ࡱ> Y[Xg r@bjbjVV .Tr<r<d8 @ @ 8<!3F66666+!+!+!2222222$g582+!+!+!+!+!2662"""+!v662"+!2""0h16P73!F1220!3,18!8 181"+!+!+!22"R+!+!+!!3+!+!+!+!8+!+!+!+!+!+!+!+!+!@ `: African Australians: A report on human rights and social inclusion issues Theme: Health Author: Nathan Swan on behalf of Hamilton James Street Doctors 25 June 2009 Table of Contents xx. Executive Summary 1 Introduction 2 Health issues for African Australians 3 Continuity of health care 4 Access to health services 6 Interpreting services 6 Culture and health 7 Conclusion 8 Recommendations 9 1 Executive Summary The general practice model of health service in Australia is not ideal in terms of meeting the needs of newly arrived African Australians. Tracking a patients medical history as well as ensuring continuity of health care is hindered by the propensity for patients to alternate between different General Practice Surgeries. A lack of central co-ordination of services related to each individual or family can result in people falling between the gaps of these services. The over-the-phone interpretation services currently available to general practice is serviceable but not ideal. The service is time consuming and problems can arise when sensitive issues need to be discussed. A lack of understanding on behalf of health workers in terms of the diverse cultural and religious backgrounds of African Australians presents barriers towards meeting their particular health needs. Recommendations The designation of a medical liaison to each individual family for the first year after their arrival in Australia to ensure the continuity of their health care. Improved local co-ordination of services available to African Australians in their region of settlement. Increased availability of face to face interpreters in general practice surgeries. Recruiting of specific general practice surgeries to be designated as centres for refugee health. 2 1.0 Introduction Hamilton James Street Doctors, a general practice located in Newcastle, NSW, provides health care to a portion of the African Australian community that has grown in the region over the last few years. Not having had any extensive experience in caring for people of these particular cultural backgrounds, as well as those who have arrived Australia as refugees, it has been a learning experience for us at the surgery and one that we wish to share. As such we are thankful that this submission process will enable us to do so. The purpose of this submission report is to communicate the experiences and opinion of the health professionals who work at Hamilton James Street Doctors relating to the specific area of Health. The report will focus upon themes listed in the relevant section of the discussion paper, African Australians: A report on human rights and social inclusion issues. These include: Health Issues for African Australians, Access to Health Services, and Culture and Health. Content for this submission was compiled through consultation and interviews with Dr. Fiona Van Leeuwen and Julie Swan, General Practice Nurse. 3 2.0 Health issues for African Australians A main area of concern in terms of the health, well being and health care of African Australians in the first year after their arrival in Australia is the identification of an individuals health issues. These may relate to previous experiences elsewhere and may be psychological as well as physical. In the case of African Australians arriving in Newcastle as refugees, initial issue identification is done through the refugee health clinics that have a screening battery of tests which look for physical ailments such as malaria, schistosomiasis, and other such diseases which may be particular to where the people have come from. The African Australians who have settled in Australia are a diverse group and come from a variety of different cultural backgrounds. Thus, the medical problems and issues that people have upon their arrival can be quite varied. 4 2.1 Continuity of health care Because of the limited funding available to the refugee health clinic only brief contact and service can be provided and thus newly arrived African Australians need to be plugged into the existing services provided by general practices almost immediately. However, the general practice model is the same for newly arrived African Australians as it is for the rest of the population, which, in light of the special needs that they have is not an ideal situation. As it stands people are able to pick and choose which GP they want to see, and if they decide to they are free to go and see someone else. In terms of how this relates to newly arrived African Australians, it creates problems in terms of determining and keeping track of their medical history and the continuity of their health care. Of course, the lack of communication and continuity between different general practices is a problem which is inherent in the Australian health care system and is something that general practice could do a lot better; however, these problems are amplified for African Australians in their first few years in Australia due to the special circumstances which can often be attributed to them, such as an inability to speak English, a different cultural understanding of health, as well as a lack of a general understanding of the way in which the Australia health care system works. As an example, a patient may come in to the surgery with a certain symptom which they have been to a few other doctors about, and which they have had tests and prior treatment for. Whereas someone familiar with the Australian health care system and with no hurdles to overcome, such as the inability to speak English, would generally notify their current doctor of any tests they have had elsewhere as well as any prior treatment, in general newly arrived African Australians are either unaware that this is the expected practice when alternating between health care providers or are unable to communicate effectively enough to let the doctor know. As a result these patients can often end up getting a lot of unnecessary tests and/or treatment, such as being over-immunised. 