Refugee Health In Australia

Refugee Health In Australia

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Refugee Health In Australia

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Refugee Health In Australia

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Questions:
1.Describe a contemporary issue in health care and explain why it presents a challenge in Clinical Practice.
 
2.Identify the issues for people affected by this problem including the impact on individuals and their Communities or Workplace.
 
3.Critically discuss strategies that could be considered for Implementation in the acute care AND primary health care/community setting (including cultural considerations) to address these issues.
 
4.Describe the implications of these issues for advanced practice nurses and nurse practitioners in terms of their need for education, resources and support.
 
 
Answers:

Refugees and asylum seekers coming to settle in different state and territories of Australia face many difficulties during settlement. Cultural shock is common among them as they are unfamiliar with urban environment and struggle to maintain western lifestyle and budget (Challenges faced by new arrivals | Department of Social Services, Australian Government, 2017). Being a legal refugee myself, I am aware of the pathos and emotions of migrants coming to settle in new land. I am a north African Sudan who came to Australia through a UN Humanitarian visa. From my own experience, I can say that health and well-being of African refugees becomes difficult due to extreme difference in culture and presence of complex physical and mental illness in patient. The article presents the contemporary issues in health care by means of evaluation of the health issues of African refugees in Australia.
1.Contemporary issues in health care and challenges in clinical practice
After the successive wave of migration from Asia and Europe, Australia has transformed into a multicultural nation. Although multicultural environment is prone to many ethical tensions, however Australia has worked hard to integrate people from different nationalities into their community. However, the transition to new culture from previous culture is difficult. Apart from difficulty in accessing housing and job opportunities, accessing health service in new country becomes challenging (Riggs et al., 2012). Therefore, the main contemporary health issue in Australia’s health care environment is the cultural barrier to accessing Australian health services among refugees. This is seen because of lack of knowledge about Australian health care system. Refugees have been found to avoid service also due to unpleasant experience with health care providers in home countries. Secondly, based on cultural difference, expectation of refuges towards the delivery of care also differs resulting in disparities in health. Language difficulties like poor English language knowledge also discourage many patients from presenting to general practitioners (Drummond et al., 2011).
 
Due to the cultural and language barrier in accessing health service, health care professional working in Australia face challenges in working cross-culturally. Lack of cultural understanding of patients lead to misunderstanding and culturally sensitive practice needs are compromised (Almutairi, 2015). Diverse language, socioeconomic background and arrival of refugees with wide range of problems act as barrier to delivery of high quality clinical care. Diagnosis of illness becomes difficult due to the conflict between biomedical health model and health model of refugees. Clinicians are also challenged by caring for refugees with physical and psychological problems as refugee often related these problems to community alienation and social disconnectedness and do not seek health care support (Hauck et al., 2012). Hence, even though refugees population has an increased need for health care support, the accessibility to health service is often limited and very low. In addition, health care professional and staff lacks knowledge regarding culturally competent care. As African refuges mostly come in large numbers in Australia, the blog further explores in detail the impact of these issues on health of African refugees living in Australia.
2.Impact of health care issue on African refugees in Australia
According to the Australian Bureau of Statistics data 2016, South Africa refuges comprise about 0.8% of the Australian population. Africans have come to Australia either as migrant through skilled and family reunion programs or refugees through the humanitarian program (3412.0 – Migration, Australia, 2015-16, 2017). Since the migration of the Africans in Australia, they have been challenged by several issues such as unemployment, issues in adjusting to Australian society, lack of understanding about legal rights and responsibilities, experience of discrimination or racism and accommodation and housing problems. The unemployment rate is high among African refugees because of lack of English language proficiency. Poor housing and unemployment has contributed to health risk and mental illness in African refugees. Great disparity exist between health of African refugees and Australians (Correa?Velez et al., 2015). This is also because health care providers lack cultural sensitivity in care and health care service is not affordable for most of the refugees.
 
