The literature clearly highlights the need to work with relevant service providers, including real estate agents, so they have an understanding of the needs of refugee communities. At the same time, there is also a need to provide education to refugee communities on their rights and responsibilities as renters in the Australian housing market.
Real estate agents have expressed interest in receiving such education or training. Organisations involved in a sector such as low-rent housing will inevitably have to deal with refugee communities. It is therefore in the business interests of these organisations to be aware of the needs of the community and the services available to them. For instance, if the renter is having problems maintaining the property, or experiencing trouble meeting rent deadlines, the real estate agent can offer a referral to an agency that can offer assistance. Good practice such as this can create a more congenial relationship between renter and landlord, as well as ensure that the property is well-maintained.199
How a person feels about their body and how they conceptualise disease and healing are all connected to their culture.200 Therefore, medical care and services must take culture into account and look at the entirety of a person’s well-being. Furthermore, social factors such as discrimination or social and geographical isolation can also have health consequences.201. Good health is necessary for full participation in society and full participation in society promotes good health.202
When addressing the health literacy of refugee communities, health promotion and medical services must take into account issues such as motivation to care for personal health, use of health information and appreciation of health promotion, rather than rely primarily on traditional notions of health literacy.203
For example, people who have arrived in Australia from rural West Africa are likely to look for traditional methods of health care rather than engaging the Western health system:
By the time they come to the Western service, they may believe their problem is an extremely dangerous one that has resisted the powers of all the other healers or methods they have accessed already. There may be shame or fear that has more to do with this perception than with the actual problem. They may be afraid of the setting; unlike with traditional methods, they might feel that they do not have choice. The sometimes magical qualities that Western treatments can have may also evoke fear about the possibility of equally powerful curses, as is the case for witchdoctors.204
In mental health care, it is vital to make a careful assessment of symptoms associated with trauma reactions or psychiatric conditions because these symptoms may also be attributed to metaphysical causes, such as witchcraft, spirit activity, curses or breaches of taboos.
20.2Meeting the health needs of refugees
Refugee women commonly report lower levels of well-being and high levels of mental health concerns. They also do not see health care as a right or understand how the Australian health care system works.
“It is important to acknowledge that even though migrant and refugee women are often referred to as a homogenous group and have some commonalities; in general these are diverse groups of women who have different health requirements.”205 This is an important point given that many services – medical and otherwise – may have a migrant services mission or training and think that this will cover the needs of refugees as well.
Refugees have specialised medical and health needs, not the least of which are lower overall levels of physical and mental health. Services that do not understand or respond to these specific needs increase the barriers to refugees in utilising health care, as well as their ability to navigate the services they do attempt to access.
20.3The need for health promotion for care providers and the refugee community
There is a need for health promotion (including health education) about the social and cultural aspects of Australia’s health care system, both for care providers and for the refugee community. The system is geared towards the Australian-born population, with the assumption that patients enter with similar, basic levels of health knowledge. However, the initial health review and basic medical tests conducted with African refugees is often the first time they have been in a modern clinic or experienced formalised medical care. Care providers that do not appreciate this fact will necessarily miss opportunities to engage with their refugee patients.
A family-centred approach to health care offers an effective model with these communities because family members are likely to have similar health needs and such an approach also fits with the family and community-centred culture of African people.
20.4Culture effect on dispensing medicine versus other health care
Another cultural issue that medical care providers should take into account is that “many migrant and refugee women perceive effective medical treatment as requiring the dispensing of some medication. When a doctor prescribes dietary change, counselling, physiotherapy or other interventions without medication, women believe they are not being treated properly or taken seriously.”206
Communication between the doctor and the refugee patient can also create barriers to effective health care. As most doctors do not expect disagreement from patients on a recommended course of treatment, they are unlikely to provide much explanation to the patient.
Similarly, a refugee patient is likely to feel unqualified to question a medical authority, such as a doctor, as it would be considered unacceptable in their culture. Further, if a refugee patient feels that they would not be taken seriously, they might assume that any questions they do pose would go unanswered.
Without understanding these cultural dynamics, the doctor is likely to assume that the patient did not ask any questions because they had no concerns about the course of treatment.