Navigating the Health System

Health Guidelines

for Migrants

Do not remove!

Contents

Navigating the Health System ...... 3

Nutrition ...... 18

Sexual Health ...... 25

Infectious diseases ...... 29

Personal hygiene & disease prevention .. 36

Emotional Health ...... 40

Child health ...... 43

Navigating the Health System

Welcome to the Maltese health system. As a migrant you have the right to be provided with appropriate health education and services to meet your physical and psychological needs according to your legal status. Adapting to a new country and coping with new social, administrative and political structures is not easy. It is understandable that you may have been feeling isolated and not physically fit. However, taking care of your health is one of your main responsibilities and this booklet will guide you to go to the right place at the right time.

It is not surprising that due to cultural differences health care professionals such as doctors and nurses may have difficulty in understanding your problem or how you feel it is affecting you. We ask you to be patient and try to build a rapport with your health provider to be able to meet your needs.

Being healthy does not only mean having no health problems, but it also means knowing how to look after yourself, avoiding the foods or substances that may harm you and you may also have to change your lifestyle habits. Health programmes in the form of educational sessions are normal in the western world as these prevent problems in the future as you get older.

The intention of this booklet is to guide you when you need to use the existing health services. It helps you to distinguish emergency care (as in life threatening situations) from routine or non-urgent visits where you need to attend as a walk-in case or by appointment.

The health system in Malta is free if you are admitted to hospital in an emergency or if you need to attend a health centre. However, if you have not been issued with a pink card by the social services you may have to purchase your medicine. You may choose to visit a doctor or a consultant in a private clinic in which case you will pay for the service after the visit.

On Your Arrival

When you arrived by boat you were seen by a doctor for any injuries you may have suffered on your journey or any other emergency/condition such as heat exhaustion, dehydration, etc in which case you would have been treated at a health centre or sent to hospital.

Screening tests for Tuberculosis Following this assessment a chest X-ray is taken in the next few days to check for Pulmonary Tuberculosis (TB) which is an infectious disease. In the case of women who are pregnant no X-ray is taken as this is harmful for the unborn baby. If the chest X-ray shows any signs of Tuberculosis, you will be referred to a specialist, who will do further tests and treat you as necessary.

In order to check for TB in pregnant women and in children a Mantoux test is carried out, which involves a painless injection in the forearm.

The area of the injection site is examined by a doctor after 48-72 hours. If the test is positive, this means that you might have been infected with Tuberculosis in the past. You will then be referred to a specialist who may order other blood tests and start you on treatment.

In the following days you may have a full physical examination by the doctors in the closed centre. It is important to inform the doctor if you suffer from any chronic illnesses such as diabetes, renal problems, asthma, high blood pressure and also if you are pregnant.

Medical services in the closed centre While you are in the closed centres you are entitled to free medical services including treatment. In the case of a medical emergency, inform the soldier/police on duty who will call an ambulance to take you to the emergency department at Mater Dei Hospital.

Due to the large number of residents in the closed centres, there may be a triage system whereby the most urgent cases are seen by the doctor before other cases which are not so urgent.

Supervised treatment If you are prescribed any treatment which needs to be supervised by a nurse, you will be given a treatment card with your treatment written on it. The nurse will sign the card each time you take the treatment in front of her/him.

Health centres in Malta & Gozo

In Malta, if you need to see a General Practitioner, you can either go to a Health Centre, which is run by the government and free of charge, or you can visit private General Practitioners, who charge a fee for their services. There is no patient registration system in Malta, so you are free to see any General Practitioner. It is important to note, however, that you can only attend a Health Centre that serves your locality of residence.

Victoria

Gzira Mosta

Floriana Rabat

Cospicua Qormi Paola

Paola 5 pm to 8am Mosta } Floriana Emergency Service only

All Health Centres: Monday to Friday - 8am to 8pm; Saturday - 8am to 1pm

Which Health centre should you attend?

Floriana Health Centre Tel: 21243314

Triq Frangisk Saver Fenech For persons residing in: Pieta', G'Mangia, Valletta, Floriana, Hamrun, Sta. Venera, Marsa, Zurrieq, Safi, Luqa, Mqabba, Qrendi, Kirkop and Hal-Far (L/O Zurrieq).

