General practitioners (GPs) caring for resettled refugees need greater support – and some of that could come from their new patients. These are two of the findings of an important study in regional NSW just published in the British Medical Journal.
University of New England (UNE) student Rachel Davison, now in the final year of her medical degree, interviewed nine doctors from five practices two years after refugee settlement began in the Northern NSW centre. Her findings now stand to inform public policy and resourcing.
Rachel’s research has already had real-world impact.
“Rachel’s research has already had real-world impact,” says Dr Michelle Guppy, Associate Professor of General Practice in UNE’s School of Rural Medicine. “There is limited information available on this subject and we presented Rachel’s findings to a meeting with the Commissioner for Multicultural NSW, who advises government on how to better prepare for refugee resettlement in regional Australia.”
The GP workforce in regional areas is already stretched and Rachel recommends this be considered in the design and implementation of future resettlement programs. She found that while GPs were very positive about providing care to refugees, better preplanning, communication and resourcing was needed to ensure both sustainable resettlement and the health of doctors themselves. The number of case workers, face-to-face interpreters, local refugee health nurses and trauma counsellors needed to increase with refugee numbers.
The major challenges for GPs were around language, cultural differences and health literacy,
“The major challenges for GPs were around language, cultural differences and health literacy, and this is against a backdrop of regional workforce shortages,” Rachel said. “Regional areas tend to have fewer generalist and specialist services than metropolitan areas and GPs provide most of the primary healthcare.
“New patients often had complex presentations that required longer consultations, and also needed adequate mental health support. Their health was exacerbated by ongoing stressors such as separation from family members and the difficulties of integrating into a new society.”
All GPs interviewed reported:
- the need for improved access to face-to-face interpreters, especially during the early months of resettlement;
- strong gender preferences for treatment, highlighting the need for more female doctors and translators;
- refugee unfamiliarity with the Australian healthcare system, which demanded extra GP time and led to financial losses; and
- difficulties for some newcomers accessing GPs, resulting in long wait times and GPs consulting outside their normal hours to meet need.
However, the employment of new refugee community members as receptionists within GP practices helped many new patients to better understand the Australian healthcare system. “Once people had an opportunity to settle in and learn English, they could be employed in critical healthcare positions, which made it easier for subsequent waves of refugees and the practices,” Rachel said.
Although the GPs received some cultural training prior to the refugees’ arrival, they considered it minimal. “The vicarious trauma the GPs experienced when consulting patients disclosing experiences of torture and trauma led some GPs to feel overwhelmed and burnt out,” Rachel said.
The study has applications for any regional community in which refugees are resettled. “Given the Australian federal government policy to increase regional resettlement over coming years and regional workforce capacity issues, it has implications for clinical management models and public planning, policy and stakeholder engagement throughout Australia,” said Rachel, whose research was supported by a GP Synergy scholarship. “Ongoing support proportional to the increase in refugee numbers is needed.”
The research was inspired by Rachel’s volunteering with an refugee family of six children and tutoring of senior biology students. “It started as weekly visits to help with reading, playing games, conversational practice and homework help. It soon developed into close friendships.”
While all nine GPs in the study mentioned the challenges of caring for members of the refugee community, they similarly developed positive and rewarding relationships. This strong rapport facilitated a continuity of care and better health outcomes.
