IOM-Migration Health Department (IOM-MHD)

International Organization for Migration believes in physical, mental and social well-being of migrants. Also believes that safe and orderly migration can benefit all. On the light of that IOM is providing health assistance for Bhutanese refugees from the commencement of third country on 2007. Till May 2013 Migration Health Department (MHD) in Damak has conducted health assessment for 98,734 and pre departure check for 80,194 refugees bound to eight resettlement countries. Several thousands of refugees have been escorted by 1,252 doctors and nurses to different countries. During this period by active screening 949 TB patients have been diagnosed and treated accordingly.

Primary Services Provided by MHD Damak

Services

Beneficiaries

Active detection of tuberculosis, certain sexually transmitted diseases and other communicable diseases

Refugees Immigrants

Detection of non-communicable disease that require follow up in the countries of destination

Refugees Immigrants

Stabilization of medical condition before travel and medical assistance en route

Refugees

Detection of life-threatening conditions and referral for life-saving treatment in Nepal or for expedited movement for treatment in the resettlement countries

Refugees

Directly observed treatment for TB, conducted in accordance to international standards and best practices, including treatment of multi-drug resistant TB

Refugees Immigrants

Immunizations against major vaccine-preventable diseases

Refugees Immigrants

Treatment of intestinal parasites

Refugees

Surveillance for malnutrition

Refugees

Surveillance for communicable diseases

Refugees Local communities

Health information and education

Refugees Immigrants

Provision of laboratory support for detection of TB in the camps

Refugees

Training of laboratory specialists and primary health care workers

Local communities


MHD Damak in Figures

Service

2007

2008

2009

2010

2011

2012

2013

Jan-May

Total

HA[*] for Australia

0

1,009

738

1,396

1,004

625

830

5,602

HA[*] for Canada

0

485

1,441

1,336

1,731

1,048

240

6,281

HA[*] for Denmark

0

158

154

174

131

137

1

755

HA[*] for Norway

0

123

126

36

145

27

0

457

HA[*] for Netherlands

0

0

2

101

0

0

0

103

HA[*] for New Zealand

3

246

220

156

136

156

98

1,015

HA[*] for the UK

0

0

0

118

91

188

6

403

HA[*] for the USA

313

9,826

18,652

15,073

17,957

17,445

4,852

84,118

Medical Escorts

0

114

257

264

174

230

 213

1,252

TB Treatment[1]

0

89

173

190

225

211

 61

949

Vaccinations[2]

0

23,158

38,625

30,032

38,131

33,369

17,560

180,875

 

Public Health Activities under resettlement projects:

Surveillance of communicable and non-communicable diseases/conditions among the Bhutanese refugees under resettlement pipeline and living in the camps is an on-going process through the IOM MHD Damak. Both active surveillance during health assessment and passive surveillance from refugee camp clinics and relevant sources are being carried out. The identified conditions/diseases of public health and/or travel health concerns are reported to the concerned authorities within IOM, in the refugee camps, government health system of Nepal and resettlement countries. Coordination with the concerned stakeholders and facilitation for appropriate actions is being carried out. Some of the public health issues identified among Bhutanese refugees till date are Vitamin B12 deficiency, higher prevalence of pulmonary tuberculosis disease, psycho-social health’s suicides/suicidal attempts, alcohol use related disorders and sporadic vaccine preventing infectious diseases. Necessary steps, in terms of, situation assessment, health education and facilitation for other appropriate intervention have been/are being carried out.

New activities:

From January 2013 following new activities have been started under the project to cover all the beneficiaries under this project:

  1. Contact Investigation: Contacts of susceptible TB cases evaluated for TB exposure and disease,   starting with the TST. Previously this method was applicable only for the contact of drug resistant TB cases.

  2.  Post-treatment follow-up for contact of LTBI of pan-susceptible TB and MDR TB developed and implemented

  3. Harmonization Project Database: A comprehensive database is currently being designed by IOM to consolidate the data being stored currently in unlinked excel files and patient charts.  This database will be linked to IOM's MiMOSA database to create the continuum of information of patients treated by Harmonization programme which later enters resettlement or patients who enters resettlement while on treatment under the Harmonization programme, laboratory database that will provide information on sputum analysis at diagnosis and follow-up, and also contain results of contact investigation and follow-up of contacts.

  4. Treatment Changes: There is difference in drug dosage by weight under NTP and CDC TB TIs recommended dosage. Since INH and RIF are mainstay of treatment of first line TB treatment regimen, the dosages of those drugs are adjusted by supplying additional medicine along with NTP drugs.

  5. Treatment Follow-up: Baseline investigations for non-RST cases have also been started as part of side-effects monitoring involving AMDA doctors.

  6. Supplementary Vitamin B6 supplied for all non-RST TB cases at camp.  


[*] Refugee Health Assessment
[1] Number of refugees treated for TB
[2] Number of doses of vaccines administered


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