A report in this week's BMJ Dr Paquita de Zulueta argues that asylum seekers and undocumented migrants must retain access to primary care, calling on her colleagues to "overcome bureaucratic barriers and register patients irrespective of their residential status."
In her role as a GP and clinical volunteer for a health advocacy program in London, Paquita de Zulueta talks about some of the vulnerable people she sees, saying:
"They are like Dante's lost souls, wafting in limbo, neither in heaven nor hell, but in a cold and lifeless purgatory, a place the world refuses to acknowledge. Many of them have not sought medical help for several years despite serious medical problems, some brought on by the lives they lead or the trauma they have experienced."
She describes some highly disturbing stories, including that of a woman who was brought to the UK and forced into sexual slavery, a teenager who suffered from severe post-traumatic stress disorder who was at risk of harming himself or others, and women giving birth at home without any clinical supervision to name but a few. She fends, "these people are all in clinical need yet have been unable to access primary healthcare in the United Kingdom." However, she writes, "despite pleas to my colleagues to take them on ... they still turn them away."
"What happens to people who have severe mental health disorders and chronic untreated diseases? And what of the risks to public health? Do healthcare professionals expect women to deliver their babies in the street?"
Doctors are required not to discriminate unfairly and should instead provide care and treatment to meet the clinical needs of all patients according to the General Medical Council's guidance. The British Medical Association also reminds doctors that someone's immigration status is not required in order to access primary care services, however, Dr Zulueta points out to "the small acts of unkindness and indifference meted out by my peers."
Despite of the bureaucratic obstacles to providing care, Dr Zulueta argues that "these impositions carry no valid legal or ethical authority," and warns that government plans to extend restrictions on free secondary care and include primary care "does not augur well for the vulnerable and dispossessed in need of humane clinical care - particularly as compassion seems to be a dwindling resource in modern medicine."
Written by Petra Rattue