Gzira Health Centre Tel: 21337245 / 21344766 / 21337244

Pjazza Meme' Scicluna For persons residing in Msida, Ta' Xbiex, Gzira, Sliema, Kappara, San Gwann, Taz-Zwejt, St. Julian's, Swieqi, L-Ibrag, St. Andrew's, Pembroke, High Ridge and Victoria Gardens.

Qormi Health Centre Tel: 21484450-3

Triq il-Vitorja For persons residing in Qormi, Zebbug, Mriehel (towards Qormi) and Siggiewi. . Paola Health Centre Tel: 21691314-5

Pjazza Antoine De Paule For persons residing in Paola, Tarxien, Sta. Lucia, Birzebbuga, Zejtun, Marsaxlokk, Zabbar, Marsascala, Xghajra, Fgura, Gudja, Ghaxaq, Benghajsa

Cospicua Health Centre Tel: 21675492 / 21673292-3 / 21821727

Triq Ljun For persons residing in Cospicua, Vittoriosa, Senglea, and Kalkara

Mosta Health Centre Tel: 22695701/2

Pjazza tar-Rotunda For persons residing in Mosta, Naxxar, Gharghur, Mgarr, Ghajn Tuffieha, St. Paul's Bay, Mellieha, Burmarrad, Bugibba, Qawra, Bahar ic-Caghaq, Madliena, Mriehel (part of), Fleur-de-lys, Salina, Xemxija, Manikata, Bidnija, Zebbiegh, Maghtab, Ta'Qali, Ghadira, Cirkewwa.

Rabat Health Centre Tel: 22563000

Civic Centre, Triq San Kataldu, Rabat. For persons residing in Rabat, Mdina, Mtarfa, Dingli, Attard, Bahrija and Kuncizzjoni. . B'Kara Health Centre Tel: 21494960

Triq Tumas Fenech For persons residing in Birkirkara, Iklin, Lija and Balzan, presently Monday to Friday from 8am -8pm and Saturdays 8am - 1pm. Bkara Health Centre is closed on public holidays.

For all conditions requiring acute or immediate medical care when Birkirkara Health centre is closed, these residents are to make use of the general practitioner services from Mosta Health Centre.

Victoria Health Centre Tel: 22156820

Triq Enrico Mizzi, Victoria, Gozo.

More information can be found on webpage: https://healthcms.gov.mt/en/phc/Pages/Health-Centres/Overview.aspx

Services at Health Centres

General practitioner (GP) and nursing services, and other specialised health services are provided here:

. Minor surgical procedures . Nursing services . Diabetes clinics . Well Baby Clinic . Immunisation . Speech therapy . Antenatal, Gynae & postnatal clinic . Paediatric clinic . Ophthalmic clinic . Life style clinics . Medical consultant clinic . Psychiatric clinic . X-Ray . Podology clinic

You may need a referral note from a doctor (general practitioner) before making an appointment in some specialised clinics in the list above.

Should you require more information regarding the services offered at health centres, at the back of this booklet you will find the telephone number of the health centre in the region of your residence.

Provision of medicines

If you are a yellow or pink card holder you will be able to receive your medicines from the government pharmacy (usually within the premises of the health centre where you reside; Note Residents at Hal-Far are to use the pharmacy at Luqa). In this case you need to have a prescription from a doctor which you will take to the pharmacy together with the yellow or pink card. This medicine may be for a few days and/or prescription may have to be repeated every 2 or 3 months. Why no medications were prescribed?

The doctor will decide on the best treatment for you, which may not involve any medications. Medicine may not be indicated because:

 many conditions can be cured without medicine, such as colds and other viral infections  antibiotics (drugs to cure infection) are only prescribed if absolutely necessary  There may be severe interactions between different medicines and have significant side-effects when taken together  you may not need medicine! Many conditions can be prevented or cured by a simple change in lifestyle, such as giving up smoking, healthy eating and getting enough exercise.

YOU MUST NEVER SHARE YOUR MEDICINES WITH OTHER PEOPLE

Referral to Hospital for investigations

Your doctor or General Practitioner at the health centre may suggest that you need to be seen by a specialist for further tests or investigations which may be performed either at Mater Dei Hospital or Boffa Hospital.

These may involve blood investigations, X-rays, CAT scans, mammogram, barium enemas, etc. Usually you will receive an appointment for such a test from the hospital. Please take time to read the instructions on the appointment form carefully. If you do not understand any part of it, you are advised to ask a health provider at your health centre.

Appointments

To avoid any disruption of the service you are requested to be on time. If you arrive later than the time stated on the appointment form you may have to miss the test or postpone the appointment.

