With Victoria on track to ease its major COVID-19 restrictions next month, community-based health centres are racing to inoculate people so far left behind by Australia's vaccine rollout.
This includes a push to boost COVID-19 vaccination rates among people from asylum seeker and refugee backgrounds.
Dr Mariam Tokhi is on the frontline of the vaccine drive as a general practitioner at Utopia Refugee and Asylum Seeker Health, a not-for-profit general practice in Melbourne's outer-west serving people from asylum seeker and refugee backgrounds, including many from the Karen Burmese community.
Utopia has been “really keen to get our community vaccinated and felt quite frustrated early on when we didn’t have the vaccine and there were other GP clinics that were provided the vaccine earlier. We’ve had to lobby quite hard for it," Dr Tokhi told SBS News.
“It's particularly frustrating now that I'm seeing COVID infections in families who wanted the vaccine, but were still waiting for their first or second doses.”
Dr Mariam Tokhi. Source: Supplied
With vaccine supply no longer an issue, the Victorian government has launched a slew of community vaccine pop-ups and drives into at-risk communities.
"It's certainly starting to ramp up now … we're seeing targeted vaccine pop-ups and targeted drives into Victoria's diverse communities which is excellent, but it's not an easy task,” Dr Tokhi said.
“You need to know the community to do this sort of work. This work needs excellent communication and care: then the word filters through community networks.”
While many in the broader community are enjoying the benefits of vaccination and getting "out there going to pubs and going to concerts", the next few months will be a "very dangerous time" for asylum seeker and refugee communities in Victoria, Asylum Seeker Resource Centre CEO Kon Karapanagiotidis told SBS News.
Asylum seekers are "at a high risk” because they've been left behind by the federal government’s vaccine rollout, Mr Karapanagiotidis said
“We're working with a community that remains highly vulnerable because they've been locked out and haven’t had equal health access,” he said.
“They've been an afterthought when it comes to the rollout of the vaccine, and it's relied on community health centres, charities, and public hospitals to deal with the failures of the federal government.”
In an ordinary year, the ASRC would be planning big end-of-year celebrations to bring the community together.
This year, plans are cancelled, with all efforts instead focussed on protecting the community by boosting vaccination rates.
“We can't in good conscience [have end-of-year parties] when we're worried about just getting people vaccinated,” Mr Karapanagiotidis said.
Barriers to vaccination
Many patients who have recently been vaccinated at Utopia felt unable to get vaccinated at the larger state vaccine hubs earlier in the year due to a range of barriers, Dr Tokhi said.
“Because, they didn't have an interpreter there. Because they couldn't navigate the booking systems. Because even when we booked it for them, they couldn't read the text messages with the appointment information. So they said, ‘we'll just wait until Utopia gets the vaccine’."
People from refugee backgrounds have been hit hard by COVID-19 due to a number of inequalities, Dr Tokhi said.
“I'm looking after lots of patients who have COVID-19 at the moment, and it's really hard for [many of them] to access health care. For example, I'm calling people who have COVID-19 and are self-isolating. They need care from someone who attempts to understand their context. Their housing and food situation, their health status, their fears and concerns. They need someone who is comfortable working with an interpreter,” she said.
“For example, I'm calling patients and they tell me they do not know how to call an ambulance. They are afraid to call if they get sick. And we need to make sure that people have safety nets. They don't have the knowledge or language to navigate the call. These are things many of us take for granted because we have grown up and been exposed to those things over time.”
'Culturally-safe, community-based' healthcare
The pandemic has highlighted “how important connection and trust is in healthcare”, Dr Tokhi said.
“Long term, we need to think about building health systems that support refugee communities and vulnerable communities.”
Having health workers, including nurses, interpreters and bi-cultural workers from the communities that Utopia serves, is key to the service's mission and its COVID-19 vaccination campaign, Dr Tokhi said.
“We've intentionally invited community representatives to create this nurturing space, because healthcare can be really intimidating, especially if you're from a marginalised population, if your family doesn't speak English or if you've got low literacy or you've had a really uncomfortable journey landing in Australia, it can be really hard for people to trust and feel like they belong,” she said.
“Nurses and bi-cultural workers are an absolutely vital part of our clinic’s model, and interpreters as well. That's been really important in Utopia's vaccination campaign. We use all the resources that we've got, and actually they've got strengths that doctors don't have in terms of outreach, and communication with patients.”
Utopia nurse Juliette Moe vaccinating a client. Source: Martin West
The fact that such workers aren’t funded under the current Medicare model is something the pandemic shows must change, Dr Tokhi said.
"We've been running clinic-based and outreach vaccine clinics, at local community spaces. For the most part, this has been reliant on Medicare funding, which doesn't really cover our costs. So, we've relied on volunteers to support this outreach work,” she said.
“I've been so heartened by the community spirit we've seen. But, I really wish that GPs were empowered and funded to work with vulnerable people. People who need a bit more time and support for their healthcare."
Dr Tokhi hopes to see “culturally-safe, community-based and community-driven primary care become normal”.
“The dividends are incredible in terms of the most marginalised people being able to access health care,” she said.
“And that saves the health dollar in the long-term. It breaks cycles of intergenerational poverty and marginalisation.”