An issue of access: Delivering equitable health care for newly arrived refugee children in Australia

Abstract

Newly arrived refugees and asylum seekers are faced with many difficulties in accessing effective health care when settling in Australia. Cultural, language and financial constraints, lack of awareness of available services, and lack of health provider understanding of the complex health concerns of refugees can all contribute to limiting access to health care. Understanding the complexities of a new health care system under these circumstances and finding a regular health provider may be difficult. In some cases there may be a fundamental distrust of government services. The different levels of health entitlements by visa category and (for some) detention on arrival in Australia may further complicate the provision and use of health services for providers and patients. Children are particularly at risk of suboptimal health care due to the impact of these factors combined with the effect of resettlement stresses on parents' ability to care for their children. Unaccompanied and separated children, and those in detention experience additional challenges in accessing care. This article aims to increase awareness among health professionals caring for refugee children of the challenges faced by this group in accessing and receiving effective health care in Australia. Particular consideration is given to the issues of equity, rights of asylum seekers, communication and cultural sensitivities in health care provision, and addressing barriers to health care. The aim of the paper is to alert practitioners to the complex issues surrounding the delivery of health care to refugee children and provide realistic recommendations to guide practice.

Caring for refugees in general practice: perspectives from the coalface

“…Australian and overseas literature has highlighted language and cultural differences, distrust of health professionals, a lack of health information, poor understanding of the health care system, an often-undertrained workforce and financial limitations as impacting on refugees' ability to access health care (Finney Lamb and Smith 2002;Davidson et al 2004;Murray and Skull 2005;Sheikh-Mohammed et al 2006;Henderson and Kendall 2011). These issues were mirrored in the comments of providers, as they discussed the barriers they experienced in providing care, highlighting the way in which patients and health care providers are struggling to overcome these issues together.…”

“…They experience higher rates of physical and psychological problems than other migrants, resulting from deprivation of resources, exposure to trauma and torture and poor access to health care before arrival (United Nations High Commissioner for Refugees 2002; Smith 2006; Victorian Foundation for Survivors of Torture 2012; Sheikh et al 2009). These issues can be exacerbated in the early resettlement period, when refugees frequently experience unemployment, discrimination and lack of family and social supports (United Nations High Commissioner for Refugees 2002; Davidson et al 2004;Sheikh-Mohammed et al 2006;Sheikh et al 2009). It is not uncommon for refugees to have multiple, complex health problems at the time of arrival but, with sensitive, intensive 'catch-up' care in the early resettlement period, most issues can be addressed (United Nations High Commissioner for Refugees 2002).…”

Challenges of Refugee Health Care: Perspectives of Medical Interpreters, Case Managers, and Pharmacists

“…16,17 Lack of knowledge of the health care system and reduced ability to negotiate and advocate for themselves creates barriers to access services, comply with medical recommendations, and succeed within the social context, making resettlement more difficult. 4,18,19 In the current literature there is limited exploration of the experiences of case managers, interpreters, and other key health care team members in regard to challenges faced in the efforts to access equitable health care for refugee populations. 12 This study aims to identify perceptions of challenges in the provision of health care for refugees from the perspective of health care team members other than physicians: medical interpreters, case managers, and pharmacists.…”

Universal Paediatric Refugee Health Screening

“…We briefly outline our recent experience with paediatric refugee screening in Western Australia (WA) based on the frameworks outlined previously in the Journal of Paediatrics and Child Health. [2][3][4] Earlier, more extensive data have also been described. 5 The wide array of health concerns that may be encountered in this vulnerable population is highlighted.…”

“…Importantly specific features of the serotonin syndrome were absent: myoclonia, tremor, disorientation, irritability and diarrhoea. 1,2 The rigidity and possible fever in this case warranted consideration of neuroleptic malignant syndrome; however, the CK level was normal.…”