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Health to me means being physically and mentally well. Being able to complete daily tasks with a healthy and functioning body and having the mental strength to overcome difficulties. Being able to express happiness and gratitude. Being free from illness and injury. Being able to live life without any physical or mental illness restricting and affecting my experiences.

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The four-pointed stars are the central theme of textiles for Hazara women. It dates back to the mid-20th century. It is hand embroidered in extremely fine cross stitches on silk or tan cotton fabric. Hazaras' are the third-largest ethnic group in Afghanistan; they're Shai Muslims mainly living in the central region of Afghanistan. Embroidery is an integral ritual as the climate is cold and can snow for up to 5 months.

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For me, the most relevant aspect of the competency standard 12.1 was the emphasis on self-awareness of one's culture, beliefs, values and biases and how they impact our practice in a healthcare setting. I have improved my understanding of self-assessing to determine its influence on my interaction in a healthcare setting as a student nurse. It is necessary to reflect due to the implications of our biases can be negative, which need to be addressed and self-assessing can also highlight our acceptance of other cultures and the positive enforcements that come with it. Having learned the significance of reflecting on my own beliefs, values, biases and culture, I now feel that I am more capable of caring for those patients of a different culture to me. This skill is essential to me in the workplace because my cultural background helps me better sympathise with patients and understand cultural differences. It highlights my differences and makes me more tolerant of others.

(Culturally Responsive Clinical Practice: Working with People from Migrant and Refugee Backgrounds, 2019)

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Principle health issues faced by refugees 

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Principle health issues faced by refugees 

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Afghanistan, a nation situated in Central Asia, is experiencing complex challenges with governance, security and human rights. With 2 decades of United Nations and NATO presence and involvement in the country, in 2021, the Taliban came into power. The country faces one of the world's biggest humanitarian crises as the nation is plunged deeper into poverty. The rapidly evolving situation in 2021 has led to 97% of Afghans living in poverty and concerns about human rights violations (Human Rights in Afghanistan, n.d.).

Australian Government allocated 26500 visas places through to 2026 for Afghans to immigrate to Australia (Department of Home Affairs Website, n.d.).

Upon arrival, three health issues present in refugees and immigrants would be:

Mental Health:
Mental health is defined as a state of mental well-being that builds the foundation of our capacity to cope with life (World Health Organization, n.d.). Refugees and immigrants from Afghanistan may present with mental health challenges due to past traumatic experiences, displacement, financial problems and separation from family. The Australian Refugee Health Practice Guide acknowledges the pre-arrival trauma that they may present with. Support for mental health is essential, and it can be through trauma-informed care, culturally sensitive counselling and access to healthcare services for mental health.

Immunisation:
Refugees and immigrants from Afghanistan may present with no immunisation history known or different immunisation schedules. Their access to necessary immunisation may have been limited. Ensuring they are up to date with their immunisation is essential for their health and the public health. Treatment options would consist of checking for vaccination records and providing the immunisation required.  Providing the necessary education on the importance of immunisation, the Australian immunisation schedule and how to access routine vaccinations.

Low Vitamin D:
Vitamin D is a fat-soluble that helps to absorb calcium, which is needed by our body to maintain strong bones, muscles and overall health (Better Health Victoria, n.d.). Sources of vitamin D are ultraviolet radiation, UV from the sun, certain foods, and vitamin D supplements (Better Health Victoria, n.d.). Afghanistan does have a hot climate, but due to not having a nutritious diet or access to supplements, they may present with a Vitamin D deficiency. Treatment options would be to monitor Vitamin D levels, provide supplements, and provide education on the importance of maintaining a sufficient level of vitamin D, having a balanced diet, sun exposure, and prioritising food that is rich in vitamin D.

Australian Department of Home Affairs. (n.d.). Afghanistan update. Retrieved from https://www.homeaffairs.gov.au/help-and-support/afghanistan-update

Amnesty International. (n.d.). Human rights in Afghanistan. Retrieved October 10, 2023, from https://www.amnesty.org/en/location/asia-and-the-pacific/south-asia/afghanistan/report-afghanistan/

World Health Organization. (n.d.). Mental health: Strengthening our response.
https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

Better Health Victoria. (n.d.). Vitamin D. Retrieved from https://www.betterhealth.vic.gov.au/health/healthyliving/vitamin-d

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Three WHO social determinants that impact refugees/ immigrants in Australia:

Unemployment and Job insecurity

Refugees and immigrants often struggle with gaining employment upon arrival due to factors such as recognition of previous qualifications, language barriers and discrimination. This may lead them to jobs with limited job security, short-term employment and low income. The Australian Institute of Health and Welfare recognises the substantial impact unemployment and job insecurity have on individuals' mental and physical health.

Education

Access to quality education is another determining factor of refugees' and immigrants' well-being. A gap in knowledge may be formed due to the language barrier, or knowledge may not be recognised due to language barrier, prior gap in education, and unfamiliarity with the Australian education system, which can slow down their educational process. Educational attainment is linked to socioeconomic position, which affects people's health (Social Determinants of Health Snapshot, 2022). Poor health contributes to a lower socioeconomic position and can be the product of the socioeconomic position (Social Determinants of Health Snapshot, 2022).

Social Inclusion and non-discrimination

Refugees and immigrants entering a new culture and environment may experience feelings of exclusion, isolation and discrimination, which can have a. negative impact on their mental health and well-being. Social inclusion and non-discrimination are recognised as health-determining factors by the World Health Organisation. It may affect refugees and immigrants' pursuit of a good life and their participation within the community.

Australian Institute of Health and Welfare. (2022). Social determinants of health snapshot.
https://www.aihw.gov.au/reports/australias-health/social-determinants-of-health

World Health Organization. (n.d.). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1

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The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.

The SDH have an important influence on health inequities - the unfair and avoidable differences in health status seen within and between countries. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health.

The following list provides examples of the social determinants of health, which can influence health equity in positive and negative ways:

Income and social protection

Education

Unemployment and job insecurity

Working life conditions

Food insecurity

Housing, basic amenities and the environment

Early childhood development

Social inclusion and non-discrimination

Structural conflict

Access to affordable health services of decent quality.

Research shows that the social determinants can be more important than health care or lifestyle choices in influencing health. For example, numerous studies suggest that SDH account for between 30-55% of health outcomes. In addition, estimates show that the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.

Addressing SDH appropriately is fundamental for improving health and reducing longstanding inequities in health, which requires action by all sectors and civil society.

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WHO's work on social determinants of health

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Afghan cultural dresses reflect the region's cultural, ethnic and regional diversity. They come in distinct designs particular to specific ethnic groups, with "Pashtun" dresses, as shown in the above pictures, being a common one. They can be vintage due to them being handmade and not mass-produced. They're colourful and bright, with distinct patterns. As the Taliban has a strict dress code, all traditional Afghan dresses have become a sign of resistance from Afghan women.

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Jewellery is more than one type, and every detail is intentional and influenced by something. It is essential to their cultural identity. It does resemble armour and is said to be due to wars way back where women would wear armour for protection. To find credible sources to confirm this is difficult.

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"Qataghani" is one of many Afghan traditional dances. It can be fast-paced, with lots of hand movements.