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I make a constant effort to maintain a positive outlook in life.

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Health to me means being in a state of total physical, mental, emotional and spiritual well-being beyond the absence of illness. Living healthy for me entails experiencing daily strength and confidence and finding balance while adapting wellness and health practices that work for me. Sustaining a balanced diet, regular physical activity, adequate sleep and good hygiene is essential for me to fully function and give my best self to my loved ones. Most importantly, keeping my faith gives me the determination to strive harder and efficiently cope with the daily stressors of life.

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For me, the most significant aspect of competency standard 12.3 was working on how to improve the overall health outcomes of people from migrant and refugee backgrounds by reducing, if not completely obliterating, culturally insensitive behaviors such as racial bias, communication gaps and the lack of cultural knowledge. I have developed my understanding of how imperative it is to acknowledge their own healthcare decisions and preferences by considering their cultural ideals and upbringing in order to provide appropriate care. Having learned about how to practice awareness and utilize introspection to evaluate my ability to accommodate care for individuals and families from various cultures gives me the confidence to communicate in a way that is respectful and suitable for them.

This knowledge will be essential for me in the workplace because it contributes to the delivery of safe, high-quality care, improved patient satisfaction, and increased understanding and adherence to clinical instructions.

Migrant and Refugee Women’s Health Partnership. Culturally Responsive Clinical Practice: Working with People from Migrant and Refugee Backgrounds, Competency Standards Framework for Clinicians, 2019.

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According to the World Health Organization (2023), the unjust and preventable variations in health status that exist both within and between nations are largely influenced by the social determinants of health. These factors are crucial to the integration of migrants in Australia, especially for those with refugee backgrounds, many of whom have endured trauma and torture, as well as protracted periods of displacement prior to arrival.

One of the social determinants identified was unemployment and job insecurity. The refugees may have had quite diverse employment experiences before moving to Australia. While the majority may have come from urban backgrounds and worked in white-collar professions, they may encounter major obstacles to getting full-time employment, such as a lack of Australian work experience and difficulty getting recognition for overseas qualifications. The stress of being unemployed and the resulting financial burden can eventually lead to depression; for this reason, employment-related issues are critical to the refugees' overall health and well-being.

Another social determinant is social inclusion and non-discrimination. Positive resettlement experiences rely on a person’s sense of safety and belonging, especially for those whose experience as refugees has inherently involved uninterrupted or disrupted feelings of safety. However, instances of racism and discrimination may put these sentiments of safety in jeopardy. Experiencing feelings of exclusion and discrimination in their day-to-day interactions serves as a barrier when attempting to access resources or health services, which may compromise their sense of safety, integration and belonging. Ultimately, this feeling of being unwanted may significantly affect the physical and mental health of the refugees. Although there are different ways in which their relationships with others, mainly those from their own communities, enable them to find the right resources and effectively navigate Australian systems, varying forms of racism and discrimination from the larger community make establishing good community ties more challenging, thus hindering the much-required source of support for optimum health and wellbeing.

In addition, access to affordable health services of decent quality is an important social determinant of health for refugees in Australia. Language barriers, system comprehension issues, lengthy wait times for appointments and needing to travel to the city for specialized care were some of the challenges that they may face. For people from migrant and refugee backgrounds who are unaware of their rights and access routes, comprehending the complexities of the Australian healthcare system can be difficult, and they may not receive the appropriate and timely health care that they need. Therefore, a clear set of specific policies to address these factors must be in place to achieve positive outcomes for both the refugees and the receiving communities.

WHO. (2023) Social Determinants of Health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1

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Principal Health Issues that Refugees face

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Principal Health Issues that Refugees face

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Country Focus: Afghanistan
Following the disintegration of the Afghan National Security Forces and the fall of Kabul on August 15, 2021, the Taliban seized power in Afghanistan. The country still faces significant economic and humanitarian difficulties, which are made worse by calamities like the earthquake that occurred in June 2022. Australia is dedicated to helping the people of Afghanistan through humanitarian program and support of crucial causes like human rights (Department of Foreign Affairs and Trade, 2023). Australia granted a total of 5,947 refugee and humanitarian visas in 2020-2021 and Afghanistan was included in the top four countries where refugees come from (Australian Red Cross, 2023).
Three common health concerns listed on the Australian refugee health practice guide that are likely to be present in people arriving from Afghanistan are Tuberculosis, malaria, and low vitamin D (Australian Refugee Health Practice Guide, 2023).

Tuberculosis (TB and LTBI):
Tuberculosis is spread through inhalation of aerosolized droplets from people with active respiratory TB. Active tuberculosis (TB) can manifest as either primary disease, which happens immediately after the initial infection, or reactivation disease, which appears after a latent period that can endure for several years (LTBI). Those who were born in humanitarian source countries such as Afghanistan have the highest rates of active tuberculosis.

Unless it is contraindicated, treatment of LTBI is advised because it has been  shown to significantly lower the individual risk of subsequent active TB.
The first line preventive treatment of LTBI is 6–9 months of isoniazid to be administered by experienced clinicians, in communication with a coordinated TB service.

Malaria:
Malaria is a parasitic protozoal infection spread by mosquitoes that causes symptoms like fever, headache, chills, sweating, diarrhea, and malaise in moderate cases,

One treatment available to refugees from Afghanistan who have asymptomatic or uncomplicated falciparum malaria is oral artemisinin-based combination therapy (ACT) and should be referred urgently to a physician with experience in the management of malaria.

Low Vitamin D:
Low vitamin D which refers to both D3 (cholecalciferol) and D2 (ergocalciferol) is prevalent in refugee and asylum seeker populations in Australia. Refugees frequently have risk factors for low vitamin D levels including dark skin, covering clothing (Afghani & Iraqi) and decreased exposure to sunlight through migration to temperate latitudes.

In order to restore vitamin D levels of affected refugees to normal range, daily dose treatment of Vitamin D3 in adults with mild deficiency is needed with a dosage of 1000–2000IU daily for 3 months and for moderate to severe deficiency, 3000–5000IU daily for 6–12 weeks, then 1000– 2000IU daily for a further 6–12 weeks.

Department of Foreign Affairs and Trade. (2023) Afghanistan

https://www.dfat.gov.au/geo/afghanistan

Australian Red Cross. (2023) Refugee and asylum seeker facts

https://www.redcross.org.au/act/help-refugees/refugee-facts/

Australian Refugee Health Practice Guide. (2023)

https://refugeehealthguide.org.au/