Demographics and Utilisation of Health Services by Paediatric Refugees from East Africa: Implications for Service Planning and Provision
Cooke, Regina, Murray, Sally, Carapetis, Jonathan, Rice, James, et al., Australian Health Review
Little is known of difficulties in accessing health care for recently arrived paediatric refugees in Australia. We reviewed routinely collected data for all 199 East African children attending a hospital Immigrant Health Clinic for the first time over a 16 month period. Although 63% of parents reported medical consultations since arrival, 77% of this group reported outstanding, unaddressed health problems. Availability of interpreters and information on health services were the main factors hindering access to care. These data have informed future service planning at the Clinic. Ongoing data collection is key to maintaining a responsive, targeted service for a continually changing population.
The Humanitarian Program in Australia resettles persons deemed 'refugees' by the United Nations High Commissioner for Refugees (UNHCR)^sup (UNHCR 1996)^ . In addition, the program resettles those who have applied and been recognised as asylum seekers in Australia (Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) 2003). Approximately 60% of Humanitarian arrivals are under 19 years of age (DIMIA 2002). In 2001-2002, almost 3,000 people from Africa were granted visas under Australia's Humanitarian Program, accounting for almost one quarter of this category of arrivals for this period (DIMIA 2002). The majority were from East Africa (in particular, Somalia, Sudan, Ethiopia, Eritrea and Kenya).
Pre-departure health screening for entrants under the Humanitarian program is minimal for children under 16 years of age. It consists of a general medical examination, urinalysis for children over five years of age and chest radiography only if there are clinical indications or a history of contact with tuberculosis (DIMIA, 2003). In Victoria post-arrival health checks ceased in 1991, except for tuberculosis screening in high-risk individuals. Previous studies from outside Australia reveal that recently arrived paediatric refugees often have complex medical and psychological needs including inadequate immunisation, parasitic infections, dental conditions and experiences of trauma (Meropol 1995; Hayes, Talbot et al. 1998) and that their families may experience difficulty In accessing appropriate health services (Uba 1992; Refugee Council 1994; Deale 1997). In addition, previous experiences of trauma may result in distrust or anxiety when encountering health professionals in the resettlement country.
No data are available for Australian paediatric refugees. In order to identify the health needs of East African immigrant children, one of the largest cultural groups arriving here in recent years, and to better inform provision of a comprehensive health service for refugee children, an Immigrant Health Clinic (IHC) was established at our hospital in February 2001. IHC offers holistic medical assessment, investigation and treatment of pre-existing or newly acquired conditions, updating of vaccination status, and also links families to other community or hospital based health services. Such services include dental services, mental health and trauma services and local community and migrant groups. The clinic staff include an administrative assistant, paediatrician, paediatric registrar, dental therapist and nursing coordinator.
A questionnaire is administered to parents of first time attendees with their consent. Initially the clinic focussed resources on East African children born outside Australia and who arrived in Australia after January 1998. These criteria have been expanded more recently to include refugee children from all origins. In this paper we present demographic and health service utilisation data for the initial group of children from East Africa.
Data were reviewed for consecutive patients attending from February 2001 to May 2002. Children were referred from hospital clinicians, general practitioners, workers employed by the local immigration settlement body and refugee mental health services, and a multilingual East African health worker employed by the clinic. …