Medical Support for Refugees Stresses Innovation and Collaboration

by Melissa Zahniser Fall 1996

Refugees flee their homeland in hopes of finding a more peaceful, if not stable, situation temporarily in another country. They seek safety and asylum for themselves and their families. News reports and personal commentaries have shown, however, that many refugee destinations are not the salvation expected. Such is the refugee situation in Russia.

Although the Russian Parliament ratified the UN Convention ensuring basic rights to refugees in 1951, the Russian government to date has refused to develop any concrete mechanism to register and resettle thousands of refugees fleeing to Russia from the near- and far-abroad. Considered illegal migrants, they are left without basic protection, subject to unwarranted harassment by police, and in some cases detained for their illegal presence in the country. The basic material and social needs of refugees are not met. Adults cannot legally seek employment and children cannot attend school because they are not registered by the government.

With funding and support from UNHCR in Moscow, refugees can receive limited medical care only by visiting select hospitals that contract with UNHCR. But the system is corrupt. Refugees are often refused services, falsely accused of spreading AIDS and other infectious diseases, and denied access to in-patient and out-patient facilities. Hospital staff are ill-equipped to handle foreigners and insensitive to cultural differences. Hospital administrators benefit financially by falsifying documents and demanding payments for services which were never performed.

In response to these conditions and with support from UNHCR, Magee Womancare International (MWI), the international humanitarian arm of Magee-Womens Hospital in Pittsburgh, began a series of innovative outreach programs to extend family planning services, improve medical care, and provide training to the refugee population living in the Moscow suburbs and to medical personnel working with them.

Beginning in the spring of 1995, MWI teamed with Equilibre, a nonprofit refugee support group, and the AESOP Center to improve the reproductive health of refugee women. The Magee-Savior's Family Planning Clinic was chosen because, unlike most Russian women's health clinics, it does not require any identification, and any woman, regardless of citizenship or address, can receive services. These women, who have never before received comprehensive reproductive health education and services, receive individual consultations, exams and free contraceptives. Translators are provided by Equilibre. Through this project, over 150 women have received better health care. But many women were unable to find the time to travel to the city clinic or simply did not know enough about the program to access the information.

The most logical and accessible place to receive health services would be in the suburban hospital clinics near the refugee camps. But the women did not trust these services. In order to better accommodate the refugees, the Magee-Savior's clinic held a series of training workshops for medical professionals in suburban hospitals. The workshops focused on educating doctors and midwives on modern contraceptive methods, patient counseling, family-focused care and cross-cultural communications. Over 100 medical professionals attended the seminars and were excited about this information and committed to working to improve patient relations. They have distributed free health education materials as well as free contraceptives to over 400 refugee and Russian women. While improving refugee-doctor relations, the program is also improving relations between Russian women and their physicians.

With nearly a year's worth of networking, development and training, MWI and UNHCR are taking the program a step further to incorporate all refugees living in the suburban camps into a better health care provision program.

Begun in March 1996, the program provides medicines and medical supplies and coordinates outpatient and hospital care to the more than 800 refugees fleeing to Moscow from war-ridden countries like Afghanistan, Somalia and Ethiopia. The program also works to eliminate discrimination and corruption within hospital structures, while keeping costs down and training medical personnel.

Implementing this new initiative on site is a Russian physician, Inna Yurkavich, who works in the accommodation centers and serves as a refugee advocate. Dr. Yurkavich's role is to identify problem areas and work with the refugees, medical professionals and UNHCR to improve communications and ensure improved health outcomes. She is on call to answer questions and intervene in cases when proper care is not administered. She holds training seminars on quality control and family-centered health care for the camp nurses and area health care providers, and works closely with all refugees, holding roundtable discussions on nutrition, smoking, alcohol abuse and preventive health measures.

With limited resources, MWI, UNHCR and other partners have developed new initiatives to integrate refugees into the Russian health care system. Results indicate greater satisfaction among refugees, a healthier population, fewer incidents of patients being refused care and a decrease in financial discrepancies. At the project's end in December 1996, a complete evaluation will be conducted to determine the overall impact of intervention and advocacy on the health status of refugees.

Robin Ellis, a program officer at UNHCR, remarked, "We are very excited about working with Magee in Moscow to improve the standard of basic care for the refugee population. I believe there is a real opportunity to make an impact on the health and well-being of this underserved community. At the same time we can educate Russian health care providers on the importance of providing quality care to all patients, regardless of national origins.

Melissa Zahniser is a program coordinator at Magee Womancare International.

Magee Womancare International: 300 Halket Street, Pittsburgh, PA 15213-3180; ph: (412) 641-1189

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