Refugee & Asylum Seeker Health Care in Melbourne s eastern suburbs
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1 Refugee & Asylum Seeker Health Care in Melbourne s eastern suburbs Marion Bailes MBBS, MHSC and Merilyn Spratling RHNP Refugee Health Program EACH Social and Community Health East Ringwood
2 Overview of the presentation Who are the asylum seekers and refugees cared for by EACH? The EACH social and community health program for Refugees and Asylum seekers in Melbourne s eastern region: - refugee health nursing -specialist GPs -allied health and other services Health issues of refugees and asylum seekers
3 Who is a refugee? A person who has suffered persecution or has a well-founded fear of persecution in their country of origin for reasons of: race religion nationality membership of a particular social group or political opinion. Once granted refugee status under the United Nations High Commissioner for Refugees (UNHCR) definition and accepted by Australia for settlement, a refugee receives an Australian visa under the Humanitarian Program which grants permanent residency and eligibility for the same services available to all Australian permanent residents. (Victorian) Dept of Health, 2014
4 Who is an asylum seeker? A person who comes to Australia by plane (usually by valid visa) or by boat (usually without a visa) and then seeks protection to remain in Australia based on refugee claims. They are known as asylum seekers while their refugee status is being determined. They may reside: in the community on bridging visas in community detention in immigration detention facilities (including Christmas Island) or offshore in Nauru or on Manus Island. (Victorian) Dept of Health, 2014
5 Annual Migration to Australia ( ) Migration Program 190,000 Migration to Australia via skilled migration, family migration Offshore Program UNHCR resettlement program (Visa numbers 200, 201, 204) Special Humanitarian program - SHP (Visa number 202) Onshore Program Asylum Claims made ONSHORE by persons who arrive via plane or boat TPV or PPV The Refugee Experience VFST
6 Top 5 countries of origin of refugees arriving in Australia on humanitarian (refugee) visa: Burma (Myanmar) 2. Iraq 3. Bhutan 4. Afghanistan 5. The Congo
7 Top 5 countries of origin of people who receive permanent visas after claiming asylum in Australia : Afghanistan 2. Iran 3. Stateless 4. Iraq 5. Sri Lanka
8 Country of birth of refugees arriving in Melbourne s east in 2013 (n=521) Iraq 1% Malaysia* 1% Liberia 1% India* 1% Pakistan Thailand* 1% 2% Syria 1% Other Aghanistan Aghanistan 1% 1% Myanmar China Egypt 1% Iran 15% Egypt Iran India* Iraq China 1% Liberia Myanmar 73% Malaysia* Thailand* Pakistan Syria Other
9 REFUGEES AND ASYLUM SEEKERS have faced circumstances that negatively impact on their health Before arrival - limited or no access to health care, adequate nutrition, clean water -torture, trauma, loss of family, loss of dignity, forced to make impossible decisions.. After arrival: - need to negotiate new systems like health - difficulty accessing services (eg use of interpreters) - living in an unfamiliar culture - continued bad news about family/friends in home or transit countries etc
10 Health services for refugees & asylum seekers in Victoria. Refugees - Permanent Protection visa holders: Settlement workers & community guides AMES Temporary Humanitarian Concern Visas-varied settlement support Asylum seekers Medicare ineligible - pro bono GPs Asylum Seeker Resource Centre & Doveton clinic Community health service Refugee health nurses Counselling Oral health Physiotherapy Dieticians Health promotion Other allied health Specialist services - Statewide & sub-regional clinical hubs in hospital & community health services Infectious diseases, paediatrics, Vitamin D also, mantoux, optometry, audiology, mental health, Asylum seekers AMES (BVE boat arrivals) Health Orientation &Triage Red Cross Life Without Barriers & AMES Family migration program? Community based approaches? General practitioners in private practice & community health Torture & trauma counselling Foundation House Refugee health & paediatric fellows Royal Melbourne & Royal Childrens secondary consult & training Asylum seekers in Community Detention Health services provided IHMS CH may become a IHMS provider
