Refugee HealthRefugee Health

Sue Willey & Gayle ComynGreater Dandenong Community Health Service

Definition of a RefugeeDefinition of a Refugee

…owing to well- founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.

Australia’s ResponseAustralia’s Response

Signatory to the UN 1951 Convention relating to the Status of Refugees

Approx. 13,000 refugees per year plus 500 Iraqi refugees this financial year = 13,500 Approx. 5,000 refugees settle in Victoria per annum

…. and of those approx. 750 settle in City of Greater Dandenong per annum(has been up to 1,000 refugees to CoGD per annum)

Greater Dandenong (C) 24.9%Brimbank (C) 13.5%

Hume (C) 10.2%Casey (C) 6.5%

Maribyrnong (C) 5.8%

Wyndham (C) 4.2%Darebin (C) 3.2%

Whittlesea (C) 3.2%

Moreland (C) 2.6%Maroondah (C) 2.5%

Others 23.3%

Total: 100.0%

Refugee settlement in top 10 Local Government areas 2002 – 2007 (DIAC settlement data 2007)

Refugee settlement in top 10 Local Government areas 2002 – 2007 (DIAC settlement data 2007Refugee settlement in top 10 Local Government Refugee settlement in top 10 Local Government areas 2002 – 2007 (DIAC settlement data 2007)areas 2002 – 2007 (DIAC settlement data 2007)

Expected Humanitarian Entrants (Vic) May 2009Expected Humanitarian Entrants (Vic) May 2009

Country of Birth (top 5)

IraqBurma (Thailand) AfghanistanSudanSomalia

Ethnicities (top 10)

Iraq – IraqiChaldean

Burma - Karen Chin

Afghanistan - HazaraSudan – Dinka

BariSomalia Ethiopian African

Humanitarian Visa CategoriesHumanitarian Visa Categories

200 Refugee

201 In-Country Special Humanitarian

202 Global Special Humanitarian

203 Emergency Rescue

204 Women at Risk

866 Permanent Protection Visa

Integrated Humanitarian Settlement Strategy Integrated Humanitarian Settlement Strategy (IHSS)(IHSS)

• Consortium of settlement agenciesAMES (Adult Migrant Education Scheme)Foundation House (VFST)Springvale Community Aid & Advice BureauRedback ServicesBrotherhood of St. Laurence

• Assistance for the first 6 months after arrival

• May then be referred other agenciesMigrant Resource Centre; New Hope Foundation

Asylum SeekersAsylum Seekers

• Amongst the most disadvantage people living in Victoria• Have supporting documentation from either the Red Cross or the Asylum Seekers Resource Centre• Bridging Visa ‘E’• Have access to DHS services such as

HospitalsAmbulance for emergency situationsCommunity Health ServicesDental Health ServicesImmunisationDisability Aids and Equipment Program

http://www.dhs.vic.gov.au/multicultural/downloads/asylum-seeker-access-to-dhs-

services.pdf

Background to Refugee Health Nurse InitiativeBackground to Refugee Health Nurse Initiative

People from a refugee background have • come from countries that

- are of a lower level of socio-economic development than Australia and- have minimal coordination of health care systems

• witnessed or survived significant violence and human rights violations

• higher levels of physical and psychological healthproblems than migrants and people born in Australia

Victorian State Government Initiative

Background to Refugee Health Background to Refugee Health Nurse InitiativeNurse Initiative

• to optimise the long-term health of refugees community members

• nurses placed in high settlement areas in the Community Health Service

• able to promote accessible and culturally appropriate health care services

• develop relationships with other community based agencies

Aims of the RHN Programms of the RHN Program

Increase refugee access to primary health services.

Improve the response of health services to refugees’ needs.

Enable individuals, families and refugee communities to improve their health and wellbeing.

Refugee Health Clinics with a Refugee Health Nurse in Refugee Health Clinics with a Refugee Health Nurse in Greater DandenongGreater Dandenong

Greater DandenongGreater DandenongCommunity Health ServiceCommunity Health Service55 Buckingham Ave, Springvale 3171PH: 8558 9000

Two Weekly Clinics• Refugee Health Nurses• Community Health Nurse• Interpreters available• Drop-In• Appointments available• Internal & External referral as required

Refugee Immunisation Clinic• Wednesday 9am – 12noon• Catch-up immunisation for adults and children

M.Y. Health Clinic• Thursday 9am – 12noon• General health assessment / needs• Pap Smears• Family Planning• For all the family

Dandenong HospitalDandenong HospitalDavid St, Dandenong 3175

Refugee Health Clinic – Outpatients DepartmentMonday 1.30pm – 5pmSupport for GPs with managing complex medical issues• Infectious Diseases Specialists• Paediatricians• Refugee Health Nurses• Community Development Worker

Other services available• GP Asylum Seeker Clinic (fortnightly)• Dietitian (monthly)• Centrelink (monthly)• Immunisation

Require GP referralInterpreters availableAppointment onlyReminder call made the week before appointment

Refugee Health & Wellbeing Action Plan Refugee Health & Wellbeing Action Plan 2008 – 20102008 – 2010

•

*3 Strategic Priorities**3 Strategic Priorities*• Provide timely and accessible

services for newly arrived refugees

• Build the capacity and expertise of mainstream and specialist services and health care practitioners in the area of refugee health care

• Support and strengthen the ability of individuals, families and refugee communities to improve their health & wellbeing

Accessible fromwww.dhs.vic.gov.au/multicultural

Highlights the need for flexible; culturally appropriate access to health services & service delivery

InterpretersInterpreters• Use frequently• Imperative • Best if able to get on-site• Telephone Interpreting Services • Some languages very difficult to get interpreters• Try to book in advance to ensure availability• Be mindful of issues that can relate to small

communities and gender difference• Do not rely on family members particularly children to

interpret

Southern Health Interpreting Guideline available on the intranet (Allied Health – Clinical Protocols & Guidelines)

Barriers / Difficulties / Issues for RefugeesBarriers / Difficulties / Issues for Refugees

• Housing – overcrowding; lack of affordable rentals• Language Barriers• Education – learning English• Child care• Transport • Delay in receiving Centrelink income • Delay with obtaining Medicare number• Linking to other services; knowing where to go;

uncertainty

Barriers / Difficulties / Issues for RefugeesBarriers / Difficulties / Issues for Refugees

• Competing demands with settlement• Australian Health system• Access to health services • Complex medical conditions

• Mental health and well-being• Physical health• Social issues – relationships; differences in Aust• Medication – cost

• Inadequate Immunisation• Interpreters• Separation from family / children

How can you help?How can you help?

• Developing awareness and understanding of the refugee experience and CALD issues• Take time to explain - sometimes explanations need to occur more than once• Easy English when explaining • Building a trusting relationship with people from a refugee background imperative • Only make promises you can keep• Recognise there will be many many other social and

health issues for this person• Ask what other services are involved; will save on

duplication / confusion

Contact Details

Sue Willey & Gayle ComynGreater Dandenong Community Health Service – 55 Buckingham AveSpringvalePH: 8558 9000

Sue WilleyMob: 0420 301 634

Gayle ComynMob: 0428 141 572