5 The way that general practice operates with patients being seen in 15 minute consultations also presents difficulties in terms of ensuring the continuity of health care for African Australians. The brevity of these consultations mean that follow up consultations are often required, and it can often be a challenge to communicate the importance of keeping the next appointment. As an example a patient may come in and after being checked out are diagnosed with gall stones and are told that they need to go for an ultrasound or have a blood test and are then advised to come back in two weeks. However, oftentimes they wont end up getting the ultrasound or coming back for the follow-up consultation for one reason or another and their condition will end up untreated or will not be dealt with as fast as it could be. Once again this relates to the fact that they are not familiar with way the health care system operates in Australia as well the difficulties they face in terms of not speaking English. As a possible solution, the designation of a medical liaison to individual African Australian families who could accompany them to appointments and ensure they are aware of any follow up action that needs to be taken could be a worthwhile initiative, and would serve to ensure the continuity of their health care as well as that of their family. This service could be provided for the first year or two after their arrival in Australia and would provide guidance and support up until such time that the family is settled in the community and feels comfortable enough to go about these actions on their own. 6 2.2 Access to health services Whilst the Australian health care system does attempt to be really comprehensive in terms of meeting the needs of African Australians, oftentimes the amount of services on offer can lead to people falling between the gaps. There are designated services to help with areas such as children, trauma counselling, immunisation, housing etc and the separation of all of these services can make it hard for anything to be achieved, and as a result people seem to fall in between each of the services. It would seem that in some instances there is not enough central co-ordination related to each individual or family. Having one or two parties to go to regarding an issue would be a lot easier than five or six both for the patient as well as for the general practice in terms of knowing where to turn in a particular situation. 2.3 Interpreting services As has been mentioned prior, effective doctor/patient communication is imperative to effective health care for African Australians and in this sense having an effective and efficient interpreter service available to doctors is especially important. As it stands, the over-the-phone interpreter service which is currently available to general practices is relatively effective; however, it is not perfect and presents several difficulties for both the patient and doctor. Problems can arise when an individual has a difficult topic to discuss as it can be quite hard to go through that process over the phone as meaning can sometimes be lost and with a limited amount of time available per consultation this service takes up a lot of time. Furthermore, the phone translating service is not available to receptionists when patients present to the surgery without an appointment. This will often lead to problems in ascertaining the severity and urgency of a patients problem. Having an interpreter present in the room would be the ideal situation and in that regard this relates back to the previous recommendation of having a case worker assigned to assist a family in attending their appointments, where they could either provide a translating service themselves or assist with the phone translation. 7 2.4 Culture and health Another key issue in terms of ensuring that the Australian health care system adequately meets the needs of African Australians is the general understanding, or lack thereof, of the particular cultural and religious backgrounds of the diverse groups of African Australians, by health workers. In general, workers in general practice are not always knowledgeable enough in terms of the needs and beliefs of African Australians and how they relate to health issues. Certain practices which may be considered the norm in terms of health care in Australian society may be culturally unacceptable or taboo in the places where African Australians have come from, and not being sure how they feel about these practices or what they are used to from their health providers can result in the patient feeling uncomfortable which may, for example, prevent them from returning for follow up consultations. In order to provide a service which adequately meets the needs of African Australians in terms of health care, a system whereby certain general practices in the regions where new African Australian communities are settled are designated by the government as centres for refugee health would be effective. These centres would then be supported in an infrastructure sense in terms of staff training, interpreter access and systems support which would enable them to provide an excellent service and would ensure continuity in the delivery of health services for members of these particular communities, at least for the first year or two after they have arrived in Australia. Whilst in some ways this may be construed as a sort of discrimination, it is nevertheless positive discrimination which would ensure the quality and continuity of health care for African Australians in the first few years after their arrival. This system would lessen the dilution of health providers they see, would ensure adequate translating services would be available, and would enable newly arrived African Australians to be helped by health professionals that are knowledgeable in terms of the cultural and religious practices/norms that are specific to them. 8 3.0 Conclusion The general practice model of health service in Australia is not ideal in terms of meeting the needs of newly arrived African Australians. Tracking a patients medical history as well as ensuring continuity of health care is hindered by the propensity for patients to alternate between different General Practice Surgeries. This can result in patients receiving unnecessary treatment such as being over-immunised. Designated medical support for individual families in their first year or two in Australia would assist in ensuring continuity of care. A lack of central co-ordination of services related to each individual or family can result in people falling between the gaps of these services. Improved local co-ordination would assist patients in accessing services that are most appropriate for their personal health care. The over-the-phone interpretation services currently available to general practice is serviceable but not ideal. The service is time consuming and problems can arise when sensitive issues need to be discussed. Furthermore, ascertaining the severity or urgency of the patients problem upon presenting to the surgery can be difficult due to the unavailability of interpreting services at reception. A lack of understanding on behalf of health workers in terms of the diverse cultural and religious backgrounds of African Australians presents barriers towards meeting their particular health needs. Recruitment of specific general practice surgeries to be designated as centres for refugee health would assist in meeting the health needs of African Australians in their first few years in Australia. 9 4.0 Recommendations The designation of a medical liaison to each individual family for the first year after their arrival in Australia to ensure the continuity of their health care (see 2.1). Improved local co-ordination of services available to African Australians in their region of settlement (see 2.2). 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