FREE ELECTRONIC LIBRARY - Dissertations, online materials

Pages:     | 1 |   ...   | 5 | 6 || 8 | 9 |   ...   | 18 |

«IOM is committed to the principle that humane and orderly migration benefits migrants and society. As an intergovernmental organization, IOM acts ...»

-- [ Page 7 ] --

• Consider the possibility of repetitive work injuries if a patient is suffering from persistent pain.

• Examine skin carefully for burns, wounds and other occupational injuries.

• Consider the possibility of exposure to toxins and other dangerous materials in the workplace that may contribute to headaches or breathing difficulties.

• Check vision because eyesight may be compromised from working in dimly lit workplaces.

• Ask about ventilation in the work environment; poor ventilation may lead to respiratory problems.

Common infections (see action sheet 15 for more details)

With the emphasis on the patient’s presenting symptoms, you may inadvertently overlook other common communicable diseases associated with the patient’s travel history and exposures, including airborne, waterborne and mosquito-borne illnesses. You should have easily accessible information on local epidemiology for all the places in which a trafficked person has been. Websites such as http://www.cdc.gov/travel/default.aspx offer up-todate information on outbreaks, changes in antibiotic resistance and endemic areas.

Preventive care, immunizations and presumptive care

While the scope of the physical and mental health needs of trafficked persons is often overwhelming, this systematic approach offers a methodical way to assess patients with complex medical problems. Because of the multitude of acute concerns, preventive care – including blood pressure screening, eye exams, immunizations and cancer screening (testicular and cervical, as well as breast and colorectal for older patients) – may be overlooked.

The question of presumptive care, or the treatment of diseases without test results, is a controversial area in the care of persons who have been


trafficked. If it is unlikely that the trafficked person can be contacted after the initial visit to discuss test results, some providers will opt to treat patients presumptively for common diseases such as chlamydia, in particular if the treatment costs less than the laboratory test. Consider having policies and procedures in place to determine under what circumstances such presumptive care would be delivered, if at all.26 Because this health assessment may be the only clinical encounter for the patient, consider offering comprehensive preventive care if resources exist for this. There should be a protocol in place for patients to receive results and be directed to follow-up care as needed.

–  –  –

See World Health Organization, Syndromic Case Management of Sexually Transmitted Diseases: A guide for decision-makers, health care workers and communicators, WHO Regional Office for the Western Pacific, Manila, 1997 and United Nations High Commissioner for Refugees, Reproductive Health in Refugee Situations: An inter-agency field manual, UNHCR, Geneva, 1999.


Zimmerman, C. et al.

2003 The Health Risks and Consequences of Trafficking in Women and Adolescents: Findings from a European study, London School of Hygiene and Tropical Medicine, London, 2003.

AC Action Sheet 5:

Special considerations

–  –  –

RATIonAle Children and adolescents are frequent targets of traffickers; they may have been trafficked by a family member or acquaintance or may have been indirectly trafficked when they accompany parents who are trafficked or when entire families are trafficked together. Children and adolescents require physical and mental health assessments according to their developmental stage. At the same time, the developmental age of a child may not be congruent with that child’s physical age, for example, due to chronic abuse or deprivation. While providers must obviously assess children to determine urgent health needs, they must also pay particular attention to health consequences of trafficking that may affect a child’s long-term health and development.

Children who have been exposed to the abuse, trauma and deprivation of trafficking are likely to have a wide range of care needs. They may have been physically and sexually abused; they may have experienced or witnessed traumatic events or been forced into forms of labour exploitation subjecting them to dangerous or life-threatening health hazards.

In child trafficking cases, a young person’s mental and emotional health is of particular concern. Severe and prolonged stress can cause cognitive and emotional developmental delays and possibly developmental regression. If forced to participate in adult activities, young persons may also have adopted behaviours, perceptions or language seemingly beyond their age. Early psychological trauma or syndromes may be predictors of longterm psychological morbidity and future risk-taking (see action sheet 12).

Children who have been chronically undernourished may also risk longterm cognitive and behavioural problems. Children’s mental, emotional and social health needs will require age-appropriate health care and various other forms of support designed for young persons.


