Baseline health care for refugees in the Netherlands

In the Netherlands there are some 20,000 refugees from different parts of the world (e.g. Vietnam, Latin America). Most of them have experienced a form of organized violence. The somatic and psychosocial complaints of the refugees are comparable to those of Dutch war victims. They are mostly of an aspecific kind and making a diagnosis can be difficult because of the culturally different presentation of ill being. In order to help general practitioners in making a diagnosis the Refugee Health Centre (CGV) has made a classification of complaints according to whether or not they have a specific cause. It is clear from the literature that there are different opinions about the causes of the somatic complaints. As far as the psychic complaints are concerned it is remarkable that in our pilot study (n = 135) only 6% of the examined refugees suffer from a classical picture of the post-traumatic stress disorder; in a number of cases the picture is limited to some components only. Psychosocial complaints of refugees are subdivided and described. The philosophy of the CGV-treatment is to give assistance as much as possible in the refugee's neighbourhood; so that the clinician(s) will become part of the refugee's new social network. Another very important aspect of the assistance given is preventing medicalization of psychological problems. The basis of help is a recognition of the problems and complaints of the refugee. The structure of the Dutch health care, built up in 'lines', is very often very confusing for a refugee; this confusion can cause communication difficulties between refugee and clinician. To develop methods of treatment, definition and registration of complaints and problems can be a first step.