Regardless of the model used to deliver health services to African refugee communities, it is imperative to address the barriers that prevent people from accessing these services. The quality of the services and the cultural sensitivity and appropriateness of a health clinic’s service and staff will not matter if no one is going to the clinic.207
The barriers for African Australians accessing health care are numerous, including culture, language, finances, lack of understanding of the system and the fact that the system does not understand the needs of refugee communities.208 The size and complexity of the health care system makes it difficult for a refugee to navigate, especially if they do not have good English language skills.209
There is also a need for more formalised networks of health providers offering services to refugees in order to share ideas and best practice approaches.210 Strengthening links between services and offering culturally appropriate models of care will contribute to the improvement of services, which will clearly benefit those patients to whom the services are offered.211
20.6Limitations of pre-arrival health screening
A medical check-up has always been required as part of Australia’s refugee application procedure. However, since 2005 there has been an additional requirement that refugees undertake a pre-departure health screening – or a ‘fitness to fly’ check – to determine if the person has any communicable diseases that would pose a public health risk to Australians.212
However, even with these pre-arrival screenings in their country of origin, many refugees arrive with undiagnosed diseases as overseas screening can often be ‘sub-optimal’.213 Furthermore, pre-arrival health screening does not assess social and mental health issues, which should be addressed as soon as possible to minimise the long-term effects of torture and trauma.214
The current pre-arrival health screening process represents a missed opportunity to identify the key health issues facing refugees. It could also potentially be used as a starting point for settlement assistance, including informing new arrivals of the health services available to them in Australia and the health services they may require upon arrival. Essentially, pre-arrival health screening could be the first point of breaking down barriers to service access.
20.7Need for a comprehensive, compulsory medical exam upon arrival
The literature points to a definite need for a comprehensive and compulsory medical examination upon arrival for refugees, which would identify any health issues that might impede their adjustment to Australian life. It would also introduce them to the Australian health care system.
It is often assumed that pre-departure and post-arrival health care is formally managed by the relevant government agencies. However, in general, Australian states and territories have no routine post-arrival health checks. In addition, pre-departure screening is limited and may vary significantly depending on the country of origin. For instance, an assessment of vaccination status is not a requirement for entry to Australia.215
In the absence of a compulsory, post-arrival health check, a refugee may wait until they experience some sort of health issue before they access the medical health care system. This is an inappropriate introduction because:
a refugee may have pre-existing health conditions they are unaware of, or conditions where treatment was not available in their home country, but is available in Australia
a refugee’s first health issue might be an emergency and it is unfair that they would have to navigate the system, starting with simply locating a medical facility/service, while trying to cope with this emergency
the fear of the unknown might deter a refugee from seeking help, causing an initially small medical issue to worsen.
“The initial aim of a comprehensive medical assessment for refugees is to begin to address the complex health concerns and inadequate health care previously experienced by this group.”216 When granting someone refuge in a new country, the primary aim should be to provide a fresh start at a new life. The first step in this process is to make sure they are healthy and able to seek out and enjoy the opportunities available to them.
20.8Learning how to access Australian health services
A major benefit of establishing a post-arrival medical assessment process is that new arrivals would learn where and how to access mainstream health services. For instance, if an emergency situation was to occur, new arrivals would understand what services were available to help them. Post-arrival assessment could also help inform new arrivals of other health services available to refugee communities including, for example, preventive care and specialised care, as well as how to deal with any problems they might have with providers or the service in general.
There is a comprehensive range of health care services available to refugees, including Medicare, early health assessment and specialised torture and trauma services. However there is a great disparity between being eligible to access health care and being able to access health care. It is critical that these barriers are addressed so that refugees can be fully integrated into the Australian health care system.217
Most significantly, a post-arrival health assessment would allow refugees to become aware of, and deal with, immediate health concerns. This would ensure that they were not suffering undue health burdens that could affect their prospects for successful settlement. For instance, health problems may result in a newly-arrived refugee being too sick to work, having to look after a sick child or dealing with mental health issues – all of which might affect their employability.