New Guide On General Practice Care for Asylum Seekers & Refugees

Doctors in Galway are to benefit from a new guide on treating asylum seekers and refugees compiled by the HSE, NUI Galway and the Galway Refugee Support Group. The forty-five page ‘Information Pack for GPs in Galway on General Practice Care for Asylum Seekers and Refugees’, offers information on the broad range of health needs of asylum seekers and refugees, and a comprehensive list of local support organizations and services.

The document also provides relevant information on issues such as women’s health, male circumcision, torture, communicable disease assessment and immunisation. GPs will also have a template and guide for completing medico-legal reports used in the asylum determination process in supporting a history of physical or mental abuse or torture. If it proves successful, the guide may be adapted for use nationally.

The guide was launched by Priya Prendergast, Local Health Manager HSE West, at the recent conference in Galway, entitled ‘Participation of Ethnic Minority Communities in Primary Care Service Design, Planning and Delivery’. You changed it to: ‘Participation of Ethnic Minorities in the Design, Planning and Delivery of Primary Care Services’. Its author, Dr Hans-Olaf Pieper, is a Fellow in Asylum Seeker and Refugee Healthcare, a position funded by HSE Western Area Primary Care Department in partnership with the Department of General Practice, NUI Galway and the Galway Refugee Support Group.

Speaking at the launch Priya Prendergast said: “This document provides a wealth of useful information and templates for specialist services. It also provides contact details of support organisations and useful templates for specialist services. By providing brief, practical and useful information, GPs will find this a useful tool when caring for asylum seekers and refugees. We will be interested in finding out how Galway GPs find and use the guide”.

According to Dr. Pieper, who has worked extensively with asylum seekers and refugees as a General Practitioner, “GPs need more support in their care for asylum seekers and refugees who present a broad range of health needs requiring specific specialist skills and information. There is support out there for doctors which we are not always aware of in the form of translation agencies and support organisations. This new guide will bring this information to the doctors’ fingertips”.

It is planned to evaluate the use of this guide at a later stage of 2007. It is envisaged to update it regularly and, if it proves to be successful, to encourage adapting the guide to local needs in other parts of the country, with a view of disseminating it nationally as an example of good practice. Further information can be obtained from Dr Hans-Olaf Pieper on ho.pieper@nuigalway.ie.

Study in the Language Barriers in General Medical Practice

Summary of CARe: Communication with Asylum Seekers and Refugees
In-depth Study of the language barrier in primary care

from
Department of General Practice, NUI, Galway
In partnership with Galway Refugee Support Group and
HSE Western Area Primary Care Unit

The arrival of new ethnic minority communities in Ireland presents new challenges for Irish health services. The provision of culturally appropriate, accessible healthcare is urgently required. The Department of General Practice at NUI, Galway in partnership with the Health Services Executive, Western Area and the Galway Refugee Support Group has been involved in a programme of work about the language barrier in general practice. Research has been carried out with Serb-Croat and Russian speaking refugee and asylum seeking patients (26 interviews) and the general practitioners (17 interviews) with whom they consult in Galway city. The research findings highlighted that while general practitioners interviewed felt that communication problems had settled down over time, language is considered a major barrier to meaningful communication in general practice consultations for refugees and asylum seekers.

In the absence of statutory interpreter services, there is a reliance on informal strategies for communication in day to day practice. These include the use of dictionaries and phrase books, gestures and body language but, mostly, informal interpreters, that is spouses interpreting for each other, children interpreting for their parents and friends interpreting for each other. While the general practitioners in our research were broadly happy with using informal interpreters and they did offer some support to refugees and asylum seekers it was also clear that they are an inadequate solution to a complex problem. General Practitioners were concerned about discussing sensitive or personal health issues with parents whose children were interpreting on their behalf. These concerns were shared by the parents who said that they avoided bringing certain health issues up if their children were present as interpreters.

There is an assumption that friends and relatives who are asked to interpret will have good English. However, our research revealed that this is not always the case. Friends and relatives who acted as informal interpreters were not necessarily people who had very good English but had, perhaps, slightly better English that the patient. One Russian speaking woman explained that she and her friend tried to ‘patch’ together the meaning of consultations after they had ended. There was also an example of a Serb-Croat speaking woman living in direct provision who needed to see her GP soon after her arrival in Galway. Her only friend was from Czech Republic who agreed to act as her interpreter on the basis that their languages were somewhat similar and they could try and make sense of what was being said together.

Refugees and asylum seekers did not always have friends or relatives whom they trusted to interpret for them. This meant that they were faced with the dilemma of asking someone in their community who they knew could speak English but who they did not necessarily trust to act as their interpreter. Given that the Serb-Croat and Russian speaking communities in the city are so small, this raised serious worries about confidentiality for some.

Another interesting finding was that even refugees and asylum seekers with good English would sometimes have valued a professional trained interpreter because they were lacking medical terminology or enough English to get subtle nuances across to their doctors. This highlights the fact that it is more helpful to think about language ability along a continuum rather than as a dichotomy e.g. whether someone has/has not English.

‘Getting by’ in general practice consultations with dictionaries and phrase books, gesture and body language and informal interpreters are the current ‘solutions’ to the language barrier in general practice. The cornerstone of good medicine is good communication and the cornerstone of culturally appropriate and accessible health care is a comprehensive statutory interpreter service provided by trained interpreters who are aware of medical terminology and issues of ethics and confidentiality. However, our research indicates that, at present, accessing and using private interpreter companies is considered negatively by general practitioners because it is time consuming and unwieldy. Therefore, once more appropriate services are available the task of encouraging and supporting general practitioners to avail of them will also need attention.

Acknowledgements
The research report was funded by Health Research Board Health Services Research Fellowship 2002-2005 (Dr. Anne MacFarlane).
The project benefited from support from the Galway Refugee Support Group.

A peer researcher group- Zhanna Dzebisova, Dmitri Kanapish, Bosiljka Kovacevic, Florence Ogbebor, Ekaterina Okonkwo, were instrumental to the collection of data from the asylum seeking and refugee community. Freelance researchers, Pauline Clerkin, Evelyn Stevens, collected data from general practitioners.