Understanding the healthcare issues of Afghan refugees settling in rural Victoria, Australia

Abstract

Introduction: Hazaras have experienced prolonged and repetitive marginalisation, stigmatisation, persecution and conflict as a minority ethnic group in Afghanistan for their linguistic, religious and ideological differences. As a marginalised group they are a product of generally poor socioeconomic and health status with resultant ill effects. Hazaras make up the largest group of refugees who have resettled in Victoria, particularly Shepparton. Part of the reason for this is that the region supports the largest food-based manufacturing industries in the country and so there are good work opportunities for those that do not have recognisable skills with limited English.
Aim: To explore the health care issues and challenges of Hazara located in Shepparton, Australia.
Results: The literature review identified that the Hazara community have multiple physical and psychological health needs most likely a result of the trauma and torture when in Afghanistan, plus from the often, dangerous journey to Australia and then from what is usually prolonged periods in immigration detention centres. On top of this are the challenges that occur with their resettlement including language and cultural differences and low health literacy as well as lack of understanding of health services in Australia. All creating barriers to access.
Discussion: The recommendation is to outline the rationale and process for the development of Health Hub (HHH) for the Hazara community within Community Health @GV Health, the major community health centre in Shepparton, Victoria. Through fostering strong relationships between the Hazaras and their primary care team in consultation with the Hazara community will, therefore, ensure the outcomes are tailored to their individual needs and help improve their health outcome.

Keywords

Hazara refugees / Health literacy / Barriers to healthcare / Rural Australia

References

[1] Runion ML. The History of Afghanistan. 2nd Edit. Greenwoord, Denver. 2017.

[2] Merrill L, Paxson D, Tobey T. An introduction to Afganistan culture. 2006.

[3] Kheradyar A, Couch D. Our Hazara communities: health and health service experiences. Murray Pri-mary Health Network. 2019. Available from: https://www.murrayphn.org.au/wp-content/uploads/2019/07/RP0060-Hazara-community-report_2019_V1B-1.pdf

[4] Central Intelligence Agency. The World Factbook: Life ex-pectancy at birth. Central Intelligence Agency. 2022. Available from: https://www.cia.gov/the-world-factbook/field/life-expectancy-at-birth/

[5] Institute for Health Metrics and Evaluation. Afghanistan. Institute for Health Metrics and Evaluation. 2022. Available from: https://www.healthdata.org/afghanistan

[6] Murray Primary Health Network.Population health Needs Assessment 2018-2022 ( November 2020 Update), Issue. Mur-ray Primary Health Network. 2020. Available from: https://www.murrayphn.org.au/wp-content/uploads/2021/03/Needs-Assessment-2020_Approved_collated2.pdf

[7] Finney Lamb CE, Whelan AK, Michaels C. Refugees and Oral Health: Lessons Learned from Stories of Hazara Refugees. Aus-tralian Health Review. 2009; 33(4): 618-627. PMid:20166911. https://doi.org/10.1071/AH090618

[8] United Nations Refugee Agency.Afghanistan Refugee Crisis Ex-plained. 2022. Available from: https://www.unrefugees.org/news/afghanistan-refugee-crisis-explained/

[9] Australian Government,Department of Health and Aged Care, 2022 What primary health networks are. Available from: https://www.health.gov.au/initiatives-and-pro grams/phn/what-phns-are

[10] Murray Primary Health Network.Our region’s health and wellbeing:July 2021. 2021. Available from: https://www.murrayphn.org.au/wp-content/uploads/2021/07/RP0043_HNA_2021_region-overview_V5.pdf

[11] Australian Government of Social Security (DSS).Settlement data reports [Online]. 2019. Available from: https://data.gov.au/data/dataset/settlement-reports

[12] Slewa-Younan S, Yaser A, Guajardo MGU, et al. The mental health and help seeking behaviour of resettled Afghan refugees in Aus-tralia. International Jurnal of Mental Health Systems. 2017; 11:49. PMid:28855961. https://doi.org/10.1186/s13033-017-0157-z

[13] World Health Organisation. 10 things to know about the health of refugees and migrants. 2019. Available from: https://www.who.int/news-room/feature-stories/detail/10-things-t

[14] Moran A, Mallman M. Understanding Social Cohesion in Shepparton and Mildura. 2015. Melbourne: Victorian Multicultural Commission.

[15] Ethnic Council of Shepparton and District Inc. Community Profile. 2020. Available from: https://ethniccouncilshepparton.com.au/?cat=44

[16] Iqbal N, Joyce A, Russo A, et al. Resettlement Experiences of Afghan Hazara Female Adolescents: A Case Study from Melbourne, Australia. International Journal of Population Research. 2012; 1-9. https://doi.org/10.1155/2012/868230

[17] Mackenzie L, Guntarik O. Rites of passage: Experiences of transi-tion for forced Hazara migrants and refugees in Australia. Crossings (Bristol). 2015; 6(1): 59-80. https://doi.org/10.1386/cjmc.6.1.59_1

[18] Pour MS, Kumble S, Hanieh S, et al. Prevalence of dyslipaemia and micronutrient deficiences among newly arrived Afghan refugees in rural Australia: a cross sectional study. BMC Public Health. 2014; 14: 896. PMid:25175525. https://doi.org/10.1186/1471-2458-14-896

[19] Saberi S, Wachtler C, Lau P. Are we on the same page? Mental health literacy and access to care: A qualitative study in young Haz-ara refugees in Melbourne. Australian Journal of Primary Health. 2021; 27(6): 450-455. PMid:34802509. https://doi.org/10.1071/PY21017

[20] Brenner JM, Baker EF, Iserson KV, et al. Use of interpreter services in the emergency department. Annals of Emergency Medicine. 2018; 72(4): 432-437. PMid:30238909. https://doi.org/10.1016/j.annemergmed.2018.05.009

[21] Joshi C, Russell G, Cheng IH, et al. A narrative synthesis of the impact of primary health care delivery models for refugees in reset-tlement countries on access, quality and coordination. International Journal for Equity in Health. 2013; 12(1): 1-14. PMid:24199588. https://doi.org/10.1186/1475-9276-12-88

[22] Bauer AM, Alegría M. Impact of patient language proficiency and interpreter service use on the quality of psychiatric care: a systematic review. Psychiatric Services. 2010; 61(8): 765-773. PMid:20675834. https://doi.org/10.1176/ps.2010.61.8.765

[23] Tyrrell L, Duell-Piening P, Morris M, et al.Talking about experiences of using health services with peo-ple from refugee backgrounds. 2016. Available from: https://refugeehealthnetwork.org.au/wp-content/uploads/Report_2016_September_Victorian-Refugee-Health-Network_Talking-About-Health_FINAL-WEB.pdf

[24] Australian Government Department of Health.PHN Program Needs Assessment policy guide. Commonwealth of Australia. 2021. Available from: https://www.health.gov.au/sites/default/files/documents/2021/07/primary-health-networks-phns-needs-assessment-policy-guide_0.docx

[25] National Health andMedical Research Council. Ethical con-duct in research with Aboriginal and Torres Strait Islander Peoples and communities: Guidelines for researchers and stakeholders. Commonwealth of Australia. 2018. Available from: https://www.nhmrc.gov.au/about-us/resources/ethical-conduct-research-aboriginal-and-torres-strait-islander-peoples-and-communities

[26] Maslow A, Lewis KJ. Maslow’s hierarchy of needs. Salenger Incor-porated. 1987; 14(17): 987-990.

[27] Dubus N, LeBoeuf HS. A qualitative study of the perceived effectiveness of refugee services among consumers, providers, and interpreters. Transcultural Psychiatry. 2019; 56(5): 827-844. PMid:31042119. https://doi.org/10.1177/1363461519844360.