What happens at the Out-patients Department

 Make sure you arrive a few minutes before the time on your appointment card

 Go to the reception desk and let the receptionist know that you have arrived. They will ask you to sit down in the waiting area

 When your doctor is ready to see you, you will be called to his/her room. Listen for your name to be called out

 If you cannot attend the appointment, let the department know as soon as possible. You will be given another appointment but it could take as long as a couple of months

 If you have a specific need e.g. you wish to see a female doctor, then let the receptionist know this when you register, and again when you make an appointment

Your turn to see the doctor

 When you meet the doctor, you will be asked to sit down and to tell the doctor about any symptoms you have had  It is important that you are honest with the doctor and tell him/her everything about your symptoms

 A doctor will listen carefully to what you say about your symptoms and may give you a physical examination e.g. test your blood pressure, look into your eyes with a special light or listen to your heart. The doctor may tell you immediately what they think is wrong with you. The solution to your problem may involve a change in lifestyle, medications that the doctor will prescribe for you or treatment in hospital

 Sometimes, the doctor may not be able to determine what is wrong with you, and may suggest further tests that can be carried out at the Health Centre or at Mater Dei Hospital

 If you need specialist treatment, the doctor will refer you to a more specialised doctor called a consultant, who normally works in a hospital. You will be instructed on how to make an appointment or you will receive the appointment to see the consultant through the post.

At the end of the visit

 If the doctor has decided to give you medications, you will be given a prescription to take with you. If you are a pink card holder these medications will be given to you free from the government pharmacy.

 If you have been told to come back to see the doctor again, you can make your next appointment at reception before you leave the department.

Referral for admission to hospital

There are 4 main public hospitals in Malta where you can be referred to:

General Mater Dei hospital Tal-Qroqq Hospital:

Mount Carmel Psychiatric

Hospital : Attard Hospital

Sir Paul Boffa Dermatology Hospital: Floriana

Kar eb Grech Rehabilitation hospital : G’Mangia

Referral for admission to hospital

As a result of a condition you may want to discuss which cannot be treated at these with the staff who home, will be taking care of you. sometimes admission to This will build up a good hospital is necessary. rapport with the medical and nursing staff and you It could also be will not feel uncomfortable to deliver your if you perform any ritual baby as home connected to your culture births in Malta are quite rare. Unless it is an emergency, your health provider will tell you when to be admitted and where to go.

If you do not understand why you are being admitted to hospital please let your doctor know so that he/she will explain in a way that you can understand. If you Please remember that the would like to bring a staff are not used to your relative or friend who customs and you are not understands used to theirs, therefore English/Maltese better than the more you communicate you do, you may do so. the more you can understand each other. If there are any cultural This two-way process of issues such as decision cultural exchange will help making with family, to avoid any traditions during birth, etc misunderstandings.

What you should take with you to hospital

As you may be staying in the hospital for a few days you will need some personal belongings such as:

. Pyjamas / nightshirts

. Towels

. Slippers

. Socks

. Underwear

. Bottled water / juice/biscuits/etc. if these

are indicated

. Soap

. Shaving gel / razors

. Comb / hair brush

. Toothpaste / toothbrush

You may also want to bring books, games and other items to help you pass the time while in hospital. Do not forget important things such as your reading glasses.

WHEN TO CALL THE EMERGENCY SERVICE

Emergency Telephone Number - 112

If someone has had an electric shock

If someone has ingested a If someone is poisonous liquid lying unconscious on the floor

Burns & Scalds

If you suspect a broken bone

Choking

Other emergencies include: Asthma attacks, chest pain, severe injuries, high fever in children, convulsions, drowning, severe blood loss, women in labour, severe vomiting & diahorrea, sudden severe illness and life threatening situations.

Important Telephone Numbers

Emergency 112

Immunization Clinic 25680214 GU Clinic 22987115 Chest Clinic 21440177 Dermatology Department 22987153

Health Centres Floriana Health Centre 21243314 B’Kara health Centre 21494961 Gzira Health Centre 21344766 Qormi Health Centre 21484450 Gozo Health Centre 22156820 Paola Health Centre 21691314 Cospicua Health Centre 21675492 Rabat Health Centre 22563000

Hospitals Mater Dei Hospital 25450000 Boffa Hospital 21224491 Gozo General Hospital 21562700 Mount Carmel hospital 21415183

Nutrition

Choosing a Healthy lifestyle

Healthy eating: The 5 food groups

It is important to eat the right food in the right proportions The Food Pyramid

Group 1: Bread, Cereals, Pasta, Rice and Potatoes. These foods are needed for energy Meals should be based on starchy carbohydrates such as bread, cereals, pasta, rice and potatoes. Choosing wholegrain and wholemeal products whenever possible will increase the intake of fibre. A large quantity of water is needed to maximise the effect of fibre in our diet.