The health provider may be the first person to identify a child or adolescent as possibly trafficked – and therefore their first and potentially only advocate until the child is referred to a broader system of care.

–  –  –

Examination and review of systems27 In addition to a standard paediatric review of systems and physical examination, there are trafficking-specific issues that require attention. Please see action sheet 4 for general information on review of the following systems in any trafficked person: oral health, ear/nose, neurological, respiratory, gastrointestinal, genitourinary, reproductive health, musculoskeletal, dermatological, nutrition, laboratory studies, and forensic examination. The following is additional information for children and adolescent trafficked persons.

neurological Infants should have an ophthalmological exam for retinal haemorrhages, which may indicate physical abuse or ‘shaken baby’ syndrome.

Reproductive health Assess every child using a focal examination for trauma and infection, and testing for specific sexually transmitted infections. Girls should receive assessments related to their reproductive health, including menstrual history and possible pregnancy. Boys should be examined for genital and anal trauma. Care must be taken not to re-traumatize the adolescent; their refusal See action sheet 4.


must be respected. Every examination should be done by a practitioner of the gender requested by the patient. The practitioner should talk the patient through every step with appropriate explanations and expectations. Requests by a child or adolescent to delay or suspend an examination should be responded to appropriately and with patience, even if this means delaying or terminating the exam (see action sheet 12).

nutrition Children are more dependent than adults for security of food and safe water. Since food is often restricted in a trafficking situation, vitamin, protein and mineral deficiencies are common. Poor nutrition impacts the growth and development of children more dramatically than that of adults.

Therefore, health professionals should assess each child’s nutritional status against international standards (e.g., World Health Organization standards) and immediately start providing for nutritional needs. Assessment includes weight-for-height measurements or a mid-upper arm circumference.

Nutritional deficiencies put children at greater risk of contracting certain infectious diseases (e.g., vitamin A deficiency). Hair color and presence of oedema should also be noted.

Infectious diseases Infectious diseases are very common among children and can present differently from similar diseases in adults. Every practitioner must have a high degree of suspicion for infectious diseases in every child and adolescent (see action sheet 15).

Substance abuse This must not be overlooked in children and adolescents. A toxicology screen can help identify drugs of abuse and poisons that are either intentionally taken or administered to a child. It is important to rule out toxic substances as an organic cause of altered mental status, behavioural abnormalities and other medical conditions. Withdrawal from some substances can present as a medical emergency (see action sheet 11).

forensic examination Health professionals should have specific training in evaluation of violence towards children that is appropriate for the patient’s age and developmental stage. Sexual assault is common among trafficked children and therefore needs to be addressed urgently, but in a delicate way. If any evidence is likely to be used in any legal proceedings, a professional trained in collection of forensic evidence should perform the examination. Appropriate national or local guidelines for collection, reporting and chain of custody of forensic evidence need to be followed. It is also essential that sexually


assaulted or exploited children and adolescents receive mental health care as soon as possible (see action sheet 12).

Treatment • Administer immunizations according to each country’s expanded protocol for immunizations. You may consider other preventive measures including hepatitis B immunoglobulin (HBIG), post-exposure prophylaxis for HIV and emergency contraception (see action sheets 13 and 15).

• Consider prescribing a vitamin and mineral supplement for all children in the acute care setting with continued supplementation for those who demonstrate deficiencies.

Infants with mothers should continue to breastfeed, unless contraindicated.

• Referral to a dentist, if necessary, should be done rapidly to reduce potentially serious complications.

• When dosing medication, it is important to remember that medicine is often dosed according to weight. If paediatric dosages are not available, it is important to determine the correct dosage of adult medication. Children metabolize medicines differently from adults and some medicines are contraindicated in children because they are harmful to a child’s physical development.

• Treatment protocols for such infections as HIV and tuberculosis are highly specific to children; such protocols should be reviewed, and a paediatric infectious disease specialist consulted if possible.

