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The provision of accessible and culturally sensitive health and human services is fundamental to the successful settlement of humanitarian refugees in Australia.

Nurse-led models of care for newly arrived humanitarian refugees are in place in each state of Australia. These programs are underpinned by strategies to facilitate access to appropriate health services and improve health literacy and outcomes for this vulnerable population group.

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Karinne Andrich is a Refugee Health Nurse in the Hunter New England Local Health District (HNELHD) in NSW, and shares some of her experiences for Health Times.

Karinne is the sole Refugee Nurse in Newcastle (Hunter region) and works alongside Paediatrician and Refugee Clinical Lead Dr Murray Webber, who works two days per week with Refugee Health. Karinne’s colleague, Joy Harrison, looks after the large area from Tamworth to Armidale in New England. Both Joy and Karinne are Clinical Nurse Specialists and work 3 days per week under manager Catherine Norman, Director of the Multicultural Health Unit.

“We follow The NSW Refugee Health Plan 2011-2016 (NSW Health) and the Australasian Society for Infectious Diseases (ASID) Guidelines” reports Karinne. The NSW Refugee Health Plan is the statewide plan for improving the health and well being of refugees and people with refugee like experiences who have settled in NSW. It states: “This Plan seeks to ensure the delivery of safe, high quality services to refugees through both refugee-specific health services and through accessible, culturally and linguistically competent mainstream health services. The Plan identifies a range of strategies designed to improve refugee and asylum seeker health and well-being.” (NSW Refugee Health Plan 2011-2016).

Karinne mostly works autonomously, but maintains supportive relations with Refugee Nurses in Sydney and is in regular contact with her colleagues in Victoria and Perth. In June this year she will attend the Refugee Health Nurse Forum 2015 in Liverpool NSW. These networks provide opportunities to discuss issues, review new practices and research, and offer peer support.

Across Australia, health needs commonly identified in refugees and asylum seekers after arrival include psychological issues, nutritional deficiencies, infectious diseases, under-immunisation, poor dental and optical health, poorly managed chronic diseases, delayed growth and development in children and the physical consequences of torture. Some refugee women may have significant gynaecological health needs and may have undergone female genital mutilation or suffered sexual assault. In addition, the process of settlement in a new country can be a source of ongoing hardship and difficulties encountered during the early settlement period may have a negative effect on long-term health and well-being.

In a regular working day Karinne might encounter any of these issues as her clients navigate the spectrum of challenges that come with rebuilding their lives. “One of their main challenges” says Karinne, is “navigating the health system!” Her work involves organising and managing new arrival home visits, health and dental assessments, all of the Refugee Clinics, Immunisation, Pathology, Dental Triages, GP visits and liaison, and referrals to Specialists, Family Planning and Mantoux clinics.

It is in the building of relationships of trust and care that Karinne hears about stories of survival, trauma, torture experiences, of families and countries left behind, of worries and happiness at being given the opportunity to come to a safe country. Engaging with clients about their mental and emotional health is difficult, she says. “Often, clients don't understand what ‘mental health' is.”

Another but equally important responsibility Karinne has is maintaining close relationships with government Settlement Services, NGO's, Migration Services and The NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS). In addition, she must always be current with any changes from the Department of Border Protection & Patrol (DIBP).

An advocate and educator for refugee health, Karinne recently initiated a 'Refugee Outreach Clinic' at TAFE Tighes Hill as a Quality Improvement Program. By educating and supporting clients she hopes to build their self-confidence to make and manage their own appointments. In her TAFE role Karinne also provides education to mainstream students at TAFE regarding Refugee Health and has been asked for help with health care issues by other CALD students from overseas. “So far, this Outreach Clinic has been busy and created more work than I had anticipated!!” But it clearly fulfills a need.

To assist with cultural appropriateness in health care delivery, HNELHD provides cultural competence training and a framework to review work with clients from CALD backgrounds to improve planning, service delivery and evaluation. Karinne believes it is crucial to use interpreters when communicating, and to provide appropriate translated material when educating clients. She emphasises the importance of understanding this diverse population, noting, “I am always respectful of their beliefs, belief systems, customs, values and religion. I believe this is critical to reducing health disparities and improving quality health care.”

