Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

General practitioner and registrar involvement in refugee health: exploring needs and perceptions

Catherine Harding A C , Alexa Seal A , Geraldine Duncan A and Alison Gilmour B
+ Author Affiliations
- Author Affiliations

A School of Medicine Sydney, Wagga Wagga RCS, The University of Notre Dame Australia, PO Box 5050, Wagga Wagga, NSW 2650, Australia. Email: alexa.seal@nd.edu.au; geraldine.duncan@nd.edu.au

B Kooringal Road Medical Centre, 295 Lake Albert Road, Wagga Wagga, NSW 2650, Australia. Email: alison.gilmour@gmail.com

C Corresponding author. Email: catherine.harding@nd.edu.au

Australian Health Review - https://doi.org/10.1071/AH17093
Submitted: 27 March 2017  Accepted: 26 July 2017   Published online: 4 September 2017

Abstract

Objective Despite the recognition that refugees should have equitable access to healthcare services, this presents considerable challenges, particularly in rural and regional areas. Because general practitioners (GPs) are critical to resettlement for refugees and play a crucial role in understanding their specific health and social issues, it is important to know more about the needs of GPs.

Methods In-depth interviews were conducted with 14 GPs and GP registrars who trained with a New South Wales regional training provider with the aim of assessing the needs and attitudes of GPs in treating refugees and the perceived effect that refugees have on their practice.

Results The interviews, while acknowledging well-recognised issues such as language and culture, also highlighted particular issues for rural and regional areas, such as employment and community support. International medical graduates identified with resettlement problems faced by refugees and are a potential resource for these patients. A need for greater information for GPs regarding services available to help manage refugees in rural and regional areas and greater access to those services was demonstrated.

Conclusions Issues such as time, costs, language and culture were recognised as challenges in providing services for refugees. GPs highlighted particular issues for rural and regional areas in addressing refugee health, such as finding jobs, problems with isolation and the effect of lack of anonymity in such communities. These social factors have implications for the health of the refugees, especially psychological health, which is also challenged by poor resources.

What is known about the topic? Providing refugees equitable access to healthcare services presents considerable challenges, particularly in rural and regional areas. Time, language and culture are commonly reported barriers in providing services for this population group.

What does this paper add? There are particular issues for rural and regional areas in addressing refugee health, including finding jobs, problems with isolation and the effect of lack of anonymity in rural communities. These social factors have implications for the health of refugees, especially psychological health, which is also challenged by a paucity of services. The findings of this study suggest that international medical graduate doctors identified with resettlement problems faced by refugees and may be an important resource for these patients. This study highlights the awareness, empathy and positive attitudes of GPs in regional and rural areas in their approach to treating patients with a refugee background.

What are the implications for practitioners? International medical graduates often identify with resettlement problems faced by refugees and are an important resource for these patients. A need for greater information for GPs regarding services available to help manage refugees in rural and regional areas and greater access to those services was demonstrated.

Additional keywords: cultural competency, international medical graduates.


References

[1]  Hannah CT, Lê Q. Factors affecting access to healthcare services by intermarried Filipino women in rural Tasmania: a qualitative study. Rural Remote Health 2012; 12 2118

[2]  Murray SB, Skull SA. Hurdles to health: immigrant and refugee health care in Australia. Aust Health Rev 2005; 29 25–9.
Hurdles to health: immigrant and refugee health care in Australia.CrossRef |

[3]  Benson J, Smith MM. Early health assessment of refugees. Aust Fam Physician 2007; 36 41–3.

[4]  Duncan GF. Refugee healthcare: towards healing relationships. Can Soc Sci 2015; 11 158–68.

[5]  Karlsen E, Phillips J, Koleth E. Seeking asylum: Australia’s humanitarian program. 2011. Available at: http://www.aph.gov.au/binaries/library/pubs/bn/sp/seekingasylum.pdf [verified 30 June 2014].

[6]  Duncan G, Harding C, Gilmour A, Seal A. GP and registrar involvement in refugee health – a needs assessment. Aust Fam Physician 2013; 42 405–8.

[7]  Australian Institute of Health and Welfare. Medical workforce 2012. National health workforce series no. 8. Catalogue no. HWL 54. 2014. Available at: http://www.aihw.gov.au/publication-detail/?id=60129546100 [verified 3 March 2017].

[8]  Han G-S, Humphreys JS. Overseas-trained doctors in Australia: community integration and the intention to stay in a rural community. Aust J Rural Health 2005; 13 236–41.
Overseas-trained doctors in Australia: community integration and the intention to stay in a rural community.CrossRef |

[9]  Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-centered medicine: transforming the clinical method. 2nd edn. Oxford: Radcliffe Medical Press; 2003.

