Almost one-third of Australia’s population was born overseas (29.8%).1 Each culturally and linguistically diverse (CALD) community has its own strengths and health needs, however, there may be substantial barriers to accessing, navigating, and maintaining engagement with healthcare. Individuals from CALD communities born in Australia may face similar barriers. General practitioners (GPs) can address equity barriers for all migrants, including offering professional interpreters.
Approximately one in five households in Australia speaks a language other than English at home.2 It is estimated that one in 10 individuals presenting to GPs reported that their primary language was not English, however, 73% of GPs reported that all their consultations were conducted in English.3 Although consideration of language is essential, culturally safe care is much broader than this. Ongoing reflective practice acknowledging cultural bias and lens is essential. Showing compassion and respectful interest by undertaking a cultural assessment can provide valuable insight to inform care. This can include an exploration of beliefs and values, health literacy, traditional health practices, as well as previous access to and experiences with health services. Understanding these factors and their influences on health, presentation of illness, access to care and adherence to treatment can assist GPs in providing culturally safe care. It can also inform advocacy and improve access to appropriate health screening, culturally appropriate health information and continuity of care.
The Australian government has accepted over 80,000 humanitarian entrants since the second world war,4 and as of March 2021 there were over 90,000 people seeking asylum in Australia.5 Refugees are people who are identified as ‘unable or unwilling to return to their country of origin owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion’.6 People seeking asylum have applied for protection but have not yet been granted a humanitarian visa.2 Every refugee was once a person seeking asylum.
Refugee and asylum seeker communities are typically resilient but may carry specific vulnerabilities which are important to acknowledge.3,7-9 These include communities who originate from countries with scarcity of resources including safe drinking water, sanitation, shelter, adequate food supply, education and employment, those who have fled areas of conflict with risk of exposure to traumatic events and the associated grief that accompanies the loss of family, friends, culture and community.3,7-9 People from these backgrounds can also face continuing uncertainty which may impact their wellbeing.3,7-9 Combinations of these factors can contribute to complex health presentations that require respectful and supportive management.3
Newly arrived humanitarian entrants are recommended to undertake a comprehensive health assessment. This includes pathology screening, catch-up immunisation, management and referrals as appropriate.4,5 An understanding of disease prevalence in countries of origin and transit (or knowing how to access this information), as well as the potential impacts of other pre-migration and post-migration factors on health, is needed to deliver holistic quality care.3,4
It is important for GPs to reflect on their consultations with people who are facing significant challenges in their lives to identify and understand signs of compassion fatigue and vicarious trauma, and to ensure that they have adequate self-care and support strategies in place.