Galway Refugee Support Group (GRSG)
National University of Ireland, Galway (NUIG)
Health Services Information Open Day
25th March 2009
11am – 4pm
Orbsen Building, NUIG

Information stalls from 50 different health-related organisations and service providers including those concerning cancer, citizen’s information, complementary health, depression, drugs awareness, mental health, nutrition, organic food, sexual health, etc…
as well as fitness, health checks and health screening

This is a FREE event, and is open to EVERYBODY
New residents of Galway, refugees and asylum seekers are particularly welcome. This is an opportunity to find out about all the health services that are available in Galway. The event is in the Orbsen building and will be signposted from all entrances to the University
For full details contact helengrsg@eircom.net or GRSG on 091 779083

Irish Health Board

The Health Board Executive (HSE) West is main organisation responsible for providing Health and Personal Social Services for everyone living in the Republic of Ireland.

Click here to access its website.

Launch of Report on National Conference on Ethnic Minority Healthcare

The report of the second national HSE conference on ethnic minority health was launched at NUI Galway on Wednesday November 24th by Diane Nurse, National Planning Specialist, Social Inclusion, HSE. The conference, Participation of Ethnic Minority Communities in Primary Care Service Design, Planning and Delivery, took place in Galway in January of this year.

The idea for the conference grew from an ongoing partnership between the Primary Care Department, HSE West, the Department of General Practice, NUI Galway and the Galway Refugee Support Group. The conference provided a forum to showcase examples of participatory approaches in research, service delivery and community health initiatives. Almost one fifth of the 150 delegates were ethnic minority community members, with the remainder drawn from statutory and non-statutory agencies.Back row (left to right): Ms. Claire Robinson, Primary Care Department, HSE West; Dr. Fiona Hardy, Regional Co-ordinator for Refugees and Asylum Seekers, HSE North West; Dr. Hans-Olaf Pieper, Fellow in Asylum Seeker and Refugee Healthcare, Department of General Practice, NUI Galway
Front row (left to right): Ms. Triona Nic Giolla Choille, Galway Refugee Support Group; Ms. Diane Nurse, National Planning Specialist, Social Inclusion, HSE; Ms. Catherine Duffy, National Specialist in Primary Care, Office of the CEO, HSE; Dr. Anne MacFarlane, Lecturer, Department of General Practice, NUI Galway

Speaking at the launch Diane Nurse said: “It is clear that there is a growing awareness at European, national, regional, and local level that people affected by policy decisions have a right to be consulted about issues and decisions that affect their lives. Participation of ethnic minorities is not just an “add on”. It is not down to individuals, individual projects or services. It comes through at national, regional and local level. It is informed and mandated by policy at government and organisational level. It is supported by a range of approaches including community development which has a lot to teach us in terms of participation. There are many examples to build upon and learn from. Participation strengthens and improves service for all of us. “

The report identifies four key areas which featured strongly in presentations and group discussions and which conference delegates felt warranted particular consideration in the forthcoming National Intercultural Health Strategy and the implementation of the strategy thereafter.

1. GP services are the first point of contact with the health services for asylum seekers and ethnic minority communities. At this time many ethnic minority community members are having difficulty in general practice. Key recommendations are to improve the systems by which an asylum seeker ‘finds’ a GP and is ‘accepted’ on a GP list as a GMS patient. GP services need to be culturally appropriate with supports in place for both GP and patient (e.g. interpretation services and cultural competence training).

2. The mental health of asylum seekers is a cause for concern. For asylum seekers, mental health issues arising from experiences in their home countries are being compounded by experiences of direct provision accommodation and the prohibition on the right to work. Existing support services are either centrally based (i.e. Dublin), under resourced (e.g. Galway Rape Crisis Centre) or not always appropriate to the needs of individuals (e.g. psychiatric services for people requiring psychological services and supports). Appropriate psychological services should be in place around the country.

3. Language is a major barrier to effective healthcare for people from ethnic minority communities who have limited English. The main recommendation is for the development of a national interpretation service, staffed by trained interpreters and subject to on-going monitoring and evaluation. In addition, health information should be made available in a range of languages and individuals should be supported to attend English language classes as a longer term strategy.

4. Participatory approaches are strongly recommended as a suitable way of working for the development of culturally appropriate primary care services. The GMS modernization programme, training for GPs and other healthcare staff, and the development of an accredited and regulated interpretation service were just some of the service developments that would benefit from the ‘voice’ and ‘expertise’ of ethnic minority communities.

At the same time, it was recommended that participatory approaches are developed and monitored in a critical manner. This report of conference proceedings has been sent to the HSE Social Inclusion Unit as a submission for the developing of the National Intercultural Health Strategy. The Intercultural Strategy aims to ensure that provision of health services is equal, accessible, culturally sensitive and appropriate in meeting the needs of minority ethnic communities. This includes improving access to health services, and reducing the risks of social exclusion and health inequalities experienced by minority ethnic groups, including travellers, asylum seekers, refugees and migrant workers.

For further information contact:
Anne MacFarlane (Department of General Practice, NUI Galway) Tel: 091 495194, e-mail anne.macfarlane@nuigalway.ie ;
Hans-Olaf Pieper (Department of General Practice, NUI Galway), Tel 0091 493608, e-mail ho.pieper@nuigalway.ie ; Catherine Duffy (Primary Care Department, HSE West, Merlin Park) Tel: 091 775673, e-mail CatherineP.Duffy@hse.ie

Sexual Health Information Sessions

Staff from AIDS WEST and the HSE wish to provide some sexual health information sessions to residents of the Eglinton. We would aim to cover many topics in these sessions such as HIV, sexual health, information on sexually transmitted infections, prevention, treatment, screening etc.

HIVand Aids can affect people in all walks of like. It may be that you have the disease, or have a family member affected, or just want more information on the topic.
Ireland has the best treatment in the world.
With treatment, people can live a very good quality of life. Yet, we have reason to believe that this disease can be viewed very negatively as people coming from countries where treatment options don't exist have seen poor outcomes with regard to the illness.

We wish to remove false information, break down stigma, allay fears, and provide information on prevention, screening, treatment, on any aspect of sexual health.

We wish to provide this service in a setting and atmosphere where residents will feel welcome to attend, safe and in a format that is beneficial to them.

A Request to Residents!
With this in mind, we wish the residents to advise us on what type of information they want. They can suggest anything and don't even have to sign their suggestions. A general suggestion box will be left at the Eglinton reception.
For example, it will be open to men and women. Do people want a mixed group, men only, women only, small groups, big groups, topics to be covers etc etc.
We look forward to your replies

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.

Hepatitis B programme in the Eglinton

The Hepatitis B programme has been running since April 2006. Residents who have to get outstanding vaccines must take responsibility for follow up. As part of our health care programme we are offering all new residents in the Eglinton the opportunity to avail of the Hepatitis B vaccine. This consists of a course of three vaccines (given once a month over a 3 month period) and a booster after one year. Adults may also avail of the opportunity to have blood tests to identify if they had previous exposure to Hepatitis B. A follow up appointment for HIV screening and a sexual health screen can also be arranged.
The clinic is held once a month from 10.00 hours to 13.00 hours on the third Thursday of each month. The clinic will be held by an Area Medical Officer and Public Health Nurse in Room 27 Eglinton Centre.
This is a free and confidential service. Appointments may be made be contacting the secretary for Asylum Seekers Ms Marella Kavanagh at 091 546250 (office hours).
A leaflet giving further information regarding Hepatitis B is available at the reception desk.