James Harold reports on an initiative, with strong Irish involvement, which aims to improve the quality of medical care provided to migrants and refugees
With an estimated 65 million people displaced globally, ever-more mobile populations need healthcare that can adapt to their needs.
Healthcare is a human right but in emergencies like the ongoing Mediterranean migrant crisis (see panel), delivering the highest attainable standard of physical and mental health continues to be a challenge for agencies on the ground.
Consultations with migrants on healthcare
The International Organisation for Migration (IOM), which is the UN’s migration agency, has partnered with an Irish user experience (UX) design consultancy, Frontend, to develop a human-centred design solution to the everyday healthcare challenges faced by migrants and refugees. In collaboration with students from Trinity College Dublin, University of Limerick, Institute of Technology Carlow and the National College of Art and Design, Dublin, the project team identified two main problems facing healthcare delivery in this context: Movement and communications.
In consultation with people who had themselves recently undertaken the perilous journey across the Mediterranean, the project team identified the pressure to keep moving as a leading factor in migrants’ reluctance to undergo medical testing. In addition, moving from place to place, patients almost never had complete medical records and duplication was commonplace. When added to face-to-face communications difficulties, these factors have left patients exposed to the risk of increased stress, misdiagnosis and an overall substandard provision of care. The response was to develop a standardised medication label concept and a cloud-based records system that allows migrants and refugees to upload, store and translate test results wherever they are.
Dr Teresa Zakaria, the IOM’s Health Emergency Operations Coordinator, noted that the IOM has over 65 years of experience in delivering healthcare to migrant populations and is acutely aware of the specific challenges that arise during crises. “Despite this, the growing number of people on the move challenges the frameworks we have put in place to ensure that no-one is left behind, a key feature of the Sustainable Development Goals,” said Dr Zakaria.
“Providing healthcare in emergency situations is at times extremely difficult. When you look at the current situation in Europe, where you have large movements of people moving across the Mediterranean, it’s easy to see just how difficult this can be. No two situations are unique. For IOM, sourcing and delivering innovative solutions, such as human-centred design and the effective use of technology, can greatly improve the standard of care we are able to provide,” said Dr Zakaria.
Member of the Irish project team, Mr Paget McCormack of the National College of Art and Design, commented: “One of the main issues that we’ve come across is that a migrant might arrive and get tested for an illness of some sort but not be around long enough to get the results.”
With medicines often dispensed in Ziploc bags with hand-written labels, confusion and inconsistent information are common problems faced by migrant patients. To help address this, the Irish project team developed standardised labelling using simple icons, colours and numbers. This easy-to-understand system has the added benefit of making distribution easier for healthcare workers. Acknowledging the important role of smartphones in the migration process, all medication information was made available in the patient’s own language by scanning the label with a smartphone.
While the labelling system seeks to reduce communication issues, the cloud-based electronic health records system aims to address the physical challenges of constant relocation. This system works by pairing volunteer doctors with migrants seeking remote medical advice using their smartphone. Added benefits of this telemedicine system include an increase in the number of medical professionals available to assist, without the need for long-term commitments or personnel relocation, and lessening the demands placed on local healthcare systems in host countries. If successful, the system could even facilitate migrants in sharing their own health records with professionals in other languages and allow them to receive test results. The human-centred design should also encourage people to get tested as soon as possible.
Frontend Director Mr Frank Long told the Medical Independent (MI): “Realising the pressure that IOM were under, Frontend volunteered to conceptualise a future vision for migrant healthcare. We’ve turned the healthcare system on its head and started from scratch. Now, this system has the potential to provide healthcare access anywhere in the world for both patient and doctor. When we started this project, we realised that we needed to create better links between all players. Through the innovative use of technology, mobile phone location information would enable us to provide migrants with details of relevant healthcare facilities almost instantly.”
Although the final product is yet to be rolled out, the team expect that the system will play a key role in helping to greatly improve healthcare service delivery for migrants and refugees. According to the IOM, the project has the potential to positively affect millions of lives. The data collected through mobile location information could also be anonymised and used to better manage logistics and geo-target specific healthcare concerns. “This collaboration is really coming at a very opportune time, in that we are now able to see how we can continue to provide healthcare to people who need it most. The potential is huge,” commented IOM’s spokesperson.
Labelling concept aims to raise standards of care
The project was the overall winner of the People’s Choice Award 2017 at the IxDA Interaction Design Awards ceremony held in New York in February 2017. The labelling concept is being earmarked by the IOM for submission to the WHO’s Global Health Cluster as a best practice for all major intergovernmental and non-governmental organisations providing emergency healthcare worldwide.
James Harold is Communications Manager with the IOM in Ireland.
Over 650 lives lost in Mediterranean Sea in 2017
Some 27,850 migrants and refugees entered Europe by sea in 2017 through to 29 March, with over 80 per cent arriving in Italy and the rest in Spain and Greece, according to the IOM. This compares with 165,697 through the first 89 days of 2016.
IOM Rome spokesperson Mr Flavio Di Giacomo reported that, on 28 March, the Iuventa ship of the German rescue organisation Jugend Rettet saved 141 migrants who were attempting to cross the Mediterranean crammed onto a rubber dinghy. The craft began to take on water and sink slowly. Many of those on board had fallen into the water and were trying to stay afloat. The Iuventa transferred 140 survivors onto the Italian Coastguard’s Unit Dattilo ship, while one other migrant — a 16-year-old Gambian boy found unconscious during the operation — was transferred onto the Spanish Canarias vessel. That ship, operating under the EUNAVFOR MED Operation Sophia, had a larger medical team on board to assist the young migrant.
Deaths on the Mediterranean Sea remained high through the first three months of 2017, with an estimated total of 655 fatalities.
In 2015, 488 men, women and children were reported lost on the Mediterranean through to 31 March that year, while the following winter, 749 fatalities were recorded in the Mediterranean through to 31 March.
The main difference between 2016 and 2017 is that total arrivals on the Mediterranean during those first months of 2016 were nearly six times 2017’s arrivals, due largely to the surge of traffic from Turkey to Greece.
According to the IOM Missing Migrants Project, fatalities through to 30 March numbered 1,157. The project tracks deaths of migrants, including refugees, who have gone missing along mixed migration routes worldwide. The Mediterranean region accounted for the largest proportion of deaths — over half of the global total.