Doctors in the General Medical Services scheme may shortly withdraw services from asylum-seekers, according to a member of the general practitioners' committee of the IMO. Dr Ronan Boland of Cork city says GP practices in Kerry and in Cork "feel overwhelmed" by the influx of asylum-seekers with problems such as language difficulties and counselling needs.
He says doctors say protest action is being considered in an attempt to get adequate resources to treat the influx in some areas of extra patients with many needs.
The GPs are also concerned about "the public health issue" of screening for infectious diseases among asylum-seekers. There are about 1,000 asylum-seekers in the area.
The problems with the treatment of asylum-seekers were not confined to the Southern Health Board region, he said, and any action would be taken nationally, as the issue was really with the Department of Health.
Dr Boland said complaints about treating asylum-seekers were not a race issue. GPs were more than willing to treat all races and creeds, he said. However, the handling by the Department of Health of asylum-seekers was in sharp contrast to the handling of the Kosovan refugees' programme.
"The Kosovan refugee programme was a Rolls-Royce service where special resources were put in place. This is a 20-yearold, clapped-out Morris Minor," he said.
Dr Boland said that since spring of this year asylum-seekers have been dispersed outside of Dublin with only an application form for a medical card and a list of participating doctors in the GMS scheme to meet their medical needs.
No information was made available on patient history or on screening, where this had been taken up, and there was no prior consultation with GPs before asylum-seekers arrive in the community, he said.
Some asylum-seekers were being placed in hotels six and seven miles from towns without any budgets for transportation. In such cases, doctors are expected to make house calls.
Recent literature tells asylum-seekers that counselling for rape and post-traumatic stress is available to them in the Southern Health Board area. But this was not the case, Dr Boland said. Such a service was not available to Irish patients either, he added.
"The Directorate for Asylum Support Services follows the accommodation without any special regard for medical needs. The DASS passes the responsibility to the health boards, and they in turn are passing the buck to GPs with no special resources, good, bad or indifferent."
The GMS Scheme was never designed to cater for groups such as asylum-seekers with communication problems and unmet medical needs, Dr Boland said. Communications problems are first among the concerns of GPs in Cork and in Kerry, with particular language difficulties among the recent arrivals of asylum-seekers in the area.
Treatment also took a lot of extra time in busy practices when there were no interpreters for asylum-seekers who cannot speak English, he pointed out.
The only translation services available are by telephone to Dublin. "Basically, the Southern Health Board asks us to avail of telephonic instructions and look for reimbursement afterwards."
The IMO now wants the Department of Health to clarify just how liable GPs are legally, where communication is difficult and where diagnoses are faulty. "If you cannot communicate with a patient you cannot adequately assess him," he said. "
GPs are also concerned about the issue of infectious disease. "Asylum-seekers are not the same as tourists. It is a major public health issue if you have patients who are infectious in terms of the health of the community."
While there is "an undoubted problem with infectious diseases" among asylum-seekers arriving here, there is also a problem with screening. "It's not just a question of the uptake in screening. My information leads me to believe screening is not always available to asylum-seekers when they arrive."
Where screening is taken up, the information is not being passed to GPs when the asylum-seekers arrive in areas outside of Dublin.
"Where asylum-seekers have refused screening that information should also be passed on."
In some cases, asylum-seekers' expectations of Ireland are also unrealistic. "Their expectation is that Ireland is a first world country with first world health care."
The Southern Health Board says they are in discussion with Kerry GPs directly and also with the IMO. Because of the diverse numbers and origins of asylum-seekers from over 100 different countries, interpreters are not available locally.
"The board acknowledges that the provision of services to asylum-seekers has been challenging. It wishes to record its appreciation to general practitioners for the support which they have given."
The Department of Health says it is aware of problems with communications. A booklet has recently been issued in different languages.
The rate of uptake in screening has risen recently in reception centres.
Meanwhile, according to Dr Boland, the IMO says it will be taking formal action sooner rather than later if the matter is not resolved with the Department of Health.