Refugee child health – a special calling
For Royal Children’s Hospital Paediatrician Dr Shidan Tosif, the rewards of being able to help some of the world’s most vulnerable children outweighs all the headaches.
For the past seven years Dr Tosif has worked at the RCH – in the last year particularly with refugee families and asylum seekers, children in community and held detention.
He has also worked as a doctor in the Solomon Islands and had rotations in Uganda and Bangladesh as a medical student.
“Our experience is that these children and families have specific medical needs resulting from circumstances in their country of origin, their journeys coming here and new issues arising from their challenges to adapt to life in Australia,” Dr Tosif said.
“What we do when we first meet is to have a chat to the child and their family to find out what their background is, if they have any past medical issues and address the reason for their referral to a paediatric immigrant/refugee health doctor.
“Then we clarify some specific refugee and asylum seeker related health issues, such as catching up with immunisation, health screening and factors to do with lifestyle and diet.
“We do blood tests to screen for infection and micronutrient deficiency such as low Vitamin D or iron deficiency anaemia. We ensure there has been tuberculosis screening and check for gut parasites with a stool test. We check for dental issues.
“One of the most significant areas we try to address is mental health, which takes time and needs rapport with families.”
Dr Tosif says some refugee and asylum seekers develop mental health issues, even after they reach Australia.
“It’s very concerning to me – particularly the families and children in held detention. We have seen a proportional relationship between mental health issues and time in held detention. My observation has been that mental health issues reduce in severity with transition to community detention and then bridging visas” he said.
“This is related to the amount of uncertainty and control people have over their lives”.
“Parents in held detention feel disempowered by the process and are unable to parent effectively. They have limited space, are unable to cook or accompany their children to school. Parents in the community who do not have work rights express feeling inactive and are unable to contribute to their family’s finances.
“To be able to work and having a meaningful way of spending their time is a big factor in improving mental health outcomes. So, mental health is a huge component in what we try to address,” he said.
“Refugees and asylum seekers families are an important group in our community. We need to focus our attention on them and ensure that health and mental health is addressed for the best possible outcomes in the long term,” he said.
Dr Tosif says an important gap in the delivery of health care to asylum seekers and refugee children was catching up with immunisations.
“This is a concern to us because generally the parents we see are very motivated to have immunisations but sometimes there are health access issues and financial limitations due to eligibility for free immunisation,” he said.
“Another area of concern is being able to successfully link people in with primary health care services when they first arrive. This is particularly important for newly arrived families with children – essentially every family needs a GP so they can get their health tests and that is where their health care pathway begins.”
Dr Tosif says the RCH does all it can to be available to families in need of specialist care. His role, which is funded by the Victorian Health Department, also involves secondary support to GPs, community based services and other health care providers.
He says that the RCH immigrant health team is aware of language issues and cultural sensitivities.
“The Immigrant Health Centre here at RCH has been operating for almost ten years now and we always use interpreters and arrange gender appropriate doctors when needed,” Dr Tosif said.
“These extra things can make it challenging to facilitate, but is a highly rewarding experience because when we have everything in place for families, they really value the opportunity to communicate with us properly.
“There can be difficulties in navigating the health system for refugees and asylum seekers and especially accessing specialist services.
“Also medical documentation can be an issue. If a family has come from somewhere overseas where there has been war or other difficult circumstances, they may not have had time to gather up their belongings. We try to work around those things.”
Because of these issues, doctors working with refugees and asylum seekers with complex medical issues benefit from seeing a multi-disciplinary team, Dr Tosif says.
“As well as doctors we have a dental therapist, clinic coordinator and volunteers that help out. We have secondary consultations with RCH mental health workers and teachers. I do a lot of work rallying around people and connecting children with services. Often when other health workers become aware of their circumstances they are very supportive of these families,” he said.
“My upbringing demonstrated to me that regardless of anyone’s background, race or religion; that we all are equal and I think that everyone is entitled to health care regardless of their background,” he said.
“And so I would treat any child from a refugee background the same as any other child. I think there should be no boundaries to health care provision.”
Dr Tosif has an interest in international child health and refugee health and has been involved in projects in the developing world, particularly in the Asia-Pacific region.
Recently, he spent three months working in the Solomon Islands.
“It was fascinating and very informative. In Australia we are privileged to have a well equipped health care system. But in the Solomon Islands, just under three hours from Brisbane, there is a very different set of health issues,” he said.
“My focus there was on paediatrics and child health. Now I’m involved with a project looking at improving neonatal health care.
“The Solomons is made up of almost a thousand islands and so delivering health care is a geographic challenge. The health care system is still developing and they have limited equipment – but they have a highly motivated paediatric team we work closely with.”
Dr Tosif says he adopts a holistic approach to practising medicine.
“This is particularly important in the case of asylum seekers and refugees. We need to look at a child’s physical, social and psychological health together as all of these are interdependent on each other.
“So we have conversations about things like family and living circumstances, as well as financial limitations – all these have a bearing on general wellbeing.”
Dr Tosif cites his colleagues and the senior doctors at the RCH as his heroes.
“One thing I’ve learned from them is to put the interests of the child foremost on every occasion,” he said.
“Another lesson is the value of effective communication. Being able to communicate properly with families from diverse backgrounds makes all the difference.
“My approach is that each child and family in front of me has unique needs and deserves the best care possible,” Dr Tosif said.
AMES Senior Journalist