Every year, around 14,000 refugees are accepted into Australia, the majority coming from resource-poor backgrounds with limited access to healthcare. Once here, a number of hurdles may stand in their way.
Screening for health conditions
Anxiety, depression and PTSD are just a few of the mental health issues that refugees and asylum-seekers are predisposed to as a result of experiencing traumatic events and undergoing challenges to get here.
These are only exacerbated by the challenging migration and visa determination processes, with resettlement often a stressful and indefinite period.
On a physical level, refugees and migrants from refugee backgrounds have an increased rate of infectious diseases, nutritional deficiencies, while immunisation rates are usually low.
“People who enter Australia under the Commonwealth’s Humanitarian Program are provided with on arrival support by Humanitarian Settlement Services (HSS) which is funded by the Commonwealth,” says Dr Aesen Thambiran, chair of the Royal Australian College of General Practitioners’ (RACGP) refugee health specific interest group and a GP in a refugee service in Perth.
Some General Practices are still unaware of TIS, and some don’t understand that it’s free or that it’s the responsibility of the doctor to organise the interpreter.
“There are HSS providers in each state and territory. The HSS providers register new arrivals with Medicare and Centrelink and also link clients with health providers and counselling services.”
Refugees and migrants from refugee-like backgrounds (“refugee-like” refers to those found to be refugees under the United Nations Refugee Convention, who hold an Australian or Humanitarian visa, and also people from refugee-like backgrounds who have entered under other migration streams including asylum seekers) who wish to apply for settlement in Australia need to undergo a preliminary health screening in the country where they lodge their visa application, Dr Thambiran explains.
The screening is predominantly to identify “red flag” medical conditions, such as pulmonary tuberculosis, which may prevent them from entering the country.
Once refugees arrive in Australia, they aren’t obligated to undergo further health checks, however ongoing health concerns are found in many who arrive here under the Humanitarian Migration Program. Asylum seekers have increased vulnerability due to a number of factors: many have left family members behind, are facing financial hardship, and have immediate family members in detention centres.
But, cultural variances and cost often stand in their way of seeking further medical or counselling assistance.
“The Commonwealth funds the Translating and Interpreter Service, which is a free telephone interpreter service for health providers to use when providing services to people do not speak English,” Dr Aesen explains.
“However, it is very much an underused service. Some General Practices are still unaware of TIS, and some don’t understand that it’s free or that it’s the responsibility of the doctor to organise the interpreter.
“Unfortunately, many health consultations are conducted without an interpreter, or with a friend or family member interpreting, which could lead to significant errors and loss of patient confidentiality.”
Asylum seekers without Medicare face even tougher challenges in accessing primary healthcare. While some GPs provide pro bono care, patients still struggle to access medication, pathology and specialist services.
But some community-based organisations and state-funded refugee health clinics will provide this service at a discounted cost. Visit the NSW Refugee Health Service for NSW providers; health.vic for Victoria; or see the link at the bottom of this article for other states.
They may not understand they need to ring ahead to book an appointment.
Navigating our complex healthcare system, with its maze of primary care, hospitals, public and private sectors, presents yet another barrier, even to Medicare card holders.
“They [refugees] may present to the Emergency departments for general practice type symptoms or may delay accessing treatment for fear of cost,” Dr Aesen says. “They may not understand they need to ring ahead to book an appointment. There may be confusion about what to do with prescriptions as in many countries, doctors dispense medication and they are unfamiliar with pharmacies.”
Addressing mental health
Cultural complexities can come into play, particularly in the mental health sector.
“People from non-Western backgrounds may have a more holistic approach to their health. They may utilise traditional healing practices or seek out a traditional healer in addition to seeing a university trained doctor,” Dr Aesen says.
Trust is another issue that needs to be better understood, according to Sue Casey, Sector Development and Partnerships Manager at Foundation House Victoria.
“If people have been subjected to torture from someone in a role of authority, then they might struggle to be able to walk into a Centrelink branch for example, or to negotiate themselves around housing or other issues,” Casey says.
Supporting the community
Roughly 4,000 refugees settle in Victoria each year, accounting for almost a third of all refugees and asylum seekers entering Australia. With an additional 10,000 or so asylum seekers living in the Victorian community on bridging visas while they wait for the determination of their refugee status, this gives the state the largest number of refugees in the country.
“We’re expecting many people will settle in the northern suburbs of Melbourne so we’re doing work in health and education with the schools in those areas and the health services in that part of Melbourne,” Casey tells.
Established in 1987, the Victorian Foundation for Survivors of Torture Inc. (also known as Foundation House) is a not-for-profit organisation that works directly with people of refugee backgrounds who have experienced torture or other traumatic events in their home country.
We don’t use formal diagnoses, it’s more a service offered to people who are struggling with their day to day lives and need support.
“Typically, people first hear about our service when they arrive in Australia,” Casey says. “People coming through the humanitarian program get support from a settlement service and those settlement workers will sometimes make a referral to Foundation House.
“We don’t use formal diagnoses, it’s more a service offered to people who are struggling with their day to day lives and need support. They might have trouble sleeping, or are experiencing flashbacks.
“We do quite a lot of work with children and their families, especially those children who have been exposed to violence and other terrible things.
The Victorian Refugee Health Network is auspiced by Foundation House and focuses on various project areas including asylum seeker health, maternal and child health, sexual and reproductive health and language services. Visit refugeehealthnetwork.org.au for more information.
For assistance across refugee health issues in all other states, visit refugeehealthaustralia.org.
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