African refugees are at disproportionately high risk of psychological distress and mental illness due to adaptation, acculturation and intergenerational conflict. They are continuously exposed to post migration stressors too after migrating to Australia because of unemployment, discrimination, limited English language proficiency and violence and anxiety among family members. There are many evidence regarding high rate of psychotic disorders post migration such as schizophrenia and depression (Chen et al., 2017). Racism and experience of discrimination also acted as a factor leading to increased risk of mental illness (Lucas & Edgar, 2014). Despite intensified rate of psychological distress among African refugees, utilization rate of mental health service is very low as African refugees lack trust in Australian health care system (Chen et al., 2017).
The need for culturally sensitive health promotion and early intervention for health and well-being of African refugees in Australia is also understood from risk factors of post-traumatic stress disorder  (PTSD) in them. Psychological distress was found to be high mostly due to pre and post migration stressors. The pre-migration factors included traumatic events leading to migration and the post migration factor included challenges in resettlement process respectively. Feeling of loneliness and several social integration stressors also aggravated the symptoms of PTSD in African refugees (Chen et al., 2017). Clark et al., (2014) also gave the evidence that limited resource and stress before resettlement in host countries leads to variety of chronic diseases among African refugees. However, health care access issues compound their health status too. Majority of them do not access health services due to language and communication difficulties and cultural beliefs. Their cultural beliefs mainly affected the expectation towards care and contributed to delayed care and poor health of refugees.
 
Overall, the challenges in accessing health service among African refugees can be understood from the theme of not meeting expectation and struggling to face a new life. African families struggle to understand new health system of Australia and mainly report barriers such as lengthy wait times, high cost medication and less ideal care. Secondly, new and unfamiliar environment also challenged then in terms of transportation, weather, language, employment and cultural difference (Woodgate et al., 2017).
3.Strategies to address the issue
To maximize health and well-being of African refugees and address health care issue, health promotion programs should focus on providing culturally sensitive health care service. The key strategies that Australian health care staffs requires at practice level includes incorporating principles of cultural competence in daily care, being familiar with African community resources and cultural perceptions, building personal working relationship and using interpreters with refugee families who have faced difficulty in speaking English (Wilson & Renzaho, 2015). This approach has the benefit of reducing the barrier faced by African refugees in seeking health care service in Australia. As alienation towards health care service is mainly seen because of poor cultural knowledge among health care staffs, integrating the principles of cultural competence has the potential to provided care according to cultural preference and expectation of refugees (Purnell, 2014). With the use of interpreters, more and more numbers of African refugees can be encouraged to seek health care resource. In addition, training Australian health care staffs about the range of cultural beliefs and health beliefs of African refugees will promote cultural responsiveness in care (Ellis,  Murray, & Barrett, 2014).
 
At the program delivery level, Australian health care organizations will have to ensure direct service providers are culturally competent and only those staff are recruited who have the knowledge of culturally appropriate care. Recruiting community members and staff will be important as they will be responsible for cultural responsiveness in care. This will help staffs to interpret meaning of symptoms and behaviors and seek adequate support from community members. While planning health care programs for African refugees, it should be ensured that the content of the program is relevant to their cultural background to promote inclusiveness in health care provisions. Family centered care should also be provided to promote involvement of all family members and address needs of children and mothers too (Cheng et al., 2015)
4.Implications of the issue for advanced practice nurse and nurse practitioners.
In relation to the issue of health care disparity and poor health status of African refugees due to cultural barriers in care, advanced practice nurse and nurse practitioners are also going to be challenged by this issue in care. This may lead to dissatisfaction with care and more burden for nurse due to the need to provide culturally sensitive care (Kaplan, Stow, & Szwarc, 2016). However, attending training regarding cultural competency will change knowledge, attitude and skills towards providing care to African refugees with different language and cultural preferences compared to Australians. Cultural knowledge will act as the foundation for expanding health care support to this group in Australia. Addressing attitude will be important to evolve nurses to a culturally competent caregiver. Communication skill will also play a role in adapting to new and different situations within the provision of care.
 
