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Culturally Responsive Clinical Practice: Trauma Informed Care

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Culturally Responsive Clinical Practice: Trauma Informed Care

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For me, the most meaningful aspect of Domain 1: Clinical Expert is the competency standard 1.2, which is about recognising the impact of refugee-like experiences and providing trauma-informed care (Migrant and Refugee Women’s Health Partnership, 2019). Learning about Syrian refugees has helped me recognise how much trauma, grief, and displacement can impact a person's health and how they connect with healthcare providers. Having South Sudanese refugee parents has given me firsthand experience with issues such as language barriers, cultural acclimatisation, and prejudice. It taught me that health is more than simply the physical body, but it also involves trust, safety, and community. As a nurse, I strive to make my patients feel comfortable by developing rapport, to encourage health-seeking habits by educating them on the benefits of the healthcare system, and to approach healthcare with patience, empathy, and respect.

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Social Inclusion and Non-Discrimination as a Social Determinant

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Social Inclusion and Non-Discrimination as a Social Determinant

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The World Health Organisation (2019) identifies social inclusion and non-discrimination as key social determinants of health, requiring equal social, economic, and political opportunities for all, alongside dignity and respect. Alwan et al., (2020) found that Syrian refugees in Australia frequently lacked social support networks leading to social anxiety, poor health literacy, and barriers such as limited child-care, and transportation. One participant reflected, “We then came here for the sense of security but still did not find it... We felt like we were locked up and restrained at home.” Social anxiety and limited English skills hindered their ability to participate in social life, manage their health, and deflated their health-seeking tendencies. The Australian Commission on Safety and Quality in Health Care (2021) recommends strategies such as community needs assessments, targeted outreach approaches to provide information about health and the health system, and programs to target communities under-utilising or not accessing health services. Addressing the socioeconomic determinants of health equality is therefore critical for reducing inequalities and improving Syrian refugee health outcomes.

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Before migration, Syrian refugees are exposed to various traumas, including war, persecution, torture, imprisonment, and loss of family, all of which contribute to a high risk of mental illness, particularly post-traumatic stress disorder (PTSD), depression and anxiety. After resettlement, Syrian refugees may experience difficulties due to language barriers, housing and financial instability, employment, and loss of cultural/community connections, which intensify mental health issues. Studies show a positive correlation between post-migration difficulties and mental depressive disorder (Sa et al., 2022). The Australian Refugee Health Practice Guide recommends that initial consultations include migration history, settlement experience, trauma screening, suicide risk assessment, and enquiry into social supports (Australian Refugee Health Network, 2018). Patients with mental health issues related to torture and trauma should be referred to a specialised torture and trauma service; otherwise, mainstream mental health services are sufficient. The presence of cognitive and behavioural attitudes that people use to cope is a determining factor that can affect an individual's psychological well-being, and healthcare professionals should provide substantial care when caring for mental health in Syrian refugees.

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Medicinal care in Syria relies on traditional herbal and spiritual care, deeply rooted in Islamic culture and supported by the country's abundance of flora. As Dr. Jihad Ibrahim Shahrour notes, “The Syrian natural environment is one of the richest in the world in terms of therapeutic herbs.” Common remedies use leaves, fruits, and seeds to treat digestive, respiratory, skin, nervous system, and blood disorders (Khatib et al., 2021). Garden cress, for example, is used as a cough suppressant, pain reliever, and anaesthetic. Cupping is a prevalent traditional medicine practice in Syria, dating back to the Assyrian era, and remains prominent today. Research from Damascus University found it can reduce blood pressure, regulate blood sugar, and enhance blood and immune cell counts (Sakr, 2017). These traditions should be acknowledged to avoid drug interactions and support safe, harmonious practices.  As healthcare professionals, it is important to understand alternative beliefs as they influence well-being and trust in healthcare providers.

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Alwan, R. M., Schumacher, D. J., Cicek-Okay, S., Jernigan, S., Beydoun, A., Salem, T., & Vaughn, L. M. (2020). Beliefs, perceptions, and behaviors impacting healthcare utilization of Syrian refugee children. PloS One, 15(8), e0237081. https://doi.org/10.1371/journal.pone.0237081

Australian Commission on Safety and Quality in Health Care. (2021). National Safety and Quality Health Service Standards User Guide for Health Service Organisations Providing Care for Patients from Migrant and Refugee Backgrounds (p. 9). Australian Commission on Safety and Quality in Health Care.

Australian Refugee Health Network. (2018). Australian refugee health practice guide. http://refugeehealthguide.org.au

Khatib, C., Nattouf, A., & Hasan Agha, M. I. (2021). Traditional medicines and their common uses in central region of Syria: Hama and Homs - an ethnomedicinal survey. Pharmaceutical Biology, 59(1), 776–786. https://doi.org/10.1080/13880209.2021.1936078

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. www.culturaldiversityhealth.org.au

Sá, F. H. de L., Waikamp, V., Freitas, L. H. M., & Baeza, F. L. C. (2022). Mental health outcomes in Syrian refugees: A systematic review. International Journal of Social Psychiatry, 68(5), 933–953. https://doi.org/10.1177/00207640221099404

Sakr, R. (2017). Traditional medicine in Syria: Knowledge, beliefs & experiences (Chapter 7, p. 75). Traditional medicine: Sharing experiences from the field. International Information and Networking Centre for Intangible Cultural Heritage in the Asia-Pacific Region (ICHCAP) under the auspices of UNESCO. https://archive.unesco-ichcap.org/kor/ek/sub8/pdf_file/09/7.%20Traditional%20Medicine%20in%20Syria-Knowledge,%20Beliefs%20&%20Experiences.pdf

World Health Organisation. (2019). Social Determinants of Health.   https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1