Rising numbers of refugees have proved to be a major challenge for physicians as well as government authorities. Treating children can be tricky, points out pediatrician Eckard Hamelmann.
Deutsche Welle: What challenges are you confronted with when treating children from refugee families?
Eckard Hamelmann: The first major challenge is communication. It is often difficult, or only possible with the help of interpreters. It is hard to find out why a certain family or certain children seek medical help. Taking down a medical history is difficult, as is describing symptoms. The second challenge is the fact that the refugee children have illnesses that we are not used to here in Germany. That means we've seen an increase of new diseases, or even forgotten ones.
What kinds of diseases do they have?
Mostly infectious diseases that people were familiar with in Germany in the past: we see many typical children's diseases, like mumps and measles, because their immunization schedules have not been completed. You also find more exotic diseases, like parasitic diseases, caused by worms, for example. But many children have often been diagnosed with tuberculosis, which has pretty much disappeared in Germany.
What kind of psychological problems do the children have after having experienced war and violence up close?
We often see very sad cases. We've seen young girls who have been raped and already had abortions. As a consequence, they are psychologically disturbed. The families do not only suffer from physical illnesses but also very intense psychological ailments resulting from typical refugee experiences.
The refugees have not brought insurance policies with them. Who pays for the physicians who treat the refugees and their children?
In this clinic, anyone who is a registered resident is provided with health insurance coverage. In this case, the district council has footed the bill. The refugees have coverage so we can also be reimbursed accordingly for regular treatment – or in case of emergency, outpatient and inpatient treatment and accommodation. Patients who live in Germany illegally have a harder time getting treatment, as they are not insured, of course.
Additional services, like interpreting, extra time needed for the patients, creating isolation wards, etc. – no one can expect them to be paid for.
How can clinics and physicians address the challenges of treating children from refugee families?
It is important to create infrastructures that can provide families and children with the best possible help and at the earliest possible moment. That means a pediatrician should actually attend the medical check-up at the first reception facility. They either have to provide proof of a completed immunization program or be vaccinated. This should become a standardized procedure, as we usually vaccinate for measles during the official contact with refugees in Germany. And then we need good infrastructures so the people in centralized accommodations can indeed go see a doctor. But then, private practitioners must also become involved; the clinics can no longer bear the costs alone.
It is important that we do not consider the phenomenon of increased numbers of refugees as something temporary. We must probably accept the fact that we will increasingly be confronted with this situation in the coming months or years. In other words, we need good infrastructures. We need something like a round table, where the private practitioners, clinicians, district governments, health departments of the municipalities, counseling institutions, and child and youth psychiatry clinics come together and try to arrange the processes so that we can consistently and efficiently help these children.
Prof. Eckard Hamelmann is a specialist in pediatrics. The chief consultant at the Protestant Hospital in Bielefeld is also heading the "Bielefeld Pediatrics Days" between August 13 and 15. The event focuses on the challenges of pediatric medicine resulting from migration.
This interview was conducted by Christoph Ricking.