Experiences with the medical and health systems for somali refugees living in Hamilton

New Zealand Journal of Psychology, Jun 2003 by Guerin, Bernard, Abdi, Abdirizak, Guerin, Pauline

Little is known about the health practices of refugee groups in New Zealand so the present research aimed to provide an overview of the reported health status and the barriers to health service utilisation of Somali refugees in Hamilton. A bilingual Somali interviewed 29 females and 25 males ranging in age from 18 to 63 years. The Somali community reported themselves as being in good health with not much concern. Participants reported that they rely on General Practitioners (GPs) to confide in about their health, to obtain health information, to deal with "mental health" problems, as well as to act as family doctors. GPs were generally judged positively and were seen as caring and friendly with expertise. While overall positive towards medical services, the Somali refugees had many problems accessing the services required, the biggest problem being language, and to a lesser extent transportation and medical costs. Language is an important consideration for health psychology interventions, since compromised language impacts on the ability to access medical services, puts demands on translator services, and wastes public health messages. Interventions to improve the women's English are especially important since the women speak less well but take both themselves and their children to the medical services. The heavy reliance on GPs could put a strain on public health resources and training specialised public nurses or Somali nurses could help this as well as employment for Somali.

Since the Second World War, New Zealand has given sanctuary to over 25,000 refugees of many nationalities who were fleeing wars or civil disasters.

Refugees from Somalia have been arriving in New Zealand since 1991, at about 150 people per year. Refugees can come to New Zealand through the quota programme, as asylum-seekers, or through family reunification. The quota programme currently is set to accept 750 refugees per year with specific acceptance of a certain number of women-atrisk, protection cases, and persons with disabilities. More than two-thirds of the world's refugees are women and children and New Zealand specifically accepts many women and children at risk. The Somali community makes up the largest community of current refugees in Hamilton, with approximately 800-900 persons. They have particular difficulties adapting to their new country because they differ on almost every social dimension: religion, colour, race, language, and cultural practices such as dress. As a specific population, only a little is known about their mental and physical health; with a few exceptions, they are a hidden group in New Zealand health research.

There are common and well-known health-related problems faced by refugees that apply even when settling into a developed country such as New Zealand. While there are physical and mental health issues resulting from their previous experiences in war and camps, other health-related problems in New Zealand arise from unemployment and housing, separation from family, poor proficiency in English, changes in food and diet, and changes in daily exercise patterns (Altinkaya & Omundsen, 1999; Blakely, 1996; Guerin, Diiriye, Corrigan & Guerin, in press; Knipscheer, de Jong, Kleber, & Lemprey, 2000). These include mental health issues, anaemia, gastro-intestinal disorders, obesity, back problems, possible diabetes, respiratory problems, dental problems, eye conditions, and vitamin deficiency disorders.

Such physical and mental health problems are exacerbated by problems in accessing medical services (Adair, Nwaneri, & Barnes, 1999; Cheung & Spears, 1995; Keleher & Manderson, 2000). These problems are relevant to psychology and the social sciences rather than medicine alone, since the difficulties stem from interconnected issues of language proficiency, transportation, different views of health, lack of childcare if the family is not reunited, and a lack of suitably written health information. The reliance on translators for all interactions with medical personnel also reflects the complexity of the issues (Davidson, 2000; Matthews, Johnson, Noble, & Klinken, 2000). Similar problems to those of physical health arise for mental health: utilization and information about services is weak (Cheung & Spears, 1995; Hauff & Vaglum, 1997), and differing conceptions of "mental" health can make it difficult for health professionals to use their expertise even if they are accessed (Bertoud & Nazroo, 1997; Bracken, Giller, & Summerfield, 1997; Mulatu, 1999).

The aim of this study was to provide an overview of the reported health status and barriers to health service utilisation of Somali refugees in Hamilton. We focused on how they conceive good and bad health, what they like or do not like about medical personnel, and problems they have utilising health services. The data gathered were aimed at providing groundwork for more intensive studies of the particular health problems faced by Somali and other refugees in New Zealand. While a few isolated studies have collected health data for refugee groups in New Zealand (Blakely, 1996; Cheung & Spears, 1995; Guerin, Diiriye, Corrigan & Guerin, in press), there is a dearth of information on both health service utilization by refugees in general and the health of Somali communities in New Zealand. This research is a start to address both these gaps.