Australia currently accepts 13,750 refugees each year through the offshore and onshore components of its Refugee and Humanitarian Program. Karinne says this number is a “drop in the ocean”.

Last year the number of refugees, asylum-seekers and internally displaced people worldwide exceeded 50 million for the first time since World War II, according to a United Nations report. The main countries of origin for refugees are Afghanistan, Iraq, Syria, Pakistan, Tibet and African countries. As a member of the international community and signatory to the United Nations Convention Relating to the Status of Refugees 1951 (UN Refugee Convention), Australia shares responsibility for protecting these refugees and resolving refugee situations.

By way of definition, a refugee is someone who is recognised as needing protection under the UN Refugee Convention, specifically someone who “owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.”
Asylum seekers are those people seeking international protection, but whose claim for refugee status has not yet been determined.

Although Australia’s refugee resettlement program is ranked in the top three countries in the world (along with the US and Canada), the number of refugees admitted through the Refugee and Humanitarian Program, along with the policy for mandatory detention and third country processing, show a different position in world rankings. The Sydney Morning Herald reported in June 2014:“When rated in terms of all refugees resettled last year, Australia's [world] ranking drops to 17th. The result worsens when Australia's contribution is ranked by the number of refugees living here. Fewer than 0.3 per cent of the 11.7 million refugees under the United Nations High Commissioner for Refugee’s mandate live in Australia, placing Australia 48th out of 187 countries. Our ranking slides even further when measured against the size of the population (62nd) and the country's wealth (74th).”

For the past six years, Karinne has been working with refugees and asylum seekers and learning about their cultures, religions and experiences. She feels honoured to be in her role and to be making a difference in her community.

Looking forward, Karinne identifies some important improvement strategies. These include the implementation of a national eHealth record to allow seamless transfer of health information between immigration health, state run public health and private health to prevent unnecessary re-screening and treatment. An extension of the Australian Childhood Immunisation Register to a lifetime national immunisation register would support appropriate documentation and catch-up immunisations for all refugees, and Medicare item numbers for interpreter use in private practice settings would reward general practitioners and private specialists for using interpreters.

It cannot be ignored that one of the major challenges facing the world today is the increasing number of displaced people who become refugees and asylum seekers searching for safety and international protection. Often fleeing from civil unrest, armed conflict, deprivation, human rights abuses and/or religious and cultural persecution, their journeys may be long and difficult, filled with uncertainty and danger.

Providing early settlement and social and health support to refugees and humanitarian entrants who arrive in Australia is crucial to helping them rebuild their lives in Australia.

Australia’s human rights record will be the subject of a global dialogue between international governments at the United Nations Human Rights Council in November 2015 when Australia participates in the Universal Periodic Review.

Special thanks to Karinne Andrich, Refugee Nurse, HNELHD
Photo Credit - Michael Rayment.

Aust Govt. Dept of Immigration and Border Protection. Fact Sheet 60 – Australia's Refugee and Humanitarian Programme:
Aust Human Rights Commission. Australia's Universal Periodic Review on human rights.
Aust Human Rights Commission. Questions and Answers About Refugees & Asylum Seekers
Australia's refugee population: A statistical snapshot of 2013-14 (Posted 28/11/2014 by karlsene)
NSW Health. NSW Refugee Health Plan 2011-2016.
Salvation Army. Humanitarian Mission Services. Refugees and Asylum Seekers Factsheet:
Whyte, Sarah and Ting, Inga. June 21, 2014. Sydney Morning Herald. As world refugee numbers hit 50 million, Australia goes backwards.


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Mary Hickson

Mary Hickson is the Educator for NSW Health's Clinical Information Access Portal (CIAP). With a diverse range of experience as an educator, manager and clinician across metropolitan, regional and rural settings in NSW and Queensland, Mary has specialised in perioperative and emergency care, and was most recently NUM Endoscopy for St George Hospital in Sydney. Mary has also worked in project and research roles and holds postgraduate qualifications in Health Professions Education from UNSW and in Arts, and is a NSW Regional Committee member for the Gastroenterological Nurses College of Australia (GENCA).