ObjectiveTo explore the perspectives of primary healthcare (PHC) professionals providing care to refugees through mainstream general practice.DesignQualitative exploratory design with semistructured interviews subjected to inductive thematic analysis.Setting and participantsNine general practices enrolled in the Dunedin Refugee Resettlement Programme, in New Zealand (NZ)’s southern health region. Participants included nine general practitioners and six practice nurses.ResultsThree analytical constructs were identified: relational engagement with refugees, refugee healthcare delivery and providers’ professional role shaped by complexity. Building meaningful relational connections involved acknowledging refugees’ journeys by getting to know them as people. This was instrumental for the development of an empathetic understanding of the complex human trajectories that characterise refugees’ journeys to NZ. Participants encountered challenges in providing care to refugees with respect to time-limited consultations, variable use of interpreter services, fragmentation of care between agencies and need for improved health infrastructure to ensure a fluid interface between PHC, secondary care and community support services. The current business model of NZ general practice was perceived to interfere with value-driven care and discouraged tailoring of care to specific patient groups, raising concerns about the ‘fit’ of mainstream general practice to address the complex healthcare needs of refugees. Meeting the needs of refugees across the social determinants of health involved a lot of ‘behind the scenes work’ particularly in the absence of shared information systems and the lack of well-established referral pathways to connect refugees to services beyond the health sector. This led to providers feeling overwhelmed and uncertain about their ability to provide appropriate care to refugees.ConclusionsThis study provides rich context-specific findings that enhance PHC responsiveness to the needs of refugees in NZ.

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The association of imperforate vagina with secretion and consequent retention of fluid is a rare condition in infancy. The following is a case in which it caused the death of the infant.

staff and a very different atmosphere from the acute wards. My own experience of geriatric long-stay wards, some with a high proportion of demented patients, is that eventually some trained staff are found who derive much satisfaction from their work. They have to learn to organize them more like homes and not to compete with the acute wards. The geriatrician does not have to spend much time in the long-stay units, but he must set the pattern and have control of admission.This difference of view is a minor matter, however, compared with our general agreement on the development of medical services for elderly people and on the great need for doctors to interest themselves in this field-I am, etc.,