[10]  Taleb ZB, Bahelah R, Fouad FA, Coutts A, Wilcox M, Maziak W. Syria: health in a country undergoing tragic transition. Int J Public Health 2015; 60 63–72.
Syria: health in a country undergoing tragic transition.CrossRef |

[11]  Peterson P, Sackey D, Correa-Velez I, Kay M. Building trust: delivering health care to newly arrived refugees. (n.d.) Available at: http://www.materonline.org.au/services/refugee-services/pdfs/building-trust_-delivering-health-care-to-newl-(1) [verified 4 August 2017].

[12]  Brough M, Gorman D, Ramirez E, Westoby P. Young refugees talk about well-being: a qualitative analysis of refugee youth mental health from three states. Aust J Soc Issues 2003; 38 193–208.
Young refugees talk about well-being: a qualitative analysis of refugee youth mental health from three states.CrossRef |

[13]  Edge S, Newbold B. Discrimination and the health of immigrants and refugees: exploring Canada’s evidence base and directions for future research in newcomer receiving countries. J Immigr Minor Health 2013; 15 141–8.
Discrimination and the health of immigrants and refugees: exploring Canada’s evidence base and directions for future research in newcomer receiving countries.CrossRef |

[14]  Piper H-O, MacFarlane A. ‘I am worried about what I missed’: GP Registrars views on learning needs to deliver effective health care to ethnically and culturally diverse populations. Educ Health (Abingdon) 2011; 24 494

[15]  Hadgkiss E, Lethborg C, Al-Mousa A, Marck C. Asylum seekers health and wellbeing: scoping study. St Vincent’s Health Australia; 2012. Available at: https://svha.org.au/wps/wcm/connect/cb7b96fc-6653-42ea-9683-749a184d3aed/Asylum_Seeker_Health_and_Wellbeing_Scoping_Study.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=cb7b96fc-6653-42ea-9683-749a184d3aed [verified 4 August 2017].

[16]  Sweet M. Call for action on asylum seekers’ health. Aust Nurs J 2007; 14 16–18.

[17]  Milosevic D, Cheng I, Smith M. The NSW refugee health service: improving refugee access to primary care. Aust Fam Physician 2012; 41 147–9.

[18]  Putsch RW. Cross cultural communication: the special care of interpreters in healthcare. JAMA 1985; 254 3344–48.
Cross cultural communication: the special care of interpreters in healthcare.CrossRef |

[19]  Dastjerdi M, Olson K, Ogilvie L. A study of Iranian immigrants’ experiences of accessing Canadian health care services: a grounded theory. Int J Equity Health 2012; 11 55
A study of Iranian immigrants’ experiences of accessing Canadian health care services: a grounded theory.CrossRef |

[20]  Atkin N. Getting the message across – professional interpreters in general practice. Aust Fam Physician 2008; 37 174–6.

[21]  Huang YT, Phillips C. Telephone interpreters in general practice – bridging the barriers to their use. Aust Fam Physician 2009; 38 443–6.

[22]  Avant Mutual Group. Consent in difficult situations. 2016. Available at: http://www.avant.org.au/resources/public/20130809-consent-in-difficult-situations/ [verified 15 July 2017].

[23]  Bird S. Failure to use an interpreter. Aust Fam Physician 2010; 39 241–2.

[24]  Bourke L, Humphreys JS, Wakeman J, Taylor J. Understanding the drivers of rural and remote health outcomes: a conceptual framework. Aust J Rural Health 2012; 20 318–23.
Understanding the drivers of rural and remote health outcomes: a conceptual framework.CrossRef |

[25]  Sypek S, Clugston G, Phillips C. Critical health infrastructure for refugee resettlement in rural Australia: case study of four rural towns. Aust J Rural Health 2008; 16 349–54.
Critical health infrastructure for refugee resettlement in rural Australia: case study of four rural towns.CrossRef |

[26]  Townsend RA, Pascal J. Therapeutic landscapes: Understanding migration to Australian regional and rural communities. Rural Soc 2012; 22 55–66.
Therapeutic landscapes: Understanding migration to Australian regional and rural communities.CrossRef |

[27]  Ager A, Strang A. Understanding integration: a conceptual framework. J Refug Stud 2008; 21 166–91.
Understanding integration: a conceptual framework.CrossRef |

[28]  Colic-Peisker V, Tilbury F. Employment niches for recent refugees: segmented labour market of the 21st century Australia. J Refug Stud 2006; 19 203–29.
Employment niches for recent refugees: segmented labour market of the 21st century Australia.CrossRef |

[29]  Norrie J. You’re not welcome, town tells refugees. Sydney Morning Herald 15 December 2006. Available at: http://www.smh.com.au/news/national/youre-not-welcome-town-tells-refugees/2006/12/14/1165685828180.html [verified 15 July 2014].

[30]  Bourke L, Sheridan C, Russell U, Jones G, DeWitt D, Liaw S-T. Developing a conceptual understanding of rural health practice. Aust J Rural Health 2004; 12 181–6.
Developing a conceptual understanding of rural health practice.CrossRef |



Export Citation