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For me, the most relevant aspects of Competency Standard 12.1 are self-awareness and respect for cultural diversity. I have improved my understanding that these are essential components of cultural competence. As a healthcare provider, I have learned that I should demonstrate self-awareness by critically evaluating my beliefs, values, ethnicity, culture and biases and how they will influence interactions with refugees and migrants. I now realise that self-awareness and respect for cultural diversity will help me avoid generalisations, stereotypes, assumptions or judgments about other cultures. This knowledge is essential in my nursing practice and allows me to provide flexible and appropriate care to people of different cultures.

Competency Standards Framework For Clinicians. (2019). Culturally Responsive Clinical Practice: Working with People from Migrant and Refugee Backgrounds. https://culturaldiversityhealth.org.au/wp-content/uploads/2019/02/Culturally-responsive-clinical-practice-Working-with-people-from-migrant-and-refugee-backgrounds-Jan2019.pdf

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Refugee and migrant health in Australia is strongly related to social determinants of health, such as housing, income, and social inclusion have a considerable impact on health (World Health Organization, 2023).

Housing, basic amenities and the environment

Housing, basic amenities and the environment are essential social determinants of health that impact the health of refugees in Australia. Housing was central to health and well-being and affected health through affordability and suitability concerning physical, social, and mental aspects, such as safety and belongingness. Refugees in Australia living in poor housing conditions negatively affected their health. Improving housing quality, affordability, and tenure security can positively impact health outcomes (Ziersch et al., 2017).

Income and social protection

Income and social protection are other social determinants of health that refugees face in Australia because of their marginalised economic circumstances. It can be quantified by economic difficulties such as food shortage, selling of possessions or relying on aid from community organisations or charities. Financial hardship increases poor health and decreases employment opportunities. Lack of social and support networks means that refugees face income strain, potentially detrimental to their health. Refugees in Australia need additional support to help them contribute and assimilate to economic productivity (Torlinska et al., 2020).

Social inclusion and non-discrimination

Social isolation and discrimination are common concerns for refugees in Australia. Family separation is one of the primary causes of post-migration stress that impacts mental health and causes depression for refugees. Social inclusion and non-discrimination benefit refugees' physical and psychological health through emotional help and coping support. Applying the social determinants framework acknowledges the impact of social connectivity on the emotional well-being of refugees in Australia (Russo et al., 2023).

Russo, A., Koch, R., & McBride, J. (2023). Promoting social inclusion among asylum seekers and refugees living in the southeast region of Melbourne, Australia, through volunteering. Health Promotion Journal of Australia. https://doi.org/10.1002/hpja.685

Torlinska, J., Albani, V., & Brown, H. (2020). Financial hardship and health in a refugee population in Australia: A longitudinal study. Journal of Migration and Health, 1-2(100030). https://doi.org/10.1016/j.jmh.2020.100030

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

Ziersch, A., Walsh, M., Due, C., & Duivesteyn, E. (2017). Exploring the Relationship between Housing and Health for Refugees and Asylum Seekers in South Australia: A Qualitative Study. International Journal of Environmental Research and Public Health, 14(9), 1036. https://doi.org/10.3390/ijerph14091036

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Tinikling is a traditional Filipino dance involving dancers' rhythmic movement in and out of bamboo poles. It is a high-energy dance that helps burn calories and is a great way to relieve stress. This dance is deeply connected to Filipino cultural heritage and provides a sense of pride and belonging.

DoveMed. (2023). Health Benefits of Tinikling Dance Philippines.

https://www.dovemed.com/healthy-living/wellness-center/health-benefits-tinikling-dance-philippines/#:~:text=The%20constant%20movement%20of%20the

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A Culturally Significant Philippine Craft

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A Culturally Significant Philippine Craft

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The Philippines' weaving culture is a tradition that uses raw materials like abaca, cotton and pineapple fibres. Handloom weaving is a cultural practice associated with the indigenous peoples' bridge to spirits who will protect them and attract good health. Laborious and challenging to master, weaving encapsulates the Filipino's tenacity and diligence.

Moya, J. (2021). Weaving Patterns in the Philippines: Heritage, Design, and Their Meanings. Tatler Asia. https://www.tatlerasia.com/style/fashion/meanings-of-indigenous-filipino-textiles

Natonal Museum Philippines. (2021). Textiles and Weaving. https://www.nationalmuseum.gov.ph/our-collections/ethnology/textiles-and-weaving/

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Traditional Filipino Patintero game. Photo credit: Mi Pham cited on Unsplash. https://unsplash.com/photos/xtd3zYWxEs4

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Patintero, or "block and catch", is the most widely played native game in the Philippines because it doesn't need any equipment. It is a physical activity that helps and supports our body to keep it healthy. This traditional game promotes camaraderie and recognises the preservation of our cultural heritage.