References
3412.0 – Migration, Australia, 2015-16. (2017). Abs.gov.au. Retrieved 22 June 2017, from https://www.abs.gov.au/ausstats/abs@.nsf/mf/3412.0
Almutairi, K. M. (2015). Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia. Saudi Medical Journal, 36(4), 425-431.
Challenges faced by new arrivals | Department of Social Services, Australian Government. (2017). Dss.gov.au. Retrieved 18 June 2017, from https://www.dss.gov.au/our-responsibilities/settlement-and-multicultural-affairs/programs-policy/settlement-services/government-programs/volunteers/why-volunteer/challenges-faced-by-new-arrivals
Chen, W., Hall, B. J., Ling, L., & Renzaho, A. M. (2017). Pre-migration and post-migration factors associated with mental health in humanitarian migrants in Australia and the moderation effect of post-migration stressors: findings from the first wave data of the BNLA cohort study. The Lancet Psychiatry, 4(3), 218-229.
Chen, W., Hall, B. J., Ling, L., & Renzaho, A. M. (2017). Pre-migration and post-migration factors associated with mental health in humanitarian migrants in Australia and the moderation effect of post-migration stressors: findings from the first wave data of the BNLA cohort study. The Lancet Psychiatry, 4(3), 218-229.
Cheng, I. H., Vasi, S., Wahidi, S., & Russell, G. (2015). Rites of passage: Improving refugee access to general practice services. Australian family physician, 44(7), 503.
Clark, A., Gilbert, A., Rao, D., & Kerr, L. (2014). ‘Excuse me, do any of you ladies speak English?’Perspectives of refugee women living in South Australia: barriers to accessing primary health care and achieving the Quality Use of Medicines. Australian journal of primary health, 20(1), 92-97.
Correa?Velez, I., Barnett, A. G., & Gifford, S. (2015). Working for a better life: Longitudinal evidence on the predictors of employment among recently arrived refugee migrant men living in Australia. International Migration, 53(2), 321-337.
Drummond, P. D., Mizan, A., Brocx, K., & Wright, B. (2011). Barriers to accessing health care services for West African refugee women living in Western Australia. Health Care for Women International, 32(3), 206-224.
Ellis, B. H., Murray, K., & Barrett, C. (2014). Understanding the mental health of refugees: trauma, stress, and the cultural context. In The Massachusetts General Hospital textbook on diversity and cultural sensitivity in mental health (pp. 165-187). Springer New York.
Hauck, F. R., Corr, K. E., Lewis, S. H., & Oliver, M. N. (2012). Health and health care of African refugees: an underrecognized minority. Journal of the National Medical Association, 104(1-2), 61-71.
Kaplan, I., Stow, H. D., & Szwarc, J. (2016). Responding to the challenges of providing mental health services to refugees: an Australian case report. Journal of health care for the poor and underserved, 27(3), 1159-1170.
Lucas, D., & Edgar, B. (2014). Africans in Australia 2011: Their demography and human capital.
Purnell, L. D. (2014). Guide to culturally competent health care. FA Davis.
Riggs, E., Davis, E., Gibbs, L., Block, K., Szwarc, J., Casey, S., … & Waters, E. (2012). Accessing maternal and child health services in Melbourne, Australia: reflections from refugee families and service providers. BMC Health Services Research, 12(1), 117.
Wilson, A., & Renzaho, A. (2015). Intergenerational differences in acculturation experiences, food beliefs and perceived health risks among refugees from the Horn of Africa in Melbourne, Australia. Public health nutrition, 18(01), 176-188.
Woodgate, R. L., Busolo, D. S., Crockett, M., Dean, R. A., Amaladas, M. R., & Plourde, P. J. (2017). A qualitative study on African immigrant and refugee families’ experiences of accessing primary health care services in Manitoba, Canada: it’s not easy!. International Journal for Equity in Health, 16(1), 5.

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