Yahoo News As millions flee Ukraine we must help refugees navigate Australia’s labyrinthine health system
A patient’s immigration status can make every step of hospitalisation harder than it needs to be
Years ago, when a young doctor admitted that she had found the previous week very troubling, I readily conceded my own conflict. We were caring for a stressed patient whose children had been separated from her during a marital breakup. She was eager to attend her long-awaited court case because she thought it would clarify the next steps, but the many people involved in her care had many different ideas about what should happen. Her interpreter who also understood the cultural nuances, made almost heroic attempts at advocacy but in the end, the day of court came and went, and the patient’s distress was multiplied by a lack of resolution about the most vital aspect of her life.
My abiding memory of that event was that the patient’s refugee status made every step of her hospitalisation harder than it needed to be. Another patient in her place would most likely have walked out and abused us on the way but the refugee patient was diminutive in every sense of the word.
Millions are now fleeing Ukraine. Australia has offered humanitarian assistance and the prioritisation of visas to those escaping the conflict. Joining recent arrivals from Iraq, Syria, Myanmar, Sudan, and Afghanistan will be fearful and exhausted people from Ukraine. We might imagine that refugees are relieved to have been spared the depredations of war by arriving in a safe country. They can sleep without the sound of missiles overhead and speak without fear of reprisal. They can breathe clean air, eat a proper meal, and contemplate the next steps to secure their future.
They will surely welcome all this, but as a doctor who works with refugees, I also know how awfully hard the “next steps” are for those confronting dispossession and displacement.
Many refugees will accept a lesser life for themselves provided their children can thrive. The children of my patients received an interrupted education in their original country followed by learning in name only in refugee camps where the emphasis is on survival. Many have little formal education but are expected to assimilate in a system that sorts students by age, not need. Their parents can be overwhelmed by new practicalities, are often unable to help them, making these children heavily dependent on school services. In the absence of proper funding and specific training, teachers cannot help as fully as they would like, thus setting up an intergenerational pattern of poor outcomes. Still out of this, stars are born, but they have to overcome exceptional challenges.
Illness can test the most formidable resolve, but it has a particularly detrimental affect on refugees. Health illiteracy, the lack of a regular doctor, inadequate medical awareness about refugee issues, and limited access to interpreters and culturally sensitive professionals all play a role but most of all, I find my patients swallowed up in the labyrinthine nature of an excellent but complicated healthcare system.
My patients go from carrying their “medical records” in their head to being ushered into a clinic with computers and official forms. The language and accent go over their head and asking for an interpreter feels like looking a gift horse in the mouth. An occasional patient waits all afternoon while someone marks them as “failed to attend.” This, because they have no idea that getting inside the hospital is just the first step, then they must register their presence and remind the desk that they are still waiting.
One of the most heart-wrenching things for me to watch is when refugees, after finding a semblance of normality in a new country, are diagnosed with cancer. Suddenly, this diagnosis upends their life all over again and threatens their tenuous links. It’s one thing for a kindly neighbour to invite a refugee family over for a barbecue but quite another to undertake months of drives to the hospital and getting the kids dressed for school. Thus, my refugee patients with cancer suffer greatly and find themselves nearly as alone as they first arrived. Their needs are simply too great for one inundated social worker, one counsellor, or one doctor, no matter how well intentioned.
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Governments play an important role in creating policies that not only welcome refugees to a country but also help them integrate with society through sensitive and pragmatic services. Almost all the refugees that I have met want empowerment over sympathy – this honourable task can also be discharged by non-government organisations, charities, advocacy groups, and volunteers.
Canada offers one example of how governments can work with individuals to assist resettlement.
The Refugee Council in the UK invites volunteers to help several thousand refugees each year, recognising that beyond food and shelter, refugees need crisis advice and mental health support that can be provided in innovative ways.
In Australia, the Uniting Church runs the Settlement Hub to help refugees foster self-reliance and community connections, recognising that a safe harbour is just one of their requirements.
The preamble to the UN Human Rights Charter evokes saving people from the scourge of war and calls upon us to “reaffirm faith in fundamental human rights, in the dignity and worth of the human person, in the equal rights of men and women and of nations large and small”.
Many of us watching the horrors unfold in Ukraine want to do more than shake our head at the footage. While we look to governments to lead the way, the capacity to do something to help a fellow human being lies within each one of us. It requires shaking off our complacency and recognising the great privilege of living in this country. Decent people must not lose sight of this.
