Nurse Uncut talks to Sandy Eagar RN, manager of the Nurse-Led Refugee Health Program, which kicked off in Sydney one year ago (in October 2012).
The NSW Refugee Health Plan identified a need for a specialist health service for refugees and there are now 11 clinics across the Sydney metropolitan area, based in existing community health centres, employing 15 part-time nurses. More than 1500 newly arrived refugees have already benefited from the program. As manager, Sandy is based in Liverpool in south-western Sydney.
“It’s a special type of nurse who works in these clinics”, says Sandy, “with good strong clinical skills – many of the nurses have worked overseas for organisations such as the UN and Medecins Sans Frontieres.” Like their refugee clients, they come from a variety of cultures; one Iranian nurse who works in the program speaks Farsi.
The nurse-led refugee health program team – Sandy Eagar is fourth from left at front.
All refugees who come to Sydney as part of the Offshore Humanitarian Program are offered an initial assessment by the nurse-led program within two weeks of arrival, with the exception of those who have been flagged as having an immediate health problem, who are seen within 24 hours.
The nurses do many home visits, to the frail, the elderly, babies… Their patients by definition have come out of warzones. But they confound popular images of ‘the refugee’ – many are professionals who have been driven out of their Middle Eastern homelands (Syria, Turkey, Jordan, Lebanon and Iraq chief among them) by war. They have spent time – often years – in offshore camps before being designated as refugees by the UN and allowed into Australia.
Ruth Sheahan-Endries RN (right) in a home visit to a Syrian refugee.
Sandy is expecting an increase in refugees from Syria following the current humanitarian disaster there, though it’s a drop in the ocean. “In one week 22,000 people crossed the border into Jordan from Syria – yet Australia takes only 20,000 refugees a year”.
Some of the people the nurses see are physically disabled. Many are psychologically disabled, having been through trauma and sometimes torture. Many suffer from flashbacks and anxiety – loud noises, helicopters, the sight of uniforms, can trigger symptoms. The nurses all dress down, casually.
The children too have seen terrible things, says Sandy – this manifests in problems like bedwetting or the loss of language in a child who was previously speaking. The nurses liaise closely with STARTTS, the service for the treatment and rehabilitation of torture and trauma survivors.
Nurses are usually the first health workers refugees come into contact with – these people have often had very little, if any, health care. So the nurses are busy doing all the catch-up Blue book checks for the under-fives, getting immunisations started and up to date, conducting hearing tests before kids start school, doing Pap smears for women – often for the first time.
Many of their patients have very low Vitamin D, as they’ve been in hiding and not seen sunshine for months at a time – they are often very pale.
Dental health is another huge issue, according to Sandy – these people have lived without toothbrushes and in areas with no fluoridation.
Georginah Tiwaringe RN with a client at the Auburn clinic.
Helping to settle refugees into the Australian health system is an important part of the work. “We link our clients up with a GP close to them who speaks their language if possible.” But many clients see the nurses as such a safe haven they would rather come to a clinic than to a hospital or even a GP.
“It’s so nice to be connected to something positive,” says Sandy. “We help reconnect these people to their future. They are so happy to be here. Some are highly traumatised and depressed but there are also those whose outlook is to put everything behind them and say ‘this is my new life’!”