Legal considerations (see action sheet 16 for more details) • Be aware of local laws pertaining to the treatment of children, consent to test for and/or treat specific conditions in children (e.g., the requirements to obtain consent for treatment of a minor), as well as legal requirements that may cover reporting of certain conditions (e.g., child abuse) and diseases in children.

• Adolescents in some places may be regarded as emancipated minors, which means that despite being younger than the legal age of adulthood, they have complete autonomy to make decisions regarding consent, refusal and direction of care.


–  –  –

RATIonAle The health care system is in a unique position to provide protection to trafficked persons. Health providers may treat persons who have already been identified by assistance organizations or police; however, there may be times when a provider receives a patient that has not been formally identified as a trafficked person. A provider may detect signs that the individual has been trafficked in the past or may still be in a trafficking situation.

Situations where trafficked persons have not yet been identified could happen in settings such as a general clinic or private practice; through care for individuals in immigration detention, at a reception facility or in prison; or via outreach services for sex workers or migrant populations. In each case, it is important to safely assess the situation and decide on appropriate response options (see action sheet 17).

Reacting to a person who is still in the trafficking situation requires wellconsidered responses that prioritize the safety of the individual, the health provider and possibly those near to them (see action sheet 7). Although trafficked persons caught in the trafficking situation are generally kept away from potential sources of assistance, given the nature of the abuse and exploitation associated with trafficking, it is not unusual for trafficked persons to become ill or injured, limiting their usefulness and decreasing their profitability to the trafficker. Because of someone’s need for medical attention, and because traffickers may consider health providers to be less of a threat compared to other service providers, traffickers may seek medical care for those they have trafficked.

This action sheet focuses on what the health provider needs to consider in a clinical setting when encountering patients whom they suspect may have been trafficked or otherwise caught in an abusive or exploitative situation


(e.g., smuggling or abusive labour exploitation), but who are not yet linked to any protection services. It outlines ways to recognize signs of trafficking and offers information on intervening in a safe, well-thought-out and professional way.

Seeing the clues, spotting red flags Although no single set of symptoms or signs indicates definitively that a person has been trafficked, human trafficking situations are associated with common features that, if linked together, may suggest that a person has been trafficked. Figure 3 lists key factors that might suggest a person has been trafficked.

–  –  –

These indicators are particularly relevant when a patient is an international migrant or appears to have migrated within a country for work.

Pages:     | 1 |   ...   | 5 | 6 || 8 | 9 |   ...   | 18 |

Similar works:

«WHAT DO SUBJECTIVE ASSESSMENTS OF FINANCIAL WELL-BEING REFLECT? Steven A. Sass, Anek Belbase, Thomas Cooperrider, and Jorge D. Ramos-Mercado CRR WP 2015-3 Released: March 2015 Center for Retirement Research at Boston College Hovey House 140 Commonwealth Avenue Chestnut Hill, MA 02467 Tel: 617-552-1762 Fax: 617-552-0191 http://crr.bc.edu Steven A. Sass is a research economist at the Center for Retirement Research at Boston College (CRR). Anek Belbase is research project manager at the CRR....»

«1 Chartering New Credit Unions December 27, 2002 New credit union chartering is a very time consuming, demanding, and worthwhile activity both for the individuals seeking the charter or license and the body or agency granting the charter. The goals of any organizational body in charge of credit union chartering should be to: • encourage the formation of credit unions in accordance with existing law and rules and regulations;• promote the formation of economically feasible, safe and sound...»

«The Algorithmic Structure of Group Strategyproof Budget-Balanced Cost-Sharing Mechanisms Paolo Penna and Carmine Ventre Dipartimento di Informatica ed Applicazioni “R.M. Capocelli”, Universit` di Salerno, Italy a {penna, ventre}@dia.unisa.it Abstract. We study mechanisms for cooperative cost-sharing games satisfying: voluntary participation (i.e., no user is forced to pay more her valuation of the service), consumer sovereignty (i.e, every user can get the service if her valuation is large...»