Group 2: Fruit and Vegetables which provide vitamins and minerals. Fruits and vegetables are an important source of vitamins, minerals and fibre. Targeting an intake of 5 portions of fruits and vegetables a day will enable you to increase your nutrient intake

Group 3: Milk, Yoghurt and Cheese are needed to strengthen bones and teeth Milk and dairy products, mainly yoghurt and cheese, should be taken in moderation. Choosing low fat products such as skimmed milk and light yoghurt will reduce the amount of fat consumed

Group 4: Meat, Fish, Legumes, Eggs and Nuts. These foods are needed for growth and repair Meat, fish, eggs and legumes such as beans, peas and nuts should be taken in moderate amounts. .

Group 5: foods that are high in sugar, fat and salt. These foods should be taken in small amounts Sugar is not essential for our health. Dried fruit can be used as an alternative to give a sweet taste to cakes or deserts. Our body needs a low intake of salt & fat due to their effects on health

Six to eight glasses of water must be drunk daily

Cooking Methods

Steaming & boiling Steaming vegetables is a healthy way as they retain their vitamins and nutrients in them. When boiling vegetables, more nutrients are lost.

Braising & stewing These can be onions, garlic, shallots, celery, carrots, peppers, spices, and herbs and mushroom which provide additional flavour to meat and poultry.

Roasting With roasting, direct heat is applied to the food. Roasting is mainly used when cooking fleshy food like fish, meat or chicken. Juices are heated inside the food, which then cooks the food. Few nutrients are lost and the

flavour is not spoilt.

Grilling In this type of cooking the heat seals the outside part of the food and the juice inside the food cooks it. The flavour of the food is preserved and few nutrients are lost.

Cooking methods to be avoided

Frying

In shallow frying food is cooked in a frying pan with a small amount of oil or fat. This increases the amount of fat in the food.

Deep-frying A lot of oil or fat is used. Food is completely immersed in the boiling fat and absorbs a large

quantity of the hot oil. The content of fat in the food is very high.

Physical activity

It is good to do a variety of different activities, at least 30 minutes a day

Activities can include:

 Brisk walking, jogging

 Dancing  Playing football  Swimming

Regular exercise should include these three types:

Sexual Health

Sexual Health If you are sexually active is important to take certain precautions to safe-guard your health and that of your partner by preventing sexually transmitted diseases (STDs). Having sexual relations without a condom with different partners or with partners at risk (sexual workers), can expose you to the risk of having STIs such as: Chlamydia, Gonorrhoea, Hepatitis B, Herpes, HIV, Human Papilloma Virus, Syphilis, Trichomoniasis and Candida.

These infections can be transmitted through seminal or vaginal fluid and blood. Some STIs can be passed from person to person by genital contact without penetration. Infection can also be passed through oral and anal sex.

THAT IS WHY YOU SHOULD USE CONDOMS PROPERLY!

1. Open the packet carefully so that you don't damage the condom. Don't test the condom by unrolling, inflating or stretching it. 2. Pinch the teat or the last 1cm length at the tip of the condom to expel any air. 3. Hold the condom over the tip of the penis and with the other hand unroll it down to the base of the penis. 4. After ejaculation, hold the condom firmly around the penis whilst withdrawing, to prevent spilling of the semen.

A condom is used only once. It fits on a man’s penis and its purpose is to prevent sperm from entering a woman’s vagina, to prevent unwanted pregnancies and sexually transmitted infections, including HIV/AIDS. Condoms are available from supermarkets and pharmacies.

