Shanti Raman

An issue of access: Delivering equitable health care for newly arrived refugee children in Australia

Abstract:  Newly arrived refugees and asylum seekers are faced with many difficulties in accessing effective health care when settling in Australia. Cultural, language and financial constraints, lack of awareness of available services, and lack of health provider understanding of the complex health concerns of refugees can all contribute to limiting access to health care. Understanding the complexities of a new health care system under these circumstances and finding a regular health provider may be difficult. In some cases there may be a fundamental distrust of government services. The different levels of health entitlements by visa category and (for some) detention on arrival in Australia may further complicate the provision and use of health services for providers and patients. Children are particularly at risk of suboptimal health care due to the impact of these factors combined with the effect of resettlement stresses on parents’ ability to care for their children. Unaccompanied and separated children, and those in detention experience additional challenges in accessing care. This article aims to increase awareness among health professionals caring for refugee children of the challenges faced by this group in accessing and receiving effective health care in Australia. Particular consideration is given to the issues of equity, rights of asylum seekers, communication and cultural sensitivities in health care provision, and addressing barriers to health care. The aim of the paper is to alert practitioners to the complex issues surrounding the delivery of health care to refugee children and provide realistic recommendations to guide practice.

Comprehensive health assessment for newly arrived refugee children in Australia

Abstract:  Providing appropriate and responsive care to refugees from diverse backgrounds and with unique health needs is challenging. Refugee children may present with a wide range of conditions, which may be unfamiliar to health professionals in developed countries. Additionally, refugees may experience unfamiliarity with the Australian health system and distrust of authority figures and/or medical practitioners. This article provides an overview of the priority areas in health and health management for paediatric refugee patients for paediatricians as well as other relevant health care providers caring for this group. Specific issues covered include general health assessment, infectious diseases, immunization, growth and nutrition, oral health, development and disability, mental health and child protection. Comprehensive health assessment can assist in identifying children at risk of poor health and to provide them with timely and effective care, advocacy and appropriate referral.

The epidemiology of health conditions of newly arrived refugee children: A review of patients attending a specialist health clinic in Sydney

Aim:  To determine the prevalence of common diseases in newly arrived refugee children, resettled in Sydney, by region of birth. To identify health needs of refugee children in Australia.

Towards better health for refugee children and young people in Australia and New Zealand: The Royal Australasian College of Physicians perspective.

Working Party Dr Karen Zwi, Chairperson of Working Party, Community Paediatrician & Senior Lecturer, Sydney Children’s Hospital and University of New South Wales, New South Wales (NSW). Dr Shanti Raman, Area Community Paediatrician: Child Protection, Sydney South West Area Health Service, NSW. Dr David Burgner, Paediatric Infectious Disease Physician, School of Paediatrics and Child Health, University of Western Australia and Princess Margaret Hospital, Western Australia. Dr Shola Faniran, Trainee Representative, NSW. Dr Lesley Voss, Paediatric Infectious Disease Physician, Starship Children’s Hospital, Auckland, New Zealand. Dr Bijou Blick, Child Health Medical Officer, Northern Beaches Child and Family Health Service, Sydney, NSW. Ms Mary Osborn, Senior Policy Officer, Royal Australasian College of Physicians (RACP), Sydney, NSW. Mr Colin Borg, Senior Executive Officer, Paediatrics & Child Health Division, RACP, Sydney, NSW. Dr Mitchell Smith, Public Health Physician, NSW Refugee Health Service, NSW.

Cultural issues in child maltreatment

Aims:  Waves of immigration from the latter half of the 20th century have changed the cultural and ethnic mix of major regions of the world. Dynamic multicultural societies now are a reality across the Western world. The relationship and influence of these diverse cultures to the understanding and identification of child abuse and neglect is challenging and complex. Health professionals working with children from culturally and linguistically diverse groups often find themselves with the challenge of exploring and resolving the tension between definitions of harm in child protection practice and various cultural and child‐rearing practices. In this paper, we set out ways of thinking about the influence of culture when approaching and dealing with the suspicion of child maltreatment.

Matching health needs of refugee children with services: how big is the gap?

Objectives: To document the health needs of refugee children accessing comprehensive refugee health services in New South Wales (NSW), to match needs with available services and establish gaps in services.

Human rights and child health

Abstract:  Human rights are those basic standards without which people cannot live in dignity.

Perspective: ‘The forgotten children: National inquiry into children in immigration detention (2014)’

Perspective: ‘The forgotten children: National inquiry into children in immigration detention (2014)’ Georgia Paxton, Shidan Tosif, Hamish Graham, Andrea Smith, Colette Reveley, Jane Standish, Kate McCloskey, Grant Ferguson, David Isaacs, Hasantha Gunasekera, Ben Marais, Philip Britton, Ameneh Khatami, Karen Zwi, Shanti Raman, Elizabeth Elliott, David Levitt, Joshua Francis, Paul Bauert, Peter Morris, Annie Whybourne, Sarah Cherian, Raewyn Mutch, David Forbes, David Rutherford and Suzanne Packer

Addressing the well-being of Aboriginal children in out-of-home care: Are we there yet?

Aim:  Children in out‐of‐home care (OOHC) have well‐documented health and developmental needs. In Australia, Aboriginal children have significantly worse health outcomes than non‐Aboriginal children. We wanted to identify the health and well‐being of Aboriginal children entering OOHC, placed with an Aboriginal organisation, who accessed a specialised multidisciplinary clinic in south‐western Sydney. We wanted to identify children entering care who were doing well and who improved in care. We also wanted to identify enablers and barriers to care.

“Nothing Special, Everything Is Maamuli”: Socio-Cultural and Family Practices Influencing the Perinatal Period in Urban India

Background Globally, India contributes the largest share in sheer numbers to the burden of maternal and infant under-nutrition, morbidity and mortality. A major gap in our knowledge is how socio-cultural practices and beliefs influence the perinatal period and thus perinatal outcomes, particularly in the rapidly growing urban setting. Methods and Findings Using data from a qualitative study in urban south India, including in-depth interviews with 36 women who had recently been through childbirth as well as observations of family life and clinic encounters, we explored the territory of familial, cultural and traditional practices and beliefs influencing women and their families through pregnancy, childbirth and infancy. We found that while there were some similarities in cultural practices to those described before in studies from low resource village settings, there are changing practices and ideas. Fertility concerns dominate women’s experience of married life; notions of gender preference and ideal family size are changing rapidly in response to the urban context; however inter-generational family pressures are still considerable. While a rich repertoire of cultural practices persists throughout the perinatal continuum, their existence is normalised and even underplayed. In terms of diet and nutrition, traditional messages including notions of ‘hot’ and ‘cold’ foods, are stronger than health messages; however breastfeeding is the cultural norm and the practice of delayed breastfeeding appears to be disappearing in this urban setting. Marriage, pregnancy and childbirth are so much part of the norm for women, that there is little expectation of individual choice in any of these major life events. Conclusions A greater understanding is needed of the dynamic factors shaping the perinatal period in urban India, including an acknowledgment of the health promoting as well as potentially harmful cultural practices and the critical role of the family. This will help plan culturally appropriate integrated perinatal health care.