Health Services

HEALTH SERVICES

Introduction

Individuals’ sense of well-being is affected by their physical and mental health and that of their families. Equitable access to the public health system is critical to the well-being of our community. As Kanitsake (1995:44) notes: “The quality of life, and life itself can depend greatly upon the availability of adequate heath care in an accurate, timely and comprehensive fashion.”

In respect to migrant communities, it is important for health services to include access to multilingual information and bilingual health professionals (or professional interpreters) and to provide culturally sensitive services as measured by individuals level of satisfaction and improved health outcomes. A health system where providers do not offer such services will result in, as Gabb (1997:49) notes: “Services and sources of vital information [being] under- utilised or inaccessible to those community groups most in need.”

The Primary Health and Community Support (PHACS) redevelopment being undertaken by the State Government aims to (HSV:1998:viii): “Improve the health status and quality of life of the community, encourage independence and reduce the burden of disease, ill health and disability by creating a robust integrated consumer responsive primary health and community support service system.” The PHACS redevelopment provides the context for future health service development and delivery in Victoria for all members of our community. Therefore, it is important that the PHACS redevelopment provides opportunities to strengthen community access to health systems and to develop service systems that are responsive to individual needs.

This chapter will discuss the needs of migrant communities as they relate to:

 Access to health services and preventative health measures,

 Access to interpreters and bilingual health professionals,

 The impact of loneliness on health, and

 Actions the MIC will undertake to improve access to health services for migrants in the Eastern Region.

Access to health services and preventative health measures

Although we were unable to obtain data on health services useage,1 research indicates that access to health services is determined through knowledge of their availability, their cost and through the

1 Service useage figures for Community Health Centres were sought from the Department of Human Services Victoria. The integrity of the data received, however, was questionable. For example, all people recorded as using interpreting services were recorded as Australian born with their preferred language recorded as English. Data was also requested from VITS on the use of interpreters by health professionals. However, the data could not be provided to this level as client confidentially may have been compromised. service meeting the needs of the individual.2 In relation to migrants, the ability of service providers to publicise their services and to provide services that are both affordable and respectful of the culture of the individual, is critical. This requires health professionals to consult with individuals in their service planning to ensure that the services developed meet the needs of a culturally diverse community. As Rice (1997:794) in a paper examining the extent multiculturalism is reflected in the delivery of health services argues, it is the responsibility of mainstream agencies to ensure that the voices of people from a Non English Speaking Background are heard.

From our research, the major issues migrants in the Eastern Region identified in respect to access to health care were:

 Knowledge of health services,

 The need for culturally sensitive health services, and

 The availability of preventative health care.

Knowledge of health services

Earlier research on the health needs of migrants in the Eastern Region found there was a general: “ . . . lack of awareness of the health care services available and ways in which people can access and use the services.”3 This finding was also confirmed by a study undertaken by Women’s Health East (1998:72) which reported that migrant women lacked information about health services in the region.

In our research, a number of residents spoke positively about the public health system identifying Box Hill Hospital as a strength of the current service system in the region. Nevertheless, residents also identified the different levels of knowledge of health services that affected their ability to access services. Firstly, written and verbal information needed to be accessible in language that can be readily understood in both English and the individuals’ preferred language. Secondly, health services that are not prevalent overseas need to be explained within a cultural context. For example, some residents knew that podiatry was available in the region. However, they did not know what “podiatry” was or how podiatry could help them. 4 Lastly, gaining knowledge of services related to the urgent need for people to access health services due to a health crisis in their family or ill health. One resident commented (MIC:1999:15) that he found out about services for carers from the Pharmacist and it was not until his partner was admitted to hospital that he advised the doctor he could not go on: “I needed sleep and to get some rest so I could go on.”

