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The flag of Nepal consists of two triangular shapes with a crimson background and a dark blue border. The crimson red indicates the brave spirits of the Nepalese people. The upper triangle has the white moon emitting eight rays, while a white sun has 12 rays on the lower triangle. The two symbols signify the hope for the country's longevity as the sun and the moon.
(Citations: Smith, W. (2021, October 22). flag of Nepal. Encyclopedia Britannica. https://www.britannica.com/topic/flag-of-Nepal)
(Citation: https://www.vdio.com/national-flag-of-nepal-and-flag-history/)

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Health to me is feeling physically and mentally well, accomplishing daily activities without pain, and enjoying life to the fullest. I feel healthy when I feel energetic, can think clearly, and concentrate, and experience a sense of happiness.

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Refugees are people who have been forced to flee their home country due to war, violence, or conflict. There has been a rapid rise in the number of people migrating to Australia from Afghanistan. According to the Australian Bureau of Statistics (ABS) 2016, there are 53,082 Afghani refugees assigned on humanitarian visas. The factor causing the migration is drought, along with the ongoing civil war with Tabalian (Kavian et al., 2020).

The three most common health issues in Afghani refugees mentioned in the Australian Refugee Health Practice Guide are mental disorders, tuberculosis, and hepatitis B ( Roozbeh et al., 2018)

1. Tuberculosis: Tuberculosis is the second leading cause of mortality worldwide. It is caused by Bacillus mycobacterium tuberculosis, affecting the lungs and other body parts. It is usually treated with a combination of antibiotics, including Isoniazid, Rifampicin, Pyrazinamide, and ethambutol, for six months (Ali et al., 2018).

2. Mental health: Mental health is a public health concern among Afghani refugees. It results in depression, isolation, trauma, and anxiety. This can be addressed by providing a culturally sensitive environment, translated educational materials, and self-help strategies as part of orientation to the Afghani refugee (Slewa-Younan et al., 2014)

3. Hepatitis B: It is a viral infection affecting the liver and transmitted through blood, semen, or other body fluids. It is prevented with vaccination. It is recommended for children, infants, and high-risk areas (Zubair et al., 2015).

(Citation: https://www.premiumtimesng.com/news/top-news/480032-u-s-hopes-to-conclude-military-mission-in-afghanistan-august-31.html?tztc=1).
(Citation: Ali, F., Shafee, M., Akbar, A., Khan, N., Khetran, M. A., Rahman, F., & Mengal, M. A. (2018). Frequency of Pulmonary tuberculosis in Afghan assylum seekers dwelling in Balochistan, Pakistan. Rawal Medical Journal, 43(4), 577-80.)
(Citation: Kavian, F., Mehta, K., Willis, E., Mwanri, L., Ward, P., & Booth, S. (2020). Migration, stress and the challenges of accessing food: an exploratory study of the experience of recent Afghan women refugees in Adelaide, Australia. International Journal of Environmental Research and Public Health, 17(4), 1379. https://doi.org/10.3390/ijerph17041379)
(Citation: Roozbeh, N., Sanati, A., & Abdi, F. (2018). Afghan refugees and immigrants health status in Iran: A systematic review. population, 3, 4.)
(Citation: Slewa-Younan, S., Mond, J., Bussion, E., Mohammad, Y., Uribe Guajardo, M. G., Smith, M., ... & Jorm, A. F. (2014). Mental health literacy of resettled Iraqi refugees in Australia: knowledge about posttraumatic stress disorder and beliefs about helpfulness of interventions. BMC psychiatry, 14, 1-8. https://doi.org/10.1186/s12888-014-0320-x)
(Citation: Zubair Ahmad, K., Mohammad, S., & Faseeh, S. (2015). Frequency and risk factors of hepatitis B and C in Afghan patients presenting to tertiary care hospital in Peshawar.)

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Herbal medicine: Tulsi, also known as holy basil, is a popular herbal medicine in traditional Ayurvedic medicine in Nepal. It is used to treat digestive, respiratory, cardiovascular, and oral health problems. In addition, it helps to boost immunity and minimize mental health problems like stress. It is often taken as tea.

(Citations: Jamshidi, N., & Cohen, M. M. (2017). The Clinical Efficacy and Safety of Tulsi in Humans: A Systematic Review of the Literature. Evidence-based complementary and alternative medicine: eCAM, 2017, 9217567. https://doi.org/10.1155/2017/9217567)
(Citation: https://www.navrangindia.in/2016/05/tulsi-basil-plant-and-hindu-worship.html)

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Nepali culture is rich in dance and music performed at various cultural events like weddings and festivals. One of the famous traditional folk songs and dances in the rural areas of Nepal is Dohori. In this, two parties- usually men and women take turns communicating with each other in the form of songs and dances as well.