11 The role of the RHN within the EACH refugee health program. Referral of all newly arrived refugees in the east from AMES to RHN; seen by RHN within 6 weeks of arrival-with professional interpreter- for initial refugee health assessment Assessment of asylum seekers (with or without Medicare) and people living in community detention (for care as above) Linked to GP and health assessment report provided referrals made by RHN as indicated by assessment (e.g. internally to EACH services such as dental, optometrist, physiotherapy, women's health clinic, etc and externally to MCH nurse, audiologist etc)
12 The role of the RHN within the EACH refugee health program. Health assessment & management of health care of refugees post immediate settlement period (on referral from MIC, Foundation House, etc) Mantoux skin testing & immunisation clinics Support for EACH GP & RCH paediatric outreach clinics
13 The role of the RHN within the EACH refugee health program. Health education sessions (e.g. prevention of heart disease for Chin men, women's health issues for Karen women, etc) Establish and facilitate the Eastern Region Refugee Health Network Participation in Asylum Seeker triage clinics (in the city) for recently released people (from closed detention) Membership of relevant policy & practice development activities (eg the Victorian Refugee Health Network)
14 A healthy start for refugees Meeting the specific health needs of refugees and asylum seekers and helping them to navigate the Australian healthcare system. DR MARION BAILES, MBBS, MHSC
15 Health issues of refugees & asylum seekers 1. mental health (inc torture & trauma) 2. infectious and vaccine-preventable disease 3. chronic disease 4. oral health 5. vision and hearing 6. social isolation 7. alcohol and drug use 8. somatic manifestations of pain 9. maternal and child health 10. sexual and reproductive health 11. diet and nutrition issues 12. vitamin D 13. disability and developmental concerns. (Dept of Health 2014)
16 Addressing Health issues of refugees & asylum seekers 1. Communication is important 1. Preferred language is documented 2. A Professional interpreter is arranged. Languages of the people of Myanmar: 1.Chin 2.Karen 3. Burmese
17 Addressing Health issues of refugees & asylum seekers 1. Which health issue is the patient s priority? 2. A full medical history is taken. 3. A full check up is done for each member of the family. 4. Investigations are organised. Pathology tests (blood/urine/faeces) Mantoux test X-rays or Ultrasounds if required
18 Addressing Women s Health issues Reproductive health - Contraception - Pap smears - Antenatal care - Postnatal care Vitamin D Breastscreen Nutrition/Healthy eating Mental health
19 Addressing Men s Health issues Nutrition/Healthy eating Vitamin D Mental health Smoking/alcohol Musculoskeletal problems (hard labour/injuries)
20 Prevention & early detection of chronic diseases Lifestyle issues: tobacco/ BMI / exercise Chronic conditions: Heart disease (BP; cholesterol/triglycerides) Bowel cancer (FOB) Kidney disease (dipstick; BP; fasting sugar) Diabetes (BMI, dipstick, fasting sugar, HbA1C )
21 Refugee background can increase risk of chronic diseases Limited access to health services. Limited availability of healthy food Low health literacy
22 The Role of the GP within the EACH refugee health program is to assess, investigate, treat, refer, liaise and support, then to transition the patient to a community GP practice.
23 In conclusion many refugees and asylum seekers settle successfully into Australia. Najeeba s story RM=HDRSC3#view=detail&mid=2AF3E3C463A0E91D8BF42 AF3E3C463A0E91D8BF4 (Amnesty International Australia 2010).
24 Questions? Refugee Health Nurse Co-ordinator Merilyn Spratling Tel: General Practitioner Marion Bailes THANK YOU
25 Training and Resources Ongoing training at Foundation House ANMF CPD (for nurses) learning module Refugee health online ( Post graduate study at Monash University: Refugee health and Wellbeing ( ml) Caring For Refugee Patients in General Practice (A desk Top guide) ( Victorian Refugee Health Network ( State wide refugee health (nurse) coordinator mobile
This presentation summaries the health pathways for refugee and asylum seeker children in Victoria. The areas covered include health screening,
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