«1997 Software Engineering & Economics Conference © The MITRE Corporation MITRE’s Architecture Quality Assessment Richard F. Hilliard II Michael J. Kurland Steven D. Litvintchouk The MITRE Corporation rh | kurland | sdl @mitre.org 617 271 8500 (fax) ABSTRACT MITRE’s Architecture Quality Assessment (AQA) is intended to provide an objective and repeatable technique for the evaluation of system architectures. This paper describes the scope of AQA and its intended use; the evaluation...»

«Draft December, 2006 Preliminary and Incomplete PAYDAY LENDERS: HEROES OR VILLAINS? Adair Morse* Ross School of Business University of Michigan Abstract I study the effect that the availability of exceptionally high-interest consumer loans (payday loans) has on individual welfare by using natural disasters as an exogenous shock to communities’ financial condition. Utilizing a propensity score matched, triple difference approach, I find that communities with payday lenders show greater...»

«International Review of Business Research Papers Vol.4 No.1 January 2008 Pp.23-44 Translation Exposure and Firm Value, Evidence from Australian Multinational Corporations Mohammad Al-Shboul* and Stewart Alison** The purpose of this study is to analyse the economic effect of foreign currency translation adjustments and to investigate the relationship between these adjustments and firm value, for a sample of 181 Australian multinational corporations, with foreign subsidiaries concentrated in...»

«The International Journal of Business and Finance Research ♦ Volume 4 ♦ Number 2 ♦ 2010 INTRA-INDUSTRY EFFECTS OF TAKEOVERS: A STUDY OF THE OPERATING PERFORMANCE OF RIVAL FIRMS Rupendra Paliwal, Sacred Heart University ABSTRACT This paper investigates whether the managers of industry rivals act to mitigate their agency exposure and improve operating performance when one of the firms in the industry is subject to a takeover attempt. The results indicate that rival firms in general decrease...»

«Guide to Cashing in on eBay -1Guide to Cashing in on eBay Guide to Cashing in on eBay LEGAL NOTICE The Publisher has strived to be as accurate and complete as possible in the creation of this report, notwithstanding the fact that he does not warrant or represent at any time that the contents within are accurate due to the rapidly changing nature of the Internet. The Publisher will not be responsible for any losses or damages of any kind incurred by the reader whether directly or indirectly...»

«4th August 2008 1. Crosby Review of Mortgage Finance 2. Special Resolution Regime 3. Proposed charges for property searches 4. Consultation on leasehold and property information in HIPs 5. EPC guides 6. Microgeneration certification 7. Energy Statistics 8. Land Use Change statistics 9. Treasury advice on regional funding 10. SPP 3 published 2nd evaluation of eco-town bids 11. 12. Severn Barrier proposals 13. Shortlist for CIF 14. LDA and Design for London 15. New PINS Director 16. The Economy...»

«John R. Kasich, Governor Mary Taylor, Lt. Governor Craig W. Butler, Director Director Craig W. Butler H.B. 64 Testimony House Finance Subcommittee on Agriculture, Development and Natural Resources March 3, 2015 Good evening, Chairman Thompson, Ranking Member O’Brien and members of the House Finance Subcommittee on Agriculture, Development and Natural Resources committee. I am Craig Butler, Director of Ohio EPA, and I appreciate the opportunity to provide testimony on House Bill 64, Governor...»

«BIS RESEARCH PAPER NUMBER 209 International Evidence Review of Basic Skills: Learning from Highperforming and Improving Countries JANUARY 2015 The views expressed in this report are the authors’ and do not necessarily reflect those of the Department for Business, Innovation and Skills. Department for Business, Innovation and Skills 1 Victoria Street London SW1H 0ET www.gov.uk/bis Research paper number 209 January 2015 International Review of Adult Basic Skills: Learning from High-Performing...»

«Falls and Fall Prevention in the Elderly: Insights from Jamaica Kenneth James Jacqueline Gouldbourne Chloe Morris Denise Eldemire-Shearer Department of Community Health and Psychiatry Mona Ageing and Wellness Centre University of the West Indies Mona, Jamaica Abstract Falls among the elderly is increasingly being recognized as an issue of concern in both developed and developing countries. Falls in the elderly may precipitate adverse physical, medical, psychological, social and economic...»

<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.