Arab Health. The single-use endoscopic ear range has been designed in response to the growing demand for this recent surgical approach. Featuring 3mm and 6mm bends to enable a more specific suc- tion, the endoscopic ear range allows bet- ter visualisation of the internal ear structure. DTR Medical offer the Otologist a choice of Curved Endoscopic Suction Tubes for use with suction regulator and Curved Zoellner Suction Fine Ends used with a Zoellner Suction Handle. DTR Medical expect to expand this range to include further options. At Arab Health 2016, DTR Medical will be displaying their full range of new products throughout ENT/MAXFAX, General Surgery, Gynaecology, Neurosurgical, Ophthalmic and Orthopaedic in Zabeel Hall 1 at Stand G30. This year the company celebrates ten years in this market, during which the product range has grown by working with clinicians and academics at leading hospitals worldwide who have increasingly sought sterile single- use alternatives to re-usable instruments. The benefits of such a move come from saving time, lives (reducing risk) and cost. For further information please contact: Kirsty Martin, Marketing Manager Web: http://www.dtrmedical.com/ Email: kmartin@dtrmedical.com Phone: +44 (0) 1792 797910 ©AlexandreRotenberg/Shutterstock.com Phone: +44 (0) 1792797910

Pages Overview