Background, motivation | The aimsProfessional preparationsOrganizational preparationsThe educational interventionQuestionnaire surveyLessons learntPublicationsFuture perspectives

Background, motivation

241International migration is a current, rapidly growing phenomenon which has affected Hungary in 2013 more critically than ever before. It is estimated that in 2011 there were nearly 50 million foreign-born residents in the EU (accounts for 9.7% of the total population.) Approximately two-third of them (32.4 million) were born outside the EU, a majority arriving from distant geographical areas (such as Pakistan, Afganistan, Syria and different North- and Middle African countries). Hungary, as composing the eastern-southern overland border of the Schengen Area, is particularly attractive for those migrants, who would like to enter the Schengen Area illegally (without any permission, identity card or other documentation), since, in case of a successful border-crossing, they may get into any part of the EU without any further border control. Since 2007, the European Commission and the Council of The European Union have recognized the importance and the challenges of the health consequences of the recent, significantly increased migration flows towards the EU. Therefore, since then migration-health, a new interdisciplinary entity, has been considered as a priority field for action. Several recommendations and declarations has been adopted dealing with the health of migrants; tackling the social and health inequalities between these particularly vulnerable groups and the host societies. Our Department, the University of Pecs, Medical School (UP-MS), Department of Operational Medicine, Migrant Health Programs Research Team is strictly committed to the health of migrants, and all our past and recent research and training activities are focusing on the development of the health and the access to a better care of this vulnerable population. Starting in the spring of 2013, with the financial supportion of the European Union and co-financed by the European Social Fund, within the the frames of TÁMOP 4.2.4. A/2-11-1-2012-0001 „National Excellence Program – Elaborating and operating an inland student and researcher personal support system convergence program”, our research group has conducted a comprehensive research entitled: ’Assessment of public health hazards in Hungarian reception centers and Schengen Border Crossing Points’.

This study had four main parts:

  • during 10 site-visits at selected Border Crossing Points, Reception Centres and Detention Centres we inspected the infrastructure of the certain institution – especially from public-health related aspects
  • we conducted questionnaire survey with the staff (both health-care and the police staff) concerning their awareness of their occupational health risks (analysis of data and publication of results is ongoing)
  • the investigation of the health documentation (also the data collection) is still ongoing as a part of a new PhD research
  • last but not least, we conducted focus-group discussions at the three main Hungarian reception centres (Debrecen, Bicske, Békéscsaba) with representatives of migrant communities

These focus-group discussions laid a special focus on the migrants’ health-related knowledge and attitudes as well as on their awareness and opinion about their access to the health care services in Hungary. Our results have clearly demonstrated significant deficiencies in both their health-literacy (e.g signs and symptoms of common infectious diseases, measures of prevention etc.) and also considerable gaps in their awareness of their duties and rights they are entitled during their stay in Hungary. As reported, since their arrival to Hungary, they had not received any information on their status-dependent rights and obligations concerning neither the performed medical examinations (screenings etc.), nor on their access to health care services. These results draw our attention to the current gaps of information and also to the urgent need to handle these controversies effectively, since it is indispensable to successful integration of the migrants to the hosting society.

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The aims

On the basis of the above specified background and reasons a research plan entitled ’Improving irregular migrants’ access to the health care in Hungary’ was designed with the following aims:

  • to develop and test a brief, health-focused training-program particularly for irregular migrants which can be easily implemented (and repeated) in the reception centres and also may be available for self-study for the target-group via internet
  • a long-term goal: through the wide dissemination of the project outcomes to improve the migrants’ health and their access to the Hungarian health care services (irrespectively to their legal status targeting both legal and irregular migrants)