(Citations: https://www.collegenp.com/article/music-and-dance-heritage-of-nepali-culture/)
(Citation: https://nepaltraveller.com/sidetrack/deusi-bhailo)

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The most relevant aspect of Competency Standard 12.3 for me was person-centred care and family-focused care. With this, I have learned to understand the unique challenges of individual migrants and refugees. I have improved my understanding to create a safe and supportive environment for them. Having learned about effective communication, dignity and safety, and quality and safety principles, I now feel more capable of caring for patients of a different culture than me. This skill is essential to me in the workplace to work in a culturally diverse environment.

(Citation: Migrant and Refugee Women's Health Partnership. (2019). Culturally Responsive Clinical Practice: Working with People from Migrant and Refugee Backgrounds. COMPETENCY STANDARDS FRAMEWORK FOR CLINICIANS. 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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There are significant impacts of social determinants on the physical and mental well-being of migrants and refugees in Australia.
1. Unemployment and job insecurity: Unemployment and job insecurity challenges among refugees are due to language barriers, cultural differences, lack of qualifications and training, and lack of opportunities. This can lead to financial instability, making it harder for them to meet their basic needs, including healthcare, causing stress and mental health issues (Kavian et al., 2020).

2. Food insecurities: The pressing concern of food security among refugees is due to displacement that disrupts traditional food systems, making it difficult for refugees to sustain themselves. This causes rejection of unfamiliar food, causing malnutrition, a weak immune system, and increasing morbidity and mortality rates. Also, financial instability, a lack of access to markets, and worry about the next meal impact their mental and psychological well-being (Roozbeh et al., 2018).

3. Housing, basic amenities, and the environment: According to Australian research, 40% of refugees face difficulty finding houses. Poor housing problems cause the spread of communicable diseases among them. Overcrowding and poor ventilation often lead to respiratory problems. Also, a lack of privacy, security, and uncertainty about the future of living in temporary settlements can cause stress and anxiety (Ziersch et al., 2017).

(Citation: WHO. (2023). Social Determinants of Health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1)
(Citation: Kavian, F., Mehta, K., Willis, E., Mwanri, L., Ward, P., & Booth, S. (2020). Migration, stress and the challenges of accessing food: an exploratory study of the experience of recent Afghan women refugees in Adelaide, Australia. International Journal of Environmental Research and Public Health, 17(4), 1379.https://doi.org/10.3390/ijerph17041379)
(Citation: Roozbeh, N., Sanati, A., & Abdi, F. (2018). Afghan refugees and immigrants health status in Iran: A systematic review. population, 3, 4.)
(Citation: 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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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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Daura suruwal is the traditional attire for men and consists of a long shirt (daura) paired with trousers (suruwal), and a Dhaka top, a traditional cap. Women wear a sari, a long cloth draped elegantly around the body, and a blouse known as cholo known as a gunyo cholo. They are often worn during festivals or formal occasions.

(Citations: https://www.holidify.com/pages/culture-of-nepal-862.html).
(Citation: https://ddhami.blogspot.com/)

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One of the most popular cuisines in the Nepalese community is Dal Bhat. It is a staple food of Nepal, consisting of steamed rice and lentil soup (dal). It goes with vegetable curry (tarkari), pickles, and sometimes meat or fish.

(Citations: https://www.holidify.com/pages/culture-of-nepal-862.html)
(Citation: https://www.thelongestwayhome.com/blog/food-around-the-world/nepalese/food-from-nepal-dal-bhat-tourist-version/)

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Dashian and Tihar are the two main festivals of Hindus in Nepal. Dashain or Bijaya Dashami usually falls in September or October and is celebrated for 15 days. It symbolizes the victory of good over evil. On the 10th day, family members receive their elders' tika (a mixture of rice, yogurt, and vermilion) and jamara (barley sprouts) as blessings. Tihar or Deepawali is known as the festival of light, which falls in October or November and lasts five days. Each day is for different animals like crow, dog, cow and ox, and ends with worshipping, offering garlands and blessing to the brother by the sister.

(Citation: https://www.nepaleverestbasecamp.com/festivals-in-nepal ).
(Citation: https://highlightstourism.com/2020/10/26/10-19-a-m-auspicious-time-for-dashain-tika/)