If you have any of the following symptoms you should see the doctor without delay: -Itching sores, lumps, pain, blisters and rashes in the genital area -Unusual discharges from penis or vagina -Burning or pain during urination or during sex -Warts or blisters on genital areas and surrounding areas -Swollen genitals -Women bleeding between periods and/or during sexual intercourse

HIV (human immunodeficiency virus) If you are having or have had is a virus that make the body weaker unprotected sex you could be at risk day by day and make it unable to fight so go and see the doctor asking to be sickness. tested for Sexually Transmitted Infections (STIs). After an undefined time period depending on different personal factors, TESTS ARE FREE AND HIV reaches the next level called AIDS -Acquired Immune Deficiency ANONYMOUS Syndrome. Boffa Hospital-GU Clinic 21227981 HIV can be transmitted: In case you are sexually active with only one partner and you 1) via unprotected sexual intercourse 2) through contact with an infected do not want to make use of a person's blood condom, ask for advice by 3) from an infected mother to her child making an appointment at the HIV could be transmitted if blood, GU clinic. sperm, vaginal fluid or breast milk from an HIV positive person come in direct contact with the bloodstream or mucous membrane (wet parts of body) . Medications are very important and they can treat HIV but cannot cure HIV. Once you get the virus you will have it for your whole life. For this reason PREVENTION is very important!!!

In case you are having a sexual relationship but you would like to avoid becoming pregnant, you should use contraception. This page illustrates the methods you can use to prevent pregnancy. Even families can choose the number of children to have and when to have them by using contraception. Talk to a doctor and decide which is the most suitable contraceptive for you.

Three examples of contraceptives:

Condom This is the only contraceptive that also prevents transmission of STIs.

Contraceptive Pill This works by preventing ovulation. The doctor will decide which pill is best for you. It does not prevent HIV infection and other STIs.

Coil This is a tiny t-shaped flexible device placed in the neck of uterus which prevents fertilized eggs from attaching to the wall of the uterus. It must be fitted by a doctor.

Infectious diseases

Tuberculosis

Tuberculosis (TB) is a communicable disease. It can be spread from person to person through the air. If you have pulmonary tuberculosis, people who are near you can breathe in the TB germs and become infected.

The symptoms of active tuberculosis in the lungs are: A cough that lasts two weeks or more, especially if fluid or blood comes from the lungs when you cough .  Fever . Weight loss .  Night sweats . Loss of appetite . Cough . Coughing up blood These symptoms may not appear until disease has already caused damage. Many of these symptoms can be confused with other illnesses .

If you are diagnosed with You will need to take this tuberculosis, you will receive medicine for 6 months. A nurse free treatment and care, will visit you daily to make sure irrespective of your legal status. that you are taking the On the other hand, you have medicines. This is recommended the duty and responsibility to worldwide to help in controlling take the treatment as tuberculosis. The nurse will also prescribed by your doctor. This help you if there are any will make sure that you get problems from the medications better and the risks to infect you are taking. Public Health others are reduced. doctors or nurses will contact you to explain the procedures Taking every dose of your TB when your doctor starts you on medicine kills the TB germs. treatment for Tuberculosis. They That is why taking your will also contact you if you stop medicine is very important! taking your medications for some reason.

Chicken Pox

Chickenpox is a common disease amongst children usually occurs one time only. It presents with an itchy rash of spots that look like blisters all over the body and may be accompanied by flu-like symptoms. Symptoms usually go away without treatment, but because the infection is very contagious, an infected child should stay home and rest until the symptoms are gone.

Signs & Symptoms of Chickenpox

 Sometimes fever, abdominal pain, sore throat, headache, or a sick

feeling a day or 2 before the rash appears.

 A red itchy rash on abdomen, back and face at first

 Several small red bumps which develop into blisters

 The blister becomes an open sore, which crusts over to become dry, brown scabs.

How to stop chicken pox from spreading

Chickenpox is very contagious from about 2 days before the rash appears and lasts until all the blisters are crusted over. A person with chickenpox should be away from other people until the blisters have dried up, usually about 1 week. In order to keep the virus from spreading, make sure you wash your hands frequently, especially before eating and after using the bathroom.

Chicken pox and Pregnancy

Pregnant women and anyone with immune system problems should not be near a person with chickenpox. If the mother-to- be develops chickenpox just before or after the child is born, the newborn is at risk of serious health complications.

Treating Chickenpox Most chickenpox infections require no special medical treatment. You can help relieve the itchiness, fever, and discomfort of chickenpox by:

 Using cool wet compresses or giving baths in cool or lukewarm water every 3 to 4 hours for the first few days.

 Patting (not rubbing) the body dry.

 Putting calamine lotion on itchy areas (but don't use it on the face, especially near the eyes).