Knowledge of health services is particularly critical to the successful settlement of refugees who may have experienced significant trauma and had limited access to health services prior to settling in Australia. One participant commented (MIC:1999:36): “Many refugees migrated to Australia after experiencing years of war. People used all their personal resources to survive and start a new life. Once they arrived in Australia, they had to face the affects and trauma of their experience.” Service providers identified the need for health service staff to 2 See for example, Ethnic Communities’ Council of Victoria (1999), Equity for All, EEC PHACS Project funded by the Department of Human Services – Aged Community and Mental Health Division. 3 Quadrant Research (1998) Needs Analysis on the Health Needs of Migrants for the Whitehorse Division of General Practice in partnership with the Cities of Maroondah and Whitehorse. 4 MIC opcit p.56. (MIC:1999:87): “Understand the immediate needs of refugees particularly trauma counselling, survival experience and backgrounds.” Recent research undertaken by Rump (1999) with Serbian refugees found that there was a significant correlation between ill health and access to community resources.

Culturally sensitive health services

The need for culturally sensitive health services has been identified by a number of authors as being critical to migrants accessing health services.5 In Victoria, the need for culturally sensitive practice was identified by participants in the consultations for the Primary Health and Community Support (PHACS) redevelopment recently undertaken by the Ethnic Communities’ Council of Victoria. Participants found that (ECCV:1999:15): “PHACS reforms must ensure quality improvement to service delivery by creating more awareness within their organisations on cultural and linguistic issues in regard to consumers from ethnic communities.”

In our research, residents spoke of the need for service providers to understand their culture and to have access to information in their own languages – a critical component of this would be that the issues are discussed with an understanding of the value systems that underpin different cultures. For example, as Van Vliet (1998:12) found in respect to mental health: “Ethnicity and culture play a part, it would seem, in how families perceive and cope with mental illness . . . We need to recognise the different interpretations of mental disorders and then work with the different communities in establishing ways to work within the various frameworks.” Local service providers (MIC:1999:87) identified firstly, the necessity of culturally sensitive health services and secondly that cultural awareness training was a key support MIC could offer to health service providers.

Preventative health care

Previous research has found that migrant participation in health education is increased when the session reflects the cultural value system of participants and is held in community languages. For example, Manfrin (1997:5) found in respect to Heart Health Education Programs: “Low rates of presentation by ethnic groups may be related to a number of factors including issues relating to cultural value systems, communication difficulties, cultural dissonance and previous experience of persecution and discrimination.”

Some residents cited preventative health forums that were held in community languages and had culturally sensitive content as a strength of the service system. As Manfrin (1997:7) states: “Cultural context is crucial to the development of effective culturally sensitive health education programs for migrant communities.” The importance of language was highlighted by residents in one focus group who spoke highly of the Chinese Women’s Health Day commenting that it was a success because it enabled them to gain information about a wide range of health issues in their own language.6

5See for example, Rissel C. (1997), “The Development and Application of a Scale of Acculturation” in Australian and New Zealand Journal of Public Health, Vol. 21, No. 6, pp. 606 –613 and Matthey S., Bryanne E., “A Vietnamese and Arabic Women’s Response to the Diagnostic Interview Schedule (Depression) and Self Report Questionnaires: Cause for Concern” in Australian and New Zealand Journal of Psychiatry (1997), 31:360–369. 6 MIC opcit p. 20. Residents identified the need for more information sessions on health care to be made available for migrant communities in the region. The model used by the organisers of Chinese Women’s Health Day may well be able to be utilised for such sessions across different cultural groups.

Residents particularly the aged, raised concerns about waiting times for community dental services in the region. The lengthy waiting times indicate that the service cannot provide preventative health care. A paper from the Department of Human Services confirmed that less than 15% of eligible people could be treated in public dental clinics and the introduction of fee for service prevented some people from accessing preventative care.7

Access to interpreters and bilingual health professionals

The ability of people to explain their concerns to health providers and to feel confident that they fully understand the information provided is critical to an individual’s satisfaction. To ensure equity of access to health services by migrants with a low level of English proficiency, this requires access to bilingual health professionals or professional interpreters, and written information in their own languages. As a recent report noted (HSV:1998:14): “The importance of language for those not proficient in English, the use of interpreters, the employment of bilingual workers . . . is stressed in almost all of the available literature.”