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Professional preparations

2432014 spring and the great majority of the summer were dedicated for the throughout professional (and organizational) preparational work, literature review and collection of relevant regulations and other informational materials. Personal discussions were also organized, firstly, with the Dr. Árpád Szép, Head of Directorate of Refugee Affairs, OIN (Office for Immigration and Nationality) and secondly with Dr. G. Nagy Árpád, director of OIN Refugee Reception Centre, Debrecen and his colleagues. During these discussions we informed the two directors about the aims and methods of our research. On the basis of the revised literature and the continuous email correspondence with experts of the relevant fields (ie. lawyer, social worker and health care workers from the refugee reception centre and pharmacist etc.), I completed the first, very-very detailed draft of the planned educational intervention and sent to director of the reception centre for revision and approval. The director of the reception centre and his colleagues (the senior social worker and head nurse) strictly revised my first draft and sent back with their comments and recommendations. After that the whole program was corrected and modified as requested, all their feed-backs and suggestions were integrated and the second version of the program. After completition it was sent back for a second revision and final approval. Following the final approval of the text the whole educational material was translated into English language and the Power Point slides of the intervention were completed both in Hungarian and in English languages. Finally, the educational materials were ready for being presented.

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Organizational preparations

244Following to the approval of the text of my presentations by the director of the OIN Refugee Reception Centre, Debrecen paralell to the development of the Power Point presentations (in Hungarian and English languages) I laid a special emphasis on the organizational preparational works of the educational program. The entrance permissions for myself and my mentored students was in time (at least 3 weeks before the visit) requested from the Office for Immigration and Nationality, but unfortunately it was summer-time and holiday in the Office…J, so there was a great delay in receiving our entrance premissions, but finally we got them (the day before travelling thanks to the directors’ personal phone-request). Meanwhile, during awaiting for the permissions I fixed the data of the presentations with the colleagues from the reception centre and completed the Invitation cards for the immigrants. The target population was defined (those immigrants of the camp which represent the largets ethnicities in the camp) and the translators/interpreters were selected and contacted. Based on the ethnic composition of the reception centre the following languages were selected (in order to reach as many immigrants as possible): Pharsi, Arabian, Albanian, Somali and English. Templates for the questionnaire survey were also developed and as well as leaflets and wall-posters in relation to disease prevention in Hungary and in the EU. All materials were sent to the translators / interpreters in order to provide them sufficient time for translating and sending back the documents and also for preparing themselves for the interpretation of the presentations (medical, juridical language). Translated invitation cards were printed and sent to the camp for distribution a few days prior to the program and also the questionnaire surveys, leaflets and wall-posters were printed in 6 languages (including Hungarian).

Downloadable pdf-files

the Invitation cards in 6 languages

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The educational intervention

245Following several months of professional and organizational preparational work, finally the completed educational intervention was persented in mid August, 2014, in the OIN Refugee Reception Centre, Debrecen. Four presentations were held, three in Hungarian language with Pharsi, Alban and Arabian interpreters and one in English with French interpreter (instead of the previously planned Somali), this latter was mainly for asylum-seekers from Africa. Altogether 106 immigrants from 19 countries participated during the 4 presentations, 75.5% of them also participated in our anonymous, voluntary questionnaire survey (80 people).

The presentations lasted approximately for 90 minutes and were followed by 5-10 minutes Q&A sessions, when the immigrants had opportunity to ask questions or to make comments, complaints.

The presentations had two main parts:

  • Part 1. covered a lot of information about the immigrants’ entitlements concerning health care services (their rights and duties), medical care in the camp, parts of their medical screening, free medical services, emergency situations when the secondary care is also free for them, Hungarian vaccination schedule and the migrants children’s vaccination
  • Part 2. was devoted for the prevention of infectious diseases that are common in Hungary and in the European Union: what are the most common pathogens (and also which pathogens are eradicated already in the EU), how can they be transmitted, and what are the most important measures in prevention

All participants got a leaflet which included 16 basic hygienic rules, key-messages which should be taken into account in order to prevent infectious diseases. The questionnaire survey included feed-back questions concerning the participants satisfactory with the presentation.

Downloadable pdf-files

the educational intervention in pdf (for the ppt-files, contact me!)

the leaflets/wall-posters in 6 languages

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Questionnaire survey

246Participants of the educational intervention were invited to participate in my pre- and post-testing questionnaire survey. 75.5% of them (80 people) agreed and completed the anonymous questionnaires. The questionnaires were translated into 6 languages and included 20+4 closed-end questions. Twenty questions were posed as ’pre-test’ for measuring participants’ sociodemographic characteristics and self-assessment of their health and health awareness (awareness of their entitlements and of disease prevention) and 4 questions were posed as ’post-testing’ of the educational intervention: to measure participants’ satisfactory. Participation was on voluntary basis and without renumeration.

Downloadable pdf-files

questionnaires in 6 languages

report on the results (under analysis)

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Lessons learnt

247Several experiences and conclusions could be drawn from the development and the testing of my program which may be useful in the future when designing educational interventions for specific populations:

→ the thorough preparational work is essential:

  • obtaining permissions if needed in time (e.g. Office for Immigration and Nationality)
  • need –assessment: consulting both target group AND assistance providers to gather information what should be included in the program, what is essential
  • collecting preliminary information of the target population in order to make the program tailored for the target-group (age, gender, ethnicity/nationality etc.)
  • organizational issues (data, location, interpreters, invitation cards)
  • submitting all materials for translation in time in order to ensure the suffiecient time for the interpreters for preparation for
    • especially in the case of professional medical or juridical language
  • considering language, cultural, religious differences (eg. muslim women)

→ as for the educational intervention

  • providing basic but relevant information
    • when fewer is more: not too much, not too scientific, but still enough
  • providing practical information (eg. how to remove a tick?, how to seek medical advice?, what health services are free of charge? etc.)
  • building up the presentation logically and systematically: to make it easy to follow
  • including a lot of graphics, pictures for the visual memory
  • repeating and laying a special emphasis on the key messages
  • making presentation interactive
    • immediate feed-back, to ensure friendly athmosphere

→ as for the future

– ensure the sustainability of the program!

Therefore:

  • make the program repetable: try to involve/train local partners: eg. social workers, health care workers or even members of the community (try to find the leaders!)
  • ensure the future availability of the information/presentation, eg. through internet, multilingual educational websites etc.
  • pilot-test the program on a small group of the target population AND incorporate their feed-backs on the final program
  • test, revise and update the information regularly (eg. Acts, Decrees)

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Publications

248This research has been introduced already on some national and international scientific platforms (both the aims and preparational works and the results):

  • oral presentation was held and abstract was published in the conference booklet of the 24th International Medical Sciences Student Congress (IMSSC), 17-19th, May, 2014, Istanbul, Turkey
  • oral presentation was held during the European-level Expert Symposium „Healthy Ageing of Roma Communities: Endowers – Realities – Perspectives”, 27-29, Oct, 2014, Pécs, Hungary
  • poster-presentation was held entitled Improving the access to health care of migrants living in Hungarian reception centers during the 7th European Public Health Conference „Mind the gap: Reducing inequalities in health and health care” 19-22th, Nov. 2014, Glasgow, United Kingdom
  • abstract was published entitled ’Improving the access to health care of migrants living in Hungarian reception centers’ in the Supplement of the ’European Journal of Public Health’ 2014, Vol. 24, Supplement 2, p 122. (Impact Factor: 2.459)
  • a report is published in ’Orvoskari Hírmondó’ (HU ISSN 1586-1295), entitled: ’Health education in the Reception Centre, Debrecen’ (Egészségnevelés a debreceni menekülttáborban), in press (link majd)

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Future perspectives

249Results and experiences of this project offer a lot of new ideas and possible fruitful future perspectives. By making this program sustainable, as it has been offered for the social and health assistance of the reception centre for future application (and they promised to do so), therefore this program may be repeated as many times as needed and we also intend to go back to the camp to present it again, if we have opportunity. The presentation itself is also already available for self-study through the internet and all information included in the presentation (and even much more!) may be found in this website separately, by topics. In the future, this currently bilingual website may be improved by making it multilingual and also may be improved by content and by technical availability (to mobile-phones, etc.).