 Giving your child foods that are cold, soft, and bland because chickenpox in the mouth may make drinking or eating difficult. Avoid feeding your child anything highly acidic or especially salty, like orange juice

 Pain-relieving creams may be applied to sores in the genital area.

As much as possible, discourage children from scratching. This can be difficult, so consider putting mittens or socks on your child's hands to prevent scratching during sleep. Moreover, trim fingernails and keep them clean to help lessen the effects of scratching, including broken blisters and infection.

Scabies

Scabies is caused by a mite. It burrows into the skin to produce intense itching, which tends to be worse at night. Not every type of itching is caused by scabies. Transmission of the mites occurs with prolonged skin-to-skin contact, including sexual contact. However, you will not get scabies through shaking hands.

Signs & symptoms

Small red blisters affecting:  the webs between the fingers  the wrists  the backs of the elbows  the knees  around the waist and umbilicus  the axillary folds  the areas around the nipples  the sides and backs of the feet  the genital area  the buttocks

Who should be treated for scabies

 People who have had significant skin-to-skin contact with a person who has scabies within the past two months  People living in the same household as the person infected with scabies

Treating scabies infestations

 First have a shower and dry yourself well

 The lotion prescribed by the doctor should be applied to the entire skin surface except the face and leave for 24 hours

 It is very important that the lotion is applied to the whole body, especially between the fingers and toes, the genital area, under the nails (nails should be cut short), palms of hands and soles of the feet & buttock fold

 Put on clean clothes after applying the cream

 Do not wash for 24 hours

 If you wash your hands, you need to reapply the lotion on the hands immediately

 You also need to wash your clothes using hot water during these 24 hours. Bed linen should also be washed in hot water. If washing the clothes and linen is not possible, put them in the sun for 72 hours or in a sealed plastic bag for 2-4 days.

Remember! The itch and rash of scabies can last for up to four weeks after the mite has been eliminated. It does not mean that the treatment has failed. (After that period, or if fresh spots appear, seek medical advice.)

If you would like further information, please contact the Infectious Disease Prevention and Control Unit on 21332235.

Hepatitis B

Hepatitis B is an infection of the liver and there are high risk areas in certain parts of the world.

Signs and symptoms Pain in upper right side of abdomen Nausea & vomiting Loss of appetite Jaundice (yellow colour of skin and eyes) Fatigue Itching

Hepatitis B is transmitted through body fluids of an infected person:  Sharing infected needles  Sharing toothbrushes  Sharing razors  Unprotected sex  Via mother to unborn child

Preventing Hepatitis

Avoid unprotected Do not share Do not share razors or sex needles tooth brushes

Personal hygiene & disease prevention

Hygiene and disease prevention

Poor hygiene can increase the risk of spreading diseases. You can easily prevent airborne transmitted diseases (TB, chickenpox, cold, cough, any type of flu including H1N1 – Swine flu), faecal-oral diseases (diarrhoea and gastroenteritis) and skin infections, thanks to the following preventive measures:

Wash your hands often and thoroughly using soap & water:  After using the toilet  After sneezing or coughing  After touching animals  Before touching food

Cover your nose and mouth when sneezing and coughing

Do not spit!

This can cause spread of disease

Do not leave

food uncovered

Shower daily with soap and brush your teeth for your personal hygiene

Food Safety

Wash your hands After cutting up raw for 20 seconds with meat, chicken and soapy water before fish, wash cutting eating or handling board thoroughly food with hot soapy water and rinse with clean water

Refrigerate fresh meat, chicken and turkey and Make sure you cook use it within 5 days. meat, chicken, turkey Refrigerate fresh fish and fish thoroughly. and use it within 1 to 2 Raw or under-cooked days. Thaw frozen eggs can make you sick. meats, covered, on a Reheat foods to 165 °F, plate or in a pan in the or until they are refrigerator bubbling and hot 39

Emotional Health

Having passed through difficult situations and still experiencing them (you live far away from your country, you are/have been detained and you are likely to have experienced traumatic events) you can be suffering from emotional disorders; you may be feeling sad, depressed, stressed, tired, worried…

You may think too much about your problems.

Quite often stressful situations can lead to physical symptoms because mind and body are linked. If your mind is suffering your body can feel it.

You may experience problems in eating and sleeping; strange behaviours; bad moods; anxiety; apathy. You may feel a generalized body pain (headache, chest pain, stomach pain). You could be feeling your heart beating too fast, or that you are breathing rapidly. Your muscles could be tightened up for a period of time due to tension and this can lead to headaches, stomach pain, etc.

Stress can also aggravate skin conditions e.g. itching from other causes (dry skin, infections). When people are feeling down or cannot cope with problems, immersing themselves in painful memories they are more likely to focus on their bodily sensations, and the body itself gives you signs of psychological distress. In this case treatment by taking tablets is not always the solution. Lying in bed all day long will not help you. On the contrary it will make you feel worse day by day.

If you are experiencing these problems:

 Speak to someone you trust (friends or family) and spend time with them. Share experiences and responsibilities with them. Instead of thinking about your problems, try talking about your problems, sharing them, otherwise they will grow inside you. Free your mind through talking, writing, etc.

 Try to do some leisure activities: walking, drawing, painting, singing, dancing, praying... Anything you like.

 Try to engage in sports and physical exercise, like playing football or any other activity.

 Try to sleep well. Use your energy during the day, by doing exercise or physical activities, avoiding too much coffee and tea especially during the evening and avoid sleeping during the day. Try to be regular with your hours. Sleeping tablets should be the last choice to avoid becoming dependent on them. Do not drink in order to sleep.

 Take care of yourself (your looks, hygiene, etc.) Learn to control your thoughts. Don't let thoughts take over your life. Try to relax by taking deep breaths.

 Every experience teaches you something that you will carry with you, therefore try to think positively.

If you don't see any improvement after all these attempts, see a psychologist or a doctor.

Child health

ANTENATAL CLINIC

It is very important to monitor your pregnancy. You should make an appointment at Mater Dei Hospital Antenatal Clinic (tel. 2545 4440) after having obtained a referral ticket from your General Practitioner.

Bring with you: - Antenatal BLUE CARD and all your medical documents - ID and POLICE CARD - APPOINTMENT CARD or LETTER - A clean container with URINE (wash yourself and then urinate in the container till it is half full) Do not be late!!

IMMUNISATION

At Floriana Health center Monday – Saturday

For appointments call: Tel. 25680222/3

Immunisation protects your child from many serious infections.

Vaccines may cause side effects. These may be mild 'local' reactions such as redness and swelling at injection site or fever. Take a look at your child’s Immunization Book where the vaccines are recorded to make sure your child has not missed any appointments.

The National Immunisation Schedule -free for all children.

Age Vaccine 2 month Diphteria/Tetanus/Pertussis DTP 1 Polio (oral) 1 Haemophilus Influenzae B HIB 1 3 month DTP 2 Polio 2 HIB 2 4 month DTP 3 Polio 3 HIB 3 15 month Measles/Mumps/Rubella MMR 1 Hepatitis B Hep 1 16 month Hep 2 21 month Hep 3 4 years DT 4 Polio 4 7 years MMR 2 12-14 year BCG – Tuberculosis 16 years DT 5 Polio 5

To get full protection it is very important that you take your child to get ALL vaccinations.

ONE dose alone IS NOT ENOUGH!!

BREAST-FEEDING

Breast milk contains everything your baby needs during his/her first 6 months. During the first 6 months – give breast milk ONLY.

Breast milk is the best food for babies. It protects your baby from infections and allergies and improves the bond between mother and baby.

The more you breastfeed, the more milk you will produce. If your baby gains weight – this means that you have enough milk!

Although breast milk is best, if you have to give bottled milk, make sure the bottle is sterilized.

You can breastfeed up to 2 years but after 6 months you can start to introduce solid food. Start with a teaspoon of vegetable purée (one vegetable or fruit at a time – after 4 days change to another vegetable or fruit) e.g. carrot or potatoes, cereals, fruit purées e.g. banana, cooked apple or pear. Don't add salt or sugar. Never give tea or coffee.

For help with breastfeeding you may contact the Breastfeeding Clinic at Mater Dei Hospital Tel. 2545 4445 Tuesday – Thursday, 8:00am-1:00pm Drop in or make an appointment

WELL BABY CLINIC

At Floriana Health Centre Tuesday ONLY BY APPOINTMENT

For appointment call: Tel. 25680226

Remember to bring your baby’s book and the baby’s birth certificate!

Migrant Health Unit Primary Health Care Department

This booklet was prepared on an initiative of the Migrant Health Unit-Primary Health Care Department (Malta) in collaboration with

Medecins Sans Frontières & the Department for Health Promotion and Disease Prevention