The importance of using trained health professional interpreters is critical to ensure the delivery of appropriate health services particularly in relation to mental health assessments. As Shah’s (1998:220) research found: “Professional translators with mental health training were significantly better [than using relatives or professional health interpreters without mental health training] because they were patient, able to translate the questions and answers appropriately, able to appreciate the significance of important symptoms and important negatives, able to develop rapport with the patient, and able to reassure the patient.”

Whilst residents identified the availability of interpreters on request within the hospital system as a strength of the service system, a number of residents sighted the lack of bilingual health workers and the availability of interpreters when they visit their local doctor, as a major issue faced by migrants in the Eastern Region.8 A number of residents raised concerns about their ability to understand both their diagnosis and the treatments that doctors were advising. One resident commented (MIC:1999:45): “Some GP’s say you have been here a long time and your English is ok. But some medical words are hard to understand. You could be in trouble because we say yes to be polite even though we do not understand what they are saying.”

The impact of loneliness on health

Social isolation was raised by a number of residents as a problem for all generations, particularly, older migrants and women at home caring for young children. Residents spoke of social isolation exacerbating feelings of loneliness, depression and ill health.9 For example, one focus group (MIC:1999:41) felt that social isolation caused sickness, nervous problems and reduced physical fitness due to lack of exercise. Other residents spoke of the need for support groups to assist

7 Department of Human Services Paper on Dental Health Care, p. 4. 8 MIC opcit see for example p. 51. 9 MIC opcit see for example p. 26. them to develop a sense of belonging in Australia to minimise the impact of loneliness on individuals’ psychological well-being.

In our research, promoting community support networks was seen as an important way for the MIC to reduce the social isolation of migrant communities including aged people, newly emerging communities and refugee communities. As Rump (1999:2) notes: “Social support may be provided at three levels . . . first[ly] help from the general community . . . secondly, the migrant’s own cultural community . . . [and thirdly the] level of social support provided by the family.”

Rump’s (1999:2) research on the health of refugees indicates that refugees who feel that they can access support in the general community as well as within their cultural community report a lower incidence of stress and ill health. Our research confirms the value of multicultural groups and elderly citizen’s clubs in providing companionship and support as well as developing a sense of belonging.10 As one focus group commented (MIC:1999:14): “The Multicultural Women’s Group . . . was seen as the place to practice English conversation, learn about other histories and cultures, and develop confidence.”

It should be noted however, that Rump’s (1999:3) research also states that: “Social support does not protect the refugee against severe depression, which may be seen as more dependent on stressful situations, personality traits and family interactions.” Although the importance of social support is critical for the successful settlement of migrants, Rump’s findings confirm the need for health and family support services to be accessible to migrant families and in particular refugees.11

Actions12

 Work in partnership with health and aged care services to meet the needs of migrant communities.

 In partnership with community leaders and community support groups, promote information on health and aged care services to migrant communities.

 Contribute to a comprehensive database of information on community based health services in the Eastern Region including mental health services.

 Work in partnership with health service providers including mental health to develop and facilitate information forums particularly for refugees and newly emerging communities on Australian health care systems.

 Provide opportunities for input and community feedback including suggestions for change on health and aged care services information and practice particularly in relation to use of language and cultural appropriateness.

 Identify and build on other relevant research to prepare and make available cross cultural training packages for health and aged care service providers.

10 The role of elderly citizen clubs is discussed in the chapter in this report entitled “Elderly Migrants”. 11 This issue is further explored in the chapter in this report entitled “Families and Young People from Migrant Communities”. 12 See Action Plan in this report for activities against the actions listed in this chapter.  Implement strategies to inform migrant communities on health and aged care services including mental health services i.e. develop communication strategies.

 Actively seek opportunities to be involved in the PHACS demonstration projects in the Eastern Region.

 Work in partnership with the Divisions of General Practice in the Eastern Region to develop protocols for easy access to interpreting services, the provision of current information on interpreting services and facilitating training sessions in the use of interpreters.

 Work in partnership with migrant community leaders to promote community development amongst isolated migrant communities particularly with refugees, women, aged and newly emerging communities.

 Actively assist migrant communities to establish and coordinate community support groups, and access funding and links with local agencies.