The refugee journey is almost always fraught with fear, loss, and trauma. Further definition states that a refugee is ‘a person who has been forced to leave their country in order to escape war, persecution, or natural disaster’.
In 2006, Waikato DHB’s Population Health service initiated a new nursing position: Registered nurse - refugee health coordinator.
This unique role was created to provide comprehensive health screening and support for refugees upon arrival within the Waikato DHB, with the focus to protect and maintain the health of the wider community by promoting, protecting, and improving the health of refugees, asylum seekers, and their families.
In 2009, I was fortunate to be appointed as the third person to this position since 2006.
Having come from a nursing background in primary care and cared for many migrants through the years, I felt I would be reasonably equipped to transition into this role but quickly discovered that my knowledge of New Zealand’s refugee communities and the impact of their journey on health outcomes was vastly different and I had much learning to do.
Thankfully, my predecessors had established strong networks with both government and non-governmental organisations (NGOs) and this proved essential in providing a holistic care model. However, my biggest challenge came in building relationships with the refugee communities which required both trust and respect built over time.
Opportunities to present to both the new and long standing refugee communities on various health topics became an essential tool for me in breaking down those barriers and through laughter at my attempts of their greetings and face to face discussions about things that matter – like hopes, dreams, and family relationships were established.
As this role has progressed through the years, the responsibilities of the refugee health coordinator has expanded and is best described as a three pronged approach which includes health co-ordination, health screening, and health promotion.
The health screening is initiated soon after arrival with a particular focus on any urgent health needs that may require prompt treatment and/or referral. This includes consultations with contracted GPs, laboratory tests, chest x-rays, and basic dental checks.
Once initial screening is completed, the client is enrolled with primary health for follow-up, ongoing management of chronic health conditions and any long-term health needs that may arise; this process can take up to six months.
Early detection and treatment of diseases has meant we have seen significant reduction in adverse events and healthy lifestyle changes within the refugee communities.
Many refugees may not have ever received education about their own health nor had access to infrastructure such as New Zealand is able to provide.
The health screening and education provision accompanied with a strict emphasis on confidentiality is frequently an early step for many refugee patients in either learning or regaining ownership of their health.
No two refugee journeys are ever the same and a key competent of this position has involved having an appreciation for those experiences, and recognising the physical, psychological and emotional sequels associated with such a journey.
People from refugee backgrounds and their families do confront a complex range of health and social problems during the process of resettlement.
Frequent experiences of torture and trauma, prolonged periods of time without healthcare, and separation from loved ones can result in some health complexities that are unique in this client group.
With language and cultural issues frequently complicating provision of care this role has been both challenging and rewarding. However, bridging the gap between patient and health services for the culturally and linguistically diverse communities, has been both a privilege and fundamental in improving their patient care and long term outcomes.
Article contributed by Denise Booth. RN, Refugee health coordinator, Population health at Waikato District Health Board
