IME and PAHA for Syrian Refugees
Immigration Medical Exam (IME)
The IME for government assisted and privately sponsored refugees is done prior to arrival in Canada. All Syrian refugees destined for Canada have their IME done in Lebanon or Jordan, and are given a paper copy of the results.
The IME consists of a medical history, a focused physical examination and the following investigations:
1. Urinalysis for patients >5y
2. Chest x-ray (posterior-anterior view) to rule out active pulmonary TB for patients >11y
3. Syphilis test for patients >15y
4. HIV test for patients >15y
Historically, Canadian practitioners have been unable to access these results. Only certain results, such as a positive HIV test, are communicated to public health officials in Canada. Rather than assuming that the absence of a notification means a negative screening result, consider repeating the HIV and RPR tests.
Post Arrival Health Assessment
The Canadian Collaboration on Immigrant and Refugee Health has developed Evidence-Based Preventive Care Checklists for New Immigrants and Refugees from different regions of the world. For Syrians, use the Central Middle East checklist, available as a printable online checklist or a PDF.
Interior Health has translated a post arrival health assessment nurse screening form into Arabic.
IFH will pay $94 for a post arrival health assessment (PAHA) and for an interpreter ($29/h x 2h), but the provider must apply for prior approval. The PAHA is usually completed over multiple visits, and divided among team members (e.g. physician and nurse). It ought to include the following:
HISTORY
Current Complaints
Psychosocial
- Family members (who's missing?)
- Country of origin and transit, and dates
- Occupation, education, literacy, housing
Medical and surgical history
Refugee patients rarely arrive with past medical records. The following are common/important issues to identify:
- Neglected chronic diseases, such as diabetes and hypertension
- Injuries (e.g.orthopedic or burn) and disability
- Mental health. Do not ask directly about trauma or torture, but consider using a screening tool.
- Visual and hearing impairment
- Pregnancy and contraception
- For children, failure to thrive and dental issues
Medications and allergies
Often the patient’s chief concern is restarting medications that were discontinued during conflict/transit. To identify foreign medications, contact the Drug Poison Information Centreat 1-866-298-5909. Often medications that refugee patients were taking previously are unavailable in Canada or not covered, and substitutions must be made.
PHYSICAL
- Vital signs
- Visual acuity
- Dental check for painful disease
- Growth for children
- Targeted physical exam based on complaints
SCREENING BLOODWORK
CCIRH-recommended screening is included in the checklists.
Based on the CCIRH Middle East Checklist, and the December 2015 CMAJ article Caring for a newly arrived Syrian refugee family, Syrian refugee screening ought to include the following:
Recommended:
- Complete blood count with differential for women of reproductive age and children aged 1-4
- Hep B serology (HBsAg, anti-HBc, anti-HBs)
- General age-based preventive screening (e.g.mammography, fecal occult blood testing, diabetes screening)
Consider:
- Varicella serology
- Hepatitis C serology
- Strongyloides serology, given the prevalence of strongyloidiasis in refugee populations and the potential of increased exposure to S. stercoralis in the unsanitary conditions of refugee camps.
- HIV testing if the results from the IME are unavailable, in keeping with the provincial STOP HIV initiative
- Syphilis testing if the results from the IME are unavailable
Not recommended:
- Mantoux testing, as the incidence of tuberculosis in Syria and surrounding countries was below the threshold of 30 per 100 000 population in 2014
- Stool samples for ova and parasites in asymptomatic refugees
VACCINATIONS
If a patient has no documented vaccination history, assume that (s)he has had no vaccinations and follow the provincial immunization ‘catch-up’ schedule. For adults without immunization records use Schedule D. Consider a referral to Public Health.
BC Refugee Readiness Fund is part of the WelcomeBC
umbrella of services, made possible through funding
from the Province of British Columbia.