Gatwiri, J. (2020). A detailed illustration of how to play patintero in Philippines. Kami Philippines News. https://kami.com.ph/112251-how-to-play-patintero-in-philippines.html

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Classic Filipino dish, vegan Kare-kare. Cited on East Meets Plate. https://eastmeetsplate.com/vegan-kare-kare/

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Kare-kare is a traditional Filipino stew featuring sliced vegetables and tofu in a rich, creamy peanut sauce. Aside from being a delicious meal, it is also packed with health benefits, such as an excellent protein source, nutrient-rich, and high-fibre. It also improves digestion, manages weight, and lowers chronic disease risk.

National Heart, Lung, and Blood Institute. (2023). Tasty and Healthy - Heart-Healthy Filipino Recipes. https://www.nhlbi.nih.gov/health/educational/healthdisp/pdf/recipes/Recipes-Filipino.pdf

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Lagundi plant is a large native shrub traditionally grown and used as herbal medicine in the Philippines. Its leaves and root extracts are generally used to ease and treat coughs, asthma symptoms, and other respiratory problems.

Philippine Council For Health Research And Development. (2022). Lagundi: Anti-cough and anti-asthma medicine. https://www.pchrd.dost.gov.ph/heartnovation/lagundi-anti-cough-and-anti-asthma-medicine/

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Hilot is the art and science of the ancient Filipino healing traditions that use massages and medicinal plants that restore one's health. Hilot healing also has a spiritual element wherein the therapist conducts a humbling ritual before treatment, reaching out to his ancestors for assistance, acknowledging wisdom and serving as an honouring tribute.

Medical Tourism Magazine. (2023). The Age-Old Healing Art of Hilot. https://www.magazine.medicaltourism.com/article/the-age-old-healing-art-of-aeoehilotae-c2-9d

Philippine Institute of Traditional and Alternative Health Care. (2023). Hilot. https://pitahc.gov.ph/hilot/#:~:text=Hilot%20is%20the%20art%20and

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Health, to me, means having a good outlook on what I have. Everyone has a different definition of health and wants to improve and be healthy. It is more about being physically healthy and fit. It is about being physically, emotionally, mentally, spiritually, culturally and educationally beneficial. Health encompasses the body, mind, and spiritual well-being and promotes a balanced life.

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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: Syria

War in Syria remains our most significant refugee crisis. As of June 2022, the UN estimates that over 6.8 million refugees need humanitarian assistance and have fled the violence in Syria (Australian Government Department of Foreign Affairs and Trade, 2022). In 2020-2021, Australia granted 5,947 refugee and humanitarian visas to people from Syria (Australian Red Cross, 2023). Three common health concerns listed in the Australian Refugee Health Practice Guide likely present in people arriving from Syria are low vitamin D, hepatitis C, and schistosomiasis (Australian Refugee Health Practice Guide, 2023).

Low Vitamin D

Vitamin D is essential for bone and muscle health and is produced in the skin through sunlight exposure, providing humans with over 90% of it. Syrian refugees frequently have the risk of low vitamin D due to covering clothing and reduced sunlight exposure. One treatment available to refugees from Syria who have low vitamin D upon arrival to Australia is vitamin D supplements and calcium therapy with health education about the importance of sun exposure to restore their normal vitamin D levels (Australian Refugee Health Practice Guide, 2023).

Hepatitis C

Hepatitis C is a viral infection also prevalent in Syrian refugees, affecting the liver and spreading through contact with infected blood, causing acute and chronic illness. One treatment available to refugees from Syria who have tested positive for hepatitis C upon arrival in Australia involves 12 weeks of all-oral antiviral combination therapy and HCV RNA test for further assessment combined with counselling regarding how to protect others from infection (Australian Refugee Health Practice Guide, 2023).

Schistosomiasis

Syrian refugees are also prone to schistosomiasis, a chronic parasitic infection caused by parasitic Schistosoma worms acquired through contact with infective cercariae, which an intermediate snail host has released in the freshwater. One treatment available to refugees from Syria who have tested positive for schistosomiasis upon arrival in Australia includes oral anthelmintic medication and evaluation for further end-organ disease with ultrasound and LFTs (Australian Refugee Health Practice Guide, 2023).

Australian Government Department of Foreign Affairs and Trade. (2022). Syria humanitarian response. https://www.dfat.gov.au/geo/syria/syria-humanitarian-response

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). Australian Refugee Health Primary Care for People of Refugee Backgrounds. https://refugeehealthguide.org.au/