RESUMO
BACKGROUND: According to the UN Committee Against Torture, all state parties to the Torture Convention have a responsibility to meet the rehabilitation needs of torture victims who have sought asylum within their borders. General practitioners (GPs) can play a crucial role in identifying torture victims and securing rehabilitation when needed. There is a pressing knowledge gap on the knowledge and practices of GPs vis-à-vis potentially tortured patients, and an urgent need for research that investigates GPs' practices of identification, referral, and rehabilitation - in Norway and beyond. This article presents an exploratory qualitative pilot study that investigates the experiences of GPs in Oslo vis-à-vis this patient group. METHODS: Semi-structured interviews with five experienced GPs in the greater Oslo area. Interview data was analyzed through thematic analysis and discussed within a theoretical framework seeing GPs as street-level bureaucrats. RESULTS: Issues that emerged in the pilot involve a consistent professional confidence and a particular concern for victims of sexual violence and sexualized torture. The pilot also found a troubling commonsensical reasoning about identification in the asylum process. The GPs asked for the re-establishment of specialist rehabilitation centers for refugees and torture victims to consult in case of need. Alas, the study also confirmed that GPs are a difficult profession to recruit for research. CONCLUSIONS: This study indicates that GPs are important actors in terms of identifying torture victims after resettlement, but that there are shortcomings in their training and knowledge, in the overall organization of the healthcare system, and in specialized healthcare, that limit prospects for rehabilitation.
To what extent are torture victims met or identified by GPs in resettling contexts? This paper presents a pilot study designed to address this knowledge gap and prepare future studies. We found:GPs were confident in their abilities to identify and meet torture victims in a good way and in the value that is patient-doctor continuity in general medicine.Troubling commonsensical reasoning about identification in the asylum process and in consultations.A lack of and need for qualified and available expertise to consult with and/or refer tortured patients to.
RESUMO
BACKGROUND: At the intersection of the Sustainable Development Goals, humanitarian assistance and health, the umbrella term 'health in the last mile' has gained traction. In August 2019, the Norwegian Red Cross commissioned a global report to conceptualise and assess what 'health in the last mile' refers to, in terms of access, needs and structural and geographical barriers and vulnerabilities, and describe how these vulnerabilities overlap in different humanitarian settings and regions. AIMS: The purpose of this commentary article is to highlight the report's most important findings for an academic audience, from the perspective of the Norwegian Red Cross. DISCUSSION: The aim of the report was to propose a definition and create a methodology to help identify people and populations living in the last mile of healthcare; acknowledging that these go far beyond those affected by armed conflicts and sudden onset disasters. As the report reveals, last-mile populations are not adequately reached by current universal health coverage strategies. The report highlights the key role played by local humanitarian actors in reducing barriers to access to healthcare. Local stakeholders have first-hand knowledge of the needs of populations in the last mile and on how they navigate the barriers to healthcare access. The report also addresses questions such as: Who are the people with least access to healthcare? What are their health needs and what barriers do they face? Not least, when many live without access to healthcare services, how do we determine where the last mile begins? The report proposes a definition of 'the last mile' involving converging factors that exacerbate barriers to healthcare and identifies 18 groups that are considered potential last-mile populations. Global epidemics, such as the latest COVID-19, have shown that the concept of vulnerability is continually changing. These situations can bring new vulnerable populations to the edge of the last mile which were already vulnerable and ignored before the outset of the outbreak. CONCLUSIONS: Millions of people do not and will not benefit from the global progress in universal health coverage under current health systems. To reach the Sustainable Development Goals 3 and 16, we need solutions to overcome the barriers